Dying and the question of dignity

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As a palliative care nurse, I have been privileged to be with many people at the time of their death. People of different ages, nationalities, professions and family histories, in homes, hospitals and aged care facilities. Dying is hard work, perhaps the hardest we will do; although living through the death of a person we love might be the toughest task of all.

Main image: Nurse holding patient's hand (Getty Images)

And yet on the faces of people close to death and those around them, I have seen not just fear, sorrow and pain, but smiles, winks, joy and flashes of pure love, too. This writing is to share just a few of the many profound moments I have witnessed in my work, which I believe speak to our human dignity in a way that euthanasia and assisted suicide never could.    

One night, I was called to see a man at his home. He lived with his family, was in his fifties and had advanced cancer. His wife asked me to come because his breathing and consciousness had changed, and she was anxious for him. He lay on the bed, she and their three young adult children close by. Sitting on the side of the bed, I carefully looked over him. His breathing was irregular; his eyes were closed. He was no longer speaking, but somehow, his face and body communicated deep peace.

I looked up to his wife and children and spoke about his death being near and how peaceful he looked. That there was no need to do anything except to stay with him and that he could hear them speaking, even if he couldn’t answer. His children were very quiet and I don’t exactly recall what his wife said to me in return, but I do remember profound relief and thankfulness flashing across her face. The man died at home early in the next day. Later, she conveyed back to me how those few words about his peace had sustained them during their last night together, and in the hard days following.

Others stay with me — an unconscious woman, whose face suddenly and unexpectedly radiated bliss as we gently turned her in the hospital bed the day before she died. Two young parents, gathered with other family around a small boy as he lay dying on bed in a room of their house one long summer afternoon and evening, sharing a small family joke that brought laughter and lightness to the almost overwhelming heartbreak and sorrow we had all felt in the hours before. When that lightness came into the room, the little boy quietly breathed his last breath and died, as though he had been waiting for just that moment.

Peace, laughter and lightness during dying might seem unlikely, but such experiences are common, not rare. Seeing and sharing in these sudden, strengthening consolations (and receiving them in my own griefs) have taught me about our awesome potential to transcend suffering, and confirmed why we don’t need euthanasia or assisted suicide.

 

'A peaceful death is a good thing for us to hope for and work towards. But, as a nurse, there are reasons to believe that giving lethal doses of medication does not make dying peaceful or gentle.'

 

A second reason why even the thought of euthanasia or assisted suicide repels me is the indignity of such acts, for all involved. The general misunderstanding in the debate seems to lie around the myth that these acts bring about a peaceful and pain-free end, as though it were ‘just like going to sleep’. A peaceful death is a good thing for us to hope for and work towards. But, as a nurse, there are reasons to believe that giving lethal doses of medication does not make dying peaceful or gentle.

During palliative care some patients require certain medications to manage symptoms such as pain, breathlessness and anxiety. The same (and other) medications form the ‘cocktail’ used to perform euthanasia/assisted suicide (the combinations of which vary in different parts of the world). Even a little too much of the medications for symptom relief can cause distressing side-effects such as dizziness, nausea, vomiting, irritability, hallucinations and delirium. Giving these medications in the extreme doses that are required to bring about death is therefore bound to cause these side effects intensely. Being sedated or paralysed during euthanasia does not guarantee every person will be unaware of the side effects, just rendered powerless to communicate the experience.

Other technical problems and complications reported in euthanasia (as well as capital punishment deaths) include cardiac arrhythmias, difficulty accessing a vein, painful injections, gasping, jerking, seizures, regurgitating ingested medications, and a longer (or shorter) than anticipated duration of dying, all of which are likely to cause distress to the person dying, the family, and the health professionals performing and assisting in the act. Health professionals involved in administering lethal injections in countries where it is sanctioned by law have described it as ‘unnatural’ and ‘a harsh and harrowing way to end life’.

There are many other wider negative ramifications of legalising intentional killing by health professionals, as other authors have comprehensively outlined. Here, I go simply to one core aspect of the matter: euthanasia or assisted suicide cannot be the peaceful, merciful or dignified death many believe it to be, because deliberately causing death requires inflicting extreme physical harm. Following this logic, do we really want a law in South Australia — or anywhere — that allows health professionals to take the lives of terminally ill people in such an undignified, violent way?

As I concluded writing this piece, National Palliative Care Week 2021 began. Readers can inform themselves about the benefits of high-quality palliative care and how it is being implemented in Australia.

 

 

 

Dr Annmarie Hosie, PhD, RN, MACN is Associate Professor, Palliative Care Nursing, The University of Notre Dame Australia and St Vincent’s Health Network Sydney. Her research is focused on improving the care, function and quality of life of older people with advanced illness. 

