On Wednesday, 1st June, I read in the Daily Telegraph that terminally ill patients are to be asked by their doctors how they want to die. The information would be put on the NHS database, and thus be available at the proper time. A barrister who specialises in this field has said that, properly signed and witnessed, it would be legally valid.
I am not surprised that campaigners against euthanasia are wary of this as a backdoor approach to electing suicide. That may be so, but I still favour the idea of writing instructions. The last words of Dietrich Bonhoeffer, about to be executed by the Nazis, were “This is the end – for me, the beginning of life.” And it seems to me to sum up the Christian idea that death is the important transitional occasion in our personal history of salvation.
We may not all be lucky to die in a way or a place which allows for choice. But I would certainly want to consider under what circumstances I would or would not wish for resuscitation. How do I feel about the withdrawal of food and water? What about long term apparent brain death? Or coma? And most certainly I would want my carers to know that I wish for the Last Sacraments (though, having made my nine consecutive First Friday Communions as a boy I should be OK there!).
And just how frank would I want people to be with me? My feeling is that I would like an honest, even if unmerciful, warning of my prospects. But those around me might feel that it would be kinder to be optimistic. How am I going to solve that?
Or, for the purposes of this Blog, how are you going to solve that? I would be interested to hear whether people will just let things take their course, or would prefer to give guidance for their relatives or even doctors, who may feel professionally obliged to take a particular course in the absence of clearly stated wishes. What would your choices be?
secondsightblogdotnet 
My mother died just over five weeks ago, at the age of 91, so thoughts about death have been fairly prominent in my mind recently. She had no religious faith and was not even baptised, so no question of last sacraments or indeed any spiritual comfort. I did drop a few hints, but they were met with a firm “No”. Yet interestingly enough, she had been reading the gospels in the last few months of her life.
For months if not years she had been saying she wished she could just go to sleep and not wake up. She was very fed-up with life.
Some explicit guidance (in the form of a declaration of what she would want done in various eventualities) would have been helpful. A couple of weeks before she died, she developed breathing problems and was rushed into hospital. Oxygen and intravenous antibiotics improved the breathing, and she came back to the care home (where she had been for the past 8/9 months) but was quite bewildered; didn’t recognise the place, though did recognise most of the people caring for her, and certainly recognised me. Within days the same thing happened again. I was called to her bedside in the middle of the night, and so was a doctor (not one of the locals; an emergency doctor). The doctor said he could have her rushed into hospital again and possibly “brought back from the brink”; it was likely the same thing would happen again; it was a difficult ethical dilemma, he said, and he would do what I wanted. (Needless to say, she was not conscious at this point). I opted not to intervene. She didn’t regain consciousness, and died three days later (on Good Friday, which I’m told is the best day in the whole year to die, spiritually speaking, though not so good from the practical point of view as no arrangements could be made until Tuesday because of the bank holidays).
If anyone cares to comment on the decision I made, I shall be interested to read it. I did what I thought she would probably have wanted herself, given the situation. She often used to argue that we “ought” to be able to ask to be helped to die; she knew I didn’t agree, and after some initial arguments we avoided the subject.
There is an old Victorian saying
“Thou shalt not kill; but needst not strive
Officiously to keep alive:” (Arthur Hugh Clough: 1819-1861).
Although this was meant sarcastically (or at least ‘tongue in cheek’) I still think it is good advice and certainly applies to Iona’s dilemma.
In my own case when my Father was dying of cancer I was asked whether he should have a pneumonectomy. To this day I do not know if my reply (“No”) was right or wrong.
In any event I considered the question totally unfair. Quite apart from the fact that, although a physician, oncology is not my field; I hold that a close family member is not able to make an objective judgement. It should be the responsibility of the physician in charge to determine the proper course of action [of course if a relative or friend (not to mention the patient) has strong objections then further qualified opinion should be sought].
For what it’s worth, Horace, my mother (aged 60) had a pneumonectomy. The operation and the aftermath were very painful. She then died of cancer of the liver a short while afterwards. It is possible that without the pneumonectomy she would have strong enough to last a little longer.
