Choice at the end of life

A bill to legalise voluntary euthanasia and assisted suicide is currently being considered here in New Zealand. Passionate campaigners both for and against have put forward compelling reasons to support their case. At one extreme are those who believe that human lives are sacred and only God can determine when they should end. At the other extreme are those who believe that each individual has the right to control the timing of his or her own death. Logically it is not possible to agree with both views, but perhaps there is scope for some compromise between them.

The term euthanasia, according to its Greek origin, means a “good death”. Much as I dislike the idea of deliberately ending a life, I do think there is a place for assisted dying for patients who are already finding their situation unbearable, or who wish to avoid likely suffering and loss of dignity in the future. But such cases are a minority. When I was in medical practice I got to know many patients with terminal or incurable conditions, mostly advanced cancer, and I do not believe that most of them would have wanted euthanasia or assisted suicide even if these options were legally available – though I remember a few who did. Similarly, recent surveys have found that many people with severe permanent disabilities have no desire for euthanasia, and are often worried that they might be pressurised into having it if the bill becomes law.

There are some strong arguments against euthanasia, but I think they need to be qualified. Looking at some of them in more detail:

“Euthanasia goes against the sanctity of life and the will of God.” This is the position of the Catholic Church and many other religious traditions. While respecting this belief myself, I do not think it justifies withholding the option of euthanasia from those who hold a different view. For this reason, when an anti-euthanasia submission was recently presented to our local congregation after Mass, I did not sign it.

“There is no need for euthanasia because symptoms and suffering can be so well controlled with modern palliative care.” I disagree with this one. Only a minority of dying patients have access to specialist palliative care. Even with the best of care, there are a few terminally ill patients whose symptoms and suffering cannot be relieved. And what about old people who may not have any specific life-limiting disease but would welcome death to release them from weakness and frailty, aches and pains, failing physical and mental faculties, loneliness and lack of purpose?

“Euthanasia may be undertaken too lightly, and against patients’ real wishes.” This is a real risk. Some people will feel obliged to request euthanasia to avoid being a burden to others. Well-meaning medical staff can judge that some patients’ lives are not worth continuing, when the patients themselves might disagree. This can also apply to the withholding of life-sustaining treatment, which could be called passive euthanasia. I have just read It’s Not Yet Dark, a memoir by the late Irish film maker Simon FitzMaurice. He describes being discharged from a hospital without being offered home ventilation because doctors had assumed that someone with his diagnosis, namely motor neurone disease, would not want their life prolonged. In his case they were quite wrong, and he was able to obtain a ventilator and spend several more worthwhile years with his family. A less informed and articulate patient could not have achieved this.

“There could be deliberate abuse.” Going further down the “slippery slope”, legalised euthanasia could provide a cover for murder. Family members might want to dispose of a sick or elderly relative, in order to make their own lives easier, or to get hold of an inheritance. Euthanising incurable chronic patients, who require expensive and time-consuming care, could be said to enable the more efficient use of scarce health care resources. Recent history has shown the potential for mass killings by authorities in the name of racial cleansing or medical research.

“There can be psychological damage to the staff involved.”  The same applies to clinicians carrying out abortions, and veterinary surgeons putting animals to sleep. There is certainly scope for conflict and distress when those trained to preserve life are called upon to end it, depending on whether they believe they are doing the right thing, and on the method used. Prescribing a fatal quantity of drugs, for the patient to take at a time of his or her own choosing, would seem a less harrowing experience for a doctor than administering a lethal injection – although the end result would be the same. Besides affecting staff, unnatural deaths can have a deep impact on the family and friends of the deceased. Consenting to euthanasia of a sick pet, and hearing about the suicide of a colleague, have counted among the most distressing events in my own life.

In summary my own view is that euthanasia and assisted suicide can be justified occasionally, though literally as a last resort, on condition that the patients concerned have given informed consent; if other treatment options have been carefully considered and excluded; if clinicians with religious or ethical objections are not obliged to take part, and if there are safeguards against abuse of the system. I suspect that many people who support euthanasia in theory might sign up in advance when still in reasonable health, then decide not to go through with the option when it actually came to the point – but having a sense of control is a very important aspect of coping with illness, and I believe patients should be allowed that choice.







