Euthanasia is on its way in Portugal. Euthanasia is seen as the “good death” for patients with terminal diseases. In mars 2020 I wrote a post (in Portuguese) about this complicated topic. Gabriel Marcel (Philosophy, France) wrote “Man is the only living being who knows he's mortal”. This is the main reason why we are talking about euthanasia. Since I know death is inevitable, at least give me a “good death” (no suffering, no pain). But in the end, I do not really want to die. This is the raw picture of reality.
Most euthanasia requests are from patients asking for help. They are afraid to suffer, afraid to be alone in death, to lose their image, to lose their daily capabilities, afraid to become useless to others. They do not want to die! They just want to be loved till the end of their lives; they just want to feel the heat of the human touch when death finally arrives.
Most euthanasia requests are from patients asking for help. The one who is asking to die is probably asking for a living.
In some countries, euthanasia has been extended for mental disorders, and even for children. In some cases, the request comes not from the patient but from his/her relatives who believe his/her life is not good to be lived. People are deciding if another people’s life other than their one is or is not worth living. Euthanasia is sliding down the slippery slope. Can you see the danger this brings to people?
In August 2021 an interesting paper about euthanasia in mental patients was published in BMJ Case Reports. Olga Schmahl from the Netherlands reports the case of a female patient diagnosed with bipolar disorder who wanted to die. She was requesting euthanasia for so long, that even her family was accepting that decision. However, in the Netherlands, a second opinion is mandatory in a case like this. The authors concluded the patient was misdiagnosed with bipolar disease, when she was in fact suffering from “intellectual disability, potentially with a comorbid developmental disorder, most likely either attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder”. With a different second opinion, the checklist for euthanasia was not met. Euthanasia was not to be allowed. The authors discontinued previous psychotropic medications and a different treatment program was initiated. The patient’s mental condition improved, and euthanasia thoughts were now decreasing. “Although she remained ambivalent regarding her request for EAS, she gratefully took the opportunity to be supported in her search for peace in life for the next 12 months.” We must not forget that euthanasia request can be a symptom of a mental disorder. In front of an opportunity to find happiness and peace in life, the mental patient suddenly had doubts about her willingness to die.
A “good life” will be a “good death”. This is the way.
I believe the best way of giving a patient a “good death” is to offer him a “good life”. I believe no one really wants to die. We all want to feel free, to feel happy, be useful, to be surrounded by people who love us and care about us. If we manage to have this “good life”, we will have the desired “good death” in our due time. The one who is asking to die is probably asking for a living. Is this true for all cases? Do not know, but in case of doubt (and it is always present) do not kill.
Let me tell you a short true story about a patient I recently treated in the ER. A refugee who is living in Portugal with his wife and 6 children for the last 5 years, was recently diagnosed with occlusive and locally advanced rectal cancer and was submitted to an emergent loop colostomy (the tumor was not resectable). Staging revealed the tumor was invading the surrounding structures and had distant metastasis. Because of intense pelvic and abdominal oncologic pain and frequent gastrointestinal hemorrhage, he was considered eligible only for palliative chemoradiation aiming at pain and hemorrhage control. He was now in front of me for the same complaints while waiting to start the palliative treatment. A refugee from a distant war who came to Portugal in search of a better life with his family was now suffering from an aggressive disease from which he could not run away, expressing facies of pain, without any smile on his lips, with intense diaphoresis. He was conscient, and at that moment he was alone in the hospital, in a foreign country, hardly understanding the language, with sadness in his all body. He was not having a “good life”. Intravenous aminocaproic acid was initiated along with a saline solution. He was put in intravenous perfusion of morphine. Pain disappeared. His face started to change. He was now showing sporadic smiles while trying to have a chat with me. He asked me if he could drink a nice Portuguese coffee. I went to the bar and brought two expressos. We shared a nice coffee time in the ER and had a little chat. He was now staring at me with a big smile on his lips. From his deep, he said: “Thank you”. During that moment he was happy, he was having a new life experience with a new stranger, he was feeling life returning to his mind, he was somehow forgetting the disease and death. I want to believe he was now having some kind of “good life”. Death is near for him, but it got farther away after this simple moment.
A society that accepts and trivializes euthanasia is probably failing as a society.
Finally, I want to remind you of Pio XII who said: “People are not owners, but rather enjoyers of their own lives.” Walter Osswald wrote that life was a gift that has been given to us and it is only up to us to make the best use of it. Nobody asked to be born, so why should we ask to die. Our life belongs not just to us but to our family and friends. What we do in life affects those around us. When the Hollywood actor Keanu Reeves was asked about what he thinks happens when we die, he said: “I know that the ones who love us will miss us.” Amazing. We are not one. We are our friends and family.
To summarize, society must work to protect those in physical pain and work harder to protect those in psychological pain. No one really wants to die. People just want to feel good, to feel loved, and to be useful. A “good life” will be a “good death”. This is the way. This is society's role in this euthanasia thing. A society that accepts and trivializes euthanasia is probably failing as a society.
Link to PubMed:
Dr. Carlos Eduardo Costa Almeida
General Surgeon
Comments