Dignity in life, dignity in death
Theological dogma should not dictate policy when it comes to assisted suicide.
By Laurie Penny Published 16 June 2011 12:14
It's not easy watching a man commit suicide on camera. The public uproar over the BBC documentary Choosing To Die, in which the author and Alzheimer's sufferer Sir Terry Pratchett visits the Dignitas euthanasia clinic in Switzerland, has reopened the debate over whether or not sufferers from terminal and chronic illness should be allowed to end their own lives. In the film, we watch Peter Smedley, a British sufferer from motor neurone disease, as he swallows the killing draught; he coughs as he begins to fall asleep, and asks for water. The prim Dignitas "escort" refuses. His wife, the picture of pseudo-aristocratic dignity, holds his hand as his head begins to drop to his chest. Sir Terry sits opposite the Smedleys as they say goodbye, swallowing obvious tears. It is terribly hard to watch.
It is no harder, however, than it would be to watch a man die slowly and in pain, longing for release. Sir Terry, whose own encroaching mortality is a constant, ominous presence in the programme, concludes with wobbling lip that this was a good death -- "When we think of all the ways people can die, that would count as a result" -- and that the creepy little blue house on the Swiss industrial estate where so many come to die exists for a good reason. It is difficult not to take his point, especially when one sees how rigorous and exhausting are the checks for fitness of mind and non-coercion run by the clinic. With an ageing population suffering increasingly from protracted, agonising end-of-life conditions, now would seem precisely the time for an adult debate about assisted dying. It seems likely, however, that the debate will be messy, drawn-out and painful.
Talking about suicide has always been taboo, even in journalism, a profession not generally known for tact and discretion. It is only 50 years since the practice was decriminalised in this country, and parts of the 1961 suicide act provide that, while you can no longer be sent to jail for surviving a suicide attempt, your friends and family can be imprisoned for up to 14 years if they are suspected of assisting a suicide -- even just for offering, like brave Mrs Smedley, a loving hand to hold at the end. There is something about this subject that repels rational debate. It sticks in the craw, disgorging reason. You can't help but feel that the reason nobody wants to ask the important questions about chosen death is that nobody really wants to hear the answers.
There is a very real fear that if we talk about this properly, we might reach a conclusion that we might not want to face: that, in some cases, taking one's own life is a sane and sensible thing to do. The term that commenters keep returning to is "slippery slope": if we acknowledge that self-murder might be acceptable for the terminally ill, what about the chronically ill? What about the mentally ill? What about those who are in perfect physical health but, like a small minority of Dignitas clients, are simply "weary of life"? If everyone could die in a time and place of their choosing, might we not see the numbers of suicides rise from current averages of just over 5,000 a year to tens or hundreds of thousands, many of them young people with everything to live for?
This is a legitimate fear. At 24, I have lost several friends to suicide. I have seen many more young people with big lives ahead of them attempt to end those lives. I have intervened personally in three suicide attempts, all of them involving young adults under 22. Those incidents were frightening, painful and heartbreaking for everyone involved. Hundreds of children and young people commit suicide every year in Britain and, according to the Samaritans and Barnados, that number is rising. I believe, like the Dignitas director, Ludwig Minelli, that the "right to self-determination" includes the right to control the manner of your death as far as possible, but the thought that it might somehow become acceptable for anyone simply to give up on life genuinely chills me.
That is not, however, what a service like Dignitas is offering. Dignitas, in fact, appears to offer a civilised solution to a problem which has dogged society, not to mention the medical profession, for centuries -- injecting a merciful dose of procedural oversight into a shadowy world of unspoken pain and moral dilemma, providing one has the £10,000 to cover the clinic's costs.
The key statistic is that 70 per cent of those who make enquiries with Dignitas never call back. The knowledge that the option of a quick and painless end is there seems, in fact, to give many people the strength to carry on. There is cause to believe that oversight and legitimacy in the field of euthanasia might, in fact, reduce the number of tragic suicides, by giving desperate people back a sense of control over the end of their lives. As Nietzsche observed, the thought of suicide, considered rationally, may well be "a powerful solace: by means of it one gets through many a bad night."
