The question of whether or not to legalise euthanasia continues to be hotly argued across the Australian mass media. In some cases the positions adopted reflect the presence or absence of religious convictions. In the following article, however, the writer, who is an agnostic, concludes that "taking a life is unacceptable." Matthew Bailey is a fourth year medical student at Monash University in Melbourne, and his article won the sixth annual Doquile Perrett Limon Medical Ethics Essay Award, established to promote debate among Victoria's future doctors and reinforce the importance of ethics in medicine. The article is reprinted with his permission.
My great-grandfather died long before I was born. What killed him was not the cancer that riddled his body and wormed its excruciating way up his spine. It was an overdose of morphine. My grandfather, a doctor himself, had discussed the matter with the treating physician and the family knew exactly what was going on. When he passed away, the matter was also laid to rest.
There is nothing unusual or controversial about his case; euthanasia was never even mentioned. He was merely given ample pain relief. That the required dose of painkiller became fatal was an unfortunate yet unavoidable side effect. Such practice still goes on today, discretely and regularly.
Today my grandmother is also dying. This time there is no cancer, but a motor neurone disease, which has already left her virtually unable to talk or swallow. Communication between her and my half-deaf grandfather is almost impossible, something which has exacerbated existing, domestic difficulties. As the disease progresses, she can expect gradual paralysis. Her death will come when she is no longer physically able to breathe.
Unlike my great-grandfather, she is not in any great physical pain. Although her osteoporotic old back does cause some discomfort, it is nothing compared to her fear, her perpetual cloud of depression, and to the difficulties she faces at home. The anti-depressants she is on do little to hold back her tide of lament. As she becomes weaker and weaker, more and more immobile, she seems to sink lower and lower. Often she talks of wanting to die, of looking forward to her death, and of being ready to leave this world. Meanwhile, I sit beside her, my mug of coffee long finished as she splutters down her now-cold cuppa. Occasionally I have thought about a quick injection, an easy end. I love Nana dearly, and that's why I might be prepared to do it.
My parents are doctors. They know what's happening, they have watched many patients die. They also have a faith which I do not share. When I discussed the issue with Mum, she looked at me and said, "You realise that I believe you would ruin her chances of eternal happiness. I don't want you even to discuss it with Nana."
She's right, of course. Suicide and murder are both grievous sins in Catholicism. If I were to give that painless, undetectable and lethal shot of potassium, Nana would be barred from Heaven. Heaven or otherwise, the suffering here on Earth would be very real. If losing a parent is hard, losing hope for them in the hereafter is intolerable. That could well ruin my mother, and our relationship.
In times such as these, my solution is to curl up in a quiet room, take several deep breaths and meditate. I try to divest myself of all my preconceived notions of right and wrong, of loyalty and obligation, and the fetters of emotion and fear. I strive to see things in the clearest light possible, free of such hindrances. Then I hope for a solution ... Nothing.
Currently I live with an elderly doctor. At 89, he is fit and at least as mentally adept as myself. With the recent controversy surrounding euthanasia, the topic came up easily. He paused a moment and rubbed his prickly old man's chin before proffering judgment. "It is not a doctor's place to decide life and death. That is for God. It is simply our place to alleviate suffering. If, in the course of doing that, the patient dies, so be it. Your particular case is a difficult one, and a terribly sad one, but it is, I believe, a crime against God for anyone, particularly a doctor, to kill."
Originally I was dissatisfied, but as I curled back up on the sofa I started to see his point. I'm an avowed agnostic. God does not feature in my decision-making, but that does not diminish the significance of what he said. For the terminally ill, alleviation of suffering is paramount. If an earlier death is the side-effect, that's acceptable, but one should never intend to kill.
The next day, when I saw him at breakfast, I asked about the current debate on euthanasia. He was unimpressed. "You can talk all you like about building safeguards into the law and having a panel with psychiatrists and the such. It doesn't mean a thing. We went through this 25 years ago with the abortion debate. We were going to have at least two doctors who had to be able to verify that there was sufficient medical reason and all sorts of paraphenalia. Recently I read that 97 per cent of all abortions in Adelaide last year were for social reasons." Whatever your views on abortion, his point is to do with the hazards of legislation. Open the floodgates and the waters will come pouring out. It is not hard to imagine the situation where someone sick, old or an economic strain on the newly wed children, might feel compelled to request death. It is also not hard to make the next leap - to killing those unable to request, but whose relatives feel it is "for the best."
I sat munching my muesli. My father had also said something similar on this particular law. Leaving the law as it stands does not mean that we prolong suffering - we should be frantically working to relieve it. It does mean that the focus is not placed on killing, but on supporting, and that a patient's death retains the gravity it deserves.
I like to think I had learnt a little more about my role in life by the time the toast was ready. Although I don't have a belief in God, I do have values. Love of life and happiness are what count for me. Upon these you can build the same moral and ethical structures that have been preached for millennia. Whether you see it as following God's rules, preserving the sanctity of life, or just helping others find their happiness, it comes to the same thing. Taking a life is unacceptable, accidentally losing a life in the process of bringing happiness into it is very different.
As he offered me the toast, I dragged my mind back to the question of Nana. She was a tough case. There is no drug that is appropriate for her to overdose on inadvertently - antidepressants just don't work that way. However, the grieving and fear she is going through now is a natural process, and one that will pass. That requires no treatment other than family support, love and perhaps some therapy. Eating and speech will still be difficult, and in time she may even need to be fed through a tube. That is part of her condition, and she needs to work through that and come to terms with her fate. It is important, not only for her, but also for the grieving process of those who will survive her.
Unfortunately, Nana's depression is only partly related to her illness. In some form or another, it has been lingering in the background for years, never really resolving, but never really treated aggressively. To my mind, this is perhaps one of our greatest transgressions. Not treating aggressively in these cases is a mistake. Everything possible should be done to make her remaining time comfortable.
The other psychological factors, while not so transient, can also be seen in a similar light. The problems at home are tricky, but all marriages have problems; being elderly does not make you exempt. That new solutions can be found, that things can be worked out, is what makes a relationship strong. It is never too late to improve your own life.
Across the table, having already finished his toast and moved on to coffee, is perhaps the finest example of what can be. Still active, always doing odd jobs, helping out here and in his church community, he is a man who still feels he has a place and a role in life. Curiously, he has prostate cancer, the very thing which took my great-grandfather's life. Euthanasia is much more than an academic interest for him. He lost his wife to cancer a decade ago and knows intimately what such a death means, but still he wants no part in "mercy" killings.
Yet it is not so for many elderly, who have very little to look forward to. They get forgotten by the following generations, their experience and wisdom unheeded. Their lose their jobs and roles In society and they are ignored as people with opinions and thoughts equally valid and burning as any younger person's.
By the time breakfast was finished, I was thinking about cake. Rich chocolate cake like Nana used to make for my birthday. She used to be famous among her friends as the "torta kiralyno" - the queen of cakes - yet it struck me that I really had no idea how she did it. Sometime this weekend, I thought, would be a particularly good time to learn.