The joy of dogs

For three years after the death of Khymer I was without a regular canine companion to walk, but am now having daily adventures on the beach with Ireland – a big black bouncy Labrador.

There is plenty of evidence that dogs are good for the wellbeing of humans. They provide loving companionship, a stimulus to take exercise, and opportunities for social interaction. Dog owners tend to have better physical and mental health than those without a dog, for example lower rates of cardiovascular disease and depression. These benefits as reported in many research studies are undoubtedly real, although they may be over-estimated to some extent because less healthy people are less likely to get a dog in the first place. Dogs have an established role as therapists: guiding the blind, visiting residents in care homes, supporting disabled children and adults, predicting the onset of epileptic fits or hypoglycaemic episodes, even sniffing out the presence of early-stage cancers.

Dogs can also present hazards. Falls are one danger, as I know to my cost: on one occasion when Khymer was forging ahead along an uneven pavement I tripped and broke my arm. Over-enthusiastic dogs often want to run up to strange people, or other dogs, and can easily knock them down. Constant vigilance is required during off lead walks.

Dog ownership is a significant responsibility. Leaving aside the dreadful cases of neglect and cruelty I have seen at the SPCA, many otherwise well-meaning owners leave their dogs alone at home while they are out at work all day, never realising how much they suffer from the lack of company and exercise. An ideal solution, as promoted through charities such as the the Dog Share Collective through which I met Ireland, is linking up such owners with people like myself who would love a relationship with a dog but for various reasons cannot have one of their own.

 

Ireland digging on beach

The building blocks of fiction

There are said to be seven key elements in fiction: character, plot, theme, point of view, setting, conflict and tone. Which comes first when writing a novel? My own current fiction project is based on a theme: how personal identity relates to family background. Though the story is not autobiographical, my interest in this topic was prompted by some recent events in my life which lead me to consider such questions as: How do people respond when faced with a stranger claiming to be a close relative? Or when their own parentage is called into question? Is personality shaped more by heredity or early environment, and can either of these influences be overridden by the exercise of choice and free will? Now that DNA testing and online genealogical databases are so easily available to anyone with an internet connection, more and more people are being faced with questions like these. I am finding the writing process quite hard going, probably because tackling a theme is not the easiest starting-point for a novel, at least not in my hands. It is best for themes to emerge subtly, rather than being thrust down readers’ throats, and sometimes even writers themselves are not aware of them.

There is no right or wrong way to begin creating a book. Some writers are inspired by the setting: a geographical location, social community, a historical period or imagined future. For some the plot is key, whether they work out a detailed outline in advance or see how it evolves as they go along. Some focus on the personality of their characters and the relationships between them. Others pay most attention to style and structure, aiming to create a sense of suspense, conflict, mystery, excitement, romance, wish-fulfilment or whatever is required by fans of the genre concerned.

My own six previous novels were inspired by personal experience of real-life settings: for example my first summer in New Zealand (Carmen’s Roses), and working with patients in an old mental hospital (Overdose). I did not consciously set out to explore particular themes when writing them but, looking back, several themes did emerge: the conflict between orthodox and alternative medicine, illicit romances, and later books contain a hint of the supernatural. They do not fit into conventional genres and were not designed to have mass market appeal, but some readers have enjoyed them enough to post nice reviews online. I have no idea when, if ever, my new novel will be ready for publication but meanwhile details of my earlier books can be found on Amazon.comAmazon.co.uk or Smashwords.com.

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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.

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.