We live, for now, in a society where theological dogma does not dictate policy, but the notion of suicide as a "sin" persists. The reasons behind religious proselytising against suicide -- which comes with the not insignificant metaphysical threat of hell -- are benign enough for anyone who believes that God and law can and should dictate the lives of human beings. There is, however, also a powerful argument that the "sanctity" of life is worth less if the individual living that life cannot determine its boundaries. There is an argument that a measure of formality, choice and control in death is no bad thing for a person living out their last days in pain and terror. These are arguments that, if we wish to live in a truly civilised society, we will soon collectively be obliged to consider.
Rather than consider them, however, much of the response to this documentary and the difficult issues it raises, particularly on the Christian right, has focused on the possibility of a second "slippery slope". The fear seems to be that if euthanasia were not taboo, the elderly and infirm might be encouraged to end their lives against their will, to spare their families and the state the burden of caring for them, despite the enormous bureaucracy already in place to prevent this from happening. The hypocrisy of this moral panic is unbelievable, when hospices and end-of-life care centres are facing funding cuts of 30 per cent, according to a report released in January.
The brutal truth is that we do not need to fear a world where the sick, disabled and terminally ill are denied support and treated as disposable. We are living in that world, right now.
On 10 June last year, Paul Reekie, a 48-year-old poet from Edinburgh, took his own life. Spread out on the table beside him, in place of a suicide note, were two letters: one informing him that his Incapacity Benefit had been stopped, and another informing him that his Housing Benefit had also been stopped. This government, expanding on the policies of the last, is currently forcing over a million sick and disabled people to undergo a work capability assessment performed by a private company, Atos Origin, with a £300m mandate to deny benefits to hundreds of thousands of claimants. As a result of these tests, patients in the final stages of cancer have been refused the pittance of state support that was supposed to make the end of their lives bearable.
This month, top mental health charities warned the government that the tests were already causing desperate claimants to take their own lives, and that more suicides can be expected if the scheme continues. Someone in government appears already to have accepted and made provisions for this eventuality, distributing handy suicide guidelines to staff at call-centres dealing with benefit claims. The callousness with which this is being done should shock us; it should shock us far more than as-yet-abstract idea of state-sanctioned euthanasia. Instead, we nod along as ministers and tabloid headlines inform us that these people are not worth the good money we could be pumping into tax relief for the banking system.
We need no longer fear a world where society and the state cannot be bothered to expend time and money looking after the sick, the dying and the unprofitable. We are already living in that world. We are halfway down the slippery slope, clutching for handholds of humanity. If we truly believe that all human life is precious, if we truly believe in dignity in life and in death, we should start by taking an honest look at the slow, unmerciful slaughter of a welfare state which, while ailing, has so much more to give - and considering what that says about all of us.
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80 comments
It's more like 200,000.
I take the view espoused by my favourite socialist. The co founder of the London School of Economics, who was aslo instrumental in the development of Fabian society (and therefore The New statesman itself), George Bernard Shaw, famous Irish Labourite playwright - and budding eugenicist. Summed up -
Life should be opt-in, not opt-out. Every five years, everyone should be put to a board and probed "would you be kind enough to justify your existance"
I present to you, a great socialist.
http://www.youtube.com/watch?v=qRoCiqzLbP8&feature=related
Classic Laurie - pmsl - starts off with euthanasia, then spins it to 'sickness' cuts!!!!!!!!!!!
Reekie is an example at point - to say cuts killed him is ridiculous - he obviously had lots of problems.
I wonder, did it say 'unemployed poet' on his passport? what the fuck is that about? If no one will buy his 'poems' perhaps he should flip burgers at Mcdonalds!!!!!!
The welfare state has taken away his energy, ambition and esteem, If anything has harmed him, it is the welfare state, not its threatened removal.
During the Cold War all Western leaders were willing to commit suicide. Unfortunately, their nation's populations, voters and non-voters alike, perished with them.
This was an essential part of a 'First Strike' nuclear strategy. Hermann Kahn and other Western 'cold' war' policy makers claimed this stance was unavoidable if the West were not to be overcome by an alien political force.
The Warsaw Pact were willing to limit a test of wills to conventional forces only resorting to the nuclear option if the West used atomic weapons first.
Can't recall any religious or other voices condemning this suicidal reasoning. [ CND is an obvious exception, but the anti-suicide protest is now being made by the very same group who proclaimed 'Better Dead than
Red! during the Cold War era. ]
Of course, apart from the kriptonite generated Superman, most of the Super Beings were created as a result of contact with radioactive material. That is on the credit side of the global ledger?
