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Wednesday, June 11, 2014

The Problem With Euthanasia

Last Thursday, Quebec passed Bill 52 "An act on end-of-life care" that brings euthanasia to the Canadian province.  The new law, passed 94-22, allows doctors to end their patient's life if they ask for it.  

The law was possible because of a loophole - Quebec will treat euthanasia as health care which is under provincial jurisdiction, while the Criminal Code, which lists it as culpable homicide, is under federal jurisdiction.

I applaud Quebec's decision and hope that one day Australia will follow suit.  I know the subject is controversial on religious grounds but remember, if the patient doesn't specifically ask for it, nothing happens. 

Although it's rather long, this account of her mother's death by Australian author Nova Weetman is honest and moving and touches on our innate selfishness of wanting to keep our loved ones around for as long as possible. She calls it "The problem with euthanasia."

Nine months ago my mum asked me to buy an axe and chop her head off. I joked with her. Told her it would be a messy way to go. She was lying in a palliative care ward, dying of cancer. Chopping her head off might have been messy, but at least it would have been quick.

Death isn’t like birth. It doesn’t happen over a couple of days. And there’s no-one standing by ready to assist if it looks like it’s going to go longer. Dying takes time. Before I watched my mum die, I’d always believed so outspokenly in euthanasia. I was adamant that I would help my loved ones find a peaceful end if I were ever in that position. I remember conversations when mum and I joked about pushing her wheelchair off a cliff if she made it to a hundred. But it’s just not that simple. It’s not a question of legality. Or morality. It’s a question of how selfish you are.

Even if I’d been able to slip mum a magic tablet to help her die painlessly in her sleep, would I have done it? I’m no longer so sure. The process of dying isn’t for the patient; it’s for the carers. I wasn’t ready for her to die. I needed it to take time. Over those weeks, I needed to process how I was going to feel. I had to prepare myself for her death, and I did it by sitting by her bed day and night, watching her struggle to breath, refusing to eat, and growing angrier and more distant. It was only after watching her suffer, that I was fully ready for her to go.

It’s selfish. I know that. I’ve struggled with that since she died. It surprised me to learn how selfish I was, even though I knew the pain she was in. It shocked me to realise how willing I was to compromise her quality of life, just so she could stick around for a bit longer. I’ve excused my selfishness by believing that I wouldn’t be like that with just anyone. I needed my mother. I still do. So I guess my need for her to live trumped her need to want help to die. I hope I would not be so selfish with my children or my partner. I hope I could recognise their pain and let them go.

We had never really discussed euthanasia until she asked me to chop off her head. We’d had the time, but instead we talked only of the holidays we would have, or the nights my children would come and stay with her, when she was better. We just never let ourselves go there; preferring to pretend that she would get better. That’s the problem with euthanasia. It’s only an option if you are prepared to consider your mortality. And for my mum, that didn’t happen until it was very obvious she wasn’t coming home from hospital and by then it was too late to plan anything as difficult as assisted suicide, even if I’d been willing to help.

One afternoon my uncle arrived from interstate to farewell my mum, his last remaining sibling. A farmer, and a father of a child who had been very ill for a long time, he was pragmatic about saying goodbye. We didn’t talk much, but he did comment on how cruel he thought dying was, that if she (my mother) were a cow, they would have shot her by now. She was in a Catholic palliative care hospital, and his only other comment was that the bloody priests could fiddle with kids but they couldn’t let people die with respect. He was right. On both counts. But that afternoon, sitting next to her, in the small room, holding her hand as he said this, I was so furious I wanted to scream. I couldn’t believe he could be so callous, so unsentimental.

He didn’t come to the funeral. He explained that he’d rather say his goodbyes when she was alive than dead, and then he hugged me and left. He was practiced in the ways of death. He’d shot suffering animals. He’d watched a whole ward of children die, with his daughter the only one to live. He was okay with it. But I wasn’t.

