In the Midst of Life

by Jennifer Worth

  If the Angel of Death had shown Leah the manner in which she would die, I am quite sure she would, like most of us, have said, ‘Oh no – not that. Isn’t there an easier way? Anything would be preferable.’ But if the Angel of Life had stepped in at that moment, and shown her fourteen months of increasing difficulty, but also of friendship and family love, I am quite sure she would have said to Death, ‘If yours is the price I must pay, so be it,’ and she would have turned and taken Life by the hand.

  EUTHANASIA

  It is surprising how many people are quite unable to talk about death, yet are happy to talk about euthanasia, and they do so with the assured confidence of one who knows all the answers. Consider the following conversation I had with a neighbour in 2008. He started:

  ‘I’ve got to go and see my mother in the local care home.’

  ‘I didn’t know she was there.’

  ‘Yes. She fell and broke her pelvis last year. She’s eighty-six. She’ll never walk again.’

  ‘That’s very sad, at that age.’

  ‘It was dreadful in the summer. That hospital’s a disgrace, you know. It ought to be closed down. She developed MRSA. We nearly lost her.’ He sighed. ‘They managed to pull her through, but her mind was gone; she doesn’t know where she is or who we are.’

  ‘It would have been better if she had died of MRSA, then?’

  ‘Oh no. I’m a great believer in euthanasia.’

  ‘But what’s the difference?’

  ‘She was suffering. It shouldn’t be allowed. But if they gave her an injection, a little prick, she wouldn’t know anything about it.’

  ‘She’s probably suffering now, in the care home.’

  ‘Yes, and it shouldn’t be allowed. Euthanasia’s the answer. I’m a firm believer in it. You want to read up about it on the web.’

  I wrote this conversation down verbatim immediately, so that I would not forget it. He was obviously shocked when I suggested that she could have died of MRSA, but then immediately said that she should be ‘euthanised’.

  In May of this year, I asked my neighbour’s permission for this story to be published, and I asked him about his mother’s present condition.

  He said: ‘She is in a dementia care home. It costs us £500 a week. She is doubly incontinent, she can’t really walk, she has no real mental understanding. Does she have any quality of life? No.’

  I asked him, ‘Is your opinion about euthanasia the same?’

  He was very clear in his reply. ‘Oh yes, definitely. And my father had the same belief.’

  ‘And would you still say that she should have died three years ago when she broke her hip, which was the beginning of the end?’

  He was thoughtful for a very long time, and then said, ‘Yes. Euthanasia is the best, but as it’s not legally possible, I think she should have been allowed to die of the MRSA infection.’

  Later in the conversation he repeated his opinion about the hospital being a disgrace because of MRSA. This attitude is heard all too often. When I was a young nurse, old people in hospital frequently developed pneumonia and died. In the 1950s massive doses of antibiotics started to be given to kill pneumococcal organisms and every other infection. But micro-organisms are the basic life form, and, when attacked, they adapt and mutate in order to survive. This is the Darwinian law of life. So these simple cells have developed a resistance to antibiotics, and no hospital can be blamed. There have always been infections in hospitals, and always will be. These ‘super-bugs’ are no more than a variant of ‘the old man’s friend’.

  The remark that suffering shouldn’t be allowed is widely held, and many would agree with him. Yet suffering is a part of life, just as happiness is, and it is certainly not a justification for ending life. Suffering stalks the wards of all hospitals, but it is not senseless; if it was, all life would be senseless, and it is not. Indeed, suffering is a mystery that we cannot fathom, and never will be able to. The mystics embrace suffering, as one of the steps towards perfection.

  I remember a lady whom I nursed when I was at the Elizabeth Garrett Anderson Hospital. I will never forget her, or what she said. She was a nun from a prestigious Roman Catholic teaching order, with schools in France, Belgium and England. She was a Latin and Greek scholar, and was deeply respected not only for her intellect but also for her teaching skills and her administrative abilities.