Medical cannabis

Access to medical cannabis is tightly restricted here in New Zealand, and progress towards a more liberal approach is slow. I understand that doctors are allowed to prescribe Sativex on an individual basis for such conditions as advanced multiple sclerosis or intractable epilepsy, but that many are reluctant to do so, and that patients have to meet the high cost of the product themselves. And following a recent law change, people with terminal illness can now use home grown cannabis without fear of prosecution for themselves or those who supply them. But using cannabis outside of these circumstances still carries heavy penalties; according to the police website, these range from a $500 fine for possession to a 14 year jail term for supply or manufacture. This despite the fact that cannabis, with its analgesic, anti-inflammatory, anti-tumour, anticonvulsant, antispasmodic, anxiolytic and sedative effects, has been used for healing purposes for thousands of years and is now legal in many other parts of the world. Cannabis oil can be taken by mouth, inhaled, or applied to the skin.

My personal interest in this topic began in an unusual way. Unlike many students I never tried cannabis at university, because I moved in fairly conventional circles and also had an aversion to smoking. Then last year I was intrigued when a homeopath suggested that Cannabis sativa would be a good remedy for me. Shortly after this I came across a series of online documentaries called The Sacred Plant promoting the value of cannabis for treating cancer, epilepsy, arthritis, multiple sclerosis, other autoimmune disorders, and AIDS. While this series was focused on the benefits of cannabis, with minimal discussion of any potential downside, it convinced me that this plant has huge medicinal potential and has been unfairly stigmatised. Heavy recreational use can certainly be harmful especially for adolescents, but it seems wrong to criminalise sick people who are seeking the plant’s therapeutic effects.

Formal research on patient populations has been hampered by the legal constraints but there are some published clinical trials, besides many laboratory studies and a wealth of anecdotal evidence, supporting its use. The National Cancer Institute in the USA has produced an excellent review, including a detailed version for professionals and a simpler one for patients, not limited to the cancer setting. Cannabis can alleviate symptoms of pain, nausea and vomiting (including that caused by chemotherapy), lack of appetite and weight loss, anxiety and insomnia. Importantly, it also has potential for treating the disease which underlies these symptoms. Like any effective drug cannabis can have unwanted effects and interactions, but these usually seem to be mild in comparison with those of many orthodox medications.

Two main constituents of Cannabis sativa are THC (tetrahydrocannabinol) and CBD (cannabidiol). Both have medicinal properties but THC is mainly responsible for the “high” sought by recreational users, whereas CBD has minimal psychoactive activity and can be freely purchased over the counter in many countries including UK, Australia and many states of America. The plant also contains hundreds of other chemical compounds, found in varying proportions in the seeds, leaves and stalks and depending on which strain is used, and there is still much to learn about how its extracts can best be prepared and used medicinally.

My own health is reasonably good but I do have a few medical problems of a kind that could be helped by CBD, and am tempted to buy some on my next overseas trip. But I doubt it would get past the clever beagle dogs who patrol Auckland Airport to sniff out illicit drugs.

Cosy Crime?

Assigning their books to the most suitable categories in online databases is an important part of marketing for self-published authors. People looking for new reading material often search under these categories, but will be disappointed if the content of what they get is different from what they expect. Several different categories would often seem equally appropriate for the same book. Determining which of them will achieve optimum exposure on Amazon is a complex process, and there are websites giving expert advice.

In my own experience I have found that classification of non-fiction books is usually quite obvious, but finding the best category for novels – many of which could be described as “cross-genre” – is more challenging. Thinking back to my medical career, it reminds me of the difficulties faced by doctors who are required to give diagnostic labels to that large number of patients who are clearly ill but whose symptoms do not match any officially recognised disease.

Taking crime, mystery and detective fiction as an example, classification systems such as BISAC (an acronym for “Book Industry Standards and Communications”) include many different divisions and subdivisions. Both as a reader and a writer I find it somewhat overwhelming to have so much choice, though I realise the development of these subject headings is based on extensive market research.

A code I have avoided up till now is the one called “cosy” (UK) or “cozy” (US). I feel this term sounds uncomfortably twee and – given that books about murder are designed to entertain – that it goes too far towards trivialising such a serious topic. The phrase “cosy crime” is surely an oxymoron, though perhaps this is the key to its appeal. Some “cozies” – an even more irritating name – are far too whimsical for my taste. But a recent conversation with a writer friend prompted me to Google descriptions of the genre, and I found that it was broader than I realised. According to the entry in Wikipedia, typical features include:

  • an amateur detective, usually female
  • a closed community setting such as a village or a house party
  • murder by a non-violent method such as poisoning, often occurring off stage
  • murder motivated by greed, jealousy or revenge, often rooted in the past
  • little or no sex
  • emphasis on character and plot rather than action
  • a thematic element relating, for example, to pets or hobbies (BISAC has introduced the subdivisions of general, cats and dogs, crafts and culinary)

Most of the books by the great Agatha Christie meet these criteria, and they are now classified as “cosy” – though I think this gives quite the wrong impression, a view apparently shared by her great-grandson James Prichard, who administers her estate. What other term would be better – “traditional” perhaps?

My own novel Fatal Feverfew, a rather lightweight and old-fashioned murder mystery set in England’s west country, fits well into the cosy genre as described above. A while ago one reader gave this book a negative review, and I think this was partly because I had referred to it as medical fiction and it did not align with her conception of that genre; medical crime novels are usually more graphic and dark. I have now moved Fatal Feverfew into the cosy category on Amazon and Smashwords, and hope this will help it reach an appropriate target readership.

Top twelve books of 2017

Once again, with the help of the annual summary provided by, I have looked back at the books I read last year and selected twelve of the best. It was a difficult choice because I had listed 44 books and these were only the ones I really liked, because out of respect for fellow authors I no longer post ratings of less than 3 stars or review books written by friends. Not having done much writing of my own lately I spent more time on reading books by other people, spanning a wider selection of genres besides my usual focus on mystery/crime/psychological thrillers, and including some that were heavy in more ways than one.  In alphabetical order:

A History of Loneliness by John Boyne: a powerful novel about the mental conflicts of a devout but somewhat naive Irish priest who is unwillingly forced to acknowledge the issue of child sexual abuse within the Catholic Church.

A Very English Scandal by John Preston: a “non-fiction novel” about the politician Jeremy Thorpe, who was accused of the attempted murder of his homosexual lover. Writing with brilliant dead-pan wit, the author manages to turn this sad and sordid story into a gripping black comedy.

Churchill: A Life by Martin Gilbert: the wartime prime minister Winston Churchill has been voted “the greatest Briton who ever lived”. This huge book is his authorised biography, and though I cannot claim to have read every word it is certainly a monumental achievement.

Daisy in Chains by Share Bolton: an intriguing if far-fetched psychological thriller about the relationship between an imprisoned surgeon, convicted of murdering some overweight women in and around the Cheddar caves, and an enigmatic female lawyer.

Eleanor Oliphant is Completely Fine by Gail Honeyman: Eleanor is an obsessional and isolated woman with a troubled past. Through a chance encounter on the streets of Glasgow, she gradually begins to relate to the world around her and make some friends. This perceptive and original novel is both funny and sad.

Floating by Joe Minihane: a memoir about the physical and mental benefits of wild swimming, as experienced in lidos, rivers and seas around the UK.

He Said/She Said by Erin Kelly: during a Cornish music festival at the time of a solar eclipse, a young couple witnesses what might or not have been a rape. The repercussions of this event will haunt them both for years. A complex psychological thriller with a shocking twist at the end.

Holding by Graham Norton: although I am not a fan of Graham Norton’s TV show I enjoyed reading this, his first novel. A gentle mystery story set in an Irish village, it is cleverly plotted and the characters are sympathetically observed.

If This is a Woman by Sarah Helm: a detailed and meticulously researched history of the appalling events at Ravensbruck, Hitler’s concentration camp for women. A harrowing but salutary read.

The Five Side-Effects of Kindness by David Hamilton: “Scientific evidence has proven that kindness changes the brain, impacts the heart and immune system, is an antidote to depression and even slows the ageing process”. In contrast to the dark character of some of my other choices, this is a positive inspirational book describing the ways in which everyday acts of kindness can benefit both others and ourselves.

