Tuesday, November 8, 2016


This afternoon I attended the Richmond Town Hall to see a performance of Four Funerals in One Day, a play that presented a comic, but sensitive look at issues surrounding palliative care and end of life wishes. A certain amount of time was spent on the somewhat problematic use of the word euthanasia in regards to end of life wishes of a person with a terminal illness, who more often than not cannot cope with prolonged pain associated with disease. The word, which has its origins in eu (good) and thanatos (death) has taken on the somewhat sinister connotation of being perceived as assisted suicide, given morphine is the drug administered in alleviating chronic, debilitating pain and patients are somewhat savvy about how quickly they could die if they were assisted in doing so. In the play the male protagonist, an eighty three year old man who does nothing much except sleep in a chair all day, asks to be put out of his misery. Given the dose of morphine is often increased to alleviate continuous pain, the eventual consequence is death of the individual. An argument against alleviating pain to the point in which the drug itself causes death was that those involved in providing palliative care, whilst mitigating symptoms via pain relief might also consider supporting the terminally ill individual, or encouraging them to consider being mindfull of their life as it is and relishing the life they have lived, often by sharing stories of their life with their families or including their family members in a discussion of the value of their lived life and any life they still have remaining. Palliative care is understood as not only about softening the impact of pain on the body, but also on lessing the psychological pain of those who know they are terminally ill. So, in this part of the argument a good death is one that encourages the individual to focus upon the value of their life as opposed to some of the negative thoughts that may arise for them during their final days. Many believe that they are a burdon on themselves, their family and the health system. They can no longer participate in society or do things they used to do. They feel worthless and this worthlessness permeates their thoughts about the life they have lived. They consider that since they have come to this (their death) that somehow this death erases their life achievements. If death is all that is left, then life means nothing at the end because it is so absorbed in waiting for the end. The play reveals the positive aspects achieved with the old man who wishes to be put out of his misery, by the fact that he has begun to communicate more with his family even though he may have only days or weeks to live. This is all very well, but what of those who are kept in palliative care, even though they would prefer not to have to suffer endless pain, because their family are not willing to let them go to their eventual death? Or those familieis who do not spend time with their terminally ill relative and may pressure staff to offer more morphine to patients because they are not able, or will not contemplate having to commit to engaging with their terminally ill family member for any length of time? Whatever you choose to call it, euthanasia, assisted suicide, palliative care, pain management, we need to ask ourselves: what do we consider to be a good death? We would not stand by and let an animal suffer, why do we think that human beings should have to suffer? Is a good death one that embraces suffering as essentially part of what it is to be human? After living our life, however long it is, haven't we all already experienced psychological and physical pain and learnt from it? Sometimes we need to experience pain in order to identify it and have empathy for those experiencing it. It seems to me that palliative care is obviously for the patient, but it is also for the staff working in the unit (it makes their job easier if they don't have to watch their patient in pain) and family members who don't wish to see their loved one in misery. However, do we rob those witnessesing the experience of the pain of another; to take that pain into themselves and by doing so derive knowledge and empathy that they may not otherwise experience? Or, as an advertisement for an everyday pain killer porports: when pain goes, life begins. As I've been writing this I've been attempting to conclude what I consider to be a good death. For me, it would have to be that at the end I would be able to be proud of the life I'd lived. To reflect and understand that I'd done my very best and tried my hardest at everything I'd attempted. To have few regrets. Most of all, I'd like to be able to check out of this life when I had no more to give and if that involves receiving pain relief so that I (and others around me) could maintain a sense of self consistent with my life and the way I perceive myself, then so be it. I have no fear of the word euthanasia, it means good death and we all ultimately want that. (Forgive any spelling errors, I wrote this quickly this evening),

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