Thursday, May 19, 2016

"Grace and Frankie" and the Right to Die

There are so many things about Netflix's original comedy series Grace and Frankie (now in its second season) to recommend it, not least of which is its pitch-perfect gallows humor.  Orbiting around the decidedly 21st century lives of four septuagenarians-- the eponymous Grace (Jane Fonda) and Frankie (Lily Tomlin) and their now ex-husbands, Saul (Sam Waterston) and Robert (Martin Sheen), who came out as gay men, divorced their wives, and married each other very late in life-- Grace and Frankie never has to reach to far for a joke, whether of the garden-variety old folks' ilk (Viagra jokes, menopause jokes, hip replacement jokes, old people doing technology jokes) or the more story-specific sort (infidelity jokes, divorce jokes, coming out of the closet jokes). For a show with all the trappings of a situation comedy, Grace and Frankie is anything but formulaic. Its humor is brutally honest, impressively thoughtful, shockingly politically progressive, equal parts probative and revelatory. And, for a series that draws the bulk of its subject matter from trials and tribulations that attend only those very near the end of life, it is also surprisingly, refreshingly smart and tender-hearted.

Those last two merits are perhaps nowhere more evident than in one of the sub-plots that emerges near the conclusion of Season 2, focusing on Babe (played the inimitable Estelle Parsons), who has decided to relinquish her "fight" with cancer and has enlisted her old friends, Grace and Frankie, to assist her suicide. The show's writers never accord Babe's story anything other than subplot status. And that decision is a credit to the show.

Here is the great virtue of Grace and Frankie's second season denouement: Babe's story isn't melodramatically told, it isn't treated as exemplary or singular, it isn't overwrought or didactic.  It isn't even tragic, really. Rather, Babe and her cancer and her decision to die and the party she wants to have before that happens are simply, effortlessly, easily inserted into the story of Grace and Frankie's lives as just one more complicated matter that Women of A Certain Age have to decide what to do about today. That Babe is dying, that we are all dying, that we all will die, is treated as exactly the kind of thoroughly mundane matter of fact that it is: existentially significant, yes, but no less quotidian, no less inconvenient and annoying, no less diurnal for being so. For Women of a Certain Age (like Grace and Frankie and Babe), what is to be decided is not if, but how and when, that inevitably we call Death is going to happen: who is going to be invited and who isn't, who will host its eventuation, what background music or tasteful decorations will accompany it, who will be responsible for setting up and cleaning up, which place settings will be used, how many bottles of wine will be required to make the inevitably unpleasant, at least, pleasant.

Like a dinner party.

The U.S. population is growing older and sicker by the day. That is a fact. Although medical technologies have advanced at near-lightspeed in their capacity to keep us "alive" longer, the pace with which we have undertaken the hard work (in both law and public opinion) of seriously re-calibrating what counts as a minimally decent quality of "living" has barely budged in the last century. That end-of-life decisions are as common as they are legion remains a discreetly unacknowledged fact on television, just as it so often is in polite company.

The right to die with agency and dignity, with and among and in collaboration with loved ones, is taken head on by Grace and Frankie as just one more thing all of us must eventually confront.  Like racism, like sexism, like homophobia, like menopause and erectile dysfunction (and the countless other corporeal failures that will eventually be made manifest in us all), like romantic infidelity, like friendship betrayals, like the many and varied iterations of emotional, psychological, and chemical addiction that both soothe and beset-- each of which are pharmakons, each in their own way both poison and cure-- like every other weakness and vulnerability of this human life, so is our ownmost existential possibility, the inevitability of our death, Try as one might to ignore it, try as one might to delay it, it stands ever persistently knocking at the door and no amount of ignoring it will make it go away.

As we all know, the "certain age" in the phrase "Women of a Certain Age" is an increasingly flexible signifier. (When I think of my own active, healthy, and very-young-looking 62yo mother, for example, I can easily see why people say that 60 is the new 40!) I'm over 40 now and, for better or worse, have found myself to be a relatively comfortable occupant of at least one meaningfully significant sense of the "Woman of a Certain Age" category. I'm no septuagenarian like Grace and Frankie, of course, but I've realized over the course of watching this series that not only their concerns, but their actual experiences and evaluations of those experiences, are much closer to mine than are the concerns and experiences of women much closer in age, but younger, than I am now.  For that reason, I want to share the following three personal anecdotes to redouble my overwhelming gratitude for what Grace and Frankie did in the conclusion to Season 2 with their story of Babe and the right to die.