Megaton Suicide
I am an unemployed poet
I say it because I know it
If I didn't say I
Wouldn't know it.
Give us 5 p?
I AM THE UNEMPLOYED POET
This was a good article - our society avoids the realities of old age and death like the plague.This is our reality and escapes and avoidances of all kinds use up finite resources on this earth. We should have the fight to decide our own fate .Often 'sleeping on it' can change our minds. 'This too Will pass' is ancient wisdom. It is a huge tragedy that so many young people make conclusions on how their lives are '. I feeling very sorry for youngsters trying to make their way forward in this increasing shallow world run by 'pr' imagery ( perceptions t facts ) .
A very poor article. Firstly, you disingenuously conflate two unrelated issues; the right to die of the terminally ill and the changes to Incapacity Benefits. You fail to see that what lies behind both these issues is that the fear of inflirmity is now greater than the fear of death. You do not seem to see that is partly to do with the fact that the segment of life that has been extended is the fag end. Neither do you - or any of the others quick to advocate suicide - outline the incredible legal problems this is going to throw up. C-
This was a pretty great piece of dot joining and argumentation.
On assisted suicide itself, my personal disquiet revolves mostly around what it says about the increasing weakness of ourselves as individuals. Complete phobia of the negative and insane assertion of our right to live without pain. I'm not convinced at all that the life without pain is a good or desirable life. Interesting in that regard that she mentions Nietzsche given he was the chief advocate of pain's role in life. To culturally sanction assisted suicide is a furtherence of this etiolation of strength and as assertion that suffering has no part in the meaningful life. I have no particular issue with suicide itself, but it is troubling where it asserts a wider principle about the role of pain in a good life.
The connection between the indifferent state and our pseudo-shock at assisted suicide was superbly made.
@Privet
I don't think anyone is saying Reekie killed himself soley because those things were cut. Demons can be easier to bear when you have reason to believe your society cares about you. If you kill yourself and leave such documents there in place of an explanation, your message is not 'they cut my benefits!', your message is: 'everything is evil! nothing cares!'.
Which, I reckon, is about right.
Only a young person can blather on about dignity in death. Death is not dignified. The most we can hope for is that it won't be painful. As for you, Laurie, you don't really believe it will ever happen to you at all. Good for you. It is not proper that a young person like you should be thinking about death.
If I was sentenced to death I would like to be stoned to death.
In fact I would like to be stoned when I'm getting stoned.
Say for instance you're in this shallow pit and surrounded by people throwing stones at you. It'll be good fun because you can dodge some of the stones and even catch some and throw them back at the throwers. If you're good at throwing you might be able to hit one of them and knock them into the pit with you. You can use the knocked out person as a shield or maybe a ladder ... and escape.
So what if the odds are stacked against you?
"The fear seems to be that if euthanasia were not taboo, the elderly and infirm might be encouraged to end their lives against their will, to spare their families and the state the burden of caring for them, despite the enormous beauracracy already in place to prevent this from happening"
Your evidence that this is not the case, beyond a rhetorical jump over the question?
I agree that religion shouldn't be part of the debate. The issue is too clouded by religion vs secularism.
And I'm glad you've mentioned the economic pressures on disabled people to die.
But I concur with Phoebe Queen's comments above.
I found the bravery and determination of Peter Smedley and his wife to be deeply moving and remarkable. Being healthy with a will to power, it isn't something can comprehend in our own existential purpose. To deny those of intelligent minds the right to end their lives in a terminal or inevitably excruciating condition is nothing but primitive.
"The reasons behind religious proselytising against suicide..." ??
Try to remember, "proselytising" does NOT mean moralising, it means trying to win religious converts.
This misuse is now a regular feature of faith-related threads and is becoming annoying.
