By Edward Zelinsky
The sad story of Casey Kasem’s last illness is now over. Casey Kasem was an American pop culture icon. Among his other roles, Mr. Kasen was the disc jockey host on the legendary radio program, American Top 40. He was also the voice of Shaggy Rogers of Scooby-Doo.
Unfortunately, for many Americans Casey Kasem is now known as the subject of a bitter dispute between his widow Jean and his children from his first marriage. In the face of Mr. Kasem’s debilitating dementia, Mrs. Kasem wanted to continue medical care while his three children from his prior marriage had concluded that care was pointless and should be discontinued. Mr. Kasem’s children prevailed in the California courts based on a document Mr. Kasen had signed in 2007. Life support was accordingly withdrawn and Casey Kasem died shortly thereafter.
At one level, it is surprising is how rarely we hear today of such stories of conflict over end-of-life care. Cases involving Nancy Cruzan, Karen Ann Quinlan, and Terri Schiavo were once prominent in our public discourse.
An unheralded accomplishment of the American political and legal systems is the largely successful privatization of end-of-life health care decisions. Through documents variously denoted as living wills, health care proxies, medical powers of attorney, and health care instructions, an individual while mentally competent can plan for the end of his life. Central to such planning is the designation a medical decisionmaker and the specification of the criteria to be applied by such decisionmaker if an individual becomes incapable of making medical decisions for him- or herself.
These planning procedures, while not panaceas, have largely ensured that end-of-life decisionmaking will be made, not in courtrooms, but where such decisions belong: by the dying individual’s designated loved ones.
Two important lessons emerge from the Kasem family’s unfortunate experience. First, spouses are not automatically medical decisionmakers for each other. Spouses should formally designate each other as medical decisionmakers, if that is what they want.
Unfortunately, debate over same-sex marriage has confused matters, leading many individuals to erroneously believe that, simply by virtue of marriage, spouses are automatically each other’s medical decisionmakers. They are not. For example, Michael Schiavo’s status as husband did not guarantee him the right to make medical decisions for his wife Terri.
It is sensible to require that spouses must formally designate each other as their end-of-life medical decisionmakers. To take the most obvious case, suppose that spouses are estranged and that a healthy spouse will gain financially through an inheritance on the death of a wealthy, ill spouse. We would not want the healthy spouse in this setting to terminate medical care unless the ill spouse had signaled that that was what he wants. Or, to take a more benign situation, spouses may love each other but still think that other persons, e.g., the children from prior marriages, will be better decisionmakers under the stress of an end-of-life situation.
The bottom line is that spouses should execute the formal instrument of their respective state, however that instrument is designated, if they want each other to be health care decisionmakers. Marriage, by itself, is not legally sufficient to make spouses medical decisionmakers for each other.
The second lesson of the Kasem story is that, even if all of the proper documents have been signed, terminating medical treatment at the end of life is a difficult and painful decision. For example, one commonly used formula specifies that medical treatment should be withdrawn when an individual’s condition is “terminal.” Unfortunately, the physicians advising in end-of-life settings do not always agree when a conditional is “terminal.” If consensus exists, it is still painful to withhold medical care even if an ill individual previously authorized such withholding while he was healthy and competent to decide.
Casey Kasem left Americans with wonderful memories. His parting contribution to the American people was to remind us of the need for proper end-of-life planning and to demonstrate that, even with such planning in place, medical decisions at the end-of-life can be painful and difficult.
Edward A. Zelinsky is the Morris and Annie Trachman Professor of Law at the Benjamin N. Cardozo School of Law of Yeshiva University. He is the author of The Origins of the Ownership Society: How The Defined Contribution Paradigm Changed America. His monthly column appears on the OUPblog.
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I got a frantic phone message one day from an elderly gentleman asking me if I could help him get his dog in the car because he needs to take him to a vet right away and he and his wife were unable to lift him. I called the gentleman back within five minutes, but by then a neighbor helped load the dog and off they went. He did appreciate my call however, and would be sure to keep my number in case he needed me in the future.
