Julie Silver Manning’s father died suddenly, without warning in 2019. The 84-year-old had a hemorrhagic stroke while on vacation and died six days later, having never regained consciousness. Although the loss was unexpected and heartbreaking, Manning said she knows her family was lucky that he went so quickly and painlessly.

“I felt devastated but grateful that he didn’t have to linger and suffer,” she said.

Her mother’s death two years later at age 85 was a different story. A woman who dealt with numerous longstanding ailments, including congestive heart failure, diabetes and neuropathy, Esther Silver’s health began to rapidly decline after losing her husband.

“I would take her to the doctor and he’d warn us that he was running out of options to help her,” Manning said.

Eventually, she was diagnosed with end-stage kidney failure.

Manning understood this meant she would die soon and her daughter was astounded her mom accepted the reality with so much courage and grace. Her last appointment was on a Friday.

“The doctor told us there was nothing more he could do,” Manning said. “On Sunday, mom began calling her friends to say goodbye.”

She urged her daughter not to mourn her passing, reminding her that she’d had an incredible life.

“It’s OK,” she said. “I’ve checked off every box. I’m ready to go.”

Silver chose to spend her final days at home and Cleveland Clinic hospice helped make that possible. Family members were with her 24/7 and she spoke individually to both her children and all her grandchildren. But each day, for six days, she woke up and asked, “Why am I still here?”

In retrospect, Manning said she knows this was not a long interval compared to what many others go through.

“But, at the time, we had no idea how long my mother would live,” Manning said. “It could have lasted weeks or even months. That was a frightening possibility for her.”

Manning said Silver asked both her hospice nurse and members of the family if they could help her die. They had no choice but to tell her they could not.

After her mother’s death, Manning was left with many questions.

“Why did it have to be that way,” Manning said. “My mother was dying. Why couldn’t she have some agency and be in control? When death is imminent, why do we have to wait it out? I wish she had been allowed to go comfortably and easily in her own time.”

Manning learned about death with dignity laws from a friend who is on the board of Ohio End of Life Options. The nonprofit, nonsectarian organization advocates for the passage of medical aid in dying legislation for the terminally ill in Ohio.

“If this law had been in effect here as it is in other states, my mother would have been a perfect candidate,” Manning said.

Silver met all the criteria: her doctor confirmed that she had six months or less to live and she was lucid and able to make the decision and take the prescribed medication herself. The loss of her parents, and the realization of how much harder it could have been, motivated Manning to get involved in the group’s efforts. “I believe in the value of this option and think it should be available to anyone who qualifies and wants it for themselves.”

As part of its virtual book club, Ohio End of Life Options just hosted a discussion of “Being Mortal: Medicine and What Matters in the End” by Dr. Atul Gawande, Oct. 14. Dr. Edward Benzel, emeritus chairman of neurosurgery at Cleveland Clinic and professor of neurological surgery, at the Cleveland Clinic Lerner College of Medicine, joined the conversation. The Zoom recorded event can be viewed after Oct. 14 at ohiooptions.org. There will be another virtual book club on Nov. 18. at 4 p.m. To register and for more information, visit ohiooptions.org/events.

“There is no script for end of life,” Manning said. “With my father, we could never have imagined what happened. Things don’t go as expected. That’s why it’s important to think about what you want, talk about death with your loved ones and plan ahead.”

Rabbi Joshua Caruso of Anshe Chesed Fairmount Temple in Beachwood agreed with Manning, who is a member of his congregation.

“We all will have to make these decisions for ourselves or family members,” he said. “There are no easy, perfect answers for how we should live out the end of our days. In our religion, we value life but also don’t wish for anyone to suffer needlessly. The reform movement allows for more flexibility between religious laws and individual options. These are conversations that need to happen, and Judaism embraces the challenge.”

To facilitate those conversations, Fairmount Temple recently published “A Jewish Guide to End of Life: Preparation, Ritual, Practice and Coping with Grief.” Created by Wendy Jacobson, a licensed independent social worker, and Cantor Laureate Sarah Sager, with support from the synagogue’s clergy team, the guide is available by contacting the temple.

Laura Taxel is a freelancer writer in Cleveland Heights.

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