by Jean Westbury
“Euthanasia” has its roots in Greek, eu meaning “good”, and thanatos meaning “death”. In the 1600s, it meant simply “a gentle and easy death”, such as a peaceful passing provided with good palliative care. Only in the late 1860s was the word co-opted to refer to legally sanctioned mercy killing.
Death is an awkward topic. Of all the uncomfortable things a doctor may be called upon to perform, delivering the news of a patient’s impending doom must be one of the most difficult. As humans, we generally enjoy some autonomy and control over our lives. Death is the ultimate loss of control; and for those who do not believe in an afterlife, it is the complete loss of hope.
However, instead of delicately dancing around the issue – even pulling the wool over the terminal patient’s eyes as in The Farewell (2019), where a Chinese family keeps their matriarch’s cancer prognosis secret from her, in order to spare her of fear and worry – now there are those who seek to wrest control back from the jaws of death, saying it is more compassionate to let people choose their time and manner of passing.
As Aristotle says, virtue is the golden mean, the path of moderation between two extremes. Instead of ignoring death or artificially hastening it, why not improve palliative care services for terminally ill patients? Why not help them live as comfortably and joyfully as possible, neither artificially prolonging nor truncating their lives, until they pass peacefully?
Palliative care – a better death
At the 2019 Cherish Life Conference, nurse Kerri-Anne Dooley spoke of palliative – as opposed to terminal – sedation:
“For a short time I worked with Dr Phillip Good, who is the Director of Palliative Care at St Vincent’s. Dr Phillip Good is one of Australia’s most pre-eminent researchers. I was his research nurse for about two years. He did a trial around syringe drivers. It’s often considered, once you start a syringe driver, that it might be passive euthanasia – I hate the term.
“It’s about symptom management, managing their pain or their restlessness; the trial was the first of its kind in Australia… I think it was about 2009. He monitored those that were started on a syringe driver and those that weren’t, who didn’t need it, and those that weren’t actually died faster than those that were. I’m probably giving just a very rough analysis of that research project, but it completely blows that theory out of the park that once you started a syringe driver that it’s actually giving them medication to make them die faster. It’s not true.”
Dr David van Gend shared:
“I’ve had to do it once. Lovely lady, horrendous metastatic breast cancer throughout all her bones, crumbling before our eyes. Terrible pain. We controlled the pain for a long time, and we even had her doing what she most wanted in life, which was to be able to go shopping with her sister in Grand Central in Toowoomba. We had her to the point where with her driver, narcotics, ketamine and everything else, she was able to do little things like that. That’s the art of palliative medicine, right? Help them live until they die.
“So we did that, but eventually, eventually it was too much. And so for the first and only time I had to say to her, ‘Look, we actually have reached the limit of our normal medications and you’re getting exhausted. If you want, we can give you a light, sort of twilight anaesthetic and just let you sleep for a bit. Now I don’t know whether you’ll sleep and wake, I don’t know whether you’ll sleep and slip right away. What do you want?’ And she said, ‘Please let me sleep,’ And I said, ‘If you wake up and you’re right, you tell us if you need a bit more. If you don’t, you won’t hold it against me?’ She said, ‘No.’ And so, the thing is, this is the big point. I never intended to make her die, did I? I fully intended to stop her suffering and we did.
“She’s dying of her underlying disease. I’m not interested in prolonging her dying, and I’m not interested in hastening it. It was beautiful. For a day and a half she drifted into this lovely sleep. We always looked after her mouth so she didn’t get a cracked, sore mouth. We looked after the bowel, all those little things. But, a day and a half later, she actually drifted up and out, and she was still very comfortable. I kid you not, she asked for some ice cream. We gave her some ice cream. She then rested back, drifted away again, I didn’t change anything. And about a day and a half later, she died.”
