Over a century ago Hugh Clough wrote:
Thou shalt not kill; but needs not strive,
Officiously to keep alive
Yet that is exactly what some would have us do.
No one should have what Daniel Callahan has called a "wild death". No one should die in pain, or with unrelieved symptoms, or without dignity. Yet readers will know this is just how too many people die today – and it is not good enough. Many members of the Dying with Dignity organisations are there because of bad deaths they have been close to – their presence is testament to massive medical failure.
Everyone should have access to palliative care (that is, the relief of symptoms) of high quality – and yet that is often not the case. It is not the case because the skills are those of specialised practice and palliative care, like other medical goods, is rationed. At a hospital where I spent twenty years there was a professor of pain management – that is how specialised it has become. Good quality palliative care is getting smarter and smarter – and yet it does not relieve some symptoms for some people. If symptoms are relieved, so are people. If symptoms are incompletely relieved, this might be enough for some people. But some people do not get relief even with good quality palliative care. It is that residuum that faces us with a moral problem each time we meet it.
Wherever there is treatable depression that should be treated. Not only that, but it should be sought out for treatment. One of the saddest occasions for me was when two people developed a viral illness and became depressed. One died by suicide, the other recovered. When the Northern Territory legislation (it was good legislation too) was operative, it required a psychiatric certificate to say that no treatable depression could be found. On one occasion we flew a good psychiatrist to Darwin to provide that certificate when local doctors refused. That requirement for psychiatric assessment has gone.
In my practice of medicine there was sometimes a request for death to be hastened. It was not ever necessary to respond to such a request as patients died promptly – but I was willing and able to help had the requests persisted.
The people who make the laws are too often those with no experience at the coal- face. They have, many of them, never seen anyone die, never shared the anguish of families. One wonders where their arguments come from – they show little compassion for suffering people. For that matter, too many people have no personal experience of death. If life is a fatal sexually transmitted condition, then more of us should be familiar with dying and death. It is the health care workers who see death and suffering – and it should be more of the community as a whole.
Not all wishes for death are irrational – if one has an imminent and unavoidable period of suffering ahead, any person might opt for a quick exit now rather than suffering and loss of dignity later on.
Two of us ascertained, from questionnaires, that Australian doctors do practise advancing death now – they just do not report it or record it on death certificates. About a quarter of all those surveyed said they had hastened death. Medical practitioners do it every day, but they do it without consulting colleagues, without supervision, without rules and out of sight. The Northern Territory legislation required more than one personal request for action over a period of time – protections against hasty or ill-considered action - not now available. And because the requests had to come from the person themselves, there was no chance of coercion.
We can do better than this. The Northern Territory legislation protected the vulnerable and gave a lot of hope to people. It was a mistake to over-ride it. Everyone dies – let us make that universal experience as good as it can be for people and for their families.
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