Main image: Nurse holding patient's hand (Getty Images)

Topic tags: Annmarie Hosie, palliative care, voluntary assisted dying, euthanasia, dying

 

 

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Existing comments

I suppose we can only record our experiences ... I asked for my mother, who was very old and prayed every night to die, to have 'terminal sedation' when it was clear that her brain function was becoming ever more reduced. She lasted 8 days and I sat with her every morning and afternoon for quite some time and never saw any sign of disturbance. She looked happy. I have experiences of other lingering deaths in the family that were horrific and I know which I would opt for, given the chance.


Russell | 25 May 2021  

A very biased one sided article. When someone's time is up let them die with dignity. When someone is dying why prolong the agony, when the person cannot speak, cannot move, cannot feed themselves. There is more love and compassion helping a person in such a situation than causing them to live like that.


Robert Colquhoun | 25 May 2021  

Deeply compassionate and truly rational. I have not yet heard any informed feedback from those who witnessed ‘dignified dying’ in Victoria. Perhaps it wasn’t as dignified as they’d hoped?


Joan Seymour | 25 May 2021  

Thank you, stay strong and clear-eyed in your service. Being there; not abandoning - powerful testimony.


Michael | 25 May 2021  

Thank you so much for this beautiful & factual discourse o death. I have been privileged to share a friend’s death and have told my family that I WILL NOT have ‘Assisted dying’ read murder. Palliative care is a beautiful way to move to our next life.


Veronica | 25 May 2021  

The whole premise of voluntary assisted dying is to take decision making out of the hands of vested interests like these. Every shred of evidence here could more realistically applied to those suffering slow, painful, undignified deaths devoid of choice. Allow people to make their own choice.


Tony McCulkin | 25 May 2021  

How I wish we had sufficient public recourses to fund effective palliative care for all.


John Bryson | 25 May 2021  

Thank you very much Dr Hosie. Two quick thoughts. To my mind one insuperable objection to euthanasia/assisted dying is that it requires one or more of us to become life-takers, rather than life-supporters. Living (or dying) “with dignity” is not something the person under discussion holds on to or loses by or in themselves. Their innate and eternal dignity is demonstrated by the way others treat them. Just as my infant grandchild is treated lovingly and supportively even when her nappy needs replacing, so too at the other end of life, when we may not have the capacities we once did, our dignity endures and must be honoured.


Gerard Hore | 25 May 2021  

I'm not sure that this article can be presented much differently than with the confronting, clinical descriptions of lethal medication listed but would suggest that the common notions of "dignity" and bodily injury or health deterioration don't have much in common. Intensive and palliative care treatments for pain have come a long way but it's only 12 months since a personal conversation with a registrar that advised both renal and liver failure due to painkillers administed post-op; when dealing with the human element of pain tolerance, particularly if medication is to be prolonged, those wonderful relief drugs can fight pain but I suggest some readers would be perturbed with the concept of being incontinent, bed-ridden but medicated within a margin of bearable pain (zonked out) for an interminable period, perhaps many years. The empathy we share with those suffering directs us to their same ultimate question: when does it stop? Perhaps it is a selfish weakness that some see a "coup de gras" as an escape for themselves as well... but most will demand it is bloodless, non-violent and somehow peaceful. Dignity in life is most commonly a preservation of self-worth; perhaps dignity in dying is also reserved for the individual?


ray | 25 May 2021  

Thank you to Dr Annmarie Hosie and "Eureka Street" for this testimony. It provides a medically considered and hope-inspiring alternative to the pro-assisted suicide accounts that usually dominate the letters pages of our daily newspapers in the lead-up to parliamentary voting on the issue.


John RD | 26 May 2021  

Robert Colquhoun: ‘A very biased one sided article.’ Yes, this article is unconvincing because of the wealth of empirical evidence that the nervous systems of many people don’t go nicely into that good night. The fact of the matter is that if a Christian is fated not to go nicely into that good night, the Christian is under an imperative not to avoid the trauma but, to put it bluntly, to suck it up for the benefit of others at risk of being involuntarily euthanased. Having other people around to lighten the load may help but the only consolation that helps a Christian, or a theist of some kind, to suck it up, is that reward awaits in exchange for duty, which may result in a delightful surprise for an atheist who is graced to die courageously for those at risk of involuntary euthanasia. The examples do not convince because there is unavoidable relief, even in the consciousness of the dying (who, if they can hear, can think), that it’s finally going to be over. Death is too important even to be left to the dying; people should orient themselves towards it well before it becomes a diary appointment.


roy chen yee | 26 May 2021  

Thank you Annmarie for your witness . I was privileged to attend my mother's passing many years ago. I agree with Annmarie that she seemed very peaceful, although in a coma by the time I arrived at her bedside. Now in my seventies, I have to face the reality that I am closer to my end . I wish for a peaceful end without its hastening.


