Podcast 4: A Millennial Perspective

Transcript:

[Autotranscript; may contain errors]

[00:00:00] Dwight Welcome. I’m Dr. Dwight Moore, the chair of Arizona End of Life Options. We have the pleasure today of talking with Ahbik Chowdhury, who is a PhD candidate in computer sciences at Arizona State University. We are including Abhik in the millennial category. We are interested in picking his brain about his knowledge of medical aid in dying and experience with death and dying, and to try to get some idea of what the younger generation believes about this critical issue here in the United States. Abhik, welcome.

[00:00:40] Abhik Dwight. Lovely to be here.

[00:00:43] Dwight Thanks for spending the time with us. I have a number of questions for you. And this is casual and informal, so we’ll go through this as we like, as if we’re having a cup of coffee together in the afternoon.

[00:00:56] Abhik Sounds perfect.

[00:00:58] Dwight I think it’d be helpful Abhik, if you give the audience a little bit of your background where you were born and raised. How did you get to the astounding position of a PhD candidate?

[00:01:10] Abhik Absolutely. So I’m an Arizona local, born and raised in Chandler, and my parents came to Arizona around ’84 and they worked at Intel. And so school was always a big thing in our house. I was never the best at it, but I have an absolutely fantastic PhD advisor who supports me a lot and yes, has enabled me to go down the path of higher education. And yeah, I’ve been here my whole life, all 26 years of it.

[00:01:44] Dwight That’s great. The PhD advisors are really critical person in getting this PhD done. I know. Have you picked a committee yet for your thesis?

[00:01:55] Abhik Not yet. I have a short list of people to reach out to, but I most recently solidified my research interests in the area of applying some machine learning techniques to mental health care. And now that I have my fundamentals, knowing what the math is, read enough in the literature to know what the vocab is. I’m feeling pretty comfortable to reach out to committee members soon here.

[00:02:21] Dwight So let me see if I understand this a little better. Applying Machine Learning Techniques to Mental health. One of the things that you’re going to learn if you don’t if you haven’t already learned it, is that PhD candidates have two speeches. One is the technical speech they give when somebody says, “what are you going to do your dissertation about?” and then the other speech is the one you give to your grandmother because they don’t understand the technical speech. So translate for our audience, please. The what you hope to do in your dissertation research.

[00:02:54] Abhik Yeah. The goal is that people can be supported in their lives, in, you know, mental health is the current institution that supports a lot of people in a very specific way when it comes to pathologizing or the problems that people have. But I definitely hope that with technology there won’t be, the ability to provide care will be a lot easier, and the ability to have care be provided for will be accessible to a lot more people through digital systems. And yeah, that could be everything from the normal things people go to see a therapist for, to everyday problems that would be categorized under wellness, stress, anxiety, that maybe not be chronic but are helpful nonetheless.

[00:03:46] Dwight Interesting. So you got some service orientation growing up. So caring for people. Empathy. Where did that come from in your in your life?

[00:03:58] Abhik Hmm. I think. It came. Relatively recently. My humanitarian aid journey definitely started mostly in college, and there was one of my good friends, volunteered a lot with an organization called No More Deaths and helping out with our local humanitarian crisis in Arizona. With the deaths happening at the southern border based on the immigration policy of deterrence, by having the border crossing be very dangerous and no more decimation is we don’t want. People to die in general. And so saying, well, if people are crossing the border, we don’t care who they are, dying of thirst, dying of starvation, dying of the elements is a horrible way to go. And we are here to stop people dying in this way. And so the way that this organization does that is that we drive out in the desert and then we walk for a few miles and we carry a lot of jugs of water and some cans of beans. And then we have locations that we drop the water and beans. And, you know, sometimes there are altercations with border security and the sort where we try to put them in locations where they won’t be found so that they’re not destroyed and put them in locations that will save people’s lives as well. So that involves saying, all right, between this mountain pass, it seems like more people are moving through these new ones. How immigration patterns change to save lives. And of course, all of the other things around there with reporting people who have passed away. And if someone is alive and needs medical attention, providing service no matter who they are. So, yeah, so that was the first step on the, you know, hey, there’s a problem. There’s a humanitarian crisis. We don’t care who you are. Nobody deserves to die that way. And. Providing care to people based on just the fact that they’re human and not what they’re trying to do.

