In Defence of Euthanasia

Euthanasia should be legal.

My father died in 2008, of colon cancer. He went into hospital April 17th and he died June 8th at the age of 91. For those seven weeks - most of which he spent in the palliative ward - he showed remarkable grace and dignity, in spite of what was happening to him and around him. There was relatively little physical pain, thanks to the drugs they administered.

At first, the doctors held out some hope that they could do something to help him.  There was a battery of extensive and conclusive tests conducted immediately upon his admission to hospital. By April 19th, they knew his condition was terminal, because the cancer had spread aggressively to his liver.

And that's when my dad started asking, calmly and seriously, for a morphine overdose. Obviously, the doctors could not give it to him, but he continued to ask every time a doctor came to see him, until he was too weak to speak.

This didn't surprise me. My father was a thoughtful, well-educated, and private man.  His golden rule was "Do unto others..."  So he always treated everyone with respect, on the premise that others would treat him the same.  In hindsight, I realize that he must have known for some time - possibly years - that he had cancer.  He had been complaining of various ailments for more than a year, but he had assured me that he was in weekly contact with his doctor and that these were just the pains of old age.  He was not prone to lying, but he was a deliberate man who had decided early on that his family mattered more than he himself did.  So I know he had his own excellent reasons for keeping the truth from me.

Not that he lied to everyone about it. I'm sure his doctor knew what was going on. Some of my cousins in Italy knew too. This must be so, because although he had been like a father to them when they were growing up, they were not at all surprised when I called them with the news that he was dying.

My dad retired at 65, so he had a long time to put his affairs in order.  I also think he sorted himself out spiritually, even though I don't know what that means exactly.  We didn't talk about that sort of thing because he knew that I lacked religion and saw no point in spirituality.  And though this probably troubled him - I'm sure he thought I was a total idiot for it - he also respected me enough to accept that I'd chosen my own way. He expected me to respect his way of life, so he respected mine even if he didn't agree with it.  There are lots of ways in which I have chosen to be different from him, but that isn't one of them.  I could do a lot worse than having his kind of respect for myself and for others.

In any case, he had a good 25 years to think about what would happen in the end. There were no special instructions, though he kept all his records up to date. He'd assigned me his Power of Attorney, but it was only the basic legal form.  We set up a DNR for him within his first week in hospital.  His had little interest in the paperwork and medicine.  Instead, he worried about how  he could make the end of his life as peaceful as possible - senza disturbo as he would say - without a fuss, to himself or anyone else.  Most importantly, he worried about becoming a posthumous burden on me and my mother.

My mom was a special matter to him, because she was becoming demented. Something else that was hidden from me was that my mom has Alzheimer's disease. My dad knew that to make her life as bearable as possible, he had to maintain her routines very carefully.  If my dad decided to fight the cancer, my mom's routines would be severely disrupted, and her condition would get much worse very fast. (He was right; within 2 weeks of his going to hospital, she was seriously incapacitated, and by the time he died she was essentially a vegetable.) Even if she herself were to start undergoing treatments or be institutionalized, she'd deteriorate.  And, worse, she would be separated from him. And that was just intolerable to him.

So, he decided to keep things as normal as possible for as long as possible, and to hope that the end would come quickly for them both.

I visited him the day they told him that he was terminal. He wasn't upset. He spent five minutes telling me where to find certain important documents (another clue that he'd known this was coming). Then he asked me endless questions about my wife and kids.  How was work?  How was school?  How were the kids doing in swimming and soccer and karate?  How were the in-laws?  Anything to keep my attention off of him.  (Some might think he was trying to keep his attention off himself, but that wasn't it.)

After that, every time I visited him, our conversations would always start exactly the same way.

How do you feel today?

A shrug. "As one would expect given the circumstances."

Do you need anything?

"I need this to be over."

He would look around at his room, at all the medical equipment they had ready for him, at the charts and sip-cups and wet-wipes, at the $7 a day TV hanging from the ceiling. "What a waste," he would say.  "This stuff should be for people who need it."

