I once supported euthanasia; now I've changed my mind: NZ Nurse tells...
First published on The Leading Edge Blog of Brendan Malone.
Ed: we have confirmed with Brendan that he knows the nurse personally even though this post was published anonymously.
I’m a registered nurse, of admittedly only a short career of seven years. I worked for three years in the hospital wing of a rest home as I studied, and since graduation I have worked in various hospitals around the country.
When I began this career path I was on the fence about the issue of assisted-suicide and euthanasia. As a practising Catholic it was never a choice that I would make for myself, but I felt I could not in conscience deny others, who did not share my beliefs, this supposed ‘right’.
Yet, frighteningly, it did not take long for my opinion to completely change based on events I witnessed.
There was the family that stood in the corridor of a very busy ward and argued about why the individual who held power of attorney was wasting everyone’s time by requesting medical staff keep the patient alive, and that they instead needed to refuse treatment and let nature take its course otherwise, on discharge, the patient would have to go into care and that would eat into their inheritance.
What was this horrible disease that was stripping this individual of their dignity?
A chest infection, which was responding well to intravenous antibiotics.
Then there was the case of the elderly patient who suffered a stroke, nothing too serious, and they started to recover – they were actually a little more peppy, their quality of life rallying. However, the frustrations of adult children and a tired spouse resulted in this patient being placed on a morphine pump. They were dead within a week. While I was only a witness to this situation and obviously didn’t have the full story, to this day I doubt very much the patient was aware of their impending fate.
There was another patient, who, other than being elderly and frail, had no significant co-morbidities and was not in any way terminally unwell. They were not suffering from disease effecting cognition or memory, and they certainly weren’t in any pain.
Yet the choice was made by family, in conjunction with medical staff, to install the morphine pump under the official assumption that a cererbal event had taken place. Again, dead within a week. Again, the patient’s knowledge of this decision was questionable.
There’s been countless family members who tell me that the patient is no longer their parent, their spouse, their sibling, that they’re dead inside, and could I please just give them more morphine to hurry things up a bit.
Then there’s the recent media attention over the practice of “granny dumping”.
This is where a family, for whatever reason (usually frivolous), dumps their elderly relative at the emergency department so they can take off on an overseas holiday, or because they just can’t be bothered checking in on them over a long weekend.
I once overheard a family member tell their hospitalised relative to inform staff that they were experiencing chest pains so that they could remain in hospital in order that the healthy family member wouldn’t miss their flight to Fiji.
I have found myself comforting many elderly patients who, through heaving sobs, recount their belief that they are a burden on their families, that they’d be better off dead, that they are cutting into their family’s inheritance, that they are of no more use to anyone, or that they are a constant nuisance on myself and my colleagues.
They often relate their desire to die as if it was their own idea, free of duress and the heartache of abandonment by those closest to them, yet their body language betrays them and tells a completely different story about what is really going on.
Sometimes it appears as if the family’s desire for their hospitalised relative to pass is driven more by their own fears around illness, death and a powerful aversion to suffering, or even being around those whose suffering cannot be quickly resolved.
Then there’s the family members who have absolutely no shame in admitting they want their relative dead.
I had a family member even ask me once if I could just cut the fingers off a deceased relative in order to remove the expensive rings.
I have heard similar comments made more than once, and it was never in jest.
People in support of euthanasia speak of fear mongering by those in opposition to a law change, and that with adequate safeguards we can ensure the system is not abused.
The media bombards us with tragic stories of intelligent, beautiful people with terrible diseases seeking legal recourse to have a doctor kill them. We are shown images of these dying people from better, healthier days – stunning wedding photos, exotic holiday shots, a happy family celebrating a graduation.
These stories are all very well and good, and I empathise with them – I have seen people die utterly awful deaths due to delays in initiation of palliation. I know what these people could face if the system fails them.
Yet they have networks of friends who support them, family who love them, and oftentimes celebrities and high profile pro-euthanasia groups getting behind them with funding and public relations campaigns designed to change the law.
The problem though is that their personalities and their photogenic natures are usurping intelligent debate about this very serious life-and-death issue.
And these slick, cleverly marketed, and highly emotive PR campaigns aimed at trying to legalise assisted-suicide are also distracting attention away from the truly vulnerable people in this debate – the elderly widow with a lot of money and a touch of dementia, the adult with Downs Syndrome whose parents are now dead, the old man with cancer who is estranged from his children while a grandchild wants his property, the lonely schizophrenic with a history of self-harm.
Furthermore, a lot of what appears in the media presenting the pro-euthanasia view is very disingenuous.
I have never worked in palliative care, but I have been a part of the process for patients outside of a hospice setting, and there is a lot of misunderstanding about what it actually is. A patient is not just dumped in some cold bed in a creepy old house with a grumpy nurse who chucks a few paracetamols at them from time-to-time, while they wither away and die in agony wallowing in their own faeces.
With palliative care there is a beautiful attention to holistic nursing, a consideration of the entire person, their symptom management, and a care that encourages involvement from their Whanau and friends.
Likewise, some articles present the concept that assisting a terminally ill patient with powerful analgesics is somehow euthanasia when it is definitely not. Instead it is morally legitimate and a part of good disease management to ensure a terminally ill patient is provided with adequate pain relief.
There may come a time when those medications are increased in dose to combat the discomfort, with the unintended side effect of the patient drifting into deep sleep and then into death, but this is not euthanasia, it is not unethical and it is definitely not illegal in New Zealand.
There is not so much a reasoned debate going on as there is just a slew of stories and slogans designed to tug at the heart, to illicit sympathy and stir in us an emotional desire to demand death from our doctors for these beautiful people.
But what about the elderly? The mentally disordered? Those with intellectual and physical special needs? The lonely? The poor?
What will they get out of all of this? Humanity has gone down this road before, it didn’t end well.
There’s a saying: hard cases make bad laws.
To those who support euthanasia, please do the research, please look into the danger that your support for euthanasia presents to the truly vulnerable. Please look into the wonderful work being done by palliative health care professionals in New Zealand.
As I reflect on the many instances of heartlessness that I have seen over my career, it strikes me that there’s no predictive formula for abuse. It cuts across all demographics, all areas of life, all diseases and disabilities.
My experience tells me that there can never be any sort of effective safeguard written into an assisted-suicide law that will ever give protection to the most vulnerable members of our community.
That’s why we need to focus our efforts on ensuring that people live with dignity whilst dying, as well as ensuring that they are afforded care and protection when they are at their weakest by medical professionals who have been encouraged by the state to uphold life and it’s inherent sanctity.