Poison vs Personal Care

It has long been an argument of the pro-euthanasia and pro-assisted suicide lobby to say that having a bottle of poison (Nembutal) in the cupboard provides a certain level of comfort and restores a sense of control. Many would add 'for those who are experiencing a terminal illness', or something similar. Philip Nitschke these days is marketing his suicide methods more broadly under the sales pitch: 'You might be healthy now - but you never know!' or similar. 

We reported recently that Dr Rodney Syme was claiming this affect as his intention in supplying Nembutal to Steve Guest in Victoria in 2005:

"My intention was to provide the most effective palliation for his psychological and existential suffering. There is ample evidence in medical and palliative care literature that the provision of control is a powerful palliative intervention."

Syme's claim muddies the waters here and seems more like an attempt to establish a law-changing precedent as a defence against assisting in suicide than it does about providing good palliative care.

Certainly, restoring or enhancing a sense of control to patients can provide peace of mind. This is simply common sense and is, after all, a stock-in-trade tool in good palliative care. But the marketing of a deadly substance to achieve such an end is exceedingly dangerous - especially as it seems to be the only path to restoring control that the euthanasia/assisted suicide crowd promote, albeit sometimes with the insipid rider 'if all else fails'.

And while assisted suicide in Oregon seems to be a provision for the elite (most who access the law are white, well-educated and well off), most people, in my experience, simply live as well as they can and die as well as they can. That is not to say that most people do not fear the trajectory towards dying; nor is it to say that most people do not fear a loss of control. Again, Oregon data shows clearly that loss of autonomy ranks far higher in the concerns of people who access the assisted suicide laws than does a fear of pain and other issues.

Sometimes expressed as concern for 'not being able to do the things I used to do' this loss of autonomy or control is a very broad category of concern. Even if we are to concede that a vial of poison in the fridge can help assuage such concerns, it is never true that having an 'easy out' actually addresses any of them. All it really does is to enable a person to decide not to address such fears.

The Guardian newspaper online had an interesting story this week about a cancer sufferer names Jo Beecham who went public in the UK earlier this year about her 'bottle of poison in the fridge'. Jo Beecham died in October surrounded by her family and friends without using her supply of Nembutal.

Beecham was, until the end, an advocate of assisted suicide. The guardian reports that, as her disease wore on, she received 'better palliative care' and support from a palliative carer, Annie, and had second thoughts about suicide.

The report pulls no punches. The journalist chronicles Annie's previously unquestioned views on assisted suicide - second thoughts on both sides. The two obviously had a great friendship. Both women have influenced each other's thinking. This is not an article about how a former assisted suicide supporter had changed their mind. It is about how effective, personalized care can and does help people to work through these fears.

What has made the difference, Jo says, is "Annie's experience, her calmness. I'm being accompanied. I'm not alone. When I'm in pain and I don't recognise it, and it's really strong, it panics me. I want Annie more and more to be here. I know she'll calm me quickly." One knee pokes up and lifts her fleece blanket like a sail.

"She was full of fear when I met her," says Annie, "fear of symptoms that couldn't be controlled."

The article also talks about Jo's friends who had agreed to 'be there' with her if and when she had chosen to suicide using Nembutal.

In July, five friends had agreed to be present when Jo chose to take the drugs. But as the months have passed, the thought of what's in the fridge has become more difficult for everyone.

"So, I feel I really understand this now," Jo says quietly, her knees swaying under the blanket. "You really are on your own."

"This is something that's coming up more now," says Annie. "Jo's feeling that if she took that route, she would do it in isolation. What you've expressed to me, Jo, is that there was a sense of relief from your friends when you told them you'd chosen the option of palliative care. You said you felt that on the whole they were sighing with relief."

"Yes. Of course, they'd go there with me, but it was like 'Oh, good! Phew!' I'm sure someone would be here, but it would be a sadder occasion." Jo shuts her eyes. "I've gone through moments where I've thought: 'If I take the stuff in the fridge, have I failed Annie?' "

Here we see both the difficulties and the advantages of inter-personal relationships. On the one hand it would seem as though Jo's friends had perhaps not had the courage to challenge Jo about her intended suicide (or if they did, they had not dissuaded her). We often here this: "Oh, well, it is her decision." On the other side, we have her interdependent, positive relationship with Annie expressed in the thought that Jo did not want to let Annie down. This must surely have helped Jo through some difficult periods.

I don't want to be seen to 'cherry-pick' one side of the argument from this excellent article; so here are the closing paragraphs in full:

Jo remains a firm advocate of the legalisation of assisted dying, alongside excellent palliative care, her experience of which has mellowed her position. The drugs no longer appear to be what she wants.

"They may not be," she says quickly, moving to sit up. "But maybe they are. Just you saying that makes me feel antsy." Their presence, if not their use, makes the future feel navigable.

"Sometimes feeling drowsy and nodding off is a relief, because that's where I see I'm going," Jo says. "My body is driving my thoughts now. I'm just going to sleep more, drift off and die. And not really be aware. And that's OK. The beauty of what's in the fridge is that it is there if you change your mind."

But Jo did not change her mind. The post-script says: Jo Beecham died peacefully at home in the company of friends…the drugs stayed in the fridge until her friends disposed of them safely.

It is entirely understandable that someone facing a difficult prognosis will experience a range of fears. We are used to autonomous self-direction of our lives. A difficult life threatening illness changes that; the disease seems to control us, to direct us to a place we don't want to go.

Jo Beecham's example of embracing good care through a developing friendship of trust is evidence of sound choices made with excellent support. Naysayers may suggest that the presence of Nembutal as some kind of backstop aided Jo in her path and provided comfort. I don't think that would be a fair reading of the article at all. As one person commented to the online article: Coming to terms with our own weakness, frailty and eventual mortality, and realizing that we do not lose dignity because we are terminally ill, makes acceptance of end-of-life care much more agreeable and beneficial.

In summary, had the 'poison in the fridge' not been there, Jo Beecham would most likely have taken the same path as the article reports. Had she swallowed the Nembutal we would have been robbed - as she would have - of the story of a wonderful relationship and a good death.

 

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