He was always kind to the nurses and doctors. Once, when he was too weak to get out of bed, and a particularly attractive female doctor came to see him, he excused himself to her for not standing up when she entered his room. Then he gave me a subtle look that said "wow!" Another time, just days before he died, and he was in and out of consciousness, he roused himself and waved me closer. Thinking I would receive some pearl of wisdom, I leaned in. He whispered to me with some urgency  "Who won the cup?"  He really liked hockey.

What does this have to do with euthanasia?

It shows how clinically rational my dad was about his sorry state. That's the kind of man he was. Some might suggest he was in denial, that he was trying to ignore his fate. But that wasn't it at all.  He had accepted his fate, and was continuing to live as best he could because anything else would just be a waste of life.

So when he asked for the morphine overdose, I know he meant it.

My father waited to die for seven weeks.  I don't think he suffered much physically, all things considered. But he had to spent nearly two months living with the horrible burden of his impending death, surrounded by it, watching Death take his body one piece at a time while his mind remained completely lucid and whole.  He'd always been fit and handsome. In his sixties, he could swim so gracefully and powerfully that men a third his age looked on with envy. A long time ago, he'd almost made it to the Olympics for the 400m butterfly. When I was a boy, he would for my amusement puff out his chest so far he'd make the buttons pop off his shirt.  For a man like that, seeing his body fail so completely must have been heartbreaking.

Have you ever seen a car accident happen?  I have.  As you're watching, time slows to a crawl and you see every detail, and throughout the seeming eternity of a second or less, you get that weird feeling like a knot in your stomach at the sheer inevitability of it.  The sensation lasts a second or two, and it's not one you'll soon forget.

Now imagine lying waiting, useless, in a hospital bed for the very same kind of inevitable event to happen to you.  Only that feeling doesn't last just a second.  It lasts seven weeks.  That's as near as I can imagine what my dad must have felt.

Medical science could do nothing for him. The hospital food was healthy but not what he wanted. The nurses were kind and considerate, but they weren't family.  His affairs were all in order.  No one to talk to - not that he'd want to, because he wouldn't want them to have to bear the sight of him in his deathbed.  Too tired to read.  Very few visitors - he'd outlived virtually every friend he'd ever had.  He'd made his peace with us and with himself.

And he wanted to die, but "we" wouldn't let him.  Why is that?  I think there's lots of reasons, none of them good.

We, the living, are scared shitless of dying, and of having to accept the hard decisions made by others.  As a society, we seem to have an absolute terror of confronting death, even if it isn't our own.  We fear that the dying person is not in their right mind and doesn't really want to die.  We fear that they've been somehow coerced to want to die.  We fear that they'll change their minds at the last minute or, even worse, after the last minute.  We fear what we don't understand, and very few of us can understand how someone of sane mind would choose to die.

More than that, we fear loss.  Especially when it's a loved one that's dying, we don't want to live in a world without them.  I know that I feel a little less security than when my dad was around.  He was there my whole life, and I knew that I could always, always count on him.  That provided a great sense of safety to me, even if I was geographically very far away.  Now, that feeling  is gone.  It sucks.

There's also a weird loneliness.  I didn't speak with my parents often - maybe once a week - but even so, the phone calls somehow defined me in a small way.  The calls are finished.  It's quite a burden to have to give that up.  Some people will keep their parents around just because they don't want to give them up, and with no regard at all to the parents' wishes or how they feel.  I've seen it happen.  And to me it's all contemptible.

Of course, all this fear is both natural and utterly selfish.  It's all about the impact that the death will have on us, not on the dying person.  It's natural because natural selection gives preference to those organisms who have a healthy aversion to risk and lack of security.  It's completely selfish also, for exactly the same reasons.  But just because it's natural doesn't mean we should accept it.  We can choose to be more than what our genes tell us.  Dying is a terrible thing; if we can help in some way, we should do so if for no other reason than no one deserves to end their lives in that kind of terror.  We need to put our selfishness aside, and think more about the dying than about ourselves.