Gavin O'Brien | 26 May 2021  

Commentary from a genuine expert like Dr Hosie who is actually involved in the care of the dying unfortunately gets drown out by the voluminous, amateur, self-promoted, expert bystanders and commentators not involved with the sick and dying, some of whom even find their views promoted in ES. The defence of this is couched in terms of the necessity for debate and, of course, meaningful dialogue, whatever that is. For a Christian adherent there is no debate and no meaningful dialogue other than that which classifies euthanasia as murder and sees death, like life as a matter for God first and man as the junior partner.. No doubt the proponents in favour of killing the sick and terminally ill will all be lining up with their care and compassion for employment as the executioners, volunteering out of their superior sense of public duty. In civilising the ancient world, Greece and Hippocrates eliminated state sponsored euthanasia. And now, our enlightenment Western Civilisation seems hell bent on a return to the barbarism of uncivilised times.


john frawley | 26 May 2021  

I've worked as a volunteer in a hospice for over 20 years which doesn't make me an expert by any means, but it does mean I'm interested. I'm particularly interested in calm, rational discussion about this topic from either side of the fence. This article fits that bill except when the author asserts that '... euthanasia or assisted suicide cannot be the peaceful, merciful or dignified death many believe it to be ...'. Of course we can't guarantee that with anyone, but to assert that it 'cannot be' seems to go against the evidence and the testimony of many. Clearly we don't hear enough about the assisted deaths that do go wrong, but to effectively claim that they never go right seems to be more of an ideological assertion rather than one from the evidence. Otherwise the article made some very good points.


Tony Carey | 26 May 2021  

One’s journey of death is entitled to the same degree of respect and loving compassion as all of life’s journeys. Like Annmarie and others who have commented, I have experience of being with people in their end-of-life phase and seen both peaceful and respectful periods and the exact opposite. I believe we do have the right to request assisted dying, something I will definitely include in My Health record when able. And I expect my family to honour my wish just as I will respect anyone who does not ask for a similar journey and will, if in the position to do so, help in any way I can to assist in whatever as possible. It is good that the topic is up for exchange. Thanks for the article and to all who have contributed to the discussion.


Elizabeth | 26 May 2021  

Elizabeth. When you say "One's journey of death is entitled to the same degree of respect and loving compassion of each of life's journeys" you are stating the ideal and, of course, you are absolutely correct. The problem is, however, that we no longer live in a society that agrees with that sentiment as evidenced dramatically by the fact that on the journey to the fullness of life millions of defenceless and innocent human beings are killed every year in their mother's allegedly nurturing wombs by "legal" abortion - and they are remarkably healthy and not suffering terribly. The aborted is killed because of its effect on the lifestyle and comfort of the abortion seeker and the income of the professional abortionist. Euthanasia, like abortion, relieves the discomfort of the onlookers, the inheritors and anyone else whose life is made uncomfortable by sickness. Palliative care delivered with the compassion you mention is very effective for the dying and should be an integral and adequately funded part of the healthcare system.


john frawley | 27 May 2021  

Hello Elizabeth: I share your views and appreciate the respectful way you have expressed them. As commented in Frank Brennan’s article, I did volunteer hospice work and have also experienced being with mainly elderly men in their end-of-life journey. I agree with your view on assisted dying. My concern is that it could become the imposed option for the powerless, like the men I visited. Without adequate funding in palliative care it could over time all too easily become the case. I agree with you assisted dying is the discussion that has to be.


Fosco | 27 May 2021  

Annmarie I agree with your conclusions. The Assisted dying act passed in 2017 by the Andrews Government was and is a disgrace, and in direct conflict with the Church's teaching (which bluntly describes medical Euthanasia as murder). Keating and Turnbull spoke out against this bill but Andrews persisted and regards it as one of his Government's stellar achievements. Holland has a similar law. Many of their citizens now believe that 50 percent of lives terminated in this fashion, a contradiction to the Hippocratic oath, have not consented. In short, it could become a convenient management tool to ease overcrowding in aged care while disguised as dying with dignity. SS physician Josef Mengele conducted inhumane medical experiments on prisoners at Auschwitz. He was the most prominent of a group of Nazi doctors who conducted experiments that often caused great harm or death to the prisoners. The so called "angel of death," justified his experiments based on the Nazi theory that Jews and Roma gypsies were inferior races. Andrews also likes to play God. He was the major push behind late term abortion in Vic 2008 under Brumby. So now, in Vic , provided 2 doctors agree, a child can be terminated up to the imminent point of birth. With respect, only God should decide when a person's life should end. Not politicians.