Associate Professor Richard Chye, director of palliative care at St Vincent’s Hospital Sydney, recounts:
“The first person I had to tell they were dying was my father, I’ll never forget it. He was 46 and suffering from kidney cancer; I was a 20-something medical student who had to read through my textbooks to find out what was happening to him.
Not one doctor had told my dad he was going to die. Not one had told him when it might happen. Not one had helped him prepare psychologically for what was happening to him.
He looked to me for answers, I looked to my textbooks. The answers were confronting and didn’t include any advice about how to deliver this kind of news.
I had to tell my dad that, based on my research, he had maybe months. He thanked me.
Advocates of euthanasia are concerned about Australians dying in unbearable pain. On this issue, I can relate to them. Absolutely, I am concerned too.
I can also tell you that complex pain can be temporary and treated. Treated pain does not mean free of pain; it means that patients and families can still function and enjoy their limited time. Palliative care can help overcome it and, when it does, people come through the other side grateful for the days or weeks they have to patch up relationships with siblings, parents or friends, or to spend valuable minutes with their grandchildren.
Most Australians choose not to engage with death until we absolutely have to; that’s understandable. I have a young patient who ‘hid’ her illness from family and friends, and now that she is close to the end, she has regretted not having the chance to resolve many things with her family but, more importantly, she has not been able to help her family plan for the future without her.
Because we avoid death, it is hard to know what we might want when confronted by its reality. When considering death in the abstract, it might seem euthanasia is a good way for Australia to head, but I am concerned we are too caught up with our ‘right’ to die, while not investing in the system that helps us live as well as possible before we die.
I agree there are problems with how Australians are dying, but I think access to good-quality palliative care can change that. Australians want to die at home but need better support services to do so. Carers need respite and your postcode often determines access to services. These are the rights we are currently denied. This is what we should be getting up in arms about.”
Traumatising doctors and family members
Proponents of euthanasia need to carefully examine what it is that they are so passionately advocating. A neighbour of mine once said, musing on her own mother’s passing: “When I get to eighty, I want my husband to smother me with a pillow. Eighty is too old to be alive.” Did she even consider how it might feel for her husband to kill the woman he has sworn to love and protect? What about a doctor, who has sworn the Hippocratic Oath to “first, do no harm”?
People say that animals receive better treatment, being euthanised when they have terminal conditions. However, they seem to overlook the fact that vets suffer from killing animals. In the 2014 Macquarie University report The Distinct Role of Performing Euthanasia on Depression and Suicide in Veterinarians, Dr Monique Crane stated: “We found that the more frequently a veterinarian performed euthanasia in an average week, the greater their risk of depressed mood, suggesting that the performance of euthanasia is a source of stress within this occupation.”
The Independent reports: “A 2012 study found that a third of veterinary students had experienced depression, compared to around an eighth in the general population. Vets are also three to four times more likely to take their own lives – significantly more than doctors.”
If euthanising animals can induce post-traumatic stress in people, what more killing human beings? Even pet owners who decide to have their animals put down may suffer guilt and sorrow for years. Have euthanasia activists considered the impact on a patient’s relatives, children, or friends of discussing active assisted suicide or mercy killing of their loved one? Not to mention the loss of irreplaceable focused family time together due to the distraction of trying to decide to support euthanasia or not.
Doctors already suffer when they lose a patient to a death they could not prevent. What more for a death they actively participate in? May they eventually sue the government for stress, anxiety and depression after being involved in killing a patient? It is selfish to create a “right” which forces someone to be involved in endnig another person’s life, an act that can cause traumatic stress.
The criterion of “intolerable suffering” is problematic in itself, with patients’ perception of their pain changing depending on their circumstances.
Fearing pain is understandable, but corrupting our medical community, placing unethical “duties” on medical staff and losing precious family moments to an untimely, accelerated death is really not worth it. It seems premature to legalise euthanasia when palliative care, despite its great advances in recent years, remains severely underfunded.
Pain passes, life passes, but what sort of culture do we leave behind for our children and grandchildren to live in?