

Part I:

When Family Devotion Leads to Killing: Some Ethical Questions



by Carol Levine



Last October David Brooks, a New York Times columnist, invited readers over the age of 70 to write a brief report about their lives so far as a "gift” to him.

Among those who responded was Charles Darwin Snelling of Fogelsville, Pa, a small town in the Lehigh Valley, an 81-year-old entrepreneur and recently retired head of the Metropolitan Washington Airports Authority. His long essay, "A Love Story and Redemption,” published online on December 12, 2011, described his successful career and 61-year marriage to his wife Adrienne. With five high-achieving children and 11 grandchildren, two homes, plenty of money, and a variety of interests, they led a "charmed life.”

When Adrienne developed Alzheimer’s disease, six years ago, Snelling made caring for his wife his new life work. He wrote: "We continue to make a life together, living together in the full sense of the word, going about our life, hand in hand, with everyone lending a hand, as though nothing was wrong at all.”

But something was terribly wrong. On March 27, 2012, four months after his essay was published, Snelling killed his wife (no cause of death has been determined) and shot himself. Although rare, this kind of murder-suicide (and that is what it is, despite some attempts to romanticize it), is not unique. Donna Cohen, a researcher at the University of South Florida who studies reported cases like the Snellings, finds that most often it is the elderly husband/caregiver who commits the violence and the wife who is ill.

We will never know what was going on in the Snelling marriage or in Mr. Snelling’s mind. But the incident raises troubling questions. I am not a mental health professional, and I leave that aspect of the commentary to my colleague Barry Jacobs. My views come from my work in medical ethics and my personal and professional experience in family caregiving.

For a start, David Brooks’ response in his column seems cold and distanced. Rather than expressing some dismay about his own inadvertent role in this drama, he chides Snelling for not "respecting the future.” Brooks says he "bought the arguments that Snelling made in his essay.” How could someone take his "gift” and regift it in this terrible way! He thinks that either Snelling "was so overcome that he lost control of his faculties, or he made a lamentable mistake.”

From my perspective, it was a desperate but entirely thought-out act that can perhaps be explained but not justified legally or ethically. Even an extreme view of autonomy does not include the right to take someone else’s life in addition to one’s own. If he had survived, he should have been charged with a crime, although his status as a pillar of the community might have spared him that indignity. Why is it that so many Americans approve of this kind of violent death but protest withdrawal of treatment from a person in a permanent vegetative state? Why do they refuse to talk about health care proxies and living wills but say that they will rely on a willing relative with pills or a gun?

Some have complained that even to comment on this "family tragedy” violates their privacy. While certainly the surviving family members’ personal privacy should be respected, Snelling took his life story out of the personal realm, first when he wrote his essay and allowed it to be published; and second, when he committed acts of violence that were certain to be reported, investigated, and discussed. These were two very public acts, and he was a man who lived in the public eye.

Nor is this a case of euthanasia, physician-assisted suicide, or that odious phrase "pulling the plug.” The medical community was not involved at all, other than perhaps prescribing medications for Adrienne. (Perhaps some astute clinician might have picked up some clues earlier on.). Refusing unwanted medical treatment is the legal and ethical right of every autonomous person. The facts of this case are not even close to that scenario. There were alternatives. With his resources he could have found a good nursing home with a special dementia program for his wife, visited her as often as he wanted, and found some time for his family and avocations. There is no shame in such a choice, and it should be respected, not criticized as abandonment.

As a person with advanced dementia, Adrienne Snelling did not have the capacity to consent, even if (as seems unlikely), at some point the couple made a verbal pact not to go on living if one partner was terminally ill. Saying, "I wouldn’t want to live without you” is quite different from saying, "Yes, give me that fatal dose of pills today and don’t forget to shoot yourself afterwards.” Nor was this some sort of old-age Romeo and Juliet story. Those who make that connection misremember Shakespeare’s play. In any event, Adrienne was, as far as we know, not imminently dying and not suffering. She might have lived for years in this condition, apparently well cared for (by aides as well as her husband) and happy as long as she could be near him.

And that is probably at the heart of what happened. In rereading Snelling’s essay, I now am struck by the feeling that he was trying to convince himself that this life—a constant caregiver to a person who was and who was no longer his wife—was not only tolerable but good and satisfying. Not a hint of how hard it really was, how diminished he felt, and how difficult it was to imagine the years and years ahead. I have interviewed many caregivers of people with Alzheimer’s; none of them has expressed this kind of total selflessness. The ability to acknowledge one’s losses and limitations is an important asset in surviving caregiving. Friends and family, as well as professionals, should accept and validate these feelings. Perhaps the accolades Snelling received when his essay was published only brought home to him the disjunction between the saintliness ascribed to him and his true feelings.