  She was only forty years old, but her body was inflamed and distorted by rheumatoid arthritis. Her joints were virtually locked, like those of a wooden doll, and any movement was agony for her. We made matters worse by administering quite the wrong treatment. At the time it was thought that aspirin helped arthritis. Perhaps it did, sometimes, but this lady was allergic to aspirin, and she developed a duodenal ulcer. Nothing was known about allergies in those days, and it was thought that milk was the best treatment for a duodenal ulcer, so she was put on a milk diet, which meant about six pints of milk a day. This caused an irritable bowel and constant diarrhoea, but still we persisted with milk and aspirin, not knowing that both were causing the violent reaction. At no time of the day or night was this poor lady without pain. She could not move because of the arthritis, and her inflamed gut allowed her no rest. She could barely sleep. We had to turn her hourly, sometimes more frequently, to clear the frothy faecal fluid and blood that poured from her. Moving her was agony for the arthritic-locked joints, but she never complained, nor even let out a moan of pain – yet we could see the suffering in her eyes.

  One day she said to me, ‘I used to think that I was doing God’s will in my religious vocation. I used to think that by teaching the girls, and instilling a love of classical learning, and the knowledge of Holy Scripture, that I was serving God. But now I know that I was wrong. God does not need my intellect, my learning, or my teaching. All that God requires of me is that I should lie here and suffer.’

  This lady had entered the hell of physical suffering and, in its depth, found spiritual peace.

  The prospect of state-sanctioned euthanasia sends a chill of despair down the spine of most medical people. Medicine is a vocation, not a job. It is a calling, comparatively rare, to care for and, if possible, to heal the sick. To promote death is contrary to the Hippocratic oath and inimical to the heart of medicine. If euthanasia became law, medicine, as we understand it, would come to an end.

  The vast majority of people are simple, trusting souls who lead decent lives, go to work, raise their families, meet their friends, and, when they get sick, they go to their doctor in the hope that he or she will be able to make them better. If there was the smallest chink of suspicion, especially in the minds of the helpless or the chronically sick, that they could be ‘put down’, the trust would be destroyed. ‘Put down’ is emotive language, usually best avoided, but it is the language of ordinary people, it is the way most of us think and feel about these things.

  I am a Christian; with every breath of my body, every beat of my heart, I trust and love God. Christian teaching guides my thoughts and my life. But when it comes to euthanasia, I flounder in a sea of uncertainty. It is horrifying, and contrary to the ten commandments, to think of killing the weak and helpless. Yet I also believe in evolution, and it may be that the necessity to decide the time of death for ourselves and others is part of God’s purpose for the evolutionary development of mankind towards responsible maturity, to which we will have to adapt mentally, spiritually and emotionally. Yet still it shivers me, and I don’t know the answer.

  State-sanctioned euthanasia would open the floodgates for the entry of unimaginable wickedness. Not everyone is well motivated, not all families are loving, not all people wish their neighbours well. Doctors are not all wise and good, and it is quite possible to become addicted to killing, as the career of Dr Harold Shipman has shown us. The Devil is alive and well in the twenty-first century, and will no doubt exploit the opportunities for evil.

  Yet a paradigm shift in the evolution of man has occurred in the last seventy years, which has altered birth, lif
e and death, totally and irreversibly. Scientists can now confidently say that human life could be extended to two hundred or three hundred years, and some even say a thousand! Having seen, in my own lifetime, the miracles (that is not too strong a word) that medicine can achieve in saving and extending lives, I do not doubt that this will be possible. But given the difficulties this could imply - questions of quality of life, overpopulation, human and natural resources - a cut-off point will have to come somewhere. If it does not come from natural death, or individual decision to die, it will have to be imposed. This is euthanasia.

  The personal decision to die at the right time, and in the right way, is the ideal promoted by those who would legislate for voluntary euthanasia. But will it really end there? If medicated life can be extended, decade after decade, with no end in sight, surely someone will have to make the decision to end it?