Fascinating article...I did feel that the younger suicides you stated be "taken as a separate group..A major player amoun"st all the fury..Is are rights taken into considaration..Dignity..a strong word escially held with more regard by older generations..How many suicides by the young are "crys for help..sadly gone wrong..amounting in there "death...now I come to the elders of our society..Myself had a cancer operation 2 yrs passed.I am fully aware of my situation,A situation that eventually go worse..In no time atall i began thinking of my own death..People take insurance whilst thier young,in my situation and that of other ,is that your concerns are for others..people who have shared your life with,and in these conditions the last thought is not take thier pain also..The pains of your love-ones..With a sane mind am I not allowed my "Human right...my right to release myself from such with those of my loved ones...This has now opened the Doors for us the silent voice.."..Its a debate needed...Just to think that my Love may face jail..is added pressure that hurts..Thank-you.Hope for all"Lawrence
Perhaps Ms Penny would demonstrate her commitment to opposing theological dogma by taking her own life... it would certainly save the New Statesmen's commission fees for these increasingly dreadful articles, and it would go some way to purifying Britain of her dogmatic relativistic agenda
@ In_Negative,
i agree it was a shame & loss of a literary figure in Paul Reekie. A horrible tragedy anyone should feel at that stage.
However you have to question the level he should be sponsored by others for his chosen lifestyle, if he wants to do whatever he wants thats great, as long as he can pay his own way its his business.., howver in common with a lot of others he partied it up to the max for many years, Irvine Welsh quoted as saying his flat was a legendary stop off place for all,
nothing stopping him squirreling away a few pounds for a rainy day or paying down his flat mortgage a bit, now another tax payer, maybe some low paid but worked all his life type chappie has top fork out to sponsor this guy in the form of benefits. Comes back to the question of 'self responsibility'
If you piss your wages away for decades can you ask a person who has grafted solidly during this time to give you his money as well?
The left is peopled by Mrs Jellabys. You will find the lady in 'Bleak House'. In my experience lefties are not kinder etc than non-lefties. Talk is cheap abd a love for the Human Race often goes with an impatience with the people you actually know. Would you honestly say that Gordon Brown, say, is a kinder, more compassionate man than, say Ian Duncan Smith? Would you say that Dame Suzi Leather is a kinder, more compassionate person than Norman Tebbitt? On what grounds?
@Privet
I think I broadly agree with that, though I doubt his life was so simple a matter of unmade practical choices.
His message too remains unaltered however irresponsible his life, that he was clearly a man in trouble and that he wanted to tell the world that these cuts had not helped whatever trouble he was in.
Plus, to make that sort of judgement is to assent to the prevailing values of the current system. Another dead poet of excess - history is full of em.
Great article.
The only way out of hell, is to redeem one's soul.
I actually think it is a slippery slope. Just because something makes something more "convenient" and "easier" for someone, it doesn't necessarily means its right. I think it is better to live in a society where death is death and there is nothing else to it. Doctors and nurses are there to keep everyone alive, no matter how terminally ill or hopeless a situation is for someone. Perhaps in certain cases its not rational or sensible but you do it anyway out of respect to everyone involved. Helping people die is a nihilist and resigned attitude. The Swiss government should close down the dignitas clinic and use the money helping poverty and helping people who are alive. Its actually incredibly selfish that people in the West can afford to pay for their death to be less painful and when they want in a clinic whilst in Africa and other impoverished nations people don't have enough money to feed their children properly and keep them alive.
If you are an adult reduced to having your bottom wiped by another adult there is no dignity and talk of palliative care improvement will not make any difference.
For some people dignity is not so important but for others it's probably almost everything. It comes down to personality not degrees of emotional strength.
If you find your illness is an intolerable indignity and there's no prospect of any improvement you should have the right to be helped to leave this world.
@Steve
What about the dignity of those in Africa who are starving? You are saying its good to use money to let someone die in what they consider to be a more dignified way than use the money to help improve the lives of millions in global poverty?
Money is a finite commodity, there is only so much available at any one time.
It would take a callous person not to be moved by the Terry Pratchet documentary. I felt a great sense of unease with the idea that humans who faced with the loss of control over their illness and ultimately their life could shape their destiny by embracing death. To me Peter Smedley and the other young man with multiple sclerosis appeared compos mentis and should have been asked to return at a later date. Under those conditions in the Dignitas Clinic I wonder how many patients would have the courage to change their mind. What is worrying too is that if euthanasia is accorded legitimacy in the UK, where will the line be drawn. Will disabled or elderly vulnerable people be forced into premature decisions about death? The existence of modern day drugs and extensive use of morphine means that no patient needs to suffer in pain at the end of their life. Doctors can now manage most types of pain and can make the end more bearable for the patient and their families. Euthanasia is a deeply emotive subject and I am not sure that the patient should have the last word. There should be consultation between the family, the doctors and the patients. It cannot be denied too that having to travel all the way to Switzerland undoubtedly places more pressure on the patient.
