Dying Doctor's Plea For Euthanasia

Dying doctor's plea for euthanasia,

July 21, 2010.

July 7 2010

Over the years our vet has put down several of our ailing, elderly pets, the latest a week ago. A contented, serene animal, surrounded by the people who have loved it for years, passed from life to death in a peaceful, painless minute. I have metastatic melanoma - how I wish that service was available to me.

If I was a citizen of Holland or Belgium or a couple of American states it would be. In NZ a doctor who performed such a merciful service would risk prison. The law insists we must provide only ameliorative help while patients may reach the most appallingly wretched states, sometimes akin to those who died of starvation in Nazi concentration camps. Ironically if we allowed a cat or a dog or a horse to reach such a condition we would be breaking the law and risking a prison sentence.

Contrast my situation with those of a couple of our friends who died of cancer in Holland not so long ago. Both were hugely comforted by the knowledge that they could choose to pull the plug when they had had enough. One was specifically afraid of losing the ability to communicate and his doctor knew that was the signal to intervene for the last time.

In fact, he was able to communicate to the end and died of his own accord. The other died in the early hours of the morning of the day she had arranged for the doctor to end it for her. So, neither was euthanased but both were happier in their final months, weeks and days because of its availability.

My cancer may kill me in a variety of ways, some very unpleasant and drawn-out. There are several scenarios which I would find intolerable and should be able to opt out of but for our old-fashioned, ill-thought-out, cruel laws which force me to suffer to the end or kill myself.

There is no doubt voluntary euthanasia will come to NZ but it needs some determined lobbying for it to be sooner rather than later. I know of no recent NZ surveys but a couple done in Britain and USA suggest about 75 per cent of the population would approve.

There are a number of prevalent arguments against it - none, in my view, reason to withhold what should, and will be, a basic human right:

* Our medical services, particularly the hospice organization, have the skills to take the unpleasantness out of dying and so euthanasia is unnecessary.

This is far from the truth. Yes, most pain can be relieved to a large extent but at the cost of symptoms such as constipation, nausea and drowsiness, which may be partially controlled by other drugs with their side-effects.

Breakthrough pain is common and its prevention requires constant medical attention which is not often available. We are not good with neuropathic pain. Other symptoms are poorly controlled - in particular that horrible, hopeless, helpless state of feeling so weak and ill you can enjoy nothing - not food, not conversation, not reading, not telly, not even the touch of loved ones.

My case is made by the fact that, in Holland where `end of life medical services' are at least as good as ours, two and a half thousand people opted for euthanasia last year. That suggests, on a population basis, about six hundred New Zealanders per year would opt for it and at least a couple of thousand would be comforted by its availability.

* The religious argument I dismiss out of hand. Our system of government, very wisely, keeps church and state separated - you only have to look at the countries that don't to see the diabolical laws that can ensue. The cause I espouse is voluntary

euthanasia - anyone who has a god who forbids it may choose to live out their life.

The New Zealand Medical Association is against euthanasia. To me this is unfathomable.

I have discussed it with many, many of my colleagues over the years and have found that the vast majority are for it. Indeed, I have met many who, at great risk to themselves, have succumbed to a patient's begging for a merciful release. Is it really likely that the profession that sanctions the termination of the lives of thousands of healthy unborn babies each year would criminalise the shortening of the lives of suffering, dying patients who ask for that last merciful service?

* Legalising euthanasia would allow people to pressure their older relatives into it so that they do not have to look after them and can get at their money sooner. I have two replies to that.

The Dutch law, which I advocate, requires your own doctor and an independent doctor to be convinced that you are suffering, are terminal and are NOT being COERCED before agreeing to your request.

Second, if you do have relatives wanting to get rid of you quickly in your last illness you would be better off in a hospital or hospice or dead anyway.

Some argue that, even uncoerced, a terminally ill person may choose to die sooner so that their family suffers less. I suggest this is a perfectly legitimate reason - your family's suffering contributes to your own - why shouldn't it be part of the reason to choose to shuffle off a little earlier?

* It is the thin edge of the wedge - if we allow voluntary euthanasia for the terminally ill it won't be long before we are killing the mentally ill, the deformed and everyone over seventy.

About as sensible as saying if we allow people to eat meat it won't be long before we are eating each other.

*No need for assisted euthanasia - you can commit suicide. So you can but there are several downsides. You have to do it while you are physically and mentally capable which may be a lot sooner than you [and your family] may like.

There is a risk that anyone with you at the time could be accused of, and sent to prison for, assisting you. You, therefore, have to die alone which is tragic for you and your family. It may go wrong - you may vomit the pills, be discovered too soon or botch whichever method you employ.

For example, a close friend with a progressive illness took an adequate overdose several years ago. She was unlucky enough to be found too soon and taken to hospital where she was, again, unlucky to be treated by a bright young doctor with lots of medical knowledge but wisdom yet to develop.

Despite her pleas, and those of her family and me, the doctor insisted on resuscitation. [In fact, she could and, perhaps, should have been sued for assault] Thereafter our friend felt she had no option but to starve herself to death. It took two long, heartbreaking months but, at least, wiser doctors were able to admit her to hospital and hospice to help her through it.

How much better off would she and her family have been if she lived in Holland? Isn't it time NZ became similarly enlightened?

If you agree I would urge you to write to your local MP and to the NZMA. Both will need a lot of pushing to act.

John Pollock MB, ChB, MRCP[UK], FRNZCGP

Letter published in New Zealand Doctor magazine.