mercy killing
Physician-assisted suicide or mercy killing – a medical thriller
Mercy by Michael and Daniel Parker (a father and son duo) begins with a quote from the Dalai Lama:
Love and compassion are necessities, not luxuries. Without them humanity cannot survive;
and ends with
Compassion is what binds us. It’s what makes living worthwhile.
A neat bookending of the substance of this novel which centres on the controversy around mercy killing. Yep, I’m back in my familiar milieu. And given that the topic comes before the UK Parliament again tomorrow, it’s topical.
The narrative opens with a chapter recounting the deliberate killing of a patient in end-stage cardiac failure – told from his perspective. But something’s decidedly wrong here. It’s certainly not a mutually agreed procedure. We feel the patient’s terror, and are hooked in immediately. And then there’s the person administering the lethal medication: coldly dispassionate not gently reassuring. We’re alert to trouble from the outset.
By contrast, the main protagonist in this story is emergency room intensivist, Dr Julie Devereux, a passionate but compassionate advocate for death with dignity. Her ambition is to take officialdom and government out of the equation and let the patient with his/her doctor decide together what’s best for them, always staying within the law.
Then one day the patient is her fiancé Sam, hideously injured in a three-vