Another day, another urinary tract infection.
Actually, I didn’t know for sure until a couple of days ago; the three previous urine cultures I had done over a period of several months all came out negative, which was driving me batty, since I am now intimately familiar with the sort of burning and urgency that go with a UTI, an unpleasant infection that has accompanied me ever since I was hospitalized for my CAR-T cancer treatment in May.
I saw a new urologist who scheduled me for a battery of tests to rule out bladder cancer. I didn’t know this urologist that well…maybe he’s an alarmist?
Still, it got me wondering and worrying: What would I do if the CAR-T didn’t work or didn’t give me the long remission I’m so hoping for? What if the chemo induced a secondary cancer, as is known to sometimes happen? Would I be brave and strong enough to go through an aggressive treatment again and suffer through the inevitable side effects?
Would it be better, at that point, to jump off the medical roulette wheel and decide, Let’s stop everything, enough is enough?
That’s a question Canadian hematologist Benjamin Chin-Yee asks in an article in Aeon magazine. The societal expectations around learning you have cancer are to fight, he writes, no matter what the physical and emotional cost. Think of the roadside billboards screaming out “Fight like hell” or “We fight for you.” It’s almost as if cancer centers exist less to cure and more to recruit patients.
This approach too often results in overtreatment. In one third-season episode of the Sex and the City reboot And Just Like That…, Harry is diagnosed with prostate cancer. “It’s small and they caught it early,” he tells his wife, Charlotte. Nevertheless, he jumps at having it removed entirely, resulting in a semi-comedic narrative arc around dire sexual dysfunction.
“In the U.S. alone, more than 50,000 men are diagnosed each year with a low-risk instance of [prostate cancer],” notes Chin-Yee. “These cancers rarely spread, and observation is a safe approach, with outcomes equivalent to surgery or radiation.”
Overtreatment isn’t limited to just the early stages of disease, prostate or otherwise.
“For many, the final stretch of life will be marked by intervention,” Chin-Yee continues. “One-in-three will receive aggressive treatment in their last months, and one-in-five will get chemotherapy in their final weeks. These treatments rarely prolong life and almost always diminish its quality … We treat not because it helps – but because the alternative feels like giving up.”
Once it had “transformed,” my cancer was not a slow-growing one. It was aggressive and would have killed me within weeks had I not opted to “fight.” But the question of “the next time” led me down a strange – and very specific – rabbit hole: I began looking into places where, if I decided against further treatment, assisted suicide is legal. The idea of slowly deteriorating at home or in a hospital, even with a strong continuous morphine drip, somehow seemed less appealing than getting it over quickly.
My friends would naturally be aghast, and my children wouldn’t want to say goodbye so soon. I would miss my grandchildren terribly, but I found support in the most surprising of places: my wife.
“I would be horribly sad, but I couldn’t bear to see you suffer so much again,” Jody consoled me.
Knowing that, even if I am cured of this cursed cancer, my days of trekking the Himalayas or throwing ecstatic toddlers up in the air were most likely over, I found myself from time to time entertaining the option.
The closest location for Israelis is Switzerland. The Swiss assisted suicide organization Pegasos is perhaps the pioneer in what people often think of as “euthanasia.” Just don’t call it that: Swiss law specifies that the person who wishes to die must press the button him or herself; it cannot be based on self-interest or monetary gain by a third party. The cost: around $10,000.
When the button is pressed, the lethal drug Nembutal is administered intravenously. The patient dies within minutes. Pegasos allows friends, family and even pets to be present. You can play your favorite music while you go. You must be 18 or older and a psychological evaluation is conducted first.
The process is not foreign for our family. Earlier this year, we put our 14-year-old Maltese to sleep when his tumors, incontinence and fatigue robbed him of any remaining quality of life.
Assisted suicide is available now in some eleven U.S. states, as well as Canada, Germany, Australia, New Zealand, the Netherlands, the U.K. and more, although Switzerland, with its funky funiculars, seems like the prettiest.
It’s nevertheless hard – nay, impossible – for me to imagine actually taking such an extreme step, even with Jody’s unexpected support. I imagine I would pull back from the brink, perhaps at the last minute, unless all attempts at curing my cancer were truly and finally exhausted.
In that respect, this article might be more of a thought experiment – albeit a morbid one – than an actionable plan.
Indeed, perhaps that was the point in writing this essay in the first place: Dive down deep to the brink of despondency in order to convince myself to ultimately go for the doctor’s next recommendation, even if there will be troublesome side effects, all the while hoping there will be no need for future treatment.
Moreover, there are people who have overcome much more limiting circumstances than me. Paraplegics. Hostages languishing in Hamas tunnels. My father, who contracted polio as a child and ended up in a wheelchair in his old age, only then to die of the same cancer I have now.
I owe him – and the family that loved him (and I know still very much loves me) – more than a shuffle off to Switzerland in a moment of despair.
I first wrote about assisted suicide for The Jerusalem Post.
