Friday, 31 July 2009

A dignified end?

Dignitas - the Zurich based assisted suicide enterprise - has been much on the morning bbc radio news listened to as our household persuades itself to get out of bed in the morning. The Times has had two articles describing the rather tawdry and less than dignified surroundings some desperate people pay to end their lives in.
In the Pays de Gex a retired minister of the Genevan church has set up an association called "Le droit de mourir dans la dignité" - the right to die in dignity. This association has nothing to do with the way many people die in dignity, which is well-cared for in hospital on wards specialisng in palliative care. It promotes the "right" to assisted suicide. The retired colleague who set up this local branch likes to think it's his role to shock what he would term Roman Catholic ethical assumptions.

When I first arrived in France 18 years ago I was shocked to discover the lack of hospice care, it was the other side of excellent medical care, death and the end of life were seen by the medical profession as failure and unmentionable. I can think of one particularly tragic situation where the father of three teenage children had invasive and completely unnecessary surgery days before he died. So weak he could only say good bye to his family with his eyes and neither he nor they were really prepared for this goodbye. This has changed enormously in the past 15 years. However, in French the word "hospice" has negative overtones as the places poor people were sent to die - not quite the same visceral reaction as the word "work house" in Britian but similar. Palliative care, pain management and home nurses are much more part of what is on offer now. And Switzerland has an excellent reputation in palliative care, even if it becoming infamous at the moment for "death tourism".

Part of the palliative care movement's philosophy is that a good death feeds out into society. Does assisted suicide feed into society or does it rather feed off and increase people's fears?

Towards the end of my father's life I remember having an uncomfortable discussion with his doctor, saying that I hoped his notes included instructions about not to over-intervene to save his life in an emergency, given his very poor general health - my father had Parkinson's disease for over 20 years, my mother was not getting the support she needed in caring for him, my brother and I both lived a long way away. My father's doctor listened to me carefully - while writing out a prescription for some MS drugs for me - and said that he understood that I felt as I did. As I think back to that conversation I am so grateful that his response sent me back to my own feelings of helplessness and frustration at my father's desperate situation.
We are encouraged to feel that death is something to be feared and the ultimate loss of control in our control-obsessed cultures. What luxury to focus on the very few rich and frightened enough to chose when to end their own lives. Most of the world's population might like access to proper mosquito netting, decent basic health care, enough clean water and regular food - to say nothing of medication. The rich worry about how best to die with dignity, the poor may not be treated with much dignity in life.