Say, What?,

Not want­ing to be a bur­den is a valid rea­son for ac­cess­ing as­sisted dy­ing, writes Gra­ham Adams, who is a cancer pa­tient.

North & South - - In This Issue -

It was 8pm on a cold Fri­day night in a packed hospi­tal emer­gency depart­ment. The triage nurse glared at me through the glass pan­els that shielded her from the throng of pa­tients in the wait­ing room. “There are NO beds avail­able!” she said. Her face was stony.

I was taken aback. It wasn’t my idea of fun to be stand­ing shiv­er­ing with a fever in front of a se­ri­ously over­worked woman at North Shore Hospi­tal, but my on­col­o­gist had told me to go there if my tem­per­a­ture spiked.

The nurse no­ticed my be­wil­dered ex­pres­sion and her voice soft­ened. “This is not the place for a cancer pa­tient,” she said, as people be­hind me coughed and wheezed. “I’ll get you a mask to wear while you wait, and I’ll find you a room away from people just as soon as I can.”

Fever­ish, neu­tropenic chemo­ther­apy pa­tients are not the most wel­come visi­tors at a busy emer­gency depart­ment. We’re not ac­ci­dent vic­tims and we may or may not be an emer­gency. But un­til some­one takes a blood sam­ple, no one knows for sure. The level of neu­trophils, which pro­tect against in­fec­tion, shift around in cancer pa­tients and you can be neu­tropenic (ie de­fi­cient) and ex­tremely vul­ner­a­ble to lifethreat­en­ing sep­sis one week but not the next. Con­se­quently, if a cancer pa­tient’s tem­per­a­ture goes above 38°C, in­di­cat­ing the pos­si­bil­ity of in­fec­tion, they are in­structed to present them­selves at an emer­gency depart­ment as soon as pos­si­ble.

The nurse was as good as her word. She com­man­deered a con­sult­ing room where I could lie down, blood was taken and a line put into my arm in case I needed IV an­tibi­otics. Ly­ing there for hours on my own wait­ing for a doc­tor to ap­pear, I lis­tened to a man some­where along the cor­ri­dor, groan­ing in pain, and an elderly woman, pos­si­bly a de­men­tia pa­tient, shout­ing, “Help me, doc­tor! Help me!”

It made me think about med­i­cal re­sources, dy­ing, and the whole damn thing.

I fig­ured it was okay for me to be on an in­ter­minable cy­cle of emer­gency depart­ment vis­its ev­ery time my tem­per­a­ture spiked while there was still hope my treat­ment would work – but would I want to be do­ing this re­peat­edly if I had only months, or less, to live?

Cancer pa­tients eat up a huge amount of time and money be­ing treated in their fi­nal months and weeks. At that point, wouldn’t al­low­ing some­one like me ac­cess to as­sisted dy­ing be a win-win for me, the hospi­tal and the health sys­tem? I wouldn’t have to suf­fer what­ever pain and dis­tress may be my fate in my fi­nal days – which is my ar­dent wish – and the money and re­sources saved could go to­wards treat­ing pa­tients who might re­gain a healthy life, rather than try­ing to pre­serve mine when I was doomed.

Sav­ing pre­cious health fund­ing is not one of my pri­mary con­cerns in want­ing as­sisted dy­ing to be avail­able, but I would con­sider it a valu­able side ef­fect. It would give me the sat­is­fac­tion of know­ing that in sacri­fic­ing the last lit­tle bit of my life, for my own rea­sons, I would also be eas­ing the bur­den

on the health sys­tem just a lit­tle.

Hours later, a doc­tor ap­peared and apol­o­gised for the de­lay in get­ting to me. “Four am­bu­lances ar­rived just af­ter you were ad­mit­ted,” she said. “We've been run off our feet.”

The idea of not want­ing to be a bur­den to oth­ers – whether it's those you love or even the un­seen tax­payer – is rarely men­tioned by sup­port­ers of as­sisted dy­ing but of­ten by op­po­nents, and al­ways as a bad thing.

Dr Stephen Child, a former chair of the New Zealand Med­i­cal As­so­ci­a­tion and an op­po­nent of as­sisted dy­ing, told the New Zealand Her­ald in Jan­uary that 48% of people re­quest­ing eu­thana­sia in Ore­gon, where as­sisted dy­ing is le­gal, list “bur­den to oth­ers” as their pri­mary rea­son for do­ing so. He asked, “Does that mean they're mak­ing an in­de­pen­dent de­ci­sion for a ra­tional sui­cide or is there a de­gree of co­er­cion in their de­ci­sion-mak­ing?”

Well, it's pos­si­ble to find out eas­ily enough – by in­ves­ti­gat­ing their mo­tives, just as we do for live or­gan donors. Although it's not com­mon, donors can de­velop com­pli­ca­tions from the surgery to re­move a kid­ney or a lobe of their liver that could cost them their lives. It's a se­ri­ous busi­ness.