But decisions don’t depend on outcomes. All we can ever do is to make the best and most sincere decision, based on the knowledge available, which we can.
It is a sad irony that healthier lifestyles and better health care inevitably lead us into the moral mazes of ethical dilemmas that would have been rare only a couple of decades ago but are now a daily occurrence.
A blog subject such as this cannot really be separated from the whole issue of ‘assisted suicide,’ euthanasia, mercy killing and ‘dying with dignity ( not my phrase.) Indeed if one wanted to be cynical about it all , then the word ‘industry’ would not be too far removed from the pressures on ending a life that might not even be yours.
Church teaching about all this may appear a bit obsolete at times but on this topic it seeks to be compassionate and ‘life ‘ afirming.
Although this post is not germane to ‘Goodbye to all that’, I just want to alert everybody that the ABC religious program called ‘Compass’ is about to broadcast an interview with Bishop William Morris entitled ‘The Sacked Bishop’. It will go to air on Sunday the 5th June 2011 at 9:55 pm Eastern Standard Time Australia, on telivison station ABC1. You can easily watch it via the internet after its broadcast on ABC1 by going to http://www.abc.net.au/compass/ .
Iona:
Both my parents are still alive though frail-they live next door to me…I intend to make the same decision as you should it come to it, thanks for sharing this.
Mike Horsnall
Iona,
Though my parents are still in rude health and this is less likely to be something I have to face soon, I think I would have done as you did. As it happens, the results were good in your case.
I know church teaching affirms the right to refuse treatment. Unfortunately, the medical profession classes food and hydration as ‘treatment’. It seems to me that the safest course is to spell out your wishes well in advance – leaving nothing to chance!
Food and hydration have only been classed as “treatment” since the case of Tony Bland (? hope I’ve remembered his name right). He was in a vegetative state but capable of swallowing, and his family wanted him fed and hydrated, which at the time was considered “care”, and somehow the feeding and hydration got reclassified as “treatment” and withdrawn. Can’t remember the exact year, but think it was the late nineties.
I agree with James H when he wrote that it is far better to make prior arrangements for one’s end of life care. In this way, the psychological progress of letting go will be far gentler and there can be calm progress for the patient and their family towards one’s final end. There has been a program called ‘Respecting Patient Choices’ in Melbourne’s Austin Hospital which seeks the desires of patients regarding their end of life treatment options. You can find out more about ‘Respecting Patient Choices’ by going to the website. http://www.respectingpatientchoices.org.au/
For the Physicians, as well as anybody else who is interested, I have some links on the subject of end of life care that you might find interesting.
http://www.bmj.com/content/340/bmj.c1345.full?sid=29a17fac-bd37-428a-86d0-64ed4a97177d
http://www.openforum.com.au/content/respecting-patient-choices-advanced-care-planning
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2844949/
Click to access 206717-upload-00001.pdf
Last weekend I heard of a man aged over 100 attending the funeral of his 80 year old goddaughter. Its poignancy seems to illustrate the extraordinary times we live in. As we know the numbers of people who live into their 80’s, 90’s and 100’s is rapidly increasing thanks to better health care etc – in fact, a claim that bears repetition, never in the history of the world have so many people lived to be so old. But the quality of life for a great number is not commensurate. Time after time friends or relatives are referring to someone whose mind has gone and for whom life seems to be meaningless.
Last week there was a news item about the problem of early onset dementia for those with Down’s Syndrome – a direct result of the extension of their life expectancy through medical advances. Today the story is of the problems facing some of those 650,000 elderly people who need home care, following on from the scandals in residential care, with calls for more resources. It is an inescapable fact that there is a crisis of enormous proportions looming for families and society. In the modern industrial societies the demographics of our societies are changing, with the costs of caring for the very elderly forecast to rise indefinitely.
My family know that they should have no qualms about ending treatment with antibiotics or switching off the machine if I request it or I am no longer mentally present. Whether they will all agree is another point, which is why I think the theologians and the philosophers and the policy makers need to work out how ethically these issues should be dealt with. I hope that Quentin will keep the file open and return to the topic in due course, perhaps with a tentative Catholic prescription of the way forward.