The future was two hours later. They had taken the dog to the vet who had painted a grim picture without much advice or hope or compassion. I agreed to meet them and their dog right away and to assess the situation. They said the dog was a Corgi and he was around 10.
I walked in the door and greeted Mimi and Ed. And then I saw Casey and my heart sank. He was nearly twice his normal weight. He had a mouth so rotten you could smell it from across the room. The only thing their vet said was that 'he has kidney disease and that's to be expected for a dog his age and there's nothing we can do except hospitalize him for a few days and give him fluids.' He said it so matter-of-factly but he failed at one of the most important things. He never looked into Mimi's eyes to see the connection between owner and dog. He stayed purely clinical and didn't show patience or respect to these sweet, elderly people who clearly loved their dog. The only thing Mimi and Ed feel that vet did right was to give them my name and number.
Here's what the next ten months meant to Casey.
First and foremost, I made an appointment with my veterinarian. It would be more than a week before we could see her and they were impatient and desperate. They scoured the phone book for other vets who could see him right away, but I convinced them that my giving fluids at home (provided by the other vet) would keep him going until he saw my vet. "She's worth the wait, I promise!" They've thanked me every day for being so insistent.
The first course of action was to treat Casey's kidney disease with a proper, low protien dog food diet. No more croissants in the morning. No sharing dinners with him. We established his age was 14+ years from looking at his records, not 10. Within 5 months we took 13 pounds off of him. I went over every single day to give him fluids under the skin to help keep his kidneys flushed, and to monitor his feedings and his progress. We all went to the vet appointments together. We got his bloodwork in good enough shape to clean up his mouth and he began enjoying his food. He would run around the long table several times a day just because he felt so good to be alive! And as much as a transformation as there was in Casey, so it was with Mimi. I'd walk in the door each day and look at her first because she was my barometer for how he was doing. They were so connected.
Things eventually began to decline a couple of weeks ago. Casey wasn't enjoying his food (which greatly upsets Mimi) and he began to walk funny. He seemed more vague to me as if he left the room but his body stayed. A recent ultrasound showed a couple of masses and funny cysts on his kidneys. And now he was dropping too much weight too fast. They could do MRI's and all sorts of extensive and expensive tests far from home but we all knew his age and other factors would probably go against any treatment.
Yesterday when I saw him we made an appointement for today to have his hind end checked out because of a new swelling. But by last night they called in a panic. Casey couldn't move his back end at all. I went over and spent a couple of hours sitting on the floor and checking Casey, but mostly letting them talk. I gave my honest opinion as I always promised I would. I felt it was time to let him go because he had nothing left to give. Mimi wanted to hold out hope for the appointment and I told her hope is a good thing.
I carried Casey to the car knowing full well that this was the last time we'd all be together. Mimi was singing to Casey in the back seat, mostly about what a sweet puppy he is. Ed was sitting in the front with me, discreetly wiping an errant tear. The doctor came in and examined him and agreed letting him go would be the kindest and bravest thing they could do. He was given a large dose of anesthesia so he'd sleep. The doctor and I let Mimi and Ed have some personal time with him and then we were all there for the final injection.
Casey was a gentle dog. An old soul in a short package. You could tell that he was grateful for the help he was getting. He never, ever complained until last night. That was the first whimper I ever heard from him in ten months.
He adored his family and he savored time in the garden with Mimi.
He lived his life with gratitude and he left us feeling more grateful for small blessings. Like Ed said when it was over, "Imagine that, we gave him 300 more days of a good life."
We sure did Ed. We sure did. And it was my great pleasure to be a part of it.
(This is a stock photo of a Welsh Corgi. Casey was camera shy.)
This must have been so hard for you all but you all did the right thing and yes, gave him some additional days of love.
Don't you wonder sometimes why we deserve that loving soulful look? It's such a present, such a lovely surprise.
love to mimi and ed....and to you
I know you will all miss him. You, casey and his pack were all lucky to have one another. What a blessing to be a part of all that love.
That is an uplifting and heartfelt, full of caring and compassion story. Real life, made better by those who cared...like you. Stories like this are part of why I am a vet tech...to end each day knowing I helped someone take care of their pet better...
