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.

 

 

 

 

 

 

Homelands

 

Happier, healthier and several pounds heavier, I am back in Auckland after spending a sunny September in England. I’ve been lucky enough to be able to revisit my home country every year since we moved to New Zealand in 2000, and this year Brian came too. We were both anxious about travelling in view of our recent heart problems, so it was reassuring to discover that a consultant cardiologist was seated next to me on the outward flight. Neither of us needed his services and there were no medical emergencies during the rest of the holiday.

This visit was more than usually nostalgic, filled with reminders of my mother who died nine months ago. One sunny Sunday afternoon a group of cousins from her side of the family, the Guys, gathered for a picnic in the grounds of Gray’s Inn; our homes are so widely scattered around the UK and overseas that many of us had not met for decades. I had a friendly meeting with my first husband, having resumed email contact with him after my mother’s death. I walked on the sands at Margate in Kent, where my mother spent part of her childhood. And scattered a portion of her ashes beside her brother’s grave in the churchyard of the Yorkshire village where she lived in later life. Thanks to her wartime service in the British Army, I was able to stay at the Victory Services Club in central London, an ideal base for making daily trips around the country with my Britrail FlexiPass.

There have been other deaths among my UK contacts in the past year: two close friends have been widowed, another couple have lost a son, others are getting old and unwell, so some of my visits were tinged with sadness. But I still have many relatives and friends around the country, including some younger ones I did not know before, and though there was not enough time to see them all I did meet people from diverse places: Malvern, Frome, Gosport, Winchester, Kirk Hammerton, Oxford, Dorchester on Thames, Hythe, Manchester, Birkenhead, Shetland, Soberton Heath, Saffron Walden and various parts of London. Everyone was so kind and hospitable – thank you! Here I am in Sue’s allotment, with Sara’s dog, and with Brian in Oxford University Parks.

There were sightseeing visits too, to Charles Darwin’s home at Down House and the Sackville-West estate at Knole, both in Kent. My most adventurous solo trip was to Limerick, a first step in exploring my Irish ancestry on the paternal side, a topic I may write about in a future post. Limerick seemed a charmingly old-fashioned small city, so quiet and peaceful after London, and I had a lovely view of the River Shannon from my hotel room.

limerick

As always these visits make me question where my true home is, but at least for now it is in Auckland, and it is good to be back as England turns towards autumn and New Zealand to spring. Wearing clothes in different colours, after the all-blue wardrobe I packed for the trip. Thinking about writing another book. Being reunited with my cats.

 

 

 

 

Where is home?

My jet lag is gradually clearing after the long flight back to my adopted country of New Zealand, following a return visit to my native country of England.

Unlike many other expats, I am fortunate enough to be able to make this journey every year.

My annual expedition requires lots of forward planning, and is not so much a relaxing holiday as an intensive round of both joys and challenges. It is always different and always worthwhile. And it always highlights the fact that life is full of paradoxes, that we cannot ‘have it all’ but often need to find a compromise between opposing choices.

Some decisions are basically trivial: Whether to stock up on clothes from Marks and Spencer, or keep my suitcase light? Whether to go for the convenience of staying in one central base, or make the extra effort of traveling round the country?

Then there are the deeper dilemmas: Whether to attempt the near-impossible and exhausting ideal of visiting all of my friends and relatives each year, knowing there are some I may never see again? Whether to stay long enough to make the trip really worthwhile, although it means being away from my husband and family in Auckland?

The Bach flower remedies Scleranthus for indecision, and Honeysuckle for nostalgia, might be helpful for some of these issues but none can solve the underlying question – where is really home? I appreciate the privileges of having citizenship of two countries which I love equally, and of being able to spend time in both. It is just rather unfortunate that they are nearly 12,000 miles apart. One day I may have to choose, or find that fate has chosen for me.