For Thou art with me

There’s a contentious programme coming up on UK BBC TV, about assisted suicide and euthanasia.

Our Alice was telling me about it this morning – she’d been reading about it online.  Apparently views are expressed to the effect that it adds to a person’s suffering to oblige them to go all the way to Switzerland for assisted suicide, putting them in a position where they have to make the journey at an earlier stage of illness than they would really have liked, as late enough to die would be too late to travel.  She said that the article she had read made mention of a lethal dose, said to be available in the US, that a patient could have on hand in case of need, and that views had been expressed in favour of such a thing being available in the UK.

I have quite a bit of first-hand experience of death and dying . . . er . . . well – technically, second-hand, I guess, but you know what I mean!  I was for several years a hospice chaplain and I’ve worked as a care assistant in a palliative care unit for terminally ill people.  I’ve pastored congregations with many elderly members, and am familiar with the struggles of their journeys, and sat at their bedsides as they made their Great Journey out of this physical realm.  I nursed my husband at home to the end of his life, still continuing to share the same bed with him, administering his medicines, caring for his tracheostomy paraphernalia and all his needs, and staying right there beside him up to the end.  So death is quite familiar to me, and I would like to make some observations about this TV programme to add into the mix of your thoughts if you plan to watch it.

When I was a younger woman – in my twenties and thirties – I was in favour of assisted suicide and euthanasia.  I no longer am.  I am not in favour either of excessive intervention to prolong life.  I am in favour of good palliative care, informed and educated pain management, and good social care for families who may be put under serious financial strain by taking time and energy to support a dying person.

With regard to assisted suicide and euthanasia in Great Britain, I do believe that once this genie is out of the bottle it won’t go back, and I think that many people who are vociferous in expressing their opinions are clearly unaware of the opportunities that exist at the present time.  You don’t need to go to Switzerland.  My husband died of a particularly cruel and horrific illness – he described himself at one point as feeling like a man trapped in a maze with a pack of mad dogs after him. When my husband was dying, he had a number of medical attendants in two different hospitals, so I want to make it clear that you will not be able to establish an identity from what I am about to say.  One of his doctors, in the last weeks of his life, said to me very seriously that the prescription medications we had at home (a quantity of diamorphine and other powerful meds) were now our property; they belonged to us, what we did with them was up to us and our responsibility.  The doctor said that if I inadvertently gave my husband more than I meant to do, that would be all right and I mustn’t worry. 

I saw what the doctor meant.  It was the same as when a policeman came to address my Religious Education class, at a school where I taught, on the subject of safety and self-defence.  He explained to them in a read-my-lips kind of way that he could not advise them to carry in their handbags (purses US) when they went out on the town a bodyspray for the purposes of spraying it in the eyes of anyone who tried to attack them, as that would be an offensive weapon, and so against the law.  But if they happened to have the body spray in their bags for the purpose for which it was intended, and happened in a moment of panic accidentally to get it into somebody’s eyes, that would be understandable and okay.

I never did give my husband – by mistake or on purpose – any overdose of his medications.  It wasn’t necessary.  The love and support I and my daughters (especially Hebe) gave him took away his fear and distress.  The dying part was easier than the part that came before.  In his last few weeks, sitting in his room, every day he would say how lucky he felt, how peaceful and how blessed.  I ensured he had palliative care support from the Hospice At Home team and the district nurses, and that he was never alone except when he wished to be.  One of the things that strengthened and soothed him almost more than anything else in his last days was music.  He listened to music most of the time.  Sacred music was playing when he died.

In the churches of our Methodist Circuit (I was a Methodist pastor then) everyone was praying for him.  Praying is powerful and it helps if the prayers of the people are following the flow of the way things are, God’s will.  So I made specific prayer requests, asking them not to pray that he be healed, but that he die swiftly, peacefully and painlessly.  People coming to our cottage to visit remarked that it was almost pulsing with love and light, and one way and another with all that prayer and Holy Spirit power, so it was.

At an earlier stage in my life I had wished it were possible to have handy at home some lethal medicine, so that if something unthinkable happened – a terrible accident where someone was screaming in agony and too mangled to live, or a nuclear war or something, I would have  the means to offer them a way out.  But when my husband died, I had the opportunity to hang onto those powerful and lethal drugs – as the doctor had pointed out, they were mine.  I didn’t, though.  I tend to depression and am sometimes suicidal, and one of the symptoms of depression is a (mistaken) sense of lucidity in the depressed person – that you are the only one who really sees and understands just what a terrible place the world is or what a terrible person you are.  I wanted to put out of my reach any possibility of acting on such times of apparent ‘lucidity’ when they visited me.  So, I do not think it’s a good idea to have lethal medicine on hand in the ordinary home.  Besides which, imagine if a dying person had their lethal dose ready in the drawer, and decided in the last stretch of life to have a farewell gathering for their family and all the tribe came round.  I can easily picture a scenario in which a couple of kids wandered off from the melee and got their hands on those controlled drugs and the wrong person died.  Can’t you?

