Choices about euthanasia

I had a close encounter with the pros and cons of euthanasia recently as I watched my mother die.

She had expert care and assistance in her home and at the hospice. The hospice uses care plans that emphasise comfort for the patient within current laws.

March
Emergency admission to hospital with reflux and difficulty eating. Tests done, suspected possible hernia. Discharged.
Continued having eating and reflux problems.

April
Further outpatient tests.

May
Diagnosed with oesophageal cancer.
Treatment options explained. Booked for radiation therapy to try to relieve symptoms.
Continued difficulty eating – can’t eat many things, can only eat liquids or near liquids. Some food, for example meat, cannot be eaten at all.

July
Three week course of radiation begins.
Admitted to hospital after first treatment.
Several days later discharged to family home, radiation continues.

August
Eating continues to be difficult, no real improvement.
Saw specialist, advised relief may take another month.

September
Liquid diet only.
Saw specialist who advised they had done what they could, referred to Hospice for in home palliative care.

Week 1
Bad back pain for several days, admitted to hospital with kidney infection.
Tests confirmed cancer now in liver.
Eating increasingly difficult.

Week 2
Back in home but has difficulty managing.
Talks about considering self euthanasia. Says she just wants to go quickly.
Has fall on footpath in town.
Needs walking frame.
By the end of the week it’s obvious she needs more care.

Week 3
1. Assessed by hospice doctor, booked into hospice for assessment
2. Arrived at hospice and advised she would be there about a week.
3. Advised that she wouldn’t be leaving the hospice.
4. Drinking is increasingly difficult. She says she just wants to go quickly.
5. Has final interview for hospice memoirs.
6. Had a fall overnight trying to go to toilet. Enjoyed watching rugby on TV. Last “meal”.
7. Significantly worse.

Week 4
1. Continues to deteriorate. Family advised she is now on final care plan, death could be within a day or two but could take much longer.
2. Looks terrible, barely recognisable. Barely awake all day. Overnight her body goes just about completely cold. Death rattle begins.
3. Bounces back in the morning. Awake and seems to enjoy family visits in the afternoon. Goes cold again overnight.
4. She looks nothing like my mother. Slight recovery, then has internal bleed.
5. Cold. Slightly warm. Cold. Hasn’t eaten since Saturday, all she has had is moisture swabs in mouth. Death rattle gets worse despite drugs.
6. Vigil continues. Turned regularly with distress. In the evening death rattle isn’t be relieved. Nurses turn her with a lot of discomfort.
7. Very distressing. Nurses leave room to get drugs.

At about twenty minutes after midnight my mother opened her eyes and looked at me, she looked desperate, pleading, terrified, I’m not sure what, just terrible.

Then thankfully she died.

After the nurses had finished my mother looked like herself again, relaxed.

My mother was lucky she died relatively quickly. Her last few months were mostly not nice for her, increasingly less so. During that time she never enjoyed a meal.

My mother had talked a number of times about wanting to go quickly when her time was up. She mentioned several times about euthanasing herself. The hospice always made it clear they had to comply with the law and within that they did a fantastic job.

But…

What the best possible palliative care did for my mother over her last few days was supply her with regular drugs, support relatives who were on death watch, and turn her regularly.

The regular turns were necessary, but they were awful. They were about the only times my mother became semi awake, because it was so disruptive and uncomfortable for her.

It was a turn that actually triggered her death. It’s ironic that they are allowed to turn a patient and know it can commonly precipitate death, but they can’t up her drugs to do the same thing.

Euthanasia is a very tricky subject. If it was legal when should it be allowed?

In retrospect I think (and I think my mother would probably think similarly) that it would have been sensible and far better for her if she had been helped to die sooner. While her last Wednesday was “useful” for saying goodbye to quite a few visitors if she could have seen how she looked she would have been horrified.

Looking back I think that her last Monday evening when it became obvious she was in a state of dying a decision could have been made to ease her pain and discomfort and help her die.  She got no benefit from being nursed through an extended death.

The last week was very hard on extended family who put their lives on hold and gathered round to watch a strange old body suffering. But the decision isn’t about them.

I’m certain if my mother had seen herself in any of her last week alive she would have been horrified – it was the sort of situation she’d made it clear she wanted to avoid if at all possible.

I know there are many variables when people are dying and it’s impossible to be certain of timeframes and discomfort levels.

But to me it seems senseless, and it could easily be seen as cruel, to extend someone’s life when there is virtually nothing to be gained from it.

If I can have a say in the course of my death I would like to be able to state that I want to be able to die comfortably, if necessary with assistance, and I don’t care if there’s a slight chance that I could have eked out another day or two of consciousness.

Care has to be taken in deciding when to go – if you are lucky to get the choice – but denying any legal opportunity to choose a more comfortable way of dying a little bit sooner is not very caring. It’s selfish of those insisting on every last minute of life extension.