What beautiful counseling you did with Mimi and Ed, and how loving you were to Casey. Hugs to all of you. Beautifully written by the way.
you/ve made me cry. you've made my heart tremble.
all because of love.
i've always enjoyed how you say things, but tonight you've written a masterpiece.
casey, say hello to my rosie. she'll be frolicking up and down those grassy hills, her stub of a tail wagging, wondering if you might have some news of me. i'd be pleased if you tell her one day i'll be calling her, "come rosie! cookie rosie!"
i love you for writing this.
I am so sorry, this had to be so hard for all of you. What a wonderful story. many hugs to all three of you.
You have an award over on my blog :-).
lolo - edd & mimi,
i am so sorry for your loss of casey. i feel like i know all of you from laurel.
laurel bought me a whole extra year with my ava who passed, with laurel at my side, in november 08.
i am so glad edd and mimi and casey got the extra time together!!!!!!!
Laurel is a true saint. the work she does with the animals and us goes way beyond anything i have ever seen.
here is to you casey!! you will be missed by so many!!!!!
xox, iva
Oh, wow...what a wonderful story...brought tears to my eyes! How great that you could be there for them! I can't imagine losing my Doozey.
How lucky Casey was to have such devoted parents and friends to give him some extra days of joy. My Sadie and Rusty and I send our condolences and tail wags.
oh lolo...this is a beautiful story.
When my dog Cinder was sick they gave her a week and I kept her an additional 8 months, relatively healthy and happy... but there is a time when you know that letting them go is the most loving thing you can do. I was very scared... but now I feel priviliedged to have been there for Cinder in those last moments.
Oh Lolo,
What a beautiful story!
You certainly helped him and gave them 10 more happy months, but now it was time to let him go.
Tears are running over my face now (I don´t cry easy, but animals can make it happen)
Casey has touched my heart across the ocean.......
What a great job you have, sometimes difficult, but think if you weren´t there for them.....
You certainly have been their pet-angel!
HAW on Thursday and thank you for taking care of our 4 footed friends on this earth, who depend on us.
love >M<
lo, this is pure love, mimi and casey, and yours...unselfish, caring and giving. i know this is you, i feel it from afar and it must be so hard for you to go thorugh this every time with a wonderful new patient. what a difficult but rewarding career path you have chosen my friend and there is a place for you in heaven one day for sure. love ya lo.
Laurel, I read this earlier today and was so very moved by your writing. Have come back now that I'm more composed again! What a marvellous story you've retold here. It seems to me you go above and beyond the call of duty for all your patients - you have such a gift for understanding, caring for and helping others, both two and four legged!
Hugs from Malaysia.
Caroline
Such a story, how good are you?
Thank you for the sweet sweet words you sent me, they meant so much. I'm still still reeling, he never murmoured.
x
I'm deeply touched by this story of love, care and compassion. There isn't much I can add, other than to say thank you, for sharing Casey with us. My heart is softened...
What a heartwrenching story. It is so wonderful that you all found each other. 300 more days, awesome. It must be difficult for you but at the same time such fulfilment at being such a help. Wonderful.
Laurel thank you for sharing this story with us. It is so heartfelt and such a blessing.
To me I love that it shows that Casey is their family. He is truly their family and they love him.
I hate when people say it is just a pet. It is never just a pet.
Thank you and I am sorry that it must have been an extremely hard day for you.
But I know you are strong and that you can handle this and I am thankful that you were there for the family.
Love you sweet angel.
Raven sister.
xooxo
I think my boss must be wondering what all the sniffling is going on in the next office. A beautiful sad story. What a wonderful human you are, Laurel!
Dear Laurel,
Thank you for sharing this story with us; it is beautifully written and steeped in love and understanding. How strong and tender you are. Love, Nancy B.
You are such a giver of love...A beautiful and touching story.
I cried when I read this because it brought back so many memories-happy and sad.
My heart goes out to Mimi and Ed and dear Casey-it's always with you my dear.
They so clearly tell us when it's time to go-and its the humans who get sudden separation anxiety-the dogs know it's only for a short time.
Don't be shy Casey!