My mother is not doing very well. She is 90 years old with multiple medical problems and lives in a long term care facility. She suffers from Alzheimer's Disease and Dementia which is getting worse. In talking with the administrator, I asked her what we could look forward to. She said that "sometimes" the dementia gets so bad that they end up sitting still, saying nothing for two or three years. I've seen some of these people and it is very sad (my mom used to talk about all the "old people" around her who do nothing all day). At that moment, it struck me that the dementia could get so bad that the person could lose the ability to give up on life.
Now, this may sound a little strange but, if you think about it, there may come a time in everyone's life when it's just that time to die and they know it. I recall my father, who died a few years ago at the age of 92. He had a great life but his final years were characterized by pain, inability to walk, partial blindness and frequent bouts of pneumonia from which he could never fully recover. Shortly before he died, it was clear that he had made the decision that it was time to go. I was incredibly lucky to have the opportunity to speak with him in one of his more lucid moments and say all the things I needed to say. His answers confirmed that he knew his time was short. But he had a relatively clear mind up to the end. He would occasionally drift into a sort of waking coma, but did not suffer from dementia at all. His life was over, he knew it, accepted it, and he made the decision to "let go". As a result, he had a "good death". It was like he drifted off into a lengthy sleep and stopped taking nourishment until his body let go. Although I was immensely sad to lose him, I felt happy for him. There was no fear, no reluctance, no more fighting.
Many people die like this, if they are lucky to make it to a ripe old age. Even my mom is now talking about "not being around" for much longer and I sincerely hope that she can hang on to enough mental presence to make the decision to let go, when the time comes. I feel so sorry for those who can't process what is happening to them such that they can't make the decision. In their cases, it may be that they are being kept alive beyond what they would want. Then again, maybe they don't know how bad things are. It's something we may never know.
As I look forward to my future, I understand that the most likely thing to happen to me is that I will "waste away". There will be lots of pain and therefore lots of drugs, but I believe (and sincerely hope) that I will have the mental presence to make the decision when it is time to go. I don't want to suffer unnecessarily, nor do I want to have my life artificially extended. I have come to grips with this already, so I think the decision will be easy and I think it will be obvious. I consider myself lucky to have this foresight and to know that I will have the time to say what I need to say, including here.
Life is precious, death is inevitable. Let's hope we all have a say in both.