TERRY PRONE: Legal shift could save families from criminal jeopardy of assisted suicide

IT was the worst thing she ever did as a doctor and it has haunted her every day of the last 15 years.

She came from a brainy family, dominated by medicine. Her parents and grandparents were medics. It was almost inevitable that she, too, would study medicine and she did, spending time at the Mayo Clinic, where she met her psychiatrist husband.

Her career as a consultant anaesthetist was well established before she gave birth to twins — a boy and a girl — and took a year at home with them before returning to work, first in the US, then in a major acute hospital here in Ireland.

The marriage was a good one. Not a quiet one, but a good one. The two of them fought all the time about everything.

They didn’t agree about politics, religion or child-rearing. She thought he drank too much and drove too fast. He thought she had an overblown sense of entitlement arising from the influence of her doting parents, and needed to learn boundaries.

By which he meant she should stay the hell away from telling him how to behave.

Her parents were scandalised when the two of them squabbled at social events or got into full-blown battles at dinner tables. Their son and daughter, however, acclimated early and seemed to understand that the arguments, which were never other than verbal, albeit at high volume, were as significant a method of expressing affection between their parents as were their frequent physical caresses. Their son came back from a school trip to Italy claiming his parents must have been born there — the loud passion of Italian conversation, he said, had made him feel at home.

The twins were in college, one in Scotland, one in Cork, when the result of a PSA test confirmed that their father had advanced prostate cancer.

He had the tests done in the hospital to which he was attached and when the consultant in charge rang him to give him the results, he laughed, believing she was misreading them.

“You’ve added a nought, there, Suzie,” he told her.

“I wish that were the case, Simon, but I haven’t,” came the deadly answer. “I’m very sorry.”

When he talked to the oncologists about treatment options, he was embarrassed that he hadn’t had more regular checkups.

He could see they thought it was crazy for a doctor to have allowed his cancer to progress to an irrevocable point. Even if it was asymptomatic, a simple test could have caught it so much earlier.

Years after the event, his wife told her daughter how taken aback they had been when they told the twins and found them to be sympathetic and concerned, but not devastated.

“Ma, the core relationship in that house was you and Da,” the 24-year-old told her. “Peter and me were always slightly on the outside. We knew that neither of us would be central to the management of Dad’s dying. Much as we loved him — and we did love him.”

The management of his dying was something they addressed as a couple, early and with the brutal clarity which is so easy in the limbo period before a disease takes away the present, the future and any faith in tomorrow.

“Brompton cocktail, right?” he had said, referring to a lethal combination of morphine, cocaine and ethyl alcohol traditionally reserved for terminally-ill patients.

“Done.”

“I’m not joking.”

“Me, neither.”

“Depending on you.”

“Nothing new there, then.”

They talked about the deaths they had witnessed where pain medication was generously used in the clear understanding on the part of the medical staff that — in such large doses — it would suppress breathing and kill the patient; the “double effect”.

It was, they realised, the first time that they had ever talked about those deaths.

“It wasn’t that we were keeping it a secret,” she told me. “It was simply an understood fact between all of the doctors involved. If you had used the word euthanasia to any of us, back then, we wouldn’t even have argued with you. Just been embarrassed at you discussing something so private and quiet and good in such a sensationalist way.”

AS the illness progressed, the psychiatrist surprised his family by his energetic pursuit of any potential cure, whether that offered itself in the form of participation in clinical trials of a new drug, or visits to a faith healer.

He desperately wanted to live, and while he was funny about the faith healer, he kept returning to her. He kept returning to his wife, too, for reassurance about their pact. When he could no longer leave the house and spent most of his time in bed, his wife administered pain-killing medicine. Morphine gave relief, a transient mood lift, but tended to tip him into sleep, and he quickly came to hate the inevitability of that sequence.

In November, eight months after the diagnosis, he told her it was time. He had no quality of life left and saw no point in her and their children remembering him either in agony or asleep.

She nodded and waited for the morphine administered a little earlier to make him drowsy, which it soon did. A couple of days later, after particularly brutal pain, he asked her again and she realised he didn’t remember asking her earlier in the week.

It seemed best to postpone intervention until after Christmas, which passed in a fog of care and pain management. He died on the 28th of January in hospice.

“I couldn’t do it,” she now says. “I could have done it if he was a stranger, but I couldn’t do it to him FOR him. I postponed and rationalised and reduced him to something so much less than what he was.”

She is ashamed of having, in her own mind, partly hidden behind the law. She admits now that she would never have been in danger of arrest. She just used the law to convince herself, at the time, that she should withhold that final cocktail from the man she loved. Failure to help him die shamed her but also, over time, convinced her that he should not have relied on a secret arrangement that could, and did, fail him.

“Any one of us can take our own lives at any time,” she points out.

“The only citizens denied that right are the dying and the physically disabled. Anyone who cannot administer drugs to themselves is denied the right to end their life when they wish to. It stands to reason that if you don’t have the competence to take medications, neither will you have access to any other means.”

She wants the law changed so families of terminally-ill or physically disabled people don’t have to put themselves in criminal jeopardy by assisting suicide. If, well in advance, any citizen could nominate a medical professional to administer medications which would remove pain while depressing breathing, it would, she believes, allow relatives peaceful time with the dying person while permitting doctors to officially do what she maintains they have always – unofficially — done.


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