For months before she went into hospital, my mum was so sick she could barely eat. Losing weight rapidly, she was a walking skeleton. I became obsessed with feeding her. I would cook six different dishes, sourcing ingredients like a crazed chef, and then drive it all across town, often ignoring the needs of my own young family, to try and tempt her with tiny mouthfuls, like a baby bird. It was perverse. She was dying, even then, and we all refused to see it. Instead I was force-feeding her like I would my son when he avoided vegetables for the third day in a row.

The sicker she got, the more I mothered her. For a while she was happy with me treating her like a child. And I was happy with that role, because if I had something practical to do then I could pretend that I was controlling what happened. I could believe that we were somehow beating the cancer.

The day she went to hospital for the last time was one of the brightest she had over those last months. I sat with her for most of the day, making her eat the hospital food that she clearly didn’t want. That day though she placated me. She even managed to sit in a chair for two hours, and talk. She had a nurse who clearly liked her and kept popping in with little extras to make her comfortable. My mum told stories and the nurse kept returning for more. She wanted my mum’s advice on things, and my mum clearly loved being asked. I realised that day that I hadn’t asked her advice for months. Instead I’d stolen something from her. I’d been so determined she would live, so terrified of considering the possibility she wouldn’t, that I’d babbled for six months. Told her all sorts of crap about what was going on. Chatted like it was pouring out of me, with no other outlet, and not once had I really asked what she wanted. If she was scared. If she knew she was dying. If she could tell me what to do.

And that’s the thing with dying. For the person doing the dying, they are ahead of the rest of us. They are waiting desperately for the audience to catch up, for us to hopefully find peace before they go, so they can unburden themselves of the conversation. But if we are too scared to see it, then all they can do is make crude jokes about cutting off their head with an axe.
When she was moved into palliative care, she shut me out. She was cross if I turned up with food. She’d stopped eating altogether, and it was only to please me that she’d occasionally accept a morsel. She was ready to go. But I still wouldn’t let her.
Over the last 24 hours of her life, we were all there. My dad, my brother, and my brother’s partner. Sitting by her bed, not really talking, holding her hand, and answering when she’d barely manage to say I love you. That night, we ordered Thai food from down the road and sat in the waiting area eating takeaway, while my mum dozed on and off in her room. I remember thinking how perverse it was that we were fighting over the last spring roll, while she was getting ready to die.

I don’t know what I expected death to be. But it wasn’t the morphine-induced state that my mother was in. As we crowded around her bed that night, waiting for her to die, the nurse kept coming in and commenting on how strong her pulse was. Death didn’t seem close. At one point, maybe an hour before she died, she even managed to sit up and pull me down on top of her, whispering in her scratchy broken voice about how she loved us. And then over and over in forced words she asked if it was time. That night, watching how totally not my mother she had become, I was ready for her to die. I wanted her to stop breathing. But instead she kept talking. Trying to tell us to look after each other. And I realised she wasn’t quite ready now. We’d somehow swapped positions. Mine was still fuelled by selfishness. I didn’t want to watch the agony of it anymore. I just wanted her to go.

And then in thirty seconds, she just stopped breathing. Just like that. No warning. No death rattle. Just silence.

After she died, I was elated. I’d sat in that room for so many weeks and slept on the fold-out chair for so many nights, drunk too many cups of coffee, and worried. Suddenly, it was all done. I wasn’t consumed anymore. Nothing else was going to happen to her. We went to Williamstown that afternoon. Wandered through the streets of my mother’s childhood. We ate ice cream and played on the docks. And I felt free.

That feeling lasted a day. The elation was gone by the next morning. When I woke, I was confused. I was ready to go and see her and then I remembered that she wasn’t there anymore. And I realised, in that moment, that if I was given the option, I would rather her remain forever dying in a hospital bed where I could at least sit alongside and hold her warm hand, than be gone. Selfish maybe, but she was my mum.