(1) The Sappy Anecdote: My Grandparents
All four of my grandparents were still alive well into my early 30s, a very fortunate consequence of my family's super-compressed generational divides.  (My parents are roughly 20yrs older than me; my grandparents were roughly 20yrs older than them. So, I knew my great-great-great-grandparents briefly, and I had living great-great-grandparents throughout high school who I knew well.  I had vigorous, lively and living great-grandparents who were a central and very active part of my life well into college.) I lost three of my four grandparents while I was in graduate school, and I lost my last grandparent only earlier this year. Two of them died relatively quickly but painfully, and the other two died relatively painlessly but very, very slowly. Having witnessed all of this from the point-of-view of an adult-- that is to say, as someone who had adult-to-adult relationships with her grandparents and adult-to-adult conversations with them about death and dying-- I am intimately aware of and genuinely outraged by the countless, morally inexcusable, and often gross indignities that we force upon people at the end of life. I never knew any of my grandparents as "old" people.  For two of them, they were sick and then very quickly (within 2yrs) they died. For the the other two, they were sick, and then "they" were no longer (Alzheimer's), and then, much too long afterwards, their bodies died.

Now, I belong to a certain ilk of Southern family-- not at all uncommon, I suspect-- that frequently says things like "if I ever get to the point of [x], just take me out behind the barn and shoot me."  I've said those words myself. No one in my family ever thinks through the real execution of this directive exactly, but I think we all understand that we all mean it, exactly. I am 100% sure that none of my grandparents, if given other options, would've wanted to "make it" to the state they were in when they died. I'd like to say that is because our family is too proud to go out like that, but that would be too simply stated.  It's also, perhaps more so, because I do not know and never have known a single person in our family that would abide not only his or her own, but anyone else in the family's, enduring unnecessary pain and suffering. So, for that reason, I am thankful that Grace and Frankie opted to present, in a straightforwardly realistic way, The Other Option. And I'm even more thankful that they did so in a way so consistent with the series title, i.e., with both grace and frankness.

(2) The Academic Anecdote: My Students
I've been teaching Medical Ethics for the last couple of years now, and I've been genuinely shocked to discover that college-aged students today are far and away more concerned with end-of-life issues than they are with (what we might call) "before-life" issues. This is especially significant, I think, given that I teach at a Catholic university, where the pro-choice/anti-choice "abortion" issue has, historically, been the most hot-button issue in medical ethics courses. Not so anymore.

Perhaps counter-intuitively, the truth is that most of my students' parents are older than me-- sometimes by as much as 10yrs or more-- which means that many of their grandparents are the age that my parents were when I was their age. That is to say, unlike myself, who never had to confront old age or dying before my 30s, many of my students are already intimately familiar with the same in their late-teens/early-20s.

Over the last two years, I've had to expand the time we devote to two (and only two) subjects in my Medical Ethics courses-- (1) end of life issues and (2) economic justice issues-- because students' concerns for these matters were not only pressing, but vocal and unrelenting. When we begin the section on end-of-life issues in my Medical Ethics course, I ask students to work together to determine the parameters of what they would consider a "minimally decent" quality of life. After they have set the parameters, I ask how many of them think that, should their own quality of life (or that of someone they love) drop below those standards, they should be legally and morally afforded the option to end a life. This is a non-scientific survey, of course, but I would say that, in every class, at least 95% of them say, yes, they ought to be granted the (moral and legal) right to die in the way they see fit if their lives have become, by their own autonomously-determined standards, unlivable.

To whatever extent students may feel genuine moral reservations about endorsing something like a "right to die," in my experience, their real-life experiences have overwhelmingly mitigated that concern. The truth is that millennials are, in increasing numbers, no longer afforded the luxury of postponing their considerations of end-of-life issues until middle age, and so (rightly) decidedly unwilling to postpone their determinations of end-of life issues until the same. If they do not already know the burdens of being a caretaker from their parents' experience, they will sooner rather than later. In fact, if they are not already, most of them will soon be caretakers themselves. It would have never occurred to me in my 20s, with lively and vibrant grandparents and great-grandparents, to even think of such things.

