A Beautiful Journey through Assisted Dying
This story was shared with us by Dave Moskovitz, who’s mother recently ended her life several years after being diagnosed with Alzheimers and heart disease. It was his Mom’s wish for more information to be available about MAID (Medical Aid in Dying), and especially personal stories. In his words – “I helped her organise things, and it was beautiful.”
Dr Sarah Traister Moskovitz
My mother, Dr Sarah Traister Moskovitz, died on 1 September 2024 through Medical Aid in Dying (MAID). It was one of the most beautiful things I’ve ever witnessed. She was 97 years old.
Mom’s memory started deteriorating in her mid 80’s, with general forgetfulness, and an increasing inability to manage her own calendar. As she approached her 90’s, her ability to drive a car became sufficiently bad that we, her children, had to convince her rather emphatically to stop driving. Her eye-hand coordination deteriorated to the extent that she was unable to use a cellphone. Her memory became noticeably worse. She’d forget that she had food cooking on the stove, and would occasionally burn out the pan. This trend accelerated during the COVID pandemic. In 2020, at age 92, it got bad enough that she sought medical advice. Her GP recommended that she see a specialist, even though she was in a state of disbelief about a possible diagnosis of early stage Alzheimers.
She enrolled with a healthcare provider that gave her a neurologist, a neuropsychologist, and a psychiatrist. At her initial interview, the neuropsychologist gave her a battery of memory tests, which showed that her brain was functioning at near-normal levels for someone in their 90s. This was followed up by regular MoCA (“Montreal Cognitive Assessment”) short memory test assessments. These MoCA tests ask questions like what day is it today? What city do you live in? Can you draw a clock face showing the time at 11:15? Please draw a copy of this simple picture, please repeat this list of five words to me, etc.
She was diagnosed with mild cognitive impairment (MCI). She had been a professor of educational psychology during her career, and was used to operating at the top of her mental game. She felt inept at things she used to excel at. She hated the loss of agency, having other people do things for her that she was used to doing for herself. She could feel herself slowly losing control over herself. She was terrified of, in her words, “turning into a vegetable and being filed away in a board-and-care”.
She was terrified of, in her words, “turning into a vegetable and being filed away in a board-and-care.”
Her neurologist prescribed Aricept and Exelon to arrest the development of the dementia. It’s difficult to determine whether these drugs had any real effect.
In addition to these medical physicians, Mom was offered sessions with Ryan Glatt, a cognitive physiotherapist who runs a “brain gym” in Santa Monica. I went to Mom’s weekly sessions with Ryan regularly, in person when I was in town, and online when I wasn’t. The idea behind cognitive physiotherapy is that you can arrest the progress of dementia by simultaneously increasing blood flow to the brain through exercise, while performing complex cognitive tasks. During these sessions, Mom would play a variety of video games, including identifying matching letters on a big screen while marching, and a complicated version of Dance Dance. But the most interesting activity was a game where Mom was on a stationary bike, pedalling hard, wearing a VR headset, and chasing a cartoon dog through a forest while catching coloured gems – red gems in the right hand and blue gems in the left. I never thought I’d live to see the day when Mom would wear a VR headset, especially at age 90-something – she was right up there with the cool kids, and looked like a space alien. But life is full of surprises.
Mom’s MoCA test scores were relatively stable, showing a very slow decline over time. her hearing seemed to deteriorate in parallel with her mental acuity. I saw a connection between the two. Deafness results in the inability to follow conversations, misunderstanding, and ultimately social isolation. All of these factors are unhelpful to dementia.
Mom and Dad lived in the same house I grew up in, for over 56 years. They were inseparable.
Dad was six weeks older than Mom, had a number of significant medical issues, and was debilitated by severe lower back pain. It got to the point that having lived independently for so long, both Mom and Dad now needed home help. They started with eight hours per day six days a week, which was ramped up to 24/7 in mid 2022, when Dad became mostly housebound. He couldn’t really wake up in the day, and couldn’t really sleep at night.
Mom resolved that she would not end her life in one of these units. And Dad did not want to leave the house that he’d lived in for so long, with his workbench, even though he rarely felt well enough to use it. So we went with the 24×7 home care option. Mom and Dad had the foresight in their earlier years to get long-term care insurance, which covered a significant portion of the costs.
About this time, we started investigating aged care facilities that might be socially better and possibly less expensive than 24/7 care. There was an issue though – if you have a dementia diagnosis, you can’t go into a rest home that does not have a memory care unit. As we toured these facilities, we asked to see their memory care units as well, knowing that Mom might very well end up there. Although some people were playing card games, and doing puzzles, others were staring into space, unable to control their movements, agitated. Mom was really frightened by this.
Mom also had a friend who had entered just such a memory care unit. Mom visited her a couple of times, but this friend did not recognise her, or anyone else, and couldn’t speak.
They both filled out POLST forms, telling any medical personnel “Do Not Resuscitate” in the event of a medical emergency. These forms were posted on the door to their bedroom so that any paramedics would see them on their way in.
In California, there are three criteria for MAID. You must: (1) Have a terminal condition with less than six months left to live (2) Be able to take the drugs yourself and (3) Be of sound mind.
Mom’s friend Edie across the street had done some reading about “death with dignity”, and Mom wanted to know more. In California, there are three criteria for MAID. You must: (1) Have a terminal condition with less than six months left to live (2) Be able to take the drugs yourself and (3) Be of sound mind. There is a “catch-22” though: you can’t really qualify for assisted death with a major diagnosis of dementia, because by the time you only have less than six months to live, you are almost certainly no longer of sound mind.
Mom knew that she had a heart condition which was serious enough to claim less than six months to live, but she knew she had to get the timing right. She didn’t want to die soon – there were so many interesting things happening in the world, especially in her family! But she knew if she left it too long and was no longer “of sound mind”, she would end up filed away in a memory care unit. She became worried that this would creep up on her quickly, and wanted to be able to act in time.