The Ice by Laline Paull: an “eco-thriller” set in the near future. An ice-cave in the Arctic collapses, due to global warming, revealing the body of a man. The intricate plot revolves around the conflict between commercial and environmental interests.

The Student Body by Simon Wyatt: I wanted to include a New Zealand book, and this first novel by a former police detective describes the investigation of the murder of a young woman near a West Auckland beach. Plenty of local colour and procedural detail.

I hope you enjoy some of these recommendations.


I sometimes regret not having consistently kept a diary during my life. But, better late than never, perhaps a blog is the next best thing. I started blogging a few years ago now and for a while I had several sites devoted to different categories such as writing, health, Bach flowers and cats. This became rather cumbersome so, even if it meant having fewer followers, I decided to combine them here. Most of my blog posts, while inspired by some recent experience of my own, aim to provide a brief overview of a topic that could be relevant to others. This present post summarising my past year’s activities is a more purely personal one, written as a record for myself and possibly of interest to a few relatives and friends.

The outstanding feature of 2017 was exploring the Irish side of my family. With the help of FinderMonkey, AncestryDNA, Rootschat and some extraordinary coincidences I discovered two half-siblings I did not know about, and had successful meetings with them both. To respect the privacy of those involved I won’t give any further details here, but it has been a remarkable experience.

Meanwhile life back in Auckland has continued on an even keel and I am happy to report that Brian has maintained a good recovery from his major cardiac surgery of 2015. He remains active physically and mentally, usually beating me at online Scrabble. My own less serious health problems are under control and I have kept up my fitness regime of Zumba Gold classes and daily cold water swims. Rather than move into one of the retirement villages that are proliferating around Auckland, we have decided to stay in our old Victorian villa with its large garden, ideal for our three cats, and pool. Following the sale of my mother’s house we have undertaken some repairs and improvements, so the inside is now ​warmer and more comfortable​, and renovation of the exterior woodwork will take place next year​.

I continue my involvement with SPCA, helping to raise funds for a Satellite Centre to care for abused and unwanted animals on the North Shore, though with regret I have given up doing regular sessions at the Animal Village because increased traffic congestion has made the commute so long. I am currently exploring other volunteer opportunities with the Heart FoundationInternational Bomber Command Centre and DogShare Collective. I ​am ​still in the alto section of St Patrick’s Cathedral Choir​,​ and attempting to sing soprano in a “Pop-Up Chorus” with NZOpera. I also see a few Bach Flower clients and recently had some success treating an anxious dog. ​

Inspiration for w​riting ​has been somewhat lacking since I published my short memoir at the beginning of the year, though I have made a tentative start on a new novel. Sales of my existing ​books trickle along slowly. Much as I dislike the marketing aspect I know I need to make more effort to stand out from the hordes of other indie authors, and have updated my profile pages on, and
I am planning to visit England again in 2018. Brian no longer enjoys long haul travel so won’t be coming with me, but we have booked to go to Australia together for a medical conference and a trip on the Indian Pacific train.
A Happy Christmas to all my readers.


Coping with physical illness; the role of Bach flower remedies

Bach flower remedies can help to relieve the emotional distress that often accompanies physical illness. They are intended as a complementary therapy to be used alongside medical, surgical and psychiatric treatments rather than instead of them.

The remedies are designed to promote a positive state of mind. This is highly relevant for patients in medical settings, up to one-third of whom will be experiencing significant anxiety, depression or other psychological problems. Negative mood states not only cause mental suffering but can worsen physical decline, due to the combination of poor self care with disordered physiology including a weakened immune system. Lightening and calming of mood, whether with Bach flowers or other therapies, may therefore improve physical as well as mental health.

Psychological problems can usually be understood as a response to the multiple stresses of having a physical illness: Bodily symptoms such as pain, nausea and breathlessness.  Having to wait for medical appointments, test results or starting treatment. The direct effects of the illness or its treatment on brain function. Receiving bad news about diagnosis or prognosis. Being unable to carry out former activities, or to provide for self and family. Practical difficulties with money, housing or transport. Changes in appearance. The prospect of deteriorating health. Existential questions about the cause of the illness, or what happens after death. Relatives and carers can be just as badly affected as patients themselves, though their plight is not always appreciated. Though some distress may be inevitable, it can often be minimised by apparently simple aspects of good clinical practice: clear communication, kindness, respect and practical support.