@james I'm sure most people who wanted to die would pay for their own assisted death here in the UK. It'd be much cheaper than going to Switzerland anyway. It could come out of their estate. I don't get how you think bringing in assisted death here would lead to more starving in Africa. Very odd.
No! We can't have it in case we start euthanasing the disabled!
Of all the people who have successfully committed suicide, none are recorded to have regretted it afterwards. I feel that adults should be trusted to make decisions of this nature for themselves, rather than being second guessed by others.
@Sciamachy: 'why the hell not?'
One problem is that if you are successful you can't change your mind.
The desire to commit suicide is sometimes only temporary. Consequently if it there was a nice easy 'painless' way of doing it without fear like in Switzerland then those people who had only temporary suicidal feelings would regrettably be dead. in short a tragic loss of life.
it was an exellent documentary and much needed.
the arguments against assisted suicide don't hold much water with me. good palliative care is very important and many people will avail of that and die in hospices and hospitals. but if you are an adult of sound mind you should be able to choose for yourself in this matter. for many people, myself included, the thought of a long, tortured, painful demise is more frightening than dying itself. choosing to end your own life is a choice someone living makes, about their own lives. who can stand in judgment of what anothers person choice is, and make proclamations about whether they are sick enough - that seems arrogant to me. the two men shown in the documentary are a good example of the people currently not provided for by law. we are not talking about dragging the elderly, or mentally incapacated off to killed by greedy relatives. these were people who were clear about their choices, but couldn;t stay in their own country. and what is the law doing - its illegal to assist someone to do something that isn;t illegal??? lets debate this very important subject properly and fully and face the difficult task of changing legislation about assisted suicide so it protects everyones life choices.
This is a great article. More like this please Laurie
Ian Silvera: perhaps you would like to pay for this parliamentary committee out of your own money. The government is already stealing enough of people's money.
In Japan a manual on how to commit suicide is regularly in the nation's top 10 books.
Given the world's massive overpopulation & the horrendous amounts of resources we in the "developed world" use per individual, I'd have thought that legalised assisted suicide would be a no-brainer. We're currently killing the world, and estimates by those who make studies of such things reckon we need to cut global population by 2/3 in pretty short order to have a planet that will survive & be capable of supporting any kind of life. I don't think people should ever be pressurised into suicide but letting people who for whatever reason really, genuinely want to go out early & are only ever going to be more confirmed in this desire do so painlessly & with dignity - why the hell not?
Thanks, Laurie. This is such a sensitively written piece. This is a topic that needs to be discussed openly, and your article is really helpful for this debate. Thanks.
Jemes, when exactly is your time up? It seems to me that your life is one thing yu can truly say is your own, and, that being so, you really do have an absolute right t end it whenever you wish. If you believe that your life belongs toGod, then of course you willo believe differently, but, hll, you're all good left-leaning atheists here, aren't you? So there seems no room for discussion on this. The idea that the money you spend on this would have been better spent enlarging some rich African's bank account is so fatuous and contemptible it does not require an answer.
Sadly, you always sound like Jane Spart, however good your argument. That is bad news for US.
The church says only "God" decides when it's time to go. If that's the case why have average life spans doubled in the last hundred years or so?
Christians talk about life being "sacred", well for most of human existence when humans got old they were killed by a wild animal. There was nothing dignified in that and so I conclude that God doesn't feel life is sacred. :D
>The callousness with which this is being done should shock us; it should shock us far more than as-yet-abstract idea of state-sanctioned euthanasia.<
It should shock but doesn't, in fact nothing much does, In a world of greed, selfishness and indifference, with politicians who couldn't care less about the people they are supposed to represent. community is out the window. I for one at 62 will be not at all sad to leave this world. To use a yankism. Stuff the future.... it sucks!
Absolutely needed to be said. It is a disgrace that we as a culture are terrified of an informed debate about what should be the natural right of someone to chose their end. With vicious cuts pushing more and more people to desperately take their own lives as a way out we hypocritically pour scorn, pity and disapproval on those who might want to end suffering or even give meaning and dignity to their deaths, rather than simply waiting to be swallowed by the void.
