Are you ready to die yet, Grandma?
How fair is it to keep my grandmother alive, in the time of the coronavirus?
I know this post will prompt a lot of highly emotional responses, but my intention in writing it is to reflect on ethical and moral implications that we apply in considering the value of one life, over another, particularly when they are older, unwell, or are limited in their ability to self-determine. In writing this, I am attempting to resolve the questions that I struggle with regarding my grandmother’s quality of life, the sanctity and value of her life, and how to let go in a way that is respectful, loving, and fair, when the time comes. Regardless of whether you inherently agree or disagree with my conclusion, I hope that you will consider the perspective and the questions that I introduce, if only in the hope that they may help you along _your_ journey towards finding an answer to some of these questions.
On Christmas Eve 2013, I boarded a plane from Montreal, Canada to Edinburgh, Scotland, and began the process of moving my life to the United Kingdom. A couple of weeks before leaving, I traveled 3,000 km (~1,850 miles) to say goodbye to my grandmother in city of Saskatoon, Saskatchewan. I think she knew that I didn’t expect to see her again, given her age and previous health issues, so she did the only thing she could do: With the strength, dignity and class that had always defined her, she told me she loved me, that she was proud of me, and that she’d miss me. I remember crying, that day, and even as I think about it now, six years later, I can’t help but feel the intense sadness of that parting.
My grandmother is still alive, and is now 93 years old. She has lived in Saskatchewan, a land dominated by farms, wheat fields, and very cold winters, since the 1960s, because that’s where my grandfather was from. She raised 8 kids by herself, after her husband died in 1974, and lived on her own until about 10 years ago, when my aunt moved back to look after her. She’s short of stature, highly opinionated, intelligent, classy, strong in her convictions, and will not let herself be taken advantage of, while still being generous and helpful to anyone who needs it.
… At least, that’s the grandmother that I remember.
My grandmother suffers from advanced staged dementia, and now spends the majority of her time in a state of confusion. The strong, independent woman who so defined my childhood now struggles to remember who I am, or even that she’s a grandmother.
In so many ways, she practically raised me, when I was young. She taught me to ride a bike, bought me my first pair of skates, and took me to the rink, to learn to use them. She bought me my first Nintendo, which sparked my passion in computers, and was always supportive of my pursuits and interests. She never failed to tell me that she loved me or that I could do anything that I put my mind to, even when I felt otherwise. She was my biggest fan, my chief defender, and the safe place I could go when I felt too small for the world. She has always been a rock in my life, and I wouldn’t be the person that I am if it hadn’t been for the love, patience, and understanding that she showed me.
It hurts to know that she suffers; that she doesn’t know what year it is; and that she’s not even sure if she is, herself, let alone anyone else. I’ve often wondered how she would react if her younger self could see what she’s become. Would she feel sadness? Guilt? Obligation? Would she want to put an end to her own life, to reduce the suffering of those around her, as well as her own?
In speaking about it with some friends who have aged parents, I know that a lot of people wonder about these things, as they watch relatives struggle, whether as a result of age, of illness, or of bereavement. Unfortunately, my grandmother cannot competently answer the question of what she’d like, so it’s left to my mother, my aunts, and my uncles, none of whom can agree, and each of whom has their own position, ethics, and morals to consider. They’ve already started the bickering over who gets what, when she passes on, and she’s not even dead, yet.
I know that everyone struggles with loss in their own way. When I last saw her, my grandmother thought I was her nephew, and couldn’t seem to understand that I was her grandson. When I arrived back in London, I was angry, and I didn’t know why, until it hit me: My grandmother was gone, even though she was still alive.
From a physical perspective, my grandmother is as well looked after as she can be. When she broke her hip, she had surgery to get it fixed, and continued in her rehabilitation, even though she spends the majority of her time in a wheelchair. She takes a lot of pills, for a variety of purposes, and she sleeps a lot. Is she happy? I honestly couldn’t tell you, and more heartbreakingly, with her constant state of confusion, I don’t think she honestly knows the answer to that question, herself.
I’m an economist, by education, and wonder about the nature of value, and the value that we get in exchange. I wonder about the value of the surgery she had, and her rehabilitation, especially given her general restriction to sleeping and the wheelchair. Was the surgery worth it, from a cost/benefit perspective? Probably not. Was it worth it, from the perspective of her quality of life? Possibly, in that it means she’s not living with the pain. What about from a social perspective? No, likely not. So why did she get the surgery? The answer isn’t about her, but about my mother, my aunts, and uncles. She got the surgery, so _they_ could feel better.
Does it really matter whether society gets value for money? The waste of successive governments, around the world, suggest that it doesn’t, but there’s a fundamental element of fairness at stake. My grandmother has always been one of the strongest people that I’ve ever known, and fairness was always one of her fundamental values, so much so that she married as socialist lawyer who fought to protect farmers from being taken advantage of.
If resources are plentiful, and there’s no need to optimise, then it makes no difference, but given everything that’s happened over the last few months, with regards to the coronavirus, the closing of borders, the lockdowns, and the restrictions that have been placed upon the world, I can’t help but really wonder: How fair is it to keep my grandmother alive, in the time of the coronavirus?
If she got sick, how much social care (e.g. money, time, energy, effort) should be spent to keep her alive, when other people are fighting for their lives, as well? She’s important to _me_, but who am I to say that her life is more valuable than that of someone else? Surely, they have people who care about them same way.
I can’t help but think that if she was aware of the world, she’d be okay with letting go. I imagine she’d say something like “I love you. I’ve had a good life and I’m proud of you, and it’s okay to let go. This is part of the journey, and I’ll be joining your grandfather, so there’s nothing to be sad about.” If I am right (and I know there’s no way to ever know), then wouldn’t it more fair to let her go, when the time comes?
As a thought experiment, I’d ask you to consider the following: If you were me, and were asked to choose between her life and that of another, random stranger, with no way of knowing whether that person is good or bad, what would you do?
I know that if I was in her shoes, being old and having had a full life, and knowing that there’s no recovering from the dementia she has, I’d want someone else to have that benefit of life, or at least the chance at it. I know that there are a lot of people with families to support, people to look after, and huge potential ahead of them. Who am I to say that my life is more valuable than theirs, under those circumstances?
I am the man that I am because she taught me to be authentic, loving, honest, and fair. I’d like to think that she’d be proud of me for my choice, especially as it’s done with love and consideration, even though it’s difficult. Not everyone will agree or come to the same conclusion, but if asked to choose between her life and another’s, I’d like to think that I’d be okay to tell her I love her and say goodbye.
I know that her life will come to an end soon enough, as that’s just the nature of get older, but _how_ it comes to an end, and how we let go is what defines us. I hope that when she passes away, that she’s filled with love, peace, and tranquility, and that she knows that she will be missed.
It’s possible that I’ve been asking the wrong question, in asking about the fairness of keeping her alive. Maybe what I should be asking comes in the form of two questions:
- How can I make sure that the people I love are able to let go, with love, without feeling emotionally burdened, when the time comes?
- How can I make sure, if I’m in a medical situation where things can’t get better, that I do my best to enjoy every day, and give someone else the chance to have the life, the joys, and the benefits that I have enjoyed?
I’d love to hear your thoughts on this. As it stands, I give blood regularly, am on the organ donation registry, and have tried to make sure that the people in my life know that I love them. It’s not always easy to be your best self, every day, but there are no guarantees about what’s coming tomorrow, so all we can do is make the effort and hope for the best.
