Death with real dignity

Doctors cannot promise patients absolute control over their dying moments.

Martin Cullen | May 9 2016 | comment

Back in November I was part of the TV audience of Q & A, the ABC’s flagship live debate program on current issues. Generally it’s a program with strong left-wing or liberal views peppered with a mild or unappealing opposition.

The topic of this episode was “Facing Death”: euthanasia and assisted suicide. As an intensive care physician I’ve had a long-standing interest in this. It is not a topic for the fainthearted. Indeed the atmosphere was tense in the studio. The ABC even needed a pre-program “clown/comedian” to relax the audience. He didn’t succeed.

Ironically the studio management mentioned a number of times that if anyone in the audience was feeling suicidal or depressed a counsellor was on hand to talk! As responsible as their decision was, isn’t it self-evident that doing harm to yourself is not a healthy act? Did they implicitly understand that, yes, people who are thinking of self-harm are somewhat vulnerable?

How can a TV station stack a panel and audience with euthanasia supporters telling patients that life is worthless when you’re dying, and then turn around and offer counselling to anyone who is feeling a bit raw? Did they just miss the point that euthanasia is the ultimate self-harm and is exactly contrary to their responsible action of having a counsellor around for support? It was a mad contradiction.

Amongst the panellists were two palliative care physicians who were swinging on the spectrum of pro-choice, a physician, a cancer sufferer and the very funny comedian and media host, Andrew Denton. Denton was responsible for the show’s topic as he has been investigating the topic for some months and has led a renewed zest for the euthanasia movement.

It is a topic that is sensitive and filled with suffering for so many people, but there has to be a respectful discussion. This was mostly adhered to during the discussions apart from Denton making disparaging and arrogant comments about an audience member’s research into the slippery slope of euthanasia practice. Denton dismissed him as a confabulator.

The debate opened up around some hard cases of people with severe disabilities or metastatic malignancies and the desire to terminate their own lives. These hard cases were reinforced by Denton articulating his pro-euthanasia viewpoint well, summarising the key themes of the debate: relieving suffering, choice and the inconsistency between being “allowed” to kill oneself by starvation (an act of omission) and not being allowed to kill oneself with a drug such as Nembutal (an act of commission). For all his argument and emotion he didn’t do himself any favours by denying euthanasia was killing and stubbornly calling it “choice”.

It struck me that against these pro-euthanasia arguments we need to repeat that the most cogent reason for opposing euthanasia lies in the fact that you are human, my fellow human, with a noble and royal dignity that needs to be honoured and held sacred, even more so when you are sick and dying; that wanting to kill yourself is breaching the dignity of your own being.

You and I belong to each other. What you do to yourself somehow tangibly impacts on your neighbour.

When a person says they want to end their life on their terms, that’s understandable and utterly reasonable, but when translated to mean “I want to kill myself” we need, with sensitivity, to explore the reasons. Maybe the problem is that as a society and medical profession we don’t travel with our dying patients well. Families also need to note how they care for their loved ones. Remember compassion means “to suffer with.” How important a slogan is that!

Life is a sacred gift; we don’t totally own it. The incredible efforts people make to keep us alive and protect our lives – exemplified in soldiers going to war to protect their country, or a selfless act of bravery in saving a life in peril – are tangible signs of our dignity. If you could be morally justified in taking your own life, thereby transgressing the greatest right we have, the right to life, then you could be justified in doing anything.

Yet we actually don’t belong to ourselves totally nor have the right to do whatever we want; our laws reflect that fact. There is no unbridled right without a responsibility as its boundary. We have a responsibility to each other; we have partial rights to others. An example of this is your personal income and tax. You may say that the money you earn is yours, but a higher order has rights over some of that money, that is, the State for the purpose of the common good and looking after the less fortunate in society.

Similarly your life is not completely yours: you didn’t bring yourself into the world, you as a person live in a society connected with fellow humans in a tangible manner, you are a member of society and have to contribute to it, people depend on each other. As John Paul II said, a neighbour is not “the other” but “another” – another me. We are bonded. “No man is an island”. The sentiment that it’s your life and you can do with it in any way you want cannot be true. Reality doesn’t reflect that idea.

Another aspect of the debate is that people too often want to end their life because they’re lonely or they don’t feel loved. You don’t kill what you hold valuable. We need to show the public that most people die well, that a lonely and scared death can be overcome by our genuine concern for the sick. Mother Teresa used to say that more people are converted by kindness than eloquent argument; people are moved by love. There are generally few problems when someone realises they are loved.

Returning to Q&A, the notion of “control” ran hot through the evening’s course. One long-suffering woman who had a neurological degenerative disease spoke about wanting to end life when she so determined. When was that going to be and how irreversible would that intention be? How was she going to “control” her death?

There is a crazy notion in the Western world that life is about control and autonomy. We can’t control lots of things, even our bowel and bladder function, so how are we to ensure control of death? It just doesn’t happen. Even those deaths that are hastened, how often are they uncontrolled? When you’re unconscious how can you control your death?

Vomiting or seizures or discomfort or incontinence can occur in dying days; there never is absolute control. It’s a misnomer. The simplistic argument that taking a “kill pill” will gently ease me out of this world is easily swallowed by pro-euthanasia followers. But I know as a clinician that when we aim to keep patients comfortable when they are dying they can require close monitoring and infusions of sedatives to keep on top of discomfort. It’s not easy.

Many in the pro-euthanasia movement are well intentioned. But the consequences of their ideas are so dangerous for society. Taking the loaded language and emotion out of the debate is key. Showing that you look after the elderly and lonely is a good place to start. Understanding that we are all in this together, suffering with the dying, going through the last days and hours of life as a companion, is what we doctors must commit ourselves to.

Martin Cullen is an intensive care specialist in Sydney.

- See more at: http://www.mercatornet.com/careful/view/death-with-real-dignity/18024#sthash.ZLUYHmop.dpuf

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