Voluntary euthanasia
is the process of bringing about death in the terminally ill,
at their request. Its legalisation is being debated in some Western
societies. Matthew Bailey, a medical student, reflects
on his personal struggle in the context of this debate.
MY GREAT-GRANDFATHER died long before I was
born. What carried him off was not the cancer that riddled his
body and wormed its excruciating way up his spine. It was an
overdose of morphine. My grandfather, a doctor himself, had discussed
the matter with the treating physician and the family knew exactly
what was going on. When he passed away, the matter was also laid
to rest.
There is nothing unusual about his case.
He was never given euthanasia, only "ample pain relief".
That the required dose of pain killer became fatal was an unfortunate
yet unavoidable side-effect. Such practice goes on today, discretely
and regularly.
Today my grandmother is also dying. This
time there is no cancer, but a motor neurone disease which has
already left her virtually unable to talk or swallow. Communication
with my half-deaf grandfather is almost non-existent. As the
disease progresses, she can expect gradual paralysis. Her death
will come when she is no longer physically able to breathe.
Unlike my great-grandfather, her condition
is not physically painful. What causes her suffering is the difficulty
she faces at home, the cloud of depression she lives under and
the fear of future degeneration. We can offer her nothing of
use; anti-depressants do little to hold back her tide of lament.
She talks often of wanting to die, of looking forward to her
death and of being ready to leave this world. Meanwhile I sit
beside her, my mug of coffee long finished as she splutters down
her now cold cuppa. Often I have thought about a quick injection,
an easy end. I love Nana dearly, but I think I would be prepared
to do it.
My parents are doctors themselves. They know
what's happening; they have watched many patients die. They also
have a faith which I do not share. When I discussed the issue
with Mum, she looked at me and said, "You realise that I
believe you would ruin her chances of eternal happiness. I don't
want you to even discuss it with Nana."
She's right, of course. Suicide and murder
are both grievous sins in Catholicism. If I were to give that
quick, painless, undetectable and lethal shot of Potassium, Nana
could be barred from heaven.
Heaven or otherwise, the suffering here on
earth would be very real. If losing a parent is hard, losing
hope for them in the hereafter is intolerable. That could well
ruin my mother and our relationship.
In times such as these, my solution is to
curl up in a quiet room, take several deep breaths and meditate.
I try to divest myself of all my preconceived notions of right
and wrong, of loyalty and obligation, and from the fetters of
emotion and fear. I strive to see things in the clearest light
possible, free of such hindrances. Then I hope for a solution
... Nothing.
Currently I live with an elderly doctor.
At 89, he is fit and at least as mentally adept as myself. With
the recent controversy surrounding euthanasia, the topic came
up easily. He looked me up and down and rubbed his prickly old
man's chin for a moment before proffering judgment. For all I
knew, he could have well been the doctor of my long-dead great-grandfather.
"It is not a doctor's place to decide life and death. That
is for God. It is simply our place to alleviate suffering. If,
in the course of doing that the patient dies, well so be it.
Your particular case is a difficult one, and a terribly sad one,
but it is, I believe, a crime against God for anyone, particularly
a doctor, to kill."
Originally I was dissatisfied, but as I curled
back up on the sofa I started to see his point. As an agnostic,
God does not feature in my decision making, but that does not
diminish the significance of what he said.
It is the volition to kill that counts, and
that is out of place in a doctor's thoughts. The alleviation
of suffering is paramount, and if death is a serious yet unavoidable
side-effect, well that is acceptable.
The next day when I saw him at breakfast,
I asked him about the current debate on euthanasia. He was unimpressed.
"You can talk all you like about building safeguards into
the law and having a panel with psychiatrists and the such. It
doesn't mean a thing. We went through this 25 years ago with
the abortion debate. We were going to have at least two doctors
who had to be able to verify that there was sufficient medical
reason and all sorts of paraphernalia. Recently I read that 97%
of all abortions in Adelaide last year were for social reasons."
I can't verify the figures, but they sound right. I could also
see his point. Once the floodgates are opened, the waters will
come pouring out. It's not hard to see the situation where Grandpa,
sick and an economic strain on his newlywed children, might feel
compelled to request death. It's also not hard to make the next
leap - to killing those unable to request, but whose relatives
feel it is 'for the best'.
I sat munching my muesli. I had heard what
he was saying before. For a long time it has been a matter for
great discretion, something a doctor has to consider carefully
and act upon wisely. Failure to do this could mean imprisonment
for murder. It is also something that the patient must be strongly
motivated towards. Having it technically illegal also means people
are less likely to consider it as a viable alternative.
I like to think I had learnt a little more
about my role in life by the time the toast was ready. Maybe
I don't have a belief in God but I do have values. Love of life
and happiness is what counts for me. Upon these you can build
the same moral and ethical structures that have been preached
for millennia, and in such a way that even I can understand them.
Whether you see it as following God's rules, preserving the sanctity
of life or just helping others find their happiness, it comes
to the same thing. Taking a life is unacceptable, 'accidentally'
losing a life in the process of bringing happiness into it is
very different.
As he offered me the toast, I dragged my mind
back to the question of Nana. She was a tough case. So much
so that I was two bites into my toast before I remembered the
butter. There was no drug that it was appropriate for her to
inadvertently overdose on. Although the antidepressants we use
can sometimes be toxic, there is no real value in taking too many.
But the grieving and fear process she is going through now is
a natural one, and one that will pass. That requires no treatment
other than family support, love and perhaps some therapy. Eating
and speech will still be difficult, and in time she may even need
to be fed through a tube. That's part of her condition, and she
needs to work through that and come to terms with her fate. It
is important, not only for her, but also for the grieving process
of those of us who will survive her. Just because she is still
alive does not mean that cannot begin. This way she can help
us.
The other psychological factors, while not
so transient, can also be seen in a similar light. The problems
at home are tricky, but all marriages have problems, being elderly
does not make you exempt. That new solutions can be found, that
things can be worked out is what makes a relationship strong.
To leave life now would be just as inappropriate as it would
be for me to end it all over the break-up of one of my relationships.
Life has its ups and downs, and it is vital to remember that
whilst in the depths of the deepest depression.
Her all pervading depression, only partly
heightened by her condition, is one which is far too common in
the elderly. That she has not responded effectively to antidepressants
is not particularly surprising either. However, across the table,
having already finished his toast and moved onto coffee, is perhaps
the finest proof that it does not have to be so. He is a man
who still feels he has a place and role in life. Yet many elderly
have so little to look forward to. They get forgotten by the
next generation, their experience and wisdom ignored. They lose
their jobs and roles in society and they are ignored as people
with opinions and thoughts equally valid and burning as any younger
person. It hardly seems surprising. These problems are widespread
throughout society. By letting Nana die, by legislating for euthanasia,
we are trying to cure the symptom without thinking enough about
the cause. By the time I find myself in her position, I sincerely
hope we aren't still doing the same thing.
By the time breakfast was finished, I was
thinking about cake. Rich chocolate cake like the sort Nana used
to make for my birthday. She used to be famous amongst her friends
as the 'torta királynö', queen of cakes, yet it struck
me that I really had no idea how she did it. Sometime this weekend,
I thought, would be a particularly good time to learn.
This essay won Matthew Bailey a tertiary
Medical Ethics Award and is reprinted courtesy of The AGE.
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