I remember a scene in a restaurant years earlier when Miklos (my husband) had seen an older man with a walker struggling to get to the restroom. He said that he would rather die than have his quality of life so diminished. My daughter, who was with us at the time, pointed out that the man seemed to have greatly enjoyed his meal and conversations with his dinner companions. I am not sure Miklos was convinced that life could be worthwhile if he was at all disabled. He has always had general fear of aging. That night, he commented on this man’s limited mobility as something he would not tolerate. Nevertheless, his greatest fear has always been of losing his mind.

The incident in the restaurant, and his insistence that he would rather be dead, led me to tease him for several years. He had a requirement to wear prescription glasses added to his driver’s license. I said, “That’s a disability. Shall I shoot you now?” He added hearing aids. Again, I asked if I should shoot him now. He knew I was being facetious because I have always held conservative views about suicide.

When we first made advanced directives for health care, Miklos said he wanted our daughters to be the ones to make decisions for him because he feared that I would want to keep him alive after he was ready to die. Although I am not an advocate for suicide, I see no reason for prolonging death. Unfortunately all too many people do just that. I hate the fact the majority of health care dollars spent in the US go for people in the last year of their lives, often on useless procedures.

We are entitled to die with as much dignity as we can maintain. Miklos is already 86 and he doesn’t have a long life in front of him, in any case. There is no reason to apply heroic, extraordinary interventions that would only prolong suffering. The terrible problem with assisted suicide is that by the time a person with dementia has reached the state where suicide might be the best option, they are no longer of sound mind to make the decision. I have his power of attorney for health care, and in the advance directive, we have listed palliative care as the only option in each scenario: do not resuscitate, do not provide artificial feeding, etc.

It still creates a cognitive conflict for me and adds to my grief. Do I really want to go so far as to withhold a flu shot or the next Covid booster? When do I say no to the next cystoscopy? Is it better to die of bladder cancer than Alzheimer’s disease? There is no clear line between routine health maintenance and extraordinary measures.