Doc­tors recog­nise some would-be donors may have mo­tives other than al­tru­ism – such as feel­ing obliged to help a fam­ily mem­ber or hop­ing to im­prove a dam­aged friend­ship. Con­se­quently, coun­selling is of­fered to check what their true mo­tives are. Sim­i­lar checks can be done to as­sess that some­one's wish for an as­sisted death is free from co­er­cion. David Sey­mour's End of Life Choice Bill, cur­rently be­ing de­bated in the Jus­tice se­lect com­mit­tee, de­tails com­pre­hen­sive pro­vi­sions to make sure it is a free choice.

In­ves­ti­ga­tions by the Cana­dian Supreme Court, the Royal So­ci­ety of Canada, and the Vic­to­rian In­quiry into End of Life Choices con­cluded that such screen­ing is ef­fec­tive in avoid­ing abuse in ju­ris­dic­tions where as­sisted dy­ing is le­gal.

It’s quite rea­son­able to not want to bur­den oth­ers with your suf­fer­ing – not be­cause loved ones are putting pres­sure on you but sim­ply be­cause you want to spare them the trauma and dis­tress of watch­ing you suf­fer when things have be­come hope­less.

In my own case, not want­ing to be a bur­den has ab­so­lutely noth­ing to do with di­rect or in­di­rect co­er­cion, or even a fear of it. It's sim­ply mo­ti­vated by con­cern for the psy­cho­log­i­cal well­be­ing of those who love and care for me. I know very well from my own sis­ter's death – tied to a hospi­tal bed and scream­ing for hours as cancer over­whelmed her – just how trau­matic a painful, dis­tress­ing death can be, not only for the per­son in pain but ev­ery­one else in­volved.

It's strange that op­po­nents are of­ten happy to ac­cept that an es­sen­tially self­ish mo­tive – want­ing to avoid pain – might be a valid rea­son for as­sisted dy­ing, but are quick to dis­miss an al­tru­is­tic mo­tive – not want­ing to bur­den oth­ers – as un­wor­thy.

So­ci­ety recog­nises al­tru­ism as the most no­ble of hu­man im­pulses, and the very essence of hero­ism, whether it's a sol­dier or life­guard or by­stander putting their own life at risk to save some­one. Nev­er­the­less, it is un­usual to hear any­one state pub­licly that not want­ing to be a bur­den to oth­ers is a le­git­i­mate rea­son to ac­cess as­sisted dy­ing.

Dr Lance O'sul­li­van is one ex­cep­tion. RNZ re­ported in Oc­to­ber last year that while “many people who chose eu­thana­sia in over­seas ju­ris­dic­tions in­cluded in their mo­tives that they felt they were a bur­den on their fam­ily, the hospi­tal or even the tax­payer”, O'sul­li­van “was not con­cerned” about this. RNZ re­ported him say­ing, “I don't think it should be dis­missed as an in­ap­pro­pri­ate com­po­nent to a de­ci­sion.”

Dr Jack Hav­ill, a former in­ten­sive care spe­cial­ist and former pres­i­dent of the End- of-life Choice So­ci­ety, agrees. He told North & South, “Feel­ings of be­ing a bur­den to oth­ers are le­git­i­mate and com­mon among many people who are dy­ing” – and these feel­ings are “sim­ply a part of their un­bear­able suf­fer­ing”.

In short, if we ac­cept that un­bear­able suf­fer­ing is a good rea­son for as­sisted dy­ing, we have to ad­mit that fear­ing be­ing a bur­den on oth­ers is an in­te­gral part of that suf­fer­ing.

“Of course,” Hav­ill adds, “just be­cause a per­son feels they are a bur­den to oth­ers does not make them el­i­gi­ble for as­sisted dy­ing un­der the End of Life Choice Bill. The pa­tient has to be ter­mi­nal or have ir­re­versible, un­treat­able suf­fer­ing and be in an ad­vanced state of de­cline. But no one can say that the feel­ing of be­ing a bur­den to oth­ers is not part of their suf­fer­ing.”

Auck­land Angli­can Bishop Jim White also sup­ports the no­tion that not want­ing to be a bur­den is a valid rea­son. In his 2016 sub­mis­sion to the Health se­lect com­mit­tee, he wrote, “It is also note­wor­thy in the as­sisted dy­ing de­bate that people may choose to die for the good of oth­ers (as ad­judged by them­selves). While we want to be cer­tain that there has been no co­er­cion in this de­ci­sion, it can be a le­git­i­mate rea­son…”

It is en­tirely per­ti­nent that a bishop should make that point; Chris­tian­ity cen­tres on the sac­ri­fice of one man dy­ing on a cross in or­der to save the rest of hu­man­ity from the bur­den of sin. Self-sac­ri­fice lies at the very heart of our Chris­tian her­itage. As St John wrote in his gospel: “Greater love hath no man than this, that a man lay down his life for his friends.”

If we ac­cept that un­bear­able suf­fer­ing is a good rea­son for as­sisted dy­ing, we have to ad­mit that fear­ing be­ing a bur­den on oth­ers is an in­te­gral part of that suf­fer­ing.

Cut Loose De­sign Stu­dio Cut­ting Edge Hair in Place Hair­line Hair Now The Hair Port Head­mas­ters for Hair Head­quar­ters Head­way De­sign Shar­ing Shed

Newspapers in English

Newspapers from Australia

© PressReader. All rights reserved.