The assisted suicide debate. FOUR FUNERALS AND NO WEDDINGS by Moray Welsh 2002 ___________________________________________________________________ In the last six years there have been four deaths in my family. With the debate raging about assisted suicide, I feel that there is clearly so much talk and not enough compassion brought to this subject. My mother was the first to go in 1996, aged 82. She had suffered from chronic lymphatic leukaemia for over ten years, and though it gradually sapped her strength, she was able to carry on with her life in such a way that very few people knew. She even managed to keep it a secret from me for eight years. She was a very motivated woman whose involvement with music gave her a reason to live, and at times a transcendent amount of energy to carry out her various activities, which included teaching and conducting choirs. Her health started to deteriorate round about 1994 when she and my father, a retired chemist and optician, moved into sheltered housing in Haddington in East Lothian. The first major problem was her sight which was beginning to deteriorate rapidly, and a diagnosis of glaucoma came rather too late to be effectively acted upon. She faced a further diagnosis of macular degeneration with stoicism, knowing that total blindness was probably in store for her. Early in 1995 while doing some energertic home improvement she suffered a slight stroke, but made a marvellous recovery from this. In the autumn of the same year she started to suffer from excruciating pain in her head behind her right eye, which was initially diagnosed as migraine , then thought to be connected to the glaucoma. Finally, however, a tumour behind the eye was discovered and in order to remove it her eye had also to be removed. Although upset by this, my mother was intensely grateful that the awful pain that she had experienced had finally come to an end. In a very short time (at her insistence) she was fitted with a false eye, and the day she had it fitted attended the theatre without some of her companions knowing that she was wearing her “falsie”. Though hard of hearing as well as almost totally blind, she was exhilarated at being able to “resume” her life. She started some of her musical activities again, including taking an evening class for sight-singing in Haddington. The following January she received some more bad news. She had always wanted her doctor to be perfectly frank with her, and she was told that she might have two or at the most three months to live, owing to the malignant cancer which had spread to her liver. She approached her death with typical practicality and stoicism, and I only once saw her slightly upset. She was particularly sad that the time in the new house had been so short. But she never stopped enjoying doing things both in and out of the house. She undertook a battle plan of clearing up her personal effects, meticulously ordering the things she felt were worth keeping, and disposing of the rest. Her music was distributed amongst pupils, and she sorted out her financial affairs with her solicitor. Having seen the progress of her condition, I had promised that I would be with her as things became critical. I had two performances of a Haydn Concerto on April 13th and 14th, and really wasn't sure if I should be doing them, but she insisted that she was going to be around till after that, when she knew that I had at least a fortnight free. After a stressful weekend I sped up to Haddington, and found her, by that time, almost continuously confined to bed. The week that followed was remarkable in many ways, and personally I felt that many miracles took place. She was remarkably focused, and surprised me by saying she wanted to write a message to the friends at her funeral, and, in spite of her by that time almost non-existant sight, did so completely unaided and committed immediately to memory. Another thing that really engaged her was a book with lavish photographs of Tibet, and I was amazed that she struggled to read some of it by herself, with a promise of more to be read to her. She had always been fascinated by Tibet, and it seemed that it fuelled her fascination all over again. She also spent a lot of time listening to many different pieces of music, planning the funeral service, and even choosing the person whom she wanted to give the tribute! Listening to the music gave her just as much pleasure as planning a concert, and when, finally, she chose the pieces, she didn't listen again. She decided she didn't want hymns, or organ and “ nothing gloomy ” ! Though not a conventional Christian, she had come to a total acceptance of her condition. Round about Thursday she said “ I feel blissful ”, not a word I had ever heard her use before, and she said that she really would like to die that week. Having been through so much pain, her tolerance level was very high. As the end of the week came, her conscious periods were getting shorter and shorter, and the sleeping deeper and longer, but her body was rapidly disintegrating as her system was unable to digest food. One of the things that she had spoken to me about was the fact that she really couldn’t bear to go through the kind of pain which she had suffered at the time of the tumour in her head, and I promised her that I would help her as much as I could. In the last two or three days, I looked after her with the help of Marie Curie Nurses at night, but it seemed to me that the GP, who was very much aware of the situation, was slow to acknowledge that she really needed morphine. At my request morphine was started. The following morning my mother was still in great distress. I rang the doctor and explained the situation, asking