  To ‘turn off the machine’ is the expression most people use to mean ending life by turning off life-support equipment, such as a ventilator or a kidney machine. But, although the ethics are exhaustively debated, and a legal decision is required before it can be done, it involves relatively few people and occurs only in special circumstances. Yet the issue is more complex. As with everything in life, it is the little things that shape our destiny. Millions of people daily take drugs that keep death at arms’ length for a few more weeks, or months, or years. Should that switch be turned off? In other words should we, who are dependent on drugs, cease to take them and allow death to come? And if so, when? This does not require the decision of a judge or magistrate. It is a personal choice.

  I have heard several ageing people, who enjoy robust good health thanks to cardio-vascular drugs and other life-maintainers, tell me quite cheerfully that when the time comes they will want to ‘take something to end it all’. When I point out that it would be far easier to stop taking life-maintaining drugs, or have the pacemaker disconnected, their smile vanishes. The muttered response is usually something like, ‘But I couldn’t do that’ and the person looks profoundly unhappy, and sometimes even shudders. The reaction is muddled thinking, certainly, but understandable. Which of us does not cling to life? When dying seems years away, we can be objective, even blasè, about it; but when it is to be next year, next month, next week - oh no! - and we reach for the pills that will prolong our time on earth.

  Yet I am convinced that within a short time – a generation, perhaps, or two at the most – we will all have to take responsibility for our own deaths, and we will have to get used to it.

  But what of those who cannot take the responsibility, or cannot articulate it? Most people would say that the doctors must decide. Under common law today, and perhaps more subtly, social pressure, doctors have to be very careful of withdrawing life-maintaining drugs. It is not strictly speaking euthanasia, but it is close.

  The people who run Dignity in Dying (formerly the Voluntary Euthanasia Society) fear being kept alive unwillingly more than they fear death, which is understandable. However, to me at any rate, their mantra of dying with dignity is less easy to understand. Dying is a biological process, and there is no dignity to it, as anyone who is familiar with death will tell you. But the departure of the soul from the body is spiritual, which is altogether different. Even people who do not believe in God, or the human soul, will tell you that at the moment of death something mysterious, even awe-inspiring, occurs which they cannot explain or understand.

  ‘To die in peace’ is the biblical expression, which I prefer. To be allowed the space, the time, and the silence in which to know that I am going to die, to contemplate death and to come to terms with the inevitable, and above all to become friends with and welcome the Angel of Death, is what I pray for. All dignity will go as control of bodily functions goes, and I will become totally dependent on others, but if peace remains, that, for me, would be the perfect end.

  Yet I am realist enough to know that such an idyll is unlikely. A hospitalised death amongst a crowd of other old ladies is what I can expect, and must accept. There will be no peace, and this, too, must be accepted. I anticipate rejection, because the old and ill are not a pretty sight, and few people want to enter these places. Few people want to draw close to death, so I must accept that I will probably die alone. It is widely assumed that the dying will be in pain, and the kindest thing is to drug them, so I accept that I may be drugged stupid, and my role will be simply to submit.

  This is not an inspiring end, but it is already the norm, and few of us will escape it. We can cry aloud: ‘Do not go gentle into that good night … Rage, rage against the dying of the light.’* We can huff and puff about our dignity and our rights, but it will avail nothing. Death, the great leveller, makes fools of us all. The Grace of Humility, and her sister Acceptance, will be a better and surer guide on the hard and stony path that lies ahead.

  But what have we to complain about? Practically everyone of my generation leads a life enhanced by, or even dependent upon, medicine. We have grabbed greedily the extra years and called them our ‘right’. So perhaps we should simply accept that a hospitalised death is the price that must be paid.

  Euthanasia is not the same as suicide, which is no longer a criminal offence. On 9 July, 2009, Sir Edward and Lady Downes died in the Swiss clinic, Dignitas. Lady Downes was seventy-four, riddled with cancer, and had been told she had only a few weeks to live. Sir Edward was eighty-five. He was comparatively healthy, but his hearing and eyesight were going, and he was finding it increasingly difficult to cope with the infirmities of old age.