If euthanasia became legal here, as many others before me have pointed out, before too long there would be economic pressure brought to bear – old people lingering on in expensive hospital beds, that kind of thing.

Many people who advocate euthanasia do so because they imagine that in a terminal illness things get worse and worse and worse until eventually you die, but it isn’t like that.  By the time the Dignitas-clinic-in-Switzerland stage is reached, you are almost through the wood.  It’s the same as having a baby – it’s the first stage of labour that’s the tough call, not the second stage.  I have travelled right up to the door of death with many many people, and I can assure you that in my experience the last bit is not usually too bad.  It is peaceful, calm, natural and easy.  The struggle is done.  Very often friends from the other side of the barrier between life and death come to meet them, to collect them.

And often the last weeks and days of life are rich and wonderful.  It was so with my husband.  At an earlier stage in his illness he was begging to die, and distraught when on the hospital nurse’s advice I wouldn’t give my permission for him to be denied all food and water – she said it would be a horrible death and an inadvisable course of action for him.  He went through some terrible things, but not in the stretch of time in which euthanasia would have been applicable.  By the time he reached the stage where euthanasia advocates imagine the assisted suicide taking place, he was at peace, his pain was under control – and he was dying anyway.  The way out was opening.    When people say we should have euthanasia clinics here so terminally ill people can wait to the last minute to go to them, they’re missing the point.  It’s over by then, there’s only the peaceful bit to go through.

I once accompanied a church member toward death who had a terribly aggressive oral cancer.  She could feel it growing every day.   The diagnosis told her it was terminal, and that death would come quickly.  She was terrified of dying of the cancer and of its progression.  During the winter she had cancer, life offered her a way out – she got pleurisy and this was expected to develop into pneumonia.  I was intrigued and surprised that instead of saying “Good!  Here we go!  Ticket home!” she was eager to take antibiotics to clear it.  When she reached the final stage of her illness, the cancer reached the point where it would breach the wall of the blood vessel in her throat, and death would be swift and spectacular.  She was afraid of that, and asked to be spared the last events of her life by being kept sedated, which she was.  She remained in her own home under sedation administered automatically by a syringe driver, and slept through the final days of her life.  My husband also, once oral pain relief was no longer holding back his pain, was fitted with a syringe driver and spent his last few days under sedation.

The people I have known who have been in pain and misery have not yet reached the category for which assisted suicide and euthanasia is advocated, which suggests to me that if this became law then we would see the category of suitability widen very quickly.  The people I have known in real distress have been in earlier stages of AIDS or cancer, or suffering from depression associated with illness – post-stroke depression, for example.   And surely we are not suggesting that anyone who feels life is unbearable should be given carte blanche to end it all?  We’d be short of a great many teenagers who could have made it through turmoil to adult happiness.

Please do not be taken in by the advocates for euthanasia.  Many of them do not have broad experience of impending death, and many are motivated by personal experience of fear, dread or grief rather than having had the opportunity to observe and consider death.

All the opportunity to manage necessary ending of life is already available for those who desire it, offered discreetly and advisedly.  It cannot be discussed because of legal implications, but it is there.  Clinics for euthanasia and suicide would not improve the profile of care provision, and in fact would likely undermine the palliative care provision we now have.

I want to leave you with one last story.  In a church where I was pastor, I went with a church member to the bedside of her dying mother.  The mother had been suffering from Alzheimers Disease for a decade, and had for some time been in effect lost to this world, a small withered body in a bed, unresponsive and incapable of anything.  Any advocate of euthanasia would have marked her as a prime candidate. 

The dying woman and her daughter were both faithful Methodist believers, and arriving at her bedside I read to her Psalm 23, prayed the Lords Prayer, and then said this prayer.

Go forth upon thy journey from this world, O Christian soul,

in the peace of Him in whom thou hast believed,

in the Name of God the Father, who created thee,

in the Name of Jesus Christ, who suffered for thee,

in the Name of the Holy Spirit, who strengthened thee.

May angels and archangels

and all the armies of the heavenly host

come to meet thee,

may Christ be thy Pilot and give thee safe crossing,

may all the saints of God welcome thee,

may thy portion this day be in gladness and peace,

thy dwelling in Paradise.

Go forth upon thy journey, O Christian soul.

As we closed the prayer with ‘Amen’, a change came over the dying woman.  It was as though her whole being flooded with light.  Her face lit up with ineffable joy, wonder and an expression of absolute triumph.  And then she gave up her spirit to God, and she was gone.  I’m glad we saw that, her daughter and me.  It was her last, and probably greatest, Christian witness; and I do not believe that anyone would have had the right to subtract such a thing from her life.  It was also evidence to me that whatever is happening to the mind or the body, the soul shines steadily on until God in His mercy calls us home.

"The Lost Sheep" by Alfred Soord (1868-1915)