Sunday, November 9, 2008

Euthnasia #3 - a good death?

So this morning the Indonesian government executed the 3 islamists who were responsible for the bombing in Bali. The Singapore government has been characteristically silent. Nothing to say really...considering we had similarly executed 2 Indonesian saboteurs back in 1968. What has been perhaps the most hypocritical was the Australian government's silence about the execution. Typically belligerent and vocal in its anti-death penalty stance, it suddenly seemed acceptable for the Indonesian government to execute these terrorists. Apparently since the Bali bombing had claimed 91 Australian lives, it somehow seemed acceptable to expect their pound of flesh (albeit with a few bullets). Apparently, the morality of taking human life even in the context of a death penalty, can be situational.

The word euthanasia really means "good death". It typically refers to "the practice of killing a human being or animal, especially one suffering greatly or with poor quality of life, as when suffering from an incurable illness or condition."

The attempt by the anti-euthanasia lobby to reduce it to suicide (physician assisted suicide) is I believe quite mischievous. It is correct to equate the two only from a technical perspective since they both involve the taking of one's own life, but truly, the two contexts are really quite different.

In a typical suicide, although the person is in an extreme state of emotional or psychological distress, there is nevertheless some hope (though often perceived as distant) of rescue or of recovery.

In the situation when euthanasia is contemplated, the situation is far from rescuable. While it is true that there is often some degree of depression, often the psychological distress is a reflection of the failure of palliation. It is clear to both patient and care giver that it is really the end of the road, and it is only a matter of time. How often have we as doctors, watch from the sidelines, and wondered about the unnecessariness of the pain and suffering. Words are quite ineffective at times like that.

Once at a well known hospice in South East London, I was briefed on the activities of the care givers. While a large part of the time was spent in managing the palliative component of the care given, I was impressed by how much effort was made to prepare the patient for death. Domestic and interpersonal conflicts needed to be resolved. Wills needed to be written. Debts settled. Reconciliation and forgiveness encouraged. Patients had to be guided towards a recognition of the reality of death. Spiritual help and solace was provided when appropriate. Then, when all has been said and done, if a patient had been prepared well, he or she would be at peace, awaiting the finality of the moment when he/she would depart this world. This was hospice care at its best.

Then when all that's left is just waiting for the final moment, one cannot help but wonder why the suffering need continue. Why would it be wrong for the patient to choose his/her moment of departure? To leave when goodbyes have all been properly said. To leave when your loved ones are all by your side.

This is truly what euthanasia is all about. A good death.

I am not supposed to support euthanasia. But I am not so sure it would be wrong if the context is correct. Death is not the end of life. It is merely a passing of life. Surely a doctor's role is also to assist that passing when the time has come.

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