I had just told Mr George* that his end-stage heart failure had become refractory to treatment, and I thought it likely he would not survive this hospital admission. He looked at me carefully and said, “Well that’s it then. Can’t you just give me something…end it for me?”
This is not the first time a patient has asked me such a question, and will not be the last. Often the question is more ambiguous, and it is unclear exactly what they are asking for: “can you just put me to sleep?” could be interpreted as a plea to end their life, but could equally be a request for a break from their symptoms or thoughts, with the hope of a more energised remaining time afterwards. It is a constant challenge to interpret such questions appropriately and personalise support and treatment for the needs of the individual.
In this case I did not hesitate in giving the only answer I could. Both the law and the GMC’s guidance are very clear that both euthanasia and assisted suicide are illegal. However, I always feel uncomfortable with the knowledge that I am powerless to alleviate suffering that is not physical. People who are dying have complex emotional and existential needs that a shot of morphine is not going to touch. What often strikes me about patients like Mr George is that the thought that they are dying still seems to be a surprise for which they are unprepared. I wondered whether he had talked about his thoughts and wishes for his death before now, and whether the many healthcare professionals he must have encountered in the year up to this admission had ever broached the subject with him.
Death is an inevitable part of life but as a society we seem unwilling to acknowledge this. As doctors we are as guilty as anyone; complicit in the idea that advances in modern medicine have the potential to cure all. The medicalisation of death and dying have hidden it away behind sanitised white doors; no longer is it commonplace to see a grandparent die at home surrounded by family, as it once was. The secularisation of society has also contributed to a disconnect between life as we experience it day to day, and a bigger concept of time, place and meaning.
As doctors we need to talk about death with our patients and give them the space to express their beliefs and wishes. As individuals we need to talk about death with our friends, partners and families and break the societal taboo. Some believe a “good death” is an oxymoron, but I disagree. For my own death I hope for comfort, dignity and a fulfilling life before it inevitably comes to take me. Life matters. Dying matters.
*names changed to maintain confidentiality