“Death creates an economy that makes life precious. One of the ways of naming that preciousness is friendship.”
Stanley Hauerwas

Euthanasia

Megan Best

I am a palliative care doctor. I look after people who are terminally ill. Let me tell you about a patient I looked after many years ago, during my training. Due to the usual department rotations of medical training, I had been on the spot when he was diagnosed with lung cancer—a tall Lebanese gentleman with an impressive moustache, patriarch of a large immigrant family. I had not seen him for some time, and when he appeared in the ward again, I could see that things had not gone well.

He was a shadow of his former self, gaunt and grey, though the moustache valiantly lingered on. It was like seeing an old friend; any familiar face is welcome in such a setting.

We soon were able to control his symptoms of pain and breathlessness with the appropriate medication. He did, however, continue to suffer. I asked him what had been the most difficult experience of his illness. His answer surprised me, back then, though it would not now. Despite the trials of discovering he had cancer, experiencing the ravages of chemotherapy, battling with pain and breathlessness and increasing debilitation, the thing that had been most difficult for him was his loss of position in his family. He no longer ruled the clan, his illness had resulted in a demotion.

He found this intolerable, he wanted his authority back, and he wanted more time with his family. Like most of my patients, thoughts of euthanasia did not cross his mind as a response to his suffering. He wanted more time, not less. 
     
 

I have always found striking the discrepancy between the public support for euthanasia (among those who are healthy) and my patients’ desire for continued life. I was informed of a recent poll which claimed that 87% of Australians support legalisation of euthanasia.[1] Research done on palliative care populations, however, tells a different story.

A study done some years ago in Sydney found that less than 1% of those referred to a Palliative Care Service made persistent requests for euthanasia.[2] My own observation is that things haven’t changed much since then. Why the disparity?

I think there are many reasons why this is the case. The absence of death in everyday life no doubt contributes—it is a remote event often occurring in hospitals, and many of us base our understanding of what really happens on hearsay. And hearsay, especially from the distant past, has some horrifying stories to tell. Y

et I think the main reason why our community voices such strong support for euthanasia is because it has been confused about some accepted end-of-life practices which are already legal, but poorly understood. These include withdrawal of life-prolonging treatment and symptom control.

When a patient is in the terminal stages of their illness, a time may come when treatments aimed at cure either no longer work (they are futile) or the burden of side-effects such as nausea and vomiting may be so overwhelming that they cancel out any benefit of treatment. At this stage the treatment may be not prolonging life so much as prolonging the process of dying.

At this time a decision may be made to stop (withdraw), or decide not to start (withhold), such a treatment. The patient himself may suggest this course. Mentally competent patients do not have to accept any treatment they don’t want. The decision is made carefully in full consultation with the patient and their family and full supportive care remains in place so the patient is kept comfortable while the underlying disease takes its course. It is not a question of whether a life is worthwhile, but whether the treatment is worthwhile.

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