Recently, colleagues from my university published an article on assisted dying and euthanasia. In these times of challenging debate in Australia over both these and abortion, it’s timely to consider the implications of each, because (like the ripple effect) much of their impact can’t be seen through the fog of media and the heat of argument.
So firstly, what are the easily-found definitions?
Euthanasia is defined (by google dictionary) as “the painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma.” Well, don’t sugar-coat it just for me …
Physician-assisted suicide is defined by Medincinenet.com as “The voluntary termination of one's own life by administration of a lethal substance with the direct or indirect assistance of a physician. Physician-assisted suicide is the practice of providing a competent patient with a prescription for medication for the patient to use with the primary intention of ending his or her own life.”
Abortion is defined as “the deliberate termination of a human pregnancy, most often performed during the first 28 weeks of pregnancy.” (Again, google dictionary).
Now, please remember, if you are starting to struggle with these concepts because they raise emotional issues or obsessive thoughts, please stop reading and seek help.
If you're struggling, call Lifeline on 131114 or BeyondBlue on 1300 22 4636 (if you’re in Australia). I’m not here to cause you trauma, and I’m sorry if this does cause you concerns.
But if you’re up to it, I would like to tell you some stories, and you can think about your own responses in your own time. Feel free to drop me a line too ...
Firstly, let’s consider a person (whom I have known for a very long time), who has a severe mental illness. He’s a kind man aged in his seventies now, who has been telling me that he wants to die for at least the past 30 years. I can imagine him asking his doctors for help to die, because I know that he has attempted suicide a number of times, and has asked me to help him too. He is still alive, nearly twice as long as the prognosis he would have heard when first diagnosed. In those days, a person with his illness would typically die in their forties. But thanks to advances in both medicine and non-pharmacological treatments, he has outlasted many contemporaries. It could be due to his own resilience too, despite wanting to die every day and night of his life.
He has remained symptomatic all his adult life. I feel for him, and I feel for him especially in his loneliness. I can tell when he has received his fortnightly injection of medication, because that’s when his symptoms are at their worst. It’s a lonely, lonely life.
I can tell that there is intelligence behind his raging symptoms, and yet, he has been unable to work for decades. It is a frustrating existence.
My sympathy tells me that he has every right to ask for physician-assisted suicide. But if I was his doctor, I would have so much difficulty with this decision.
So, let’s consider the doctors (physicians) who are at that interface. In 2013, when I started working in cancer, I found a book called “When Professionals Weep”, and it provided such a deep insight into how and when our medical professionals find themselves staring death in the face. It might be ...
a patient who believes they would be a burden to their family and friends, because they know their health will deteriorate and they will quickly become dependent on others for everything (including personal hygiene).
the physician’s own beliefs influencing their decision.
the physician’s own experiences colouring their choice.
the family pushing to end what they see as “suffering”.
someone who is not a patient, but who has a dark secret eating away at their heart …
The boys, with whom I went to senior high school, had a dark secret. They all knew about the sadistic male teacher who practised “Cornering”, the sleazy female teacher who brushed breasts against their pubescent arms and backs during class, and the hebephile who preyed on them for four years. A hebephile is sexually attracted to children who are in that first phase of adolescence (11-14 years), and this one was the Year 7 Form Master. Approximately 720 boys went through Year 7 in the four years he was Form Master. I had no idea about any of this when I started co-instruction at their school. I was enrolled in the sister school next door that was just for Years 11-12, and we shared most classes with the boys in those years.
Decades later, I discovered what a horrible place it was for my friends and how inadequate sentencing is in New South Wales for historical cases like theirs. It took so much courage to come forward, and then to relive it all in court; and all he got was a maximum 16 months per boy. Around that time, one of them took his own life.
My compassion for these men, who showed the utmost bravery, was tempered with a hope that was challenged daily. They had raised themselves above and beyond what that man (a priest) had done to them as children, but the triggers became so constant. All they could see, hear, smell, and taste was what he had left them with – memories of the devil’s work. He caused them to lose faith, in God, in family, friends, themselves. I could see how suicide could be the only way out for some. I hope they have had the help they’ve needed to move on from all they’ve survived; and I hope that being a “survivor” becomes just another chapter in their lives.
I wonder how their medical and allied health professionals would deal with it when asked about assisted suicide. Our culture is becoming more accepting about assisted suicide for people with debilitating physical illnesses and injuries, but not so compassionate about people who suffer mental and emotional torment. The disparity is glaringly obvious to me.
Imagine a world where we treat people with severe and lifelong mental illness with the same compassion and dignity that we give to people with cancer or who are in a coma….
When my mother was a nurse, before she and Dad married, she worked at the Mater Misericordiae Hospital, and lived in the Nurses’ Home on campus. Whenever Matron had a patient who was dying on her ward, she would call Mum in to care for that person in their last day and nights; she knew what to do to make them comfortable and to give them a dignified death. Fast-forward to the week of her own death in June 2011, and I believe she knew exactly what could happen to her, and how she could choose to have a peaceful and happy death. As much pain as she was in, in those last few days and nights, she was in control and had as happy a death as she could, surrounded by her family. Dad, too, died the following year in November 2012, after living with cancer for twice as long as he was told he would. In the end, he received palliative treatment while we all shared in his at-home care. I believe that the palliative medication probably put an end to his life; and as I was the one holding his hand when he breathed his last breath, I can tell you that it really was peaceful. The best way to go, really.
So, let’s think about those physicians for a moment too.
The article I mentioned at the start was called, “An indelible mark” The response to participation in euthanasia and physician-assisted suicide among doctors: a review of research findings. The authors (most of whom I know after many years in mental health research), conducted a review of the scientific literature on euthanasia and physician-assisted suicide (E/PAS), and particularly doctors who have “participated” in it. The authors found that up to half the doctors who participated suffered emotional burden, and up to 20% continued to suffer a significant effect from the experience. Conversely, half the doctors reviewed found some comfort or satisfaction in meeting the patient’s request. So, there could be some who would consider E/PAS and some who wouldn’t want to. It truly justifies having these conversations.
Finally, the friend that I mentioned earlier, is not the first person dear to me who has talked of suicide … Which makes this such an important conversation to have. Please check on people and see how they are. Please consider completing a Mental Health First Aid Certificate so you have confidence to approach people who behave in troubled and troubling ways. And finally, continue to speak gently, walk quietly, and dispense … hope …
The article I mentioned at the start can be found via the Abstract.