Juries of one’s peers
Newly out of a San Francisco jury pool, though I hardly got wet, I am reflecting on this being-judged-by-a-jury-of-one’s-peers business.
The defendant, turning to face us as we filed into the courtroom, was a 60-something man with a kind face and gentle demeanor. I knew from the color of his skin and the neighborhood he called home that I had had advantages in life which he had not. I knew from the well-known attorney handling his case that causes I support were supporting the defendant. I was in the defendant’s pocket. But — a peer?
In short order, however, we were told the case involved heroin and handguns, causes I do not support. As a card-carrying Brady Campaign member, and someone intimately acquainted with addictions – even if only, happily, nicotine and alcohol – I am disinclined to be sympathetic to those who go around with hard drugs and 9 mm hardware. Plus, I was impressed with the prosecuting attorney; you could say I felt peer-ship with her. The two sides were a wash, and I figured I could be fair as the law requires.
About halfway through the first round of questioning one prospective juror brought up California’s three strikes law. No way, one after another of us said, could we convict someone of a relatively minor crime (details of which of course we did not yet know) when we knew he’d be effectively in the slammer forever. The judge rather pointedly explained we were forbidden from considering punishment – but the specter had been raised. DNA, someone asked? Uh oh, a whole row of scientist types had opinions. And don’t even get us started on what we think of police in general (vehement pros and cons, nobody near neutral) – the case is going to rest on who believes whom, and an awful lot of the who’s will be officers of the law. The eliminations began.
By the time we were thanked and excused, either by the court because we had obvious reasons we should be sent home, or by the opposing attorneys for reasons known only to opposing attorneys, dozens of seemingly level-headed citizens had come and gone, most of them peers whom I thought I’d want for my judges. It seemed worrisome.
Who was left? I don’t know precisely, since I was not among the remnant that remained. But in hindsight this is the group I believe was there: Quite likely at least one or two people from the defendant’s ’hood. At least one or two who believe cops are good guys and one or two who think anyone in a uniform is brutal and corrupt. Probably a recovering alcoholic, a marijuana smoker, and at least one or two people who think it is none of the government’s darned business what we citizens put in our bodies. A hunter. Someone who had been mugged. I met them all in the pool. Peers. The case is in good hands.
Which does beat having some autocrat chop off your head.
Juries of one’s peers
Two guys in one hospice room
Hal is down to about 80 pounds, blind, bedridden, unable to feed himself, incontinent for the past six years and in a VA hospice. There he receives good care and dozens of daily meds that keep him alive. At the request of a friend of his, I visited him recently to talk about his options. They are, essentially, keep doing what he’s doing – or let what’s being done to him keep on being done – for as long as his remaining cells agree, or stop eating, drinking and accepting all medications but pain control and shorten that period ahead. As it turns out, Hal, a long-time supporter of aid-in-dying, chooses the former; that is surely his right.
As I was leaving, though, the man in the other bed asked me to talk with him. “I heard everything you said,” he told me. “I’m dying. It’s taking too long. Can you help me?”
Well, no, I can’t help him much at all. And that makes me sad for us both, as he is clearly in need of help: pain control, advocacy, methadone, comfort care and social contact. The latter two he is getting to the extent possible; round-the-clock methadone, which is what I think he really wants, is not exactly mandated by the VA. But somebody should be listening to him a little more carefully.
Joe, I’ll call him, since he didn’t ask me to share his story, is 66 but could pass for older. He has cancer in his liver and elsewhere, he says. “It’s pretty much all over, but I think it started in the liver. I’m in a lot of pain. I get a shot of methadone every night at six and that helps for about three hours; after that I just try to hold out until the next shot. I don’t want any more of this.”
Joe reached over, opened a drawer to the little table beside his bed and pulled out several folders. He has an appointment for dental work in three weeks, and is scheduled to begin chemotherapy. “How can they make me do all this?” he said. “I don’t want any dental work, and I don’t want chemo. I just want out of the pain.”
At some point, many of us just want out of the pain, and welcome death as the inevitable way out. Others of us, luckier or sometimes wiser, welcome death because its time has come and that’s what we mortals do, we die. Might not always be the worst thing that happens.
The hospice where Hal and Joe are is part of a huge VA medical center at which excellent care is provided. Since I know nothing of Joe’s history, and since everything I know about the medical center is positive, I can only assume they are doing the best they can for him. Perhaps they see him getting better, going home – although he told me he has no home, no family, no close friends – or to somewhere outside the center’s campus. At a sprawling center staffed with skilled, caring people whose aim is to heal and to cure, there may be few people available to talk to Joe about dying, or to help him gently do so.
A lot of progress has been made toward end-of-life care, but the ability to face death with honesty and compassion eludes us. And until we find a way to do so people like Joe will be around to break the hearts of those who meet them.
Two guys in one hospice room
Dementia, the last taboo
Dementia, the elephant in the conversational room, has begun to lift its trunk and trumpet around. Ask anyone over 60, or almost anyone whose parents are over 60, to list the Big Fears, and dementia will be up there at the top. But precisely because it defies solution, can’t be predicted and won’t go away, it has long been among the great taboos for meaningful public discourse.
Perhaps that’s beginning to change. There are a few answers emerging as alternatives to warehousing, or being warehoused, in an institution somewhere when Alzheimer’s or other dementia takes over. Some of them make very good sense. All of them require consideration with a cold, clear eye while still sane and healthy, and that’s when the elephant in the room needs to be shoved aside so conversation can happen.
At a recent meeting of advocates for improved care and expanded choice at the end of life, a small group gathered to discuss raising awareness for Compassion & Choices, one of the leading organizations addressing these issues today. The talk quickly turned to the subject of advance directives – everyone in the room had such documents in place – and from there to dementia.
“I suppose if my Alzheimer’s gets really bad I won’t care any more,” said one, “but I absolutely hate the idea that the images my friends and family will be left with won’t be images of who I am at all.” Said another, “To me, it’s the money. I just don’t want every last penny I want to leave my family going instead to some nursing home.” And a third added, “My husband has promised to slip me poison.”
Actually, there may be better solutions, even if they remain only partial solutions. Compassion & Choices now offers a “Dementia Provision” document that may be attached to one’s advance directives, stipulating that in the event he or she winds up with dementia the signer declines all measures that would prolong life. Author/ethicist Stanley Terman is taking this concept farther (devising stronger, more explicit instructions) for those wanting to avoid prolonged life after dementia strikes. While I don’t always agree fully with Dr. Terman (except for his inclusion of a story of mine in The Best Way to Say Goodbye; I don’t get royalties) I applaud his dogged search for answers, partial or absolute, to a problem that defies easy solution. The conversation is also being aided and abetted by some good new books, including John West’s The Last Goodnights, and everything starts with the conversation.
If the conversation continues, the elephant may leave the room.