  Sir Edward had been a very distinguished opera conductor. I knew his name fifty years ago when I was a young girl haunting Covent Garden Opera House, queuing for hours for a cheap ticket. Edward Downes was a repetiteur in those days, occasionally taking the baton when someone fell sick. Later, he earned international acclaim. I was stunned to read of his death, and of the way it had occurred.

  This clinic, Dignitas, gives me the creeps. What sorts of people administer it? I shut my mind to such thoughts. But when it came to contemplating the death of Sir Edward, it seemed to me entirely logical. He had married the ballerina Joan Weston in 1955 and theirs was a true love match, lasting for fifty-four years. The thought of life without her must have been intolerable to him. Had her illness come ten years earlier, when he was still conducting, he might have seen things differently. But at eighty-five, with his life’s work over, due to failing sight and hearing, and beset with the usual problems of old age, and above all, the loss of his wife, he wanted to go with her.

  In the olden days – as my grandchildren would say – a man like Sir Edward would probably not have survived for long after the death of his wife. Grief-laden, lost and disorientated, unable to cope, perhaps not eating, not taking care of himself, he would have wandered aimlessly around and ultimately ‘taken to his bed’, from which he would neither have had the strength nor the will to rise. No one would have been surprised. It would have been a welcome and merciful end to a long, happy, and fulfilled life.

  But we are not living in the olden days. We are living in the twenty-first century, when it is not lawful for an old man to die of old age. A team of doctors and nurses and social workers would have been on to him, assessing and monitoring every function of his mind and body. Dozens of things would have been found to be ‘wrong’ with him, for which drugs could be prescribed. Had he attempted to refuse treatment, psychiatrists would have been called in to assess his mental capacity. It could have gone on for years. Sir Edward was having none of it. He wanted to go with his wife, and he chose to do so in the only way that he felt he could.

  Less than a month after the deaths of Sir Edward and Lady Downes the Law Lords required the Director of Public Prosecutions (DPP) to clarify the law on assisted dying. Hitherto, to aid, abet or assist anyone to commit suicide had been a criminal offence with a maximum penalty of fourteen years in prison. However, no one in the UK has ever been prosecuted for doing so.

  In February 2010 the DPP confirmed th
at someone who was ‘wholly motivated by compassion’ should not be charged with a crime. This is one of six factors for prosecutors to consider as they decide on the merits of each case. Assisting suicide is still a criminal offence, but the new guidance means that it may not be regarded as being in the public interest to prosecute.

  We are on the cusp of a seismic legal change concerning the condition of human life at its close. Events are moving so fast that, at the time of publication, this section of my writing may already be out of date.

  A Commission on Assisted Dying was set up in 2010 and is expected to continue until the end of 2011. After that it may well be that new legislation comes into place.

  2010

  HELGA

  Is there anything more enduring than an old friendship? Beautiful, elegant … Helga will always be associated in my mind with Paris in the mid-1950s, where we both worked as au pairs. She was about twenty-eight, and I seven years younger. She was German, from Munich, where her father was an opera singer at the State Opera. The Nazi Party, the war, and the virtual destruction of Germany had overshadowed all her early life; she had known nothing else. Her mother had died, and, after the war, Helga and her sister were homeless - I never knew exactly why, because her father was still alive. She hinted that her father was a very difficult man, a musician and singer, wrapped up in his art, expecting and revelling in the adulation of his fans (mostly women), and quite incapable of looking after two teenage girls. The two sisters walked hundreds of miles to an aunt who lived in or near Hamburg. They ate whatever they could find, and slept where they could. She told me that the American soldiers stationed in Germany were always very good to them, and it was through contact with them that she learned to speak English, which she spoke all her life with a delightful touch of an American accent.