There's a certain responsibility one assumes when one accepts another's decision to die.  When I accepted my dad's desire to not wait for the cancer to claim him, I was agreeing with him, endorsing his decision.  That means that I had made a decision too.  And many people can't do that because they're cowards.  Responsibility can bring fear: fear of criminal liability; fear of violating a social taboo; fear of having to confront one's own mortality; fear of God's wrath; fear of letting death into one's consciousness.

Fear is, however, nothing to fear.  It's just nature's way of telling us something may be wrong.  It's up to our minds to make the final call: will we let ourselves be led by our most primitive emotions, or will we reason our way to a better solution?  I think that if you can set aside the fear (and the things that cause it), your reason will let you see that helping the dying to find peace - if they ask for it - is the right thing to do.

Being a staunch anti-theist, I will completely ignore all of the religious arguments against suicide, assisted or otherwise, and euthanasia, because they are entirely specious.  I will say this: though my father was a devout catholic and I am anything but, we still agreed on this point - he should have been in control of his own death.

Some people say that suicide, assisted or otherwise, is "wrong." These kinds of absolute value judgments are entirely without merit because values are subjective and based on dynamic context that changes across time, culture, and all kinds of other factors.  If the values are not dynamic, then they're dogma, and dogma is useless.

Very few people will argue with the notion of withholding medical treatment for terminal cases, even if the treatment will improve the quality (though not necessarily the quantity) of life.  "Do not resuscitate" orders are not only common in practise, but well established as proper medical procedures.  And while still controversial in some circles, withholding life support is also a fairly common practise.  How exactly is turning off a respirator different from implementing a dying (but still rational) patient's wish to end his or her life peacefully?

Some say that the Hypocratic Oath excludes doctor-assisted suicide and euthanasia - above all do no harm, and all that.  But what is harm?  Doesn't it include the psychological terror of having to wait two months for one's own death, sometimes in excruciating pain?  Is the mental pain not as awful as the physical agony?  We long ago discovered that health is more than just the state of one's body.  Proper medicine is holistic, and must balance a patient's physical needs with his mental needs.  Surely, then, to treat only the pain of the body and ignore the pain of the mind is a violation of the physician's duty.

There's lots of other reasons we think euthanasia is bad.  There's a huge body of work - most of it available on the Internet - that describes all the arguments for (and against) euthanasia.  But I keep coming back to the ones I've sketched out quite roughly above.  (One could write volumes just on these, I think.)  I think they're the basics.  Until one can disarm these basic arguments, no others will hold any water, and euthanasia remains one of the great missing links in our so-called "advanced" society.

Don't get me wrong: I didn't want my father to die. But I didn't want him to suffer either.

And not that euthanasia is the right thing in any situation, of course.  But just because it isn't right for everyone doesn't mean it's wrong for everyone either.  We need to find a way to give individuals the chance to make this choice, if they can.  There are ways to implement things so that choosing death could be done with dignity.  We just have to have the balls to make it happen.

My dad should have been able to die faster than he did, because he wanted to.  But he couldn't  because the rest of us are stupid, selfish cowards.

I wish this on no one, but if you ever have to look into the eyes of a loved one who is dying, you will see what real pain is. And if they want to be released from it, it's your responsibility - your duty - to put your own needs aside and think of how you can help that person find peace. Maybe there are other ways besides euthanasia; but for some people, euthanasia may be the only way.  And if that's what confronts you, I sincerely hope you will not have to deny that last wish as I was forced to deny it to my father.

You'll have the rest of your life to sort yourself out, but that final act of kindness will be the last thing you do for the other. And I can only imagine the gratitude they will feel that you've put their needs ahead of your own.  I'm going to spend the rest of my life carrying the regret that I couldn't do anything to give my father the peace he wanted so badly.  I wouldn't wish that on anyone either.

If you love someone, the saying goes, set them free.