Plan B

The first article in this issue of the journal addresses one of the most sensitive topics in our field: assisted suicide. This is a subject I have thought about intensely over the past 4 decades, but especially in more recent years when the law was introduced in my state of California. I respect the greatly diverse opinions on this subject, but, to be very honest, I have always held strong personal beliefs opposing assisted death. I invested tremendous energy in opposing assisted suicide legislation over many years, and so I was taken quite off guard when in the fall of 2015 the legislature in my state passed this bill into law. I think, perhaps as patients often do, I had coped with the possibility through a sense of denial-surely it couldn't happen. But it did.

And now, I and many other palliative care professionals need to crawl out of our denial and devise a new way to exist within this state that has accepted assisted dying. We need Plan B. I think a good first step in Plan B is to read the article by Lehto and colleagues, which suggests that our first essential response is to listen closely to the voices of patients and families, hearing without judging their decisions and learning to be present, even when our personal beliefs conflict with those we serve.

For me, Plan B means a decision to no longer devote my energy opposing what is now a reality. Instead, I think my Plan is to commit to deeper understanding of the fear and suffering underlying strong public concern about how death will happen in their lives.

I am not alone on this journey of finding a new path. Canada also recently voted to legalize assisted suicide. A leader in palliative care in Canada, psychiatrist Harvey Chochinov, has also shared with me his similar response and commitment to address the suffering and fears, which lead to adoptions of assisted dying in his country. Others have also shared similar shock and distress to see that assisted suicide has become a reality but also their renewed commitment to act through research, education, and practice change.

Switching gears, changing tides, abandoning Plan A, and going forth to a very unknown Plan B are not easy, but sometimes it is our only possibility. As is often the case, we as professionals can learn a lot from our patients and families. One such voice who has spoken eloquently about a Plan B is Sheryl Sandberg, who, in June 2015, wrote an editorial on Facebook about the sudden death of her husband:

Today is the end of sheloshim for my beloved husband-the first 30 days. Judaism calls for a period of intense mourning known as shiva that lasts 7 days after a loved one is buried. After shiva, most normal activities can be resumed, but it is the end of sheloshim that marks the completion of religious mourning for a spouse.

A childhood friend of mine who is now a rabbi recently told me that the most powerful 1-line prayer he has ever read is: "Let me not die while I am still alive." I would have never understood that prayer before losing Dave. Now I do.

I think when tragedy occurs, it presents a choice. You can give in to the void, the emptiness that fills your heart, your lungs, constricts your ability to think or even breathe. Or you can try to find meaning. These past 30 days, I have spent many of my moments lost in that void. And I know that many future moments will be consumed by the vast emptiness as well.

But when I can, I want to choose life and meaning[horizontal ellipsis].

Sheryl's entire essay is so beautifully written, and she shares how those around her have struggled to offer their support. She concludes her essay by writing:

[horizontal ellipsis]I was talking to one of these friends about a father-child activity that Dave is not here to do. We came up with a plan to fill in for Dave. I cried to him, "But I want Dave. I want option A." He put his arm around me and said, "Option A is not available. So let's just kick the shit out of option B."

Dave, to honor your memory and raise your children as they deserve to be raised, I promise to do all I can to kick the shit out of option B. And even though sheloshim has ended, I still mourn for option A. I will always mourn for option A.

And so we move forward. My plan is to hope for, and plan for, a future where suffering is relieved, and patients facing serious illness and their families get the care they deserve.

Betty Ferrell, PhD, MA, FAAN, FPCN, CHPN

Editor-in-Chief

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