Sublime article, considered and well-written. Stirling work Laurie.
Isn't £10000 a bit steep for the average suicidal person?
So they can choose between leaving their children a little inheritance and jumping off a cliff; or going to a privatly ran clinic and splashing the dosh, i think i know what most baby boomers would choose...
Now some public toiletesque suicide booths, that would be progress
@Fergus: I am only an atheist sometimes. Sometimes I'm a believer in God and sometimes I'm an agnostic. sometimes I'm not too sure what the hell I am. Most of the time I'm convinced I am the First Seal in the Book of Revelations and that nobody will ever believe me.
This is a strange chimera of an article, with content that doesn't appear to match the byline. The first half seems to be working up to a discussion of whether we should have assisted suicide clinics in the UK, then it switches that at the end for an emotive comparison with driving people to suicide by dismantling the welfare state. I imagine you might be trying to pull people into realising the hypocrisy of being anti-Dignitas but pro-cuts, but I'm not sure how many people actually fall under that umbrella.
@Fergus Pickering
Suicide is the ultimate escapism. Any form of suicide is devastating for the people left behind who love the person who has decided that his or her life is no longer worth living: it is especially damaging for children. This "right" bullshit about having "control" over when you top yourself is fair enough but it is also extraordinarily selfish, irresponsible, nihilst, and escapist.
All euthanasia money should be used for research into those areas.
Your are saying in other words unsurprisingly that people in the developed west are superior to people in the third world. There is no "dignity" for families in Ethiopia in extreme poverty. How grotesquely selfish that the all so important "dignity" of a rich person in the West to top themselves early out of fear is more important than the life of a third world child. Its also racist, but i wouldn't expect anything else from a reactionary bourgeois intellectual that only cares about themselves and their money.
With current attacks in the media on the sick and disabled which I know you are aware about it is unfortunately not a simple debate. There are drugs available to alleviate many conditions which are deemed to be too expensive. If someone who is sick and disabled is denied a drug which alleviates symptoms and in some cases gets rid of symptoms completely is not available then that could put someone in a situation of not wanting to live. Until these issues are addressed how can we honestly say that people who are sick and disabled are given a proper choice as to regards of ending their life? This is a back-handed way of saying you are unsustainable. In an ideal world the pressures put on the sick and disabled via the benefits system and via the NHS re the cut back in drugs (and some of these drugs are comparitively cheap ones) until these pressures no longer exist I do think it is extremely dangerous to legalise this. In an ideal world I would say yes legalise it - but having myself gone through a battle regarding medication it is a very unsafe area. No religious views invovlved here just knowing how the govt thinks economically.
@James: 'Suicide is the ultimate escapism'
Really? I think quite a few things beat suicide for escapism. A few pints and a couple of bongs for starters. And if that doesn't get you off then move onto the harder drugs. Before you go you wanna get a least a chance of the other possible ultimate escapistic possibilities. And if the drugs don't succeed try psychosis. Be psychotic for a while as that is pretty ultimate escapistic.
I mean you've got to make a proper comparison.
Brava Laurie. You have treated this very delicate subject fairly and with great compassion. The subject needs to be debated because the problem is certainly with us. However, the dangers attendant are of an extreme nature. Acceptance of euthanasia in any form could open floodgates known and unknown. We have to keep forever in mind that the Nazis justified euthanasia for a number of reasons (some of which are also quoted inadvertently in Laurie's article) and look what we got - concentration camps, deaths by the millions.
This benefit changes = mass sucide idea does need some debate, like most things its useful to look at facts
'The 48 yr old poet from Edinburgh...' who unfortunately killed himself had a long list of problems beside his benefits changes
to quote from a local paper & people who knew Paul Reekie well.. 'Everyone who knew Reekie well talks about him having demons. Barry Graham remembers seeing him cursing at and exposing himself to a nightclub bouncer. "Sometimes you would run into him and he would be absolutely exuberant, but at other times he would have this field of blackness about him." "I don't think Paul killed himself because he had his benefits cut," Williamson says. "It may have been something that tipped him over the edge, but it was more complex than that."
Reekie suffered from poor health, having undergone heart surgery in recent years. He was recovering from an attack outside a pub which friends speculate had left him feeling vulnerable. He is also said to have felt terribly lonely at times despite a wide social circle. & Heavy drug & alchohol usage through the years.
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