Sue asked that this be sent the day after her celebration, which was yesterday. That celebration was impeccably planned by Sue, beautifully implemented by Alina, Mary and their crew and very well-attended.
 
My Final Exit – A Power Outage
by Sue Reynoldson, 1942– 2015
 
Dear friends and familiars: Some say its better to beg forgiveness than ask permission. Consider yourself begged. I couldnt say goodbye. I had to plan s secretly to not risk lock-up for observation (a 5150). Chronic pain from a 1973 injury took 42 years to kill me. By 2015, I preferred dying to any imaginable future, and dying sooner as myself, rather than a lessened other. Some say life is a gift, but a gift you cant give away is a burden. Some say suffering has value in penance or redemption; suffer at will, but dont force it on me. Helium hypoxia is a peaceful exit, but I had to go while I could still turn stiff tank handles with weak hands. My plan enabled me to endure pain to live longer, but in Europe I could have planned openly and perhaps lived still longer with a legally prescribed, easily ingested pill secreted for future use.
 
I didnt commit suicide. Mine wasnt an irrational act by an insane or depressed person, but a preemptive, rational, self-directed death. English has no word for a careful choice to avoid intolerable, intractable suffering. Suicide is legal here and in most developed countries. A failed attempt costs 72-hour lock-up to guess if you may be a danger to yourself or others. But suicide is often preceded by committed, implying a crime. What other legal and usually benign act does one commit?
 
I was never clinically depressed. Some psychiatrists say all who wish to end their lives are in thrall to neurotic, depressive needs, including the excessive need to control their own deaths. Psychological pain always accompanies chronic pain, but I have never suffered from any depressive illness that would diminish my ability to make an informed decision. To get an intrathecal opioid pump implant, I pass two psychologists who agree Im doing all I can for understandably severe pain from multiple causes, including genetic and hormonal. (Judy Foreman, A Nation in Pain)
 
Chronic pain­an invisible disability. A 1973 yoga injury crosses ligaments over my hip that stay crossed five years until Ernest Smith, DC (deceased) reads soft tissue on the X-ray and massages them apart. The stretched, useless bands destabilize my spine. Complaining is useless for unseen pain. I must support myself. I learn to ignore the pain, mask it with drugs, distract and hypnotize myself, meditate, and control my affect (dress up and smile). COX2 inhibitors strip my gut, discs degenerate. In 1996, L4 vertebra edges off L5. At last pain is believed! Laminectomy surgically decompresses nerves. Later, bi-level vertebral fusion, knee replacement, major feet and heart surgeries. Oral opioids become a last-resort necessity. In 2013, pain and opioid side effects require intrathecal infusion-pump implant. Dosage must be steadily increased for new damage from degenerative disc disease, failed back surgery syndrome, and damage from the opioids themselves. What slows the pain slows the brain. Driving is risky. Reclining at home is isolating, but sitting up worse.
 
I consider Three Alternatives:
 
1) Assisted living. I need more help, but pain and lethargy make supervising employees difficult. I consider sacrificing autonomy, solitude, and privacy for prepared meals I can eat in a semi-reclining position. I tour nursing homes in town and see a remote warehouse crowded with softly moaning, dying shells of former selves. I too might end up neglected, abused, and sedated to keep my cries from disturbing others. Even if I could afford a retirement residence like Ambrosia Manor, Id be trapped in a for-profit home and headed for the feared advanced living wing. (Margaret Atwood, Stone Mattress: Nine Tales, Torching the Dusties)
 
2) Wait. Maybe Ill die from a stroke or heart attack. But the present is unbearably painful. I cant wait. And in hospital, my advance directive might be overlooked or overruled in my best interest. Most of us wish to die at home, but few besides doctors make alternative plans that are enforced. All deserve good palliative care, but comfort is always uncertain, despite faith-based assurances, some to deter support for Physician Assisted Dying (PAD). I might be forced to take every last breath with ineffective comfort care. If I were stable and competent, friends would bring me home to round-the-clock care so I could die refusing food and water, but home care for weeks to starve would use savings I hoped to leave others, and this method often causes much suffering, even with hospice. Dr. Erika Preisig, with decades of experience in Switzerlands Dignitas program, writes in Dad, You Are Allowed To Die, Dying a voluntary assisted death never involves suffering. In contrast to the many difficult deaths Ive experienced assisting patients with only palliative care, the better alternative is to go deliberately; peacefully and happily. (See also Chris Docker, Five Last Acts: The Exit Path, The arts and science of rational suicide in the face of unbearable…)
 
3) Try for PAD in Oregon. Even if I could move, I dont qualify. Im terminally ill, but lack the six-months-or-less diagnosis required by all states. Im only grievously, incurably ill and too sick to travel. However, busloads of incurably ill, non-terminal seniors may be heading to Canada in 2016. The Canadian Supreme Court recently overturned PAD prohibitions with an ironic twist, given disability rights groups fear of coercion. Despite no proof of abuse in decades, the court recognized the pressing need to protect the vulnerable, but it found absolute prohibition unnecessary and unconstitutional. That the able-bodied can take control over their end-of-life decisions while the disabled cannot is an unfair disadvantage burdening those with physical disabilities. Less drastic means of preventing coercion are by stringently limited, carefully monitored exceptions allowing grievously, incurably ill, fully-informed adults to access PAD for pain the sufferer deems physically or psychologically unbearable.
 
I choose preemptive, rational, self-directed death. More than death, I fear mounting pain and side effects with no new analgesia in sight. Opioids were last resort in 2006, decades after my injury. My PCP knows I cant go back, but experts say non-cancer patients need no analgesia. After all, opioids were prescribed only for cancer in 1928. History repeats, but today cannabis and enactogens are classed with heroin. Of course heroin deaths surge! Why do we make dying so difficult? Many tribal societies allow elders to find a peaceful way home. Cultural denial of death and stigmatizing of individuals who dare to make their own end-of life choices inhibits family and community conversations. (film: Whose Life Is It Anyway?) Palliative care failures increase PAD acceptance and promote preemptive suicide as a rational choice before onset of foreseen suffering that might disable the sufferer from taking action on her own behalf. If you disagree with my choice, I hope you agree the person best qualified to determine my destiny was me, or at least that in a free society, individuals are allowed to make personal choices that dont physically harm others.
 
Whose life is it anyway? My dads mom reportedly worshipped Freya; my moms mom was always at the church. Dad complained his life belonged to the army; mom thought hers belonged to God. Cognitive dissonance led me to discard beliefs in supernatural beings and other theories not based on solid scientific evidence. The law of gravity still looks pretty good in this universe: What goes up must come down, including all of us. I offer the following intuitions: beliefs are addictive traps; this universe is one unified, organic whole with no independent parts; and nothing is lost forever, especially love. The world is a wonderful place to contain the friends I have had, and I have died the best way I could to leave a positive memory for you.