for help with the dosage. At that stage the doctor simply said to me “if you feel she needs more, just increase the dose”. At the time I was surprised to find myself being entrusted with the responsibility of administering a lethal drug, but I realised that the doctor was unwilling to actually prescribe in response to my request. Later that day the medication was stepped up, and my mother died peacefully that night. ______ Later the same year my aunt Jenifer (my mother’s brother’s wife) died after several heart attacks, exacerbated by the curious cicumstances of her and my uncle’s religious beliefs. Jenifer collapsed unexpectedly while shopping one Friday in November 1996. When I spoke to my uncle on the phone on the Saturday evening, he told me that, although she was obviously not well and very weak, he would delay telling the doctor until the following Tuesday, when he himself had a doctor’s appointment for a check-up. I urged him to call the doctor immediately. By the Tuesday he had still not contacted the doctor. In the afternoon, as planned, he left the house to go to his appointment. He had left Jenifer lying on the sitting room floor wrapped up in a duvet, close to the fire for warmth (as the house was not centrally heated), and as he himself said he could not understand why her arms and legs were so cold. Having had his check-up he told the doctor, who from the description given said he would come round the next morning. By the time the doctor did come, Jenifer was dead, having had a series of heart attacks, the first of which had been on the previous Friday. As I had been in contact several times over the weekend, the seriousness of her condition was apparent to me even over the phone, but his manner of dealing with it left me speechless. It was only later that I discovered that the religious group to which he and his wife belonged, the Armageddon-inspired Philadelphia Church of God, rejected recourse to doctors in case of illness. I suppose that my uncle managed to justify his own check-up in view of the fact that it was not motivated by illness. But I also believe he was haunted by guilt after her death, realising that he had probably wittingly caused her to die in great distress. At the time, I was shocked enough to privately consider his action culpable in terms of the law. His own death two years later was also curious. By this time, at the age of 91, he had developed Aortic Stenosis, a critical condition for which there was no cure. His religious beliefs had led him to undertake a trip to Israel from which I personally believe he had not expected or hoped to return - and there were very good reasons, according to his cult, why he would have been better to die there. He survived the journey back, but was admitted to hospital immediately he arrived back at Edinburgh airport, having developed an infection in his bowel. As his next of kin, the doctor rang me from the hospital explaining that my uncle had chosen to go ahead with an operation knowing that the chances of his surviving the anaesthetic were mimimal. He was an intelligent man, and I have no doubt that he chose to assist his own death with the help of a painless anaesthetic. ______ The most recent death in my family was that of my father, whose circumstances were not dissimilar from my mother, save that he was ninety seven, and had survived my mother by six years. I was privileged again to be able to spend the last week of his life with him, and my experience was again very similar. Though he was being cared for in a home, I kept vigil by his bedside for most of the week. As a result of pneumonia, he was no longer able to eat or drink and had become greatly distressed by his condition. But he had stressed to me, after bouts in and out of hospital, that he no longer wanted anti-biotics. He had been a chemist and was at all times very aware of the drugs that the doctors were using. It was again at my suggestion that the doctor started a controlled dose of morphine. Dad repeatedly told me that he wanted to die, that he could not go on, but his heart was extremely strong, and his body fought on with incredible strength. I felt that for his sake he had endured enough and it was apparent that the morphine was having very little effect on him. Luckily I had a friend who worked in a hospice, whose advice I sought. That advice was to add another drug, Midazolam, to the coctail, to which the doctor agreed. My father died quietly the next day. _______ After my father’s death, I did feel a twinge of guilt that I had precipitated his death, but was reassured by the nurse that the doctor woulld probably have taken the same course a day or two later.This information both calmed me and dumbfounded me. Why, when it is so obvious that someone with a terminal illness is suffering, should their own wishes not be paramount ? These experiences left me with something to ponder. My uncle chose his own “medically sanctioned” suicide - he had a tacit understanding with the surgeon and was lucky. His wife was not so lucky, having endured five days of slow death because of some kind of twisted religious theory. After the event he could not forgive himself for having let his wife suffer in this way, but was cowed into doing so because of his own fear of divine retribution. And in the case of my parents I feel extremely privileged to have been able to help them, to have eased their passage out of this world. They had both lived long and fulfilled lives. I am glad that I was emotionally strong enough to have been able to take some action for both of them, but I am also aware that to have to take on that responsibility at a time of grief could be extremely hard for some people.