The burdens associated with physical illness are very real, and it is perhaps surprising that not all patients become seriously anxious or depressed, and that those who do can recover even if the physical illness continues to progress. Some even find the experience brings positive changes in their attitudes and lifestyle: Closer relationships. Less concern for material things and trivialities, and a sense of what is really important. Feeling able to follow their own path in life regardless of others’ opinions. Appreciation of the present day. Spiritual awareness. The Bach flowers can help to promote such benefits.

The remedies, being free of side effects or interactions, can be used alongside psychotherapies or prescribed drugs. The only possible caution is that brandy is used as a preservative during their preparation. This can be a contraindication for those who wish to avoid alcohol completely, although after the fluid has been diluted into a treatment bottle the concentration of brandy is minimal and most unlikely to have any biological effect.

Here are some examples, from the list of 38 remedies, of those flowers often relevant in cases of physical illness.

Mimulus (illustrated) for named fears, even if these seem justified.

Star of Bethlehem for shock, loss and grief.

Gentian for disappointment after a setback.

Gorse for feelings of hopelessness.

Olive for mental and physical exhaustion.

Crab Apple for feelings of uncleanliness or impaired body image.

White Chestnut for worrying thoughts.

Red chestnut for anxiety about other people, even when this is understandable.

Holly, Honeysuckle and/or Willow for those who harbour resentments about the past; there is evidence that chronic anger and hatred are risk factors for disease, whereas the practice of forgiveness has benefits for both physical and mental health.

Rescue remedy (Crisis formula) for any acute emotional distress.

Simplicity is the key to using Bach flowers. There is no need to get bogged down in the complexity of mind-body relationships, and unanswerable questions such as “Which came first – the anxiety or the heart attack?” or “Is the loss of energy due to cancer or to depression?” Remedies should be chosen according to the person’s current emotional state. There are no specific remedies for particular physical symptoms or diseases.

More detail on this topic can be found in my free ebook Bach Flowers for Mind-Body Healing. Bach flowers also play a small part in my Three Novellas, available from various online stores including, and



Book reviews: the good, the bad and the ugly

I depend almost entirely on reviews for discovering books that sound interesting and enjoyable to read. The best reviews, I think, provide a balance between a factual description of the book and the personal opinions of the reviewer. They usually include a summary of the content, though in the case of a novel it is infuriating when they reveal too much of the plot. There is also a discussion of the context, perhaps citing similar books and filling in the historical or cultural background, acknowledgement of the book’s good points and constructive criticism of its flaws. Writing a review, as I was sometimes asked to do during my former academic career, is quite an art. It takes a lot of time to read through the book and take notes, perhaps do some research about its subject-matter, and then compose a piece that is fair to the author and will hopefully prove interesting and informative for potential readers.

The detailed reviews in quality publications such the Listener, Spectator and Literary Review are often worth reading as essays in their own right, even when the books in question do not appeal. Many of the shorter reviews on public platforms such as Amazon and Goodreads are also well written and thought out, but a few of them represent individual opinions of an extreme kind, ranging from lavish praise to abusive condemnation. Some of the good ones have been paid for by the authors; some of the bad ones say more about the prejudices of the reviewer than about the book itself.

Many books never get reviewed at all, so from the authors’ perspective perhaps any review is better than none for publicity purposes. However, all but the most stoical authors feel a certain trepidation before looking at their reviews. Some have been so badly angered or upset by reading them that they no longer do so. While most of my own books have received positive reviews, and these are highly gratifying, it is the occasional negative one that can stick in the mind and feel soul-destroying. And it is baffling when there are completely different verdicts on the same book. Having recently been devastated by a 1-star rating of my Three Novellas on one site, I was comforted to find on its Amazon UK page a 5-star rating with the comment “Jennifer brings together all her experiences from previous work to produce a superb trilogy finishing with an interesting twist.”

I would encourage reviewers to be kind as well as honest, remembering that all books have both good and bad points, and that those they hate might be loved by someone else and vice versa. Personally I no longer post ratings or write reviews for books I dislike, but prefer to give up reading them and move on to something else.