What would you do? Let the individual decide.

In the first week of the new year came the news of an elderly ill couple that had ended their lives together. As people read these words, their responses may be of many different kinds.

There are those who are, quite simply, grieving. We miss a person’s passing. We mprobably hope that they did not suffer. Other emotions are common with any bereavement, such as sadness, shock, anger, wanting to blame someone or wondering if something else could have been done. Some people immediately feel that suicide in any shape or form is wrong. Others want to know more details. How old were they? Were their illnesses terminal? Or, could I do it in their situation?

My own first reactions are usually, “I hope the person did not suffer. I hope they had a good death.” Is death ever good, you ask? Some deaths are clearly better than others – as you will know if you have ever watched someone suffer terribly before the moment of death. It is true that, with advances in technology, most pain (but not all) can (at least theoretically) be treated. Yet it is also true that a large proportion of pain is not successfully treated in practice. In addition, there are often other factors making life sometimes less than bearable. Catheters, drips, side effects of chemotherapy, or being so doped out by morphine that any meaningful interaction with the world and one’s loved ones is very significantly reduced. It can get to the point where the patient’s possibility of any good experience is virtually nil.

This does not discount the value of last-minute exchanges with loved ones, and the crisis of impending death can reveal new bonds. There is also a practicality when death does not come too quickly. My old doctor, right up to his last year of life, had always expressed the hope that he would die of cancer. When asked why, he said that palliative care is more advanced for cancer than many diseases but most importantly it gives you time to put your affairs in order.

Mr and Mrs Phillips clearly had time to plan. They even posted a letter of intent to their lawyers so their bodies would be found at the appropriate time afterwards. They were discovered sitting calmly on their sofa. They had died within seconds of making the final decision. The means (reported in the newspapers) was helium. Safe, effective, painless, odourless.

The bedrock consideration must be the amount of suffering the person is experiencing in the last phase of life and whether they are the sort of personality that decides, Sooner rather than later: With dignity, rather than dragged screaming. It is up to that person to decide what amount of suffering is ‘unbearable.’

In the case of newborn babies, clear guidelines exist to allow a baby to die, for instance, when a baby had been born very prematurely, suffering brain damage, epileptic, and the evidence is that the child would be blind, deaf, dumb and quadriplegic but fully capable of experiencing pain, then the law allows that child to die. (This was the case of Baby J). Similarly, a person with an advance medical directive (living will) can legally refuse treatment and choose to die from an underlying condition. But these examples refer to people kept alive with life support or medical treatment and who will die swiftly without it. The law makes no provision for those who will simply die a slow, often agonizing death.

Except for the lucky few living in a country where you can ask a doctor to assist legally, or who can afford the large sums necessary to go to Dignitas for an assisted death in Switzerland, the only other option is doing it yourself. The methods of peaceful death using helium (the method chosen by Mr and Mrs Phillips) are now so well-known that there is little or no question of being able to stop someone who has made up their mind. Yet the emails to Exit show some marked differences. Members of organisations such as ours (Exit), or Final Exit Network (in America), or Exit International (in Australia, no connection with Exit), almost always choose inert gas as a safe and reliable means of self-deliverance (rational suicide), if and when things get too bad. Whereas persons feeling suicidal due to a psychiatric condition or psychological trauma tend to go for more dangerous methods. We wouldn’t like to see anyone choose death unnecessarily, for reason of something that could be put right. Yet if death cannot be avoided and the suffering is unbearable and unrelievable, any human being would wish that the last moments of another, whether natural or by their own hand, are as peaceful and dignified as possible.

When couples end their lives together, it can have a romantic sense to it . . . yet only if both are old, both suffering from a disease that is likely to be fatal. We should never glamorize to the extent that one half of a couple feels influenced by a ‘trend;’ but at the sort of ages that we are talking about, surely most people are old enough to make up their own minds.

At the far end of the end-of-life spectrum, some people have simply had enough, thank you very much, and wish to bow out gracefully. For some, disease or injury precipitates the decision or hastens the choice. Others want to let the doctors do their best and see what happens (bearing in mind that there may come a point, possibly in hospital or through incapacity, that you no longer have that choice). Nothing, no-one, should persuade someone else. Let each individual investigate the options and so be prepared. Understand the disease and its likely progression. When you get a diagnosis, wait a few days at least until the shock has worn off and you can think about it with a clear head. Above all, it is your life, your decision. We have a tendency not only to cling to our own lives but to cling to those of others, sometimes to the point of taking away a person’s choice. Yet the motto of life in relation to others should ultimately be: let the individual decide! With a proper assisted suicide law, there would be little, if any, call for self-deliverance. A person could consider their options, what they would want in different stages of a disease, how much and what sort of palliative care, and know that they would be listened to without prejudice. The transparency would not increase early death. It would allow doctors to share their expertise more openly, and without patients ‘keeping mum’ to avoid putting doctors in an impossible position. There are enough doctors that would be willing to help. The courts have on more than one occasion deemed it would be appropriate to pass a law. The only ones that still need to decide are heads of government. Will they continue to support personal agendas? Or will they allow the possibility that the individual could decide?

Further reading:
Husband’s cancer led to couple’s helium suicide pact
Prostate cancer symptoms
Prostate Cancer Support Helpline
Prostate Cancer UK (management of advanced symptoms)
Medical review of prostate cancer palliation
Prevalence of pain in cancer patients
Management of death in severely premature neonates (book)
The Exit template for a new Assisted Suicide Act