The dignity of life and death - an uncomfortable conversation

On Monday I found out my companion of nearly thirteen years had chronic renal failure.  Murray had been acting strangely for a while and his breath had been foul.  But when he refused to eat at the weekend and hid away I knew it was time to seek professional help.  And it wasn't good news.  Murray's numbers were at a level that the professional who saw him said there was very little they could do.

Why couldn't they do anything?

Because we don't offer kidney dialysis or transplants to cats in New Zealand.

Murray McFlurray

As Murray's "mummy" I had to make that decision we all dread making.  Whether or not to do the kind thing and put him down, or to let him suffer because you can't imagine life without him.

Like I said, Murray had gone off his food at the weekend and had hid himself away.  When he doesn't jump on the bench and raid the scrap bin for chicken bones or seek out the butter that has been accidentally left on the bench, then I know he, a chronic bench walker, is not at all well.

So I made the decision to put my loyal, loving friend down.  And even though Murray is a cat, my heart is full of sorrow.

I know what it is like to lose a human loved one too.  I've lost grandparents and much loved aunties and uncles.  I've lost a most beloved cousin who died far too young and in a way I wouldn't wish anyone to suffer from.  I've lost friends and students.  I've seen people die of old age, which isn't always a kind way to die.  I've seen people die from agonising cancers.  I've seen people die from accidents that have shattered the lives of the people left behind.  Grief is a soul destroying demon that carves an ugly path in our lives at various points.

But as hard as it was to make the decision to put Murray down, to let him die with dignity and not suffer, I don't envy watching any human go through the agony of a long, drawn out death because we do not have the ability to be as kind to ourselves as humans as we are to animals in regards to dying with dignity.

I didn't want to see my cat Murray suffer, but all to often we see or hear about those who are suffering from agonising deaths.  I don't remember my father's father dying, and I have only small memories of his brother dying, but cancer wasn't a kind death.  My mother nursed her father in law while she was a new mum, and my aunty cared for my uncle.  These deaths took months, their bodies eaten away by the cruelty of cancer.

Just two years ago I watched my "aunty" (my mother's best friend) die of a cancer she only found out about just weeks before her passing.  The doctors had thought that pain that had crippled her for months was due to osteoporosis in her hips and back.  While it was only a matter of a few short weeks from diagnosis to passing, she had been suffering for months with a cancer that is usually only detected during surgery (as it was this time) or after death.

Recently my last grandparent passed away.  At 91 Gran had lived a long and good life, but the last few years with dementia were difficult for her and the wider family.  I had come to terms in November that she would soon pass, but she held out till Christmas.  On Christmas Eve she went down hill and family sat with her for the next eleven days until her body finally gave out.  Her children and the rest home staff endeavoured to give her as much comfort as possible and dignity - but how much dignity is there when you are in pain and unable to control your bodily functions?

But to me the worst dimension to this discussion would be if you were diagnosed with a condition that you knew had no known cure and would result in your own death in a premature and painful way, or worse, incapacitate and trap you in your body, but in the meantime your dignity and independence would be eroded step by step, leaving you reliant on someone else for all the cares you would need daily.

While euthanasia is illegal in New Zealand, as patients we are able to make decisions to decline treatment to shorten our own lives and have written advance directives, such as Do Not Resuscitate, for medical personnel.  These are pathways that a patient must choose, before one gets to that point.  This link to the Hospice NZ statement on hospice care and assisted dying is able to clarify the current views in New Zealand.  But what happens to those incapable of making that decision due to stroke or an accident that incapacitates ones ability to communicate?

The Te Ara site has this to say about euthanasia in New Zealand:

Arguments for euthanasia

Those in favour of voluntary euthanasia argue for the right of individuals to die with dignity and argue that the person concerned is best able to assess their quality of life and make decisions about whether they want to go on living.

Arguments against euthanasia

Objections to euthanasia are that it devalues life and undermines human dignity. Some believe that it also breaks religious laws. The New Zealand Medical Association considers that voluntary euthanasia is illegal and unethical, but supports patients' right to pain relief. It argues that the proper provision of such relief, even when it may hasten the death of the patient, is not unethical.

(from Te Ara Encyclopedia of New Zealand page:  Euthanasia - Death and dying, 18/4/15)

We have two high profile cases in New Zealand of assisted euthanasia which have resulted in court cases:

Lesley Martin

Lesley Martin received nationwide media coverage over the trial of the attempted murder of her mother. In her 2002 book To Die Like A Dog she revealed that she killed her mother due to the pain that she was suffering and was arrested shortly after its release. Martin was given a 15-month sentence of which she served seven and a half months. Ms Martin has since retired from euthanasia reform activism and dissolved Dignity New Zealand.

Sean Davison

In a similar case professor Sean Davison wrote his memoirs in the book Before We Say Goodbye published in 2009, documenting final days of his mothers life in 2006.  A leaked copy of an early manuscript of the book revealed that he offered his mother a dose of morphine to help end her life. He was initially charged with attempted murder in 2011, but later pleaded guilty to the lesser charge of inciting and procuring suicide. He was sentenced to five months home detention.

(from Wikipedia page: Euthanasia in New Zealand, 18/4/15).

The closest an assisted death piece of legislation has come to being passed in New Zealand was a bill called Death with Dignity in 2003 introduced by then New Zealand First deputy leader Peter Brown.  It was defeated by three votes, with one other abstaining and two not voting.  (How MPs voted on the Death with Dignity Bill, NZ Herald 31/7/03). 

It is interesting to note that in 2003 John Key voted for the Bill, but today will not entertain even a conversation about this topic.

And the conversation has gone dead.  Maryan Street from Labour had a bill put forward in 2012 called End of Life Choice Bill.  In this article from Stuff published 12/8/12, Euthanasia bill close to MP's heart, Ms Street discussed the impact of seeing her mother and sister dying from a terminal illness and pain and suffering.  But in September 2013, Ms Street withdrew the Bill from the Members Ballot as there were only two more days of debating members bills before parliament closed for 2013 and she was concerned it would become an election football in 2014 and not get the proper attention (Voluntary euthanasia bill withdrawn, Stuff 26/9/13).

With Maryan Street failing to win an electorate seat or get in on the list in the 2014, the chalice was passed to Iain Lees-Galloway to champion this thorny topic.  Andrew Little said, upon his election as Labour party leader, that this bill was not a priority for Labour at this time, and Mr Lees-Galloway has been asked to put the topic at the very back of the stove.

And so no conversation will happen.

Personally I am conflicted on this.  I do not like to see people suffer and linger unnecessarily, so if it is enacted there will have to be tight controls and parameters.  I can also see the opportunity for the abuse of such a law and the ethical dilemmas that will erupt and divide society and increased issues with elder abuse in particular.

And while I don't know which way to leap on this, I believe this is a discussion we need to have as a country.  We need to have it because other countries have had to have this conversation already and have taken action.  We have to have this conversation because we have people dying a death no one would wish on their worse enemy let alone a loved one.

So which politician, which political party, will have the guts to bring this conversation to life again?

To not have a full and frank discussion on this topic is to fail the standard for those who suffer.