[00:06:17] Dwight You’re clearly passionate about this cause it’s obviously a worthy cause and an important one. I would also imagine that in addition to the life and death possibilities in border crossing, there’s also trauma involved in terms of leaving your own country, dealing in a different language, not having employment, feeding your kids. That probably plays part in part of what your concern is.

[00:06:44] Abhik Absolutely. It’s a really tough time. And I think that the techniques that a lot of the border agents use to deter through danger and death, people from crossing involve splitting up groups of people in ways where when someone gets separated from the group, it’s very low likelihood that they will survive that incidence. There’s only so many things that we’re legally allowed to do. And so I think a go to example is if we see someone dying in the desert and we. Get them in our car and we take them to the closest medical facility. That is something we’re allowed to do. If Border Patrol asks us, Hey, who’s in the back of your car? The the answer is we have no idea. We just know that they need help and we are taking them to the closest facility to help them do that. But we are not allowed to house people. We are not allowed to transport them closer. If we find them, we can give them water, but we can’t physically move them. So they have a really good legal team they’ve never lost to this day. They have not lost a legal challenge yet on the premise that humanitarian aid can never be a crime. And so. Under that premise, we can provide water, provide medical care taken to the nearest facility as a human, but we cannot do anything that would get in the way of the America’s border policy. Yeah, there’s few things that we can’t help out with, unfortunately, that I think you’re really right are still big problems for people who live through those kinds of situations.

[00:08:25] Dwight So this is kind of a dramatic introduction to death and dying in terms of the nonprofits that you’ve described for us and the audience. Is this your first set of experiences with death and dying, or did you have some earlier in your life?

[00:08:43] Abhik It was never very much in the forefront of our family talking about these things. My mom, at least, is a little bit better at talking about death and dying as a very functional process. My dad still gets a little bit nervous about it. And of course I am very pro talking about it all the time. But well, I did see when my mom’s dad passed away and my dad’s dad passed away as well and how that affected them. It was a little bit removed from me as I was, you know, in high school and in college and not fully, aware of the family and they lived in India. We lived here, so we weren’t particularly close. But I got to visit India this last time, this last summer, and one of my grandmothers is bedridden now and not the most verbal. And it definitely makes me feel some regret about. They visited America when I was in high school and I was being a high schooler, and I didn’t necessarily prioritize getting a lot of the life wisdom from those interactions when they were more verbal. And that’s definitely something that I recently realized that valuing people when they’re around and this last time I got to spend time with my other grandmother on a trip and she told me a lot of really good stories about my mom when she was growing up and so getting to immediately capitalize on those learnings was very nice as well.

[00:10:11] Dwight So it seems appropriate to me that a millennial is not focused on death and dying. It’s really not your journey at this point. By the way, what is the official definition of a millennial? How old do you have to be or how young?

[00:10:27] Abhik It was funny. I was talking with one of my partners about this yesterday, and I consider myself a very young millennial and one of my partners considers herself like an older millennial. 1996, which is around the age that I was born, is around the cutoff between Millennial and what’s called Gen Z. Oh, I don’t know what the exact year date is, but I think, yeah, around 45 to 55 is Gen X, those kinds of cutoffs. And so I would go Gen X 45 to 55 area. 25 to 45 kind of millennial area and younger than that would be historically considered Gen Z. But these are just intuitions, so definitely don’t quote me on that.

[00:11:12] Dwight Well, but I just want to get some general sense about that. It seems to me that the age bracket that you’re describing for millennials, the kind of the job of the character at that point is to set up a family, get a career going, keep your health as well as you can do it. And it’s not really thinking about retirement, thinking about advanced directives, thinking about death and dying. The focus is more in immediate focus on career trajectory. Is that a fair statement on my part?

