Dying with dignity

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This award-winning article by Dr Bulten has previously been published in Medical Forum Magazine.

Geraldton GP Dr Bertel Bulten draws on his experiences in general practice and in the Netherlands to suggest the profession keeps the debate on euthanasia open.

A horrific death is what my patient Mr Brown feared the most. Nearly 90 years old with metastatic bowel carcinoma, this ex-marine officer knew his end was nigh and he asked me if I could ensure he would die at home and in dignity. The latter meant not bed-ridden, not with an indwelling catheter, not having to take high-dose opioids and above all, not becoming totally dependent and incontinent.

Upfront as he was, he asked me if I would help him with what he called “dying with dignity”. Reluctantly, but gratefully for the care he received, he had to accept this would not happen. A few months before he died at home, he slashed both his wrists in an attempt to hasten his death. He died exactly the way he feared so much, incontinent, drugged and emaciated.

Recently, I heard Phillip Blond, a theologian/philosopher, commenting on the possibility of legislation of euthanasia here in Australia on the ABC’s Q&A (August, 2012). Euthanasia would lead to an indecent and “vaguely horrific society”, he claimed.

In this vaguely horrific society Mr Brown would have been confident that his wishes were respected and that his physician would be able to seriously consider his request, giving some piece of mind, even though tough restrictions would be put in place.

The Netherlands, my country of origin, is one of these countries where ‘active’/’voluntary’ euthanasia has been legalised for 10 years. I come from this vaguely horrific society. It seems that the Dutch euthanasia legislation is supported across the board by population and politicians and scrutinised regularly. It also seems that the Netherlands is not sliding into a state of amorality and denial of the right to live. Euthanasia as a cause of death fluctuates around the 2-3% mark and has remained the same since legislation in 2002.

In my 10 years as a GP in the Netherlands, I received regular requests for euthanasia from terminally ill patients. Almost all died a natural death without the suffering that was so much feared, thanks to state-of-the-art palliative care. They died with the knowledge though, that under strict regulations, their wishes were seriously respected.

The legalisation of euthanasia did not happen overnight; it required many years of discussion and profound debate in the political, religious, and public arena.

As a GP in a regional town in WA, I enjoy the variegation of being a doctor here working with a broad spectrum of Australian society: Aboriginal people, sixth generation Australians, prisoners and migrants. It’s a beautiful and colourful society and certainly not vaguely horrific. I understand the majority of Australians are supportive of legalising euthanasia. Let us therefore keep the debate open. To ensure a real debate we require careful investigation and serious listening to the public and our patients. Let us also look open-mindedly at so called ‘vaguely horrific societies’.

Source: Medical Forum Magazine. Original title: Dying in a vaguely horrific society.