Grieving, and mourning loved ones, or friends who have changed our lives, is more than a complex matter. Here am I, intellectualising over yet another deeply emotional loss, for me and others, that is happening today in Canada, my other home. It’s not intended to be dispassionate. Far from it! It is, for me, yet another deep sadness. I’m losing another great friend.
Six years ago, my beloved wife chose to leave us, her children, and me, ‘behind’. It was a rational, yet truly deeply emotional decision. She had a terminal malignancy that we both knew would kill her painfully and in an undignified way for which there really was no cure. Both of us were medically qualified, she as a psychologist and I as a physician.
Euthanasia: medical assistance in dying
Canada had just approved MAID (Medical Assistance in Dying, or if you prefer, euthanasia). There was no cure for her cancer, and three of her siblings had died, two in desperate circumstances and a third, her delightful older sister, in a hospice, all before MAID was eventually approved.
I am still grieving my wife’s death, and shall always more than miss her. It is suggested that the dead will continue to be remembered by those who they leave behind. Unforgotten. But how often do we think of our emotional burden that we must carry until perhaps, our inevitable death? Are we being selfish recognising that we are left to grieve? It’s us who bear the brunt. It has always been so.
Today, as I’ve said, in now-distant British Columbia, another close friend who also has a terminal, and painful medical condition, will die, at her choosing, surrounded by her family, as was my wife.
We sometimes imagine the end of life to be accompanied by the watchful vigil of family, around the bed. My experience of death as a medical clinician, was seldom like that. The 19th-century painting of a doctor and dying child gives an expression of some of my continuing grief.
This is perhaps too romantic, but it also expresses our helplessness in some situations. We do not have all the answers, and death is, ultimately inevitable.
A merciful and dignified end of life
MAID is quick and merciful, and a truly dignified end of life. Some have likened it to suicide. The choice, however, is far more examined than is the tragedy of suicide, which is often the result of depression or perhaps financial or other pressures. The compassion of the physician who administers the propofol, or other medication, was, in my experience, quite remarkable. I have throughout my career, been present at, or after, the routine deaths, of patients, as if death is ever routine. The emotional trauma experienced by those present, including myself, is simply unconscionable. You don’t forget.
Those who oppose euthanasia often suggest it is contrary to the duty of care expected by the medical profession. They quote ‘first do no harm’, or they suggest that the doctor has ‘taken the Hippocratic oath’, which is perhaps the oldest code of medical ethics, but has been long ago superseded in most cases by ‘the four pillars of medical ethics’.
There are continuing debates, often quite angry, over the issue of suicide, euthanasia, and dignified dying. Much of the time the concern about suicide relates to mental illness. This is also raised with euthanasia. Being of sound mind is considered important. Is it rational to wish to die?
The law and ethics of ending a life
Of course, I have not even mentioned religion, so far. Humanism may have organised, with organisations like Humanists UK, but there is simply insufficient emotional power to compete with say, the Catholic church. Nor have I mentioned our compassion when it comes to domestic animals. I have to remember the choice of Socrates and the cup of hemlock made in pre-Christian times.
Perhaps the practice of hara-kiri is considered rational, after all the reputation of the person is so much more important than life, itself, isn’t it? And it is an honourable death for the dishonoured.
It is not that long since suicide was decriminalised. Society considered life more important than the emotional state, or perhaps the emotional rationality, of the person, so they were considered, paradoxically, criminals, possibly even ‘mad’! In countries such as Britain, it remains against the law even to aid someone seeking euthanasia in, say, Switzerland or Holland!
Nevertheless, campaigns such as those by Dr Jack Kevorkian in the USA, or by Exit International (started by an Australian, Dr Philip Nitschke) hope to change such illogicality.
I certainly don’t wish for a society like that in the science fiction movie Logan’s Run in which, to prevent overpopulation, everyone must undergo the rite of ‘carrousel’ and when they reach the age of 30 they are killed under the guise of being ‘renewed’. This might suggest one of the scenarios often used by opponents of voluntary euthanasia.
I stress here ‘voluntary’. These opponents suggest that allowing MAID, or its equivalent, would result in increased, almost mandatory deaths. There is no evidence that this has happened anywhere that medical euthanasia has become allowable, because of very strict criteria, and strict patient consent.
My personal loss through MAID has taken its toll. But so too have other natural, sometimes unexpected, deaths among family and friends. Rather than imagining that human life is sacrosanct, as if other lives are not, we simply must reconsider what ‘caring’, in its best sense, really means. Is it beneficent to enable choice; nonmalificent to consider pain, both physical and psychological in our caring; just to the individual who remains without their choice; and respectful of their autonomy?
Yes, the doctor must be also allowed their autonomy, their choice as to whether to endorse the patient’s decision. Nevertheless, as doctors we must consider the patient first and foremost. We joined, chose, a profession with this as our focus. We really cannot be judgemental and impose OUR values on others.
I rather expect to be criticised for this last statement! But I have lived in two jurisdictions. I know which I would choose.