Times have changed, and not for the better for old people... which means, inevitably and correspondingly, not for the young(er) people who love them, either.  We all know this, of course, but oh how we postpone the recognition of such. To wit, I wish I could require viewing of the last 3 episodes of Season 2 Grace and Frankie for all my Medical Ethics students, as those episodes neither diminish the moral importance nor the heart-wrenching complexity of assisted-suicide decisions. What those episodes do well and carefully is to present end-of-life decisions, from the point of view of the dying, as autonomous moral decisions worthy of consideration-- including, perhaps most importantly, moral consideration vis-รก-vis our obligation to not intervene where good is not done by our intervention.

(3) The Existential Anecdote: My So-Called Life
One of things that troubles and saddens (if not also enrages) my parents all the time is that I frequently tell them: "you'll bury me first."  They think this is an expression of what, I suspect, they suspect is some sort of inherent nihilism on my part. (Fwiw, I'm literally the furthest thing from a nihilist.) The fact of the matter is that, as the genetic the lottery goes, what I am is a colossal loser.

I was born with a number of congenital diseases/defects-- most of which my family is aware of, some of which they are not-- that, if you considered any one of them in isolation, statistically reduces my predictive life-span by ~20yrs. (Consider them altogether, however, and statistically I'm a living miracle!)  I really do not have a pessimistic or fatalistic life-view as a result of this incredibly crappy genetic hand that I've been dealt.  Nevertheless, I do possess a basic understanding of biology, I do believe in science, I do not believe in miracles and, so, I'm more or less happy for every day that I get.

Unlike many of my friends in my age-group, I've spent a considerable amount of time thinking about how I do not want my life to end, which is more or less to say that I've spent a considerable amount of time thinking about how and when and under what conditions I want to die. That's not morose. That's not resentful or ill-tempered or gloomy.  It's just a clear-headed reckoning with what philosophers call "the given" (il y a), as far as I'm concerned. I do not have the luxury of delaying end-of-life considerations-- I really haven't since the day I was born-- but this fact was made most undeniably manifest to me only a few years ago on 2 October 2009, the day I experienced the single scariest moment of my life. That day, I suffered a TIA (transient ischemic attack, more commonly known as a "mini-stroke") on the way to class and, subsequently, endured several terrifying hours of aphasia.  Nothing has ever been the same for me since.

So, on a very personal level, I am incredibly grateful to Grace and Frankie's writers for taking up the story of "Babe" in the same straightforwardly honest, unapologetically forward-thinking, eminently humane and inimitably sensitive, these-are-our-decisions-to-make-like-them-or-not manner that they've taken on so many other social and political issues (racism, sexism, ageism, homophobia) in the series. I may, for my own broken-body reasons, think about end-of-life issues far in advance of my age-group fellows, but I often fear that they are doing themselves (not to mention their parents and loved ones) an gross disservice by neglecting to reckon with the bureaucratic details of mortality sooner rather than later.


We see far more serious and reflective renderings, in current cinema and television, of the potential dangers that might accompany our near-future lives alongside fully-realized A.I. or a fully-integrated Internet of Things than we see serious and reflective renderings of the potential dangers of our present-life failure to reckon with that one and only one thing that remains inevitable for us all: human death.

As uncommon as the characters in Grace and Frankie seem-- and, let's all admit that they are, unfortunately, far from uncommon in their demographic and experience, though they may remain (unfortunately) uncommon in their political persuasion and moral acuity -- there remains nonetheless a "wisdom of the elders" core to the series that is not only admirable, instructive, and enlightening, but also deeply insightful in a way that is more prophetic, perhaps, than it is sage.

To wit,
  • if you are a millennial and have never had a conversation with your parents or grandparents about end-of-life issues: DO SO NOW.
  • if you are a a Gen-Xer and have never had a conversation about end-of-life issues with your parents or spouse/partner: DO SO NOW
  • if you are a Baby Boomer or a member of the Greatest Generation and your family is behaving as if you will be around forever, HAVE A CONVERSATION WITH THEM NOW about how you want to die.
  • if you are an actually existing, mortal human being who does not already possess a magical force-shield protecting you against any possible injury, impairment, or disease, FIND YOUR STATE'S ADVANCED DIRECTIVE FORM AND FILL IT OUT POST HASTE, Then, have it notarized, send it to a member of your family, store it in the cloud, and go ahead and commit one of your fridge magnets to posting it in an easily accessible, public place, just for good measure.
Y'all can thank me later.

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