[00:11:45] Abhik I think it happens to a lot of people where, yeah, it’s not really the focus death and dying, but I think that in a lot of other communities there is a lot of death that happens in turbulent the younger years where people take their lives, people have complications, people have parents and grandparents that they’re interacting with, especially when it comes to the turbulence that comes with being young and not being established in the world yet and the stresses that those can cause with suicides. It definitely makes people think about a lot of the things that everyone should think about when it comes to, Hey, what are my values, what are my plans? How can I make my death a good death when yeah, there’s a lot of examples of not good deaths that happen at this age and that happened at later ages too. And in some circles there aren’t a lot of people who go out that way at such a young age. But in other circles there’s a lot higher instances of people who die by suicides. And so there’s definitely chasms of people who have these kinds of things on their mind but aren’t necessarily the most equipped to answer these questions for themselves.

[00:12:59] Dwight So you’re saying that it does happen in your category age category, that suicide is probably the most in accidents, I suspect, the most frequent cause of death. What are you and your peers talk about in terms of suicide? What’s the language you use and what’s those discussions like?

[00:13:19] Abhik Hmm. So for me, I’m I might be a little bit of a weird one. There’s a interpersonal theory of suicide that you’re probably familiar with, where it posits that there are a couple of contributing factors, and there’s a pipeline that leads to suicidal behavior, and some of the contributing factors are thwarted belongingness and perceived burdensomeness. And then those in combination with a loss of hope or change of the future. Can lead to suicidal ideation. And then the last steps are access to means or ability to self harm is what the term is, which could to lead to suicidal outcomes. And so if my friend is coming to me and saying that they’re suicidal, I will look at the earlier parts of those where it’s like, Hey, are you feeling thwarted belongingness? And is that something that is reflective or is that potentially a cognitive distortion? Where I would say no. I think that there’s a lot of people who care about you, and I think that and especially in the perceived burdensomeness. Definitely also affirming that, hey, I don’t think that you’re a burden. I think that the life that you have adds to the people around you in a very net positive way and those are affirmations that I take The loss of hope one is also one where I give people a little bit more autonomy, where people can make the call for themselves about, Hey, do you see yourself getting better?

[00:14:51] Abhik And I can posit statistics of, “oh yes, this is an especially turbulent time. It might get better. These are the stats on that. You can make the call for yourself. And the quote, unquote ability to self harm part is one where, you know, it’s a tool that is used by institutions sometimes that I kind of disagree with, where saying, “oh, by withholding access we can reduce suicides”. And it’s like, okay, well, I mean, yes, by withholding access to options, you can achieve your outcomes, but not in a way that addresses the underlying problems. And so I definitely shy away from those. People should have the rights to have their values respected no matter how they go out and no matter whether or not I agree with it. So definitely give them the respect that they deserve when thinking about those things, providing any assistance that I can in. Yeah, if they want to live supporting them, but also acknowledging that it’s really their call and making sure that their values are respected all throughout that pipeline. I don’t know if that is APA certified and so you do not need to endorse or.. (laughs)

[00:16:26] Dwight And as a psychologist, I understand and I find you to be wonderfully sophisticated, actually, in having a model in your own brain to kind of understand suicidal tendencies and the possibility underlying with a great deal of respect for where somebody is coming from, what is their truth and what is their reality. You talked about some of the dimensions about loneliness, for example, I’m going to use my own language, but loneliness, feeling like you’re not connected anymore, that you don’t really have a sense of purpose that’s quite similar to the traditional death and dying experience of an 80 year old. As you probably know, this is another unusual thing for you as you’re involved in Arizona End of Life Options as an action team member and help us with moderating the webinars, that the loss of autonomy is the primary cause for people to choose medical aid in dying. And part of that is inability to have some degree of dignity in their lives, being able to take care of their own bodily needs in terms of toileting and eating and those sorts of things. Loneliness, the isolation that some folks, older folks, have and the sense of helplessness in terms of physical pain and also anxiety. Does the philosophy that you talked about here just a minute ago, very beautifully, fit with your understanding of medical aid and dying?

