Physician Assisted Dying…If Ever There Were a Case

I am sitting in Canada, feeling helpless, as someone very special to me–an elderly man, a retired physician, a surrogate father, a true in loco parentis'– dies by inches with advancing motor neuron disease (MND) in a Perthshire, Scotland, nursing home. He is virtually immobile now in his mid 80s, struggles to eat, and is losing his ability to speak. Everything is an effort and he sees nothing positive to live for. We go back a long way.

I spent a quite glorious two weeks with him when I was a medical student 35 or so years ago. I was then recently bereaved and motherless in England with an ailing father and an only brother 3000 miles away in the United States. He was a family physician in Hamilton, near Glasgow. The link between us was his son, a close friend of mine from Oxford days, who suggested I might spend some time learning from his dad. Learn I did. Not just about some aspects of medicine but about life, families, longstanding loyalties and kinship, and, not least, a lifelong appreciation of Russell Flint water colors that adorned his Hamilton home. Never one to exaggerate or over dramatize, his top offering of praise for his beloved late wife's quite sublime cooking was, “Hmmm, not bad.” He fished, walked the Scottish hills, and was a tower of strength in so many fields. He became simply “Father …” in his transatlantic phone calls and letters to me, and “Grandfather …” as my children started arriving. As a fine rugby player he had a tryout for Scotland and there is a wonderful cartoon on the wall in his nursing home room depicting him as captain of Glasgow University half a century ago.

I saw him again last spring on a trip back to the United Kingdom. Nothing summed up his situation more than his parting words to me on that clear day. “See you sometime next year,” I said as I prepared to leave. “I hope not,” came the reply.

A Christmas card from his son has just arrived. More news of his ongoing decline, his inability or desire to communicate with anyone other than his sons and his brother. He would check out now if he could. He is a sad (but not depressed) shadow of his former self with no desire to live this way a moment longer. As many have before him, he is craving the release of the “old man's friend,” but pneumonia has yet to strike. With no effective palliation available for his condition, he is doomed to wait in his silent miserable world, decaying quietly and slowly from an illness that seems interminable, inexorable, unrelenting, and utterly soul destroying. If asked by him, I would in a moment fly across the Pond and help him put an end to this. I know a thing or two about end-of-life care. And yes, I'd face condemnation from many quarters, vilification perhaps, censure certainly. Yet I would consider it worth all that for what I owe this man. And as the sun sets on my career I fear none of this.

He hasn't asked for my help and is not of a generation to do that, so perhaps these things are easy for me to say, though the emotions at play are not easy at all. At some point in 2012 I expect to hear the news that he has finally set out for the great rugby pitch in the sky. But for now I am haunted by the question, why does this great man, who eased the passing of many a generation ago, why does he have to suffer in this way? After many years of caring for dying patients^1,2 I look at the world and ask, Why does any competent individual have to suffer totally against his will the awful indignities of end-stage anything, when others have the means and the willingness to help to provide a welcome and merciful release?