In the end I feel most deeply for the Snellings’ 11 grandchildren who will live the rest of their lives without the love and pride that is the special contribution of grandparents, but instead with the dark knowledge of violence in their family history.

Carol Levine directs the Families and Health Care Project and the Next Step in Care campaign at the United Hospital Fund in New York City. She is a Fellow of The Hastings Center, a bioethics institute, and writes frequently about ethical issues in health care.



Part 2:

Narrative Means to Homicidal Ends



by Barry J. Jacobs, PsyD







What’s your idea of end-of-life redemption? As medical family therapists, we often try to guide our clients—the dying and their family caregivers—to use the last days, weeks and months of life to express love, complete unfinished business, and make reparations—the better to provide healing and lay the groundwork for successful resolution of grief. But do we regard actively trying to end a loved one’s life as a justifiable means of redemption? I believe that’s the crux of how each of us may view the Snelling case.

In the immediate aftermath of the murder-suicide, the Snelling family was reported to have said that its patriarch had acted "out of deep devotion and profound love.” But I agree with my colleague Carol Levine that we can and should make distinctions between ending a loved one’s death’s-door suffering (say, through removal of life-supporting machinery or administering high doses of morphine under hospice guidance) and killing someone with an as yet irreversible disease who is terminal but still viable and who may or may not be suffering.

I also agree with her that Mr. Snelling’s violent acts were probably not the result of a brain addled by depression but of a mind too taken with itself and with its redemptive mission. As Carol points out, cases like these are rare but not unique. A decade ago, I wrote an essay on a similar case (please see "Instructions to the Jury,” Families, Systems & Health, Vol. 20, 2002, 101-104) in which a husband-caregiver was clearly desperate and severely depressed at the time he put a pillow to the face of his wife of 43 years; he soon afterward was placed in a state psychiatric facility. But there is little of the tone of the tormented depressive in Snelling’s long, meandering essay. Rather it is deliberative and full of gratitude even in its allusions to the grinding work of Alzheimer’s caregiving. We all know about "reaction formation,” Freud’s classic defense mechanism in which people state and do the opposite of how they really feel in order to prevent themselves from being plagued by self-condemnation and anxiety. (Shakespeare’s line from Hamlet-- "The lady doth protest too much, methinks”--captures the same insight.) But there is no telling if Snelling were covering up anger or sadness or anything at all negative with his opaquely self-satisfied essay.

Because that essay was undertaken in response to a prompt to provide a "life report” to New York Times columnist David Brooks, it can be read as a narrative in the clinical sense of noted family therapist Michael White—that is, as a construction or justification for a particular life course. Snelling may even have intended it as explanatory back-story for his children of what he already planned to do. So what do we learn from Charles Darwin Snelling’s narrative? He grew up in a materially rich but emotionally impoverished family in which he was subjected to his prominent father’s unremittingly harsh judgments. He developed into an oppositional, disdainful and willful young man who irritated authority figures but still possessed something of his father’s intelligence and determination. Under the nurturing influence of his wife, he softened somewhat but was still known to their 5 children as a curmudgeon. Then his wife became demented. Others didn’t think he had the capacity for nurturance himself to care for her, but he was determined to prove them wrong. He also saw this as an opportunity to redeem himself—to give back to her some of the love he’d received from her.

It made for a nice story in the Times. But, in my opinion, the postscript to this story reveals that Snelling was not redeemed from his upbringing. We know that childhood neglect often produces narcissistic adults —people of shining public facades but with interior lives marked by feelings of inadequacy, despair and resentment. I consider his writing of an essay for national publication to be a grand-standing effort to make a positive impression and garner prominence. I see in his acts of murder and suicide an application of the harshness, bleakness and willfulness he harbored within. These were sharply negative edges to him that his wife had long blunted until she wasn’t competent enough to have that influence on him any longer. Then he was psychologically on his own. In seeking death, Snelling found the severest form of deliverance for himself and, more especially, for her.

Dr Jacobs is the Director of Behavioral Sciences at the Crozer-Keystone Family Medicine Residency in Springfield, PA. He has written broadly on family and caregiver issues, including the book, The Emotional Survival Guide for Caregivers—Looking After Yourself and Your Family While Helping an Aging Parent.