When I met Carol (not her real name), one of the first things she said to me was "You need to know, I'm going to be dead in a few years." The statement was neither a dire prediction nor a statement of fear, but rather a declaration of intent.
The 'Good' Death
In her way, Carol was a larger than life figure to me, and it is hard to encompass who she was to an audience that did not know her. She was a mystic, a caring mother to someone who needed her, a philanthropist, a lover of animals and nature, but perhaps most of all, she was a woman who knew her death was imminent. She was determined that in a few short years her life would end, and Carol could be quite the determined woman.
I didn't know what to make of Carol when we met only a few years before the end of her life. During that short time however, she and I would develop an abiding friendship, I would see up close the progression of her illness, and come to truly understand and appreciate the impetus behind her impending demise.
Carol suffered from an early onset form of a common degenerative illness. As a child watching her grandfather's slow, degrading, and horrific decline from the same disease, she had promised herself that she would not endure the same end. Over the course of her life, this lead Carol to be an ardent supporter of assisted suicide and become deeply involved in the assisted suicide movement in Europe, where she was a involved with Dignitas in Switzerland, and Exit in the UK, and in the United States with Dr. Jack Kevorkian, whom she would want me to mention, she later developed a deep and passionate hatred for.
Suicide by Hypothermia
By the time I knew her, she was already beginning to suffer the earliest symptoms of the disease, and knew that the official assisted suicide organizations in her native Switzerland would almost certainly be unable to help her. This is the paradox of degenerative illnesses that can effect the mind: when one is competent to consent, one isn't sick enough yet for assisted suicide; but by the time one is sick enough for assisted suicide, one can't consent to the procedure.
Carol had decided decades earlier to die by hypothermia. She had good reasons for choosing this method, even if I find the idea particularly terrifying: death by overdose is all too often in fact death by choking on one's own vomit, firearm suicides have a surprisingly high failure rate, leaving one still alive but brain damaged and with only a partial head, drowning is particularly unpleasant and hard to force on oneself, and being somewhat squeamish, she didn't feel exsanguination via cutting open a vein was an option for her. In the case of extreme cold, hypothermia is unpleasant for a relatively short period of time, before one becomes comatose, and then dead. Moreover, it leaves little mess for someone else to deal with, unlike a firearm, jumping from a ledge, or some such thing. The concept of the courteous suicide was very important to her.
The downside of this method, was that Carol was terrified of having some animal start chewing on her body after she had lost the strength to move, but before she'd lost full awareness. On top of that, she had a rather complex estate, and it was important to her that it be apportioned as quickly as possible, meaning her body had to be identifiable. Crime shows on TV notwithstanding, DNA analysis can be exceedingly slow, which could leave her estate tied up for months if not longer.
She ended up having to go to extreme and extensive lengths, eventually buying property in northern New England (although Swiss, she had lived in California for many years) and having an animal proof structure built under the guise of wanting an outdoor meditation chamber. All this to ensure that she and her body would not be interfered with during or after death, until it could be found by the police. I think it galled her to have to care about the state of her "meat sack" as she was known to call it, even after it was no longer precisely hers.
Carol once told me that the relief she felt when she saw the "meditation chamber" standing in her woods for the first time was palatable. She had first envisioned something like it when she was nineteen years old, and seeing the reality of it was like lifting a weight off her shoulders.
Dignitas: Assisted Suicide Without Dignity
And then, it looked like it wouldn't be needed after all. Carol had been working with her doctors and lawyers to meet the draconian requirements of Dignitas, one of the Swiss assisted suicide organizations, to prove that she was both competent and terminally ill. Finally, after months of work, she'd received approval for suicide. She could die in the country she loved, in a warm and comfortable bed, with someone there to hold her hand while the deadly drought took effect.
She flew with her adopted daughter to Switzerland for a last visit to the places and people she cared about, and said goodbye to her daughter, who as an American citizen couldn't be present during Carol's death without risking homicide charges in the United States. I asked her during our last conversation if she regretted the immense investment of time and money in building the her "meditation chamber," and she assured me that having hypothermia as a viable backup plan was the only thing that kept her sane through the fight with Dignitas.
I think even as she said it, Carol still believed that she would need her backup plan. Less than twelve hours before she was scheduled to die, Dignitas pulled her approval, saying they needed another month or two to consider it.
The problem for Carol was that this meant the possibility of waiting another year. It was already February, and the quick-killing cold she needed for the hypothermia to be effective would be dispelled by the coming spring within a month or two at the outside, even in northern New England. If Dignitas came back with a "no" she didn't believe she'd be in condition to follow through with her plan by the following year.
With the same decisiveness that had marked so many other things in her life, Carol boarded a plane for New York. There she hired her regular driver, and had him take her to the property she had purchased up north, where fate waited for her. From there I can only speculate on the sequence of events that followed.
Alone in the Cold and Darkness
She probably had a glass or two of wine, both to thin her blood and to toast her life and its end. Then she climbed up into the chamber for her life's last meditation, where she stripped down to a light cotton shirt and pants. I can still here her voice saying "Winter, isn't it enough that some poor policemen have to go out to the woods to retrieve a dead old lady's corpse? I'm not going to make them deal with a naked dead old lady!" I imagine she said a prayer to her gods, and then lay down to die.
The evening temperatures in that area hovered around 5°F (-15°C) and, unconsciousness should have come relatively quick, with death following not long on its heels. Her delayed mail letter arrived little less than a week later, notifying the police of where to find her body.
Death may have come quickly for Carol, but it very nearly didn't come soon enough. She once told me that she wanted to die before she forgot her gods' names. Then after the adoption of her adult daughter, it was her gods' and her daughter's name. Over the course of our friendship I witnessed both. The only time I ever saw her close to tears, it was not out of fear of death, but fear that death might be too delayed.
While Carol was proud that she was taking control of her destiny by sparing herself the pain and indignity of her illness, she was also quite bitter at having to do so in the way that she did. For all that it was the death that she had envisioned for much of her life, Carol died alone, shivering in the cold and the darkness, and she didn't have to.
The Right to Die
She was blessed to have the financial means needed for the manner of death she'd chosen, not to mention the fortitude to go through with freezing to death on her own. How many other people lack one or both of those factors, yet would seek an end to terminal suffering if they could? The hospice system is a wonderful one in the U.S, yet I know from speaking to medical professionals, that not everyone can have all their pain alleviated at the end. Where is the fundamental humanity in forcing someone to die in agony if they want to be released?
I know that many of her friends and family have an unshakeable anger at Dignitas for teasing her with the prospect of a gentle death, only to snatch it away at the last moment. That she was a huge financial contributor to their organization only compounds the cruelty of their treatment in my mind. On the subject of Dr. Kevorkian, whom she only ever referred to as "Jack," Carol blamed him for the unavailability of assisted suicide in the U.S. She considered him an egotist, whose grandstanding on 20/20 had violated the legal protections in place at the time (he pushed the button, not the patient), which led to both his jail sentence and the widespread legal assault on assisted suicide.
There were few causes as dear to Carol's heart as the right to die. It was one of her greatest sadnesses that she didn't live long enough to see that right embraced by mainstream society and legal thinking. Hopefully even in death, she can continue to inspire the change she so dearly wanted to see in the world.
"If we don't own our bodies, we don't really own anything. And if we can't choose the end of our life, we've lived as slaves all along" - Carol S. San Francisco 2009
(Frozen woman art via Bigstock)