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Holistic Environment: LIFE, DEATH AND COFFEE



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Voluntary euthanasia is the process of bringing about death in the terminally ill, at their request. Its legalisation is being debated in some Western societies. Matthew Bailey, a medical student, reflects on his personal struggle in the context of this debate.

MY GREAT-GRANDFATHER died long before I was born. What carried him off was not the cancer that riddled his body and wormed its excruciating way up his spine. It was an overdose of morphine. My grandfather, a doctor himself, had discussed the matter with the treating physician and the family knew exactly what was going on. When he passed away, the matter was also laid to rest.

There is nothing unusual about his case. He was never given euthanasia, only "ample pain relief". That the required dose of pain killer became fatal was an unfortunate yet unavoidable side-effect. Such practice goes on today, discretely and regularly.

Today my grandmother is also dying. This time there is no cancer, but a motor neurone disease which has already left her virtually unable to talk or swallow. Communication with my half-deaf grandfather is almost non-existent. As the disease progresses, she can expect gradual paralysis. Her death will come when she is no longer physically able to breathe.

Unlike my great-grandfather, her condition is not physically painful. What causes her suffering is the difficulty she faces at home, the cloud of depression she lives under and the fear of future degeneration. We can offer her nothing of use; anti-depressants do little to hold back her tide of lament. She talks often of wanting to die, of looking forward to her death and of being ready to leave this world. Meanwhile I sit beside her, my mug of coffee long finished as she splutters down her now cold cuppa. Often I have thought about a quick injection, an easy end. I love Nana dearly, but I think I would be prepared to do it.

My parents are doctors themselves. They know what's happening; they have watched many patients die. They also have a faith which I do not share. When I discussed the issue with Mum, she looked at me and said, "You realise that I believe you would ruin her chances of eternal happiness. I don't want you to even discuss it with Nana."

She's right, of course. Suicide and murder are both grievous sins in Catholicism. If I were to give that quick, painless, undetectable and lethal shot of Potassium, Nana could be barred from heaven.

Heaven or otherwise, the suffering here on earth would be very real. If losing a parent is hard, losing hope for them in the hereafter is intolerable. That could well ruin my mother and our relationship.

In times such as these, my solution is to curl up in a quiet room, take several deep breaths and meditate. I try to divest myself of all my preconceived notions of right and wrong, of loyalty and obligation, and from the fetters of emotion and fear. I strive to see things in the clearest light possible, free of such hindrances. Then I hope for a solution ... Nothing.

Currently I live with an elderly doctor. At 89, he is fit and at least as mentally adept as myself. With the recent controversy surrounding euthanasia, the topic came up easily. He looked me up and down and rubbed his prickly old man's chin for a moment before proffering judgment. For all I knew, he could have well been the doctor of my long-dead great-grandfather. "It is not a doctor's place to decide life and death. That is for God. It is simply our place to alleviate suffering. If, in the course of doing that the patient dies, well so be it. Your particular case is a difficult one, and a terribly sad one, but it is, I believe, a crime against God for anyone, particularly a doctor, to kill."

Originally I was dissatisfied, but as I curled back up on the sofa I started to see his point. As an agnostic, God does not feature in my decision making, but that does not diminish the significance of what he said.

It is the volition to kill that counts, and that is out of place in a doctor's thoughts. The alleviation of suffering is paramount, and if death is a serious yet unavoidable side-effect, well that is acceptable.

The next day when I saw him at breakfast, I asked him about the current debate on euthanasia. He was unimpressed. "You can talk all you like about building safeguards into the law and having a panel with psychiatrists and the such. It doesn't mean a thing. We went through this 25 years ago with the abortion debate. We were going to have at least two doctors who had to be able to verify that there was sufficient medical reason and all sorts of paraphernalia. Recently I read that 97% of all abortions in Adelaide last year were for social reasons." I can't verify the figures, but they sound right. I could also see his point. Once the floodgates are opened, the waters will come pouring out. It's not hard to see the situation where Grandpa, sick and an economic strain on his newlywed children, might feel compelled to request death. It's also not hard to make the next leap - to killing those unable to request, but whose relatives feel it is 'for the best'.

I sat munching my muesli. I had heard what he was saying before. For a long time it has been a matter for great discretion, something a doctor has to consider carefully and act upon wisely. Failure to do this could mean imprisonment for murder. It is also something that the patient must be strongly motivated towards. Having it technically illegal also means people are less likely to consider it as a viable alternative.

I like to think I had learnt a little more about my role in life by the time the toast was ready. Maybe I don't have a belief in God but I do have values. Love of life and happiness is what counts for me. Upon these you can build the same moral and ethical structures that have been preached for millennia, and in such a way that even I can understand them. Whether you see it as following God's rules, preserving the sanctity of life or just helping others find their happiness, it comes to the same thing. Taking a life is unacceptable, 'accidentally' losing a life in the process of bringing happiness into it is very different.

As he offered me the toast, I dragged my mind back to the question of Nana. She was a tough case. So much so that I was two bites into my toast before I remembered the butter. There was no drug that it was appropriate for her to inadvertently overdose on. Although the antidepressants we use can sometimes be toxic, there is no real value in taking too many. But the grieving and fear process she is going through now is a natural one, and one that will pass. That requires no treatment other than family support, love and perhaps some therapy. Eating and speech will still be difficult, and in time she may even need to be fed through a tube. That's part of her condition, and she needs to work through that and come to terms with her fate. It is important, not only for her, but also for the grieving process of those of us who will survive her. Just because she is still alive does not mean that cannot begin. This way she can help us.

The other psychological factors, while not so transient, can also be seen in a similar light. The problems at home are tricky, but all marriages have problems, being elderly does not make you exempt. That new solutions can be found, that things can be worked out is what makes a relationship strong. To leave life now would be just as inappropriate as it would be for me to end it all over the break-up of one of my relationships. Life has its ups and downs, and it is vital to remember that whilst in the depths of the deepest depression.

Her all pervading depression, only partly heightened by her condition, is one which is far too common in the elderly. That she has not responded effectively to antidepressants is not particularly surprising either. However, across the table, having already finished his toast and moved onto coffee, is perhaps the finest proof that it does not have to be so. He is a man who still feels he has a place and role in life. Yet many elderly have so little to look forward to. They get forgotten by the next generation, their experience and wisdom ignored. They lose their jobs and roles in society and they are ignored as people with opinions and thoughts equally valid and burning as any younger person. It hardly seems surprising. These problems are widespread throughout society. By letting Nana die, by legislating for euthanasia, we are trying to cure the symptom without thinking enough about the cause. By the time I find myself in her position, I sincerely hope we aren't still doing the same thing.

By the time breakfast was finished, I was thinking about cake. Rich chocolate cake like the sort Nana used to make for my birthday. She used to be famous amongst her friends as the 'torta királynö', queen of cakes, yet it struck me that I really had no idea how she did it. Sometime this weekend, I thought, would be a particularly good time to learn.

This essay won Matthew Bailey a tertiary Medical Ethics Award and is reprinted courtesy of The AGE.

Last update: 2000-02-12 17:20:20 (EEST).
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