Francis Armstrong | 27 May 2021  

Annmarie, I see now as well as this Bill being tabled in Adelaide for future use, it has also been tabled for use in Qld by the Premier Annastacia Palaszczuk on May 25 when she said : "the Voluntary Assisted Dying Bill 2021 will now be scrutinized by the Health and Environment Parliamentary Committee, and will go through further public consultation." Sugar coated with a promise of $171 in extra palliative care, dissenters can only comment and propose amendments to specific clauses rather than reject the proposed bill out of hand. This is an attempt to railroad the unsuspecting public into accepting a poison needle disguised as a juicy red apple for mindless consumption so Doctor Death can operate unimpeded. Heaven help us all.


Francis Armstrong | 03 June 2021  

From what I have read about what is transpiring recently in the Netherlands and Belgium regarding 'voluntary' euthanasia/suicide I am deeply worried. My late father, almost the archetype of the stiff upper lip Raj Era British Indian Army officer with all the trimmings, lived till 94. Like many older people he suffered a number of debilitating conditions. For the last six months of his life he was in an excellent nursing home. I was the last person to see him alive. He went to sleep on me. If someone had suggested euthanasia to either of us we would have hit the roof. You do need good, sensitive doctors and proper facilities. Dad is probably in Heaven leading fierce little men from Nepal with very sharp kukris once again at Monte Cassino. Whadya mean you can't do that in Heaven? ROFL. Seriously, would there were more like you, Annemarie. Thanks a million for this article. It and its like are sorely needed.


Edward Fido | 08 June 2021  

Amen, Francis Armstrong (12/6).


John RD | 20 June 2021  

So everyone here who wants to deny a person the right to end his or her own life prematurely but with dignity is also, presumably, an absolute pacifist? After all if, as Francis asserts 'only God should decide when a person's life should end', how could you possibly support the use of lethal force by the military or police?.


Ginger Meggs | 22 June 2021  

Ginger Meggs: ‘if, as Francis asserts 'only God should decide when a person's life should end', how could you possibly support the use of lethal force by the military or police?’ Different contexts. The second context is self-defence.


roy chen yee | 23 June 2021  

Our involvement in Afghanistan has been 'self defence' Roy? Pull the other leg. In any case, 'if only God should decide when a person's life should end', self defence is not an excuse. But if you insist that there is an exception such as self defence, why exclude other exceptions?


Ginger Meggs | 24 June 2021  

Ginger the military (Tatmadaw) are doing a good job of that in Myanmar. Using lethal force against the unarmed is a convenient and permanent way to repress dissent. There is a time for everything under the sun. CJB Yes, rescue those being dragged off to death — won’t you save those about to be killed? Proverbs 24:11 And Ginger the Taliban committed some appalling atrocities in Afghanistan that cried out for vengeance.


Francis Armstrong | 25 June 2021  

Ginger Meggs: ‘Our involvement in Afghanistan has been 'self defence' Roy?’ Yup. You fly planes into skyscrapers and receive refuge in X’s home, X is endangering your security. ‘'if only God should decide when a person's life should end', self defence is not an excuse.’ As I said, different context, or, should I have said, because you seem to be a bit tardy in picking up these nuances, Francis was speaking in a different context. ‘But if you insist that there is an exception such as self defence, why exclude other exceptions?’ Because suicide is wrong and not defending yourself is suicide. If you have a gun and you see some malignant form of life wielding a machete bearing down on you, you’re going to let yourself be chopped and chived? As a matter of fact, if you see the same malignancy bearing down on your friend Brett and his tiny canine colleague (whose name I temporarily forget), you’re going to watch them get chopped and chived? Assign Brett with a new name, One World Trade Center, and the malignant entity, Spirit of Taliban, and you get the picture.


roy chen yee | 02 July 2021  

Self-defence or vengeance, Roy? The action in Afghanistan was too late to defend against the attack on the twin towers so your attempted metaphore of an imminent danger to Brett is off target. Now, after 20 years, what has our involvement achieved other than the extra-judicial killing of a suspect? Even our own military people are questioning it. But we're getting further away from the subject of the article, whether it is ever permissible to deliberately cause death, if so why, and if not why not.? I actually think Margaret Somerville advanced more compelling reasons - social rather than religious - against VAD than all the earnest vigil-keepers have ever put forward.


Ginger Meggs | 11 July 2021  

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