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Live and Let Go: An American Death

Associate Professor, Anesthesia, Stanford University School of Medicine Staff Anesthesiologist, Veterans Affairs Palo Alto Health Care System
Director: Arts, Humanities, and Medicine Program Stanford Center for Biomedical Ethics Anesthesia Service 112A VAPAHCS 3801 Miranda Ave. Palo Alto, CA 94304 ashafer{at}stanford.edu

Live and Let Go: An American Death. Video/2002/56 min. A film by Jay Niver and Jay Spain. Live and Let Go Productions, LLC. Distributed by Fanlight Productions, 4196 Washington St., Suite 2, Boston, MA 02131. 800-937-4113. Online: www.fanlight.com. E-mail: info{at}fanlight.com. Rental $60. Purchase $199.

Live and Let Go: An American Death documents the suicide of 76-year-old Samuel J. Niver, Jr., in a coastal town of North Carolina in 1998. Niver, diagnosed with metastatic prostate cancer 8 years before, had undergone multiple rounds of radiation therapy. He lived in constant pain, and his cancer was terminal. His beloved wife of 50 years, Sweeny, had died in the hospital the year before, incapacitated by a stroke. At the time of his death, Niver is mentally sharp but unable to bathe or clothe himself. As he states, "Life has no meaning. ... It's no fun anymore."

Niver's three adult children all support his decision to end his life. His older son, Jay, a journalist like his father, agreed to enlist friend and filmmaker Jay Spain to document his father's end-of-life decision. Niver's daughter, Gretchen, coproduced the video, and both she and her brother are present during the actual suicide. Niver's prodigal son, Teigh, decides not to be present at the death, but he also supports his father's decision. His interaction with his father provides one of the tender moments of the video; his father forgives his son's youthful indiscretions, and they hug in a final embrace. All three offspring are interviewed throughout the video, and they respond frequently with tear-filled eyes.

The video is essentially an intimate portrait of a White American family and, in particular, its patriarch. Niver is depicted as a classic 20^th century male: induction into the Army to serve in World War II—where he was deployed to the dense jungle of Assam, India, for chemical warfare transport and storage; pragmatic gratitude for being an American; belief in the Golden Rule; a life of community service and public works resulting in a town street named for him; and a populist, aphoristic style of writing for the paper he managed for 27 years. The viewer sees video, photo stills, and graphics of pithy quotes from Niver's writing depicting his home, military service, work, moral, and civic lives. As if to the underscore this homespun patriotic theme, the distributor of the video has featured Niver sporting an Uncle Sam outfit with his Colonel Sanders goatee in the video, on the cover of the video box, and on the website at http://www.liveandletgo.com/index.shtml. Indeed it is the very mainstream nature of Niver's background and character which buttresses the argument made throughout the video to support assisted suicide for those in appropriate circumstances.

Niver seeks to control the end of his life; he wants to die before he burdens his family or loses self-respect. He is a chain smoker and a melanoma survivor. But now because of advanced prostate cancer, his body has failed him and cannot be repaired. Once he makes the decision to end his life, he and his family read Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying by Derek Humphry (2002; now in its 3^rd edition), recommended by The Hemlock Society (now merged into Compassion and Choices at http://www.compassionandchoices.org/). Niver, per the book's guidance, collects all the necessary medications and equipment.

The most interesting editing decision of the video occurs here. Chronology is interrupted; the death has already occurred, and the scene skips to the arrival of police and emergency medical workers at Niver's home. The authorities erect yellow crime scene tape and question Jay and Gretchen, who become increasingly agitated. The body is never shown, but it is removed for a postmortem by the coroner. According to notes available on the video distributor's web site, which also has Niver's suicide note (http://www.fanlight.com/catalog/films/381_llg.shtml, see study guide), the Nivers' "didn't want to inconvenience" the family physician to drive an hour on a Sunday to sign a death certificate. If they had such a document in hand, the authorities would not have needed to interrogate the family.

Time reverses and the viewer sees Niver, suicide note pinned to his shirt, and his two oldest children sitting on the deck of his house. The content of this graphic scene is inappropriate for young viewers or those who may be disturbed by watching a person kill himself via the "Final Exit" double-insurance method. It distressed me, even though I realize that the amount of sedative that Niver swallows before he put the plastic bag on his head would have made him groggy before the asphyxia. Nevertheless, he is able to clearly say "Give me another rubber band"—his last words—after he affixes the white plastic bag, which balloons over his neck as if he were an unfinished ghost. The indignity of having to place the plastic bag over one's head is yet another compelling argument for improved end-of-life choices for the terminally ill.

However, the video does not provide, nor does it intend to provide, an overview of the medical and legal issues of assisted suicide, physician-assisted suicide, or euthanasia. A few scattered topical headlines are shown, and the family attorney is briefly interviewed, as well as Niver's two sisters, who provide the only counter arguments in the video ("It's up to God when you're going to die."). Rather, the video remains homespun to the end in its public declaration of private pain. The video concludes with the scattering of Niver's ashes in the Atlantic and the sobering knowledge that Jay Niver has been diagnosed with prostate cancer, though fortunately at an early stage.

In sum, the video personalizes the politics and slogans of end-of-life issues in a compelling family narrative appropriate for mature audiences. Like Niver himself, the cinematography is neither flashy nor radical. Since the viewer will witness the suicide, anyone showing the video in any setting, educational or otherwise, should include an explicit caveat announced prior to screening. Although many may say they would prefer to die rather than live incapacitated in a prolonged, painful, and inevitable slide towards death, relatively few will act on this vision. This documentary is the tale of one man's determination to avoid what he believed were insufferable indignities as he faced the final stages of terminal cancer. In our society, such a personal decision continues to have public ramifications.

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