A Most Undignified Death

This column ran in The National Post on January 20, 2016.

The Supreme Court hearing that granted the Liberals a four-month extension to review assisted-dying legislation last week brought out the usual coterie of critics, many of them religious. We are being warned about slippery slopes and disposable lives. Some of the concerns are fair, others essentially boil down to, “My God wouldn’t want you to do this, so it should be illegal.”

One of the more interesting, and credible, reactions, however, from those who would restrict access to euthanasia on moral grounds is that better palliative care is all that’s needed to fully tend to those in the end-stages of life. There is some truth in this — Canada does need a better palliative-care system, for those who’d wish to take that route.

This argument, however, ignores the uncomfortable reality that a sort of medically facilitated death is already well-established in the medical system, but through the cruellest of possible methods. Simply put, our terminally ill are permitted to starve themselves to death.

This isn’t a decision made lightly by any involved — the patient, their family, or the medical professionals tasked with keeping the patient “comfortable” — and it’s an excruciating experience for all. The body can, for a short time, rely on reserves and stores to maintain some basic level of function. In time, though, it begins to consume itself, seeking to convert any usable tissue, including organs, to fuel.

In 2013, I found myself in an unfortunate and frightening medical situation which, by the grace of God, I survived. When I was in hospital, I had a roommate, a woman in her late-70s who, as I fended off sleep for the very real possibility I’d not wake up, sought for herself a very different outcome.

My situation, a gastro-intestinal disease that took hold and spread, making digestion of food impossible, was not terminal. Or, at least, was not meant to be. Her cancer, though, was, and was as at such an advanced state she could no longer handle the daily intubations; the constant poking and prodding and needling; the unrelating physical and mental agony. She was far beyond treatment, and she now had an intestinal obstruction which required surgery to rectify — one which would not add quality to her remaining days, assuming she survived the operation, but would simply allow for the continued oral intake of nutrition.

The alternative was to sustain life through intravenous feeding (TPN). I’d already had that PICC line inserted — a long, specialized IV threaded from the bend in the elbow, up the the arm, and directly into the heart — to deliver basic nutrition.

She was entirely of sound mind and had all other affairs in order, and her family didn’t object when she refused to consent to either the surgery or the central line, asking instead to be allowed to die.

We shared the same highly-skilled surgeon. He was tasked with directing two very different roads of treatment: fighting to keep my body supplied with nutrition while I recovered, and overseeing her demise.

Both our bodies were self-catabolizing. Both were in various states of multi-organ failure — the putrid, potent, unmistakeable stench of renal failure was inescapable and unbearable. For me, the threat of imminent death was terrifying. For her, it was a most merciful gift — an escape from the hell of a body in the final stages of rebellion.

Her suffering was considerable, and I lay in silence, listening as her anguish intensified. Sometimes what I heard carried over into dreams. When asleep, I heard the very real sound of nurses struggling to place a tube in her esophagus, played out in my own shallow nightmare in which I was choking on my own and failing to breathe.

After a series of conversations between my roommate, our surgeon, and her family, she was moved to a private, under-no-circumstances-to-be-disturbed room directly across from the one we’d shared, where she’d quietly deteriorate and rapidly emaciate. Her son held vigil, stoic, at first, and then less so.

The end was neither merciful, painless, nor swift. It took weeks for her to die. Her pain eventually came to an end, but her son’s never will. Had euthanasia been available, as she wished it was, it would have spared my roommate the drawn-out ravaging, and her son the unnecessary, additional trauma. The end result, of course, would have been identical.

It’s not clear to me where the ultimate line should be drawn in terms of age or disease, or what would constitute sufficient level of suffering — or how the extent of which would be measured. These issues are, to state the obvious, complicated. But as the government works to draft new assisted-suicide legislation, it’s essential people be aware of what is currently the status-quo, and why it cannot be allowed to stand. We’ve had a form of medically facilitated death in Canada for years. It is far crueller, but no less fatal, than a quick, merciful needle.