[00:18:04] Abhik Yeah, absolutely. Because I think that in the medical aid and dying case, as an activist, very obvious situations where it’s like, this is a situation where people should have autonomy, where with the six months left to live, the loss of hope is not something that they have a choice of whether they have a diagnosis. It’s the hope has not something that they can come up with themselves. And the statistics on the reasons why people choose medical aid in dying are a point of contention for some people where they would say that is not a legitimate reason to want to end your life. “A loss of autonomy, that is not a good enough reason for you to do this.” And a bit of judgment on the part of people who disagree to say when a life is, or is not worth living. Yeah, and my philosophy, that is a big call. We all judge people. I think the step that actually relates it back is as it relates to the ability to self harm. And so in the medical aid and dying process, the whole idea is, should we provide reasonable access for people to end their lives in a way that is reflective of their values as a society? So it’s more of, “hey, what is the government’s role in this and what is society’s role in this?” As people who are not them, society’s role to withhold people’s ability to exit gracefully, I believe is not right. And so whether or not you personally agree with someone’s desire to end their life, like there’s been people who have come to me on the edge that I’ve disagreed with. But saying, “hey, as a friend, as a government, as an outside party, what is the reasonable right that I have?” And in some countries they have, yes, very aggressive laws where people can restrain others by any force necessary to, quote unquote, save their life. It’s definitely from a perspective that does not respect the autonomy of the person who’s dying and the person who decides their values for themselves about what about their life they find enriching and when they are ok ending it.

[00:20:28] Dwight So I think what most of our listening audience understands is medical aid and dying is a choice that people make, an autonomous choice if they have a terminal illness, six month terminal illness, and two physicians have certified that they are competent, mentally competent, the component of independence, the component of choice, sounds to be central to the way you think about this also, and it’s something that you would advocate for somebody if they personally choose it, but if they chose not to do that for whatever reasons, you would also support that choice.

[00:21:10] Abhik Yeah, I’m very anti-suffering in general, but I think that people can choose what suffering they find meaningful and they can also choose when they stop finding meaning in that suffering. And so if somebody who is suffering a lot but still doesn’t want to live for whatever reasons, I would say like, ones that I find less convincing are, “oh, they’re afraid of death, they’re worried about what others would think.” I would say like, “Oh, you don’t need to worry about what others would think.” And yes, the fear of death is very human, but if you don’t find your suffering meaningful, you can make that call for yourself. So even in situations where someone is making arguments that I might disagree with, I definitely would still say that they have the right to make those calls for themselves and whether it is pro-suffering or not pro-suffering.

[00:22:03] Dwight Were you raised in any particular religious tradition?

[00:22:07] Abhik I think my mom might tell you that I’m a Hindu, but outside of that, not particularly. The Humanist Society of Phoenix sent me a card. I pay dues, but haven’t been to too many events. But yeah, I’m not particularly religious, but I do very much enjoy having a lot of religious friends because they have very good thoughts about answers to metaphysical questions that many people don’t really consider and values questions that I find very refreshing.

[00:22:39] Dwight So you enjoy the metaphysical and value-based discussions about this and kicking this around with your friends to try to understand basically how this part of life works.

[00:22:52] Abhik Yeah. And also ally with religious people in the No More Deaths nonprofit. It was actually started by a group of religious people because again, a lot of humanitarian aid organizations are founded in areas of faith. And I as someone who yes, I’m very passionate about reducing suffering, find allies and faith groups a lot of the times.

[00:23:18] Dwight One last question and then we can go anywhere we want with this. I’m going to give you permission now to give advice to old people like me about our end of life journey. What kinds of things should we be aware of and thinking about and what advice would you give us?

[00:23:36] Abhik Let’s see. Mhm. Settling in on what’s really important to you, because I think that I was really privileged growing up, getting to think about, “hey, what’s really important to me? Who am I really? What are the big things and what are the little things?” From a relatively young age, I at least had like the bandwidth since my parents came to America, they had corporate jobs that enabled them to make enough money to support my sister and I, to not have to worry about money so much and be able to yeah, think about the things that really make life meaningful and who we are in the context of a bigger world. And I think that that is not always a given, especially in an older paradigm of ‘nose to the grindstone’ until your career is over. Then once you’re retired, then you can look around and figure out what it is that you really want and and who you are in the sort. Getting those questions answered sooner rather than later is always a really good thing where it’s hard to look at yourself and make those grand statements, especially if there’s not a lot of data to pull from takes a really long time. But when you have to make grand decisions like, about the end of your life, or the relationship you want to have with your kids, or the people around you and what was your life all about, then these kinds of thoughts play a role in making those decisions. And so, yeah, thinking about that, having those conversations with your friends, your family, even if it might bring down the energy of the dinner party or the sort. But yeah, making sure to, to have deep relationships, not even just within your family, but everywhere, to help answer those really important questions.

[00:25:35] Dwight So really the context here is to spend time thinking about what you value, what’s important to you, and do it in communion, if I can use that word, with other folks, different age groups, different religious backgrounds. When you are talking about this Abhik, I’m struck by how few conversations I have. I’m a front-edge baby boomer, so I’m 75 years old, and it doesn’t occur very often that somebody younger asks me about what I think. In fact, I miss that. So one of the things I encourage my kids to do, is to engage with me in conversations rather than, I’m not sure what they assume, maybe that I have nothing to say anymore and I’m set in my ways. But these are as you know, these are vital conversations, particularly end of life conversations, about how do we deal with issues of dementia and quality of life when physically we’re diminishing. And I would love to have the support of your generation in engaging in those conversations.

[00:26:48] Abhik I look to the relationships with my parents most when thinking about these things and they change a lot, and there’s a perspective from a kid’s perspective, is ok, that parents set in their ways. They would never budge on these things. But once you leave the house, once you see the world for yourself, and then you come back to interacting with your parents and come back in with a little bit more distance, they yeah, my parents have changed a lot on a lot of things that I never thought they would, and I’ve understood them in ways that I never would have before. There’s a lot of stories volunteering with Arizona End of Life Options of people’s kids, disagreeing with their parents, or not being able to have those kinds of deep understanding conversations that are so necessary when the stakes are so high with making sure your values are realized in such important times. And parents sometimes have ideas that are nuanced in ways that kids don’t realize, but also maybe biased in ways that the parents don’t realize as well, and that by talking about it together, you can cut through some of those assumed perspectives.

[00:28:13] Dwight Abhik, think there’s another avenue I’d like to pursue with you. You are obviously aware that we are going to introduce a law again in January for medical aid in dying, to be passed by the Arizona State legislature. In passing a law, one of the dimensions that we deal with is building different coalitions of people who support the law and who can articulate from their different points of view what that law means to them and why it might be important. Some of those constituents have religious constituents, they are obviously legislative, some of them are political parties themselves, and then there are professional constituents, also doctors and nurses who weigh in on this issue. It becomes a little messy to build these coalitions, in a sense, but also exciting. What would your take be on kind of the legislative conundrums that we’re facing and how to manage some of those?

[00:29:17] Abhik Hmm. I’m pretty new to the legislative process, but I definitely am excited by people from very different worldviews constantly being engaged in a way that reflects their values. And so I definitely have interacted with people where the unified narrative disenfranchises them to the extent that although they agree with the legislation, they have trouble seeing themselves in a way that would motivate them to advocate for it.

[00:31:00] Dwight Well, I really like what you’re saying here, because we at Arizona End of Life Options have a need for voices in a number of areas that we don’t currently hear. So, for example, we need a stronger disability voice in talking about the medical aid in dying, we need a stronger First Nations or native voice. We need a stronger gay and lesbian LGBT voice in this process. We have pretty good voices from doctors and nurses and the humanitarians and Secular AZ and those folks. But for any of those folks who might be listening, please get in touch with us at Arizona End of Life Options. If you have a particular different way of articulating the value of choice at the end of life and between Abhik and myself, and some of the other steering committee members, we’ll help you get heard. If I’m hearing you correctly, Abhik in your concern.

[00:32:03] Abhik Yeah, that sounds like a fantastic idea. Yes, the way grassroots organizing operates, where those are the roots.

[00:32:16] Dwight Thank you very much for taking the time today. I had the pleasure of talking with a PhD computer science candidate. I wish you the best of luck with your completion of your degree. I know you’ve got a couple of steps to complete so far are coming up, but I appreciate your time today.

[00:32:33] Abhik Thank you so much, Dwight. It’s always a pleasure to talk. I definitely always appreciate your wisdom when it comes to these things, having so much experience with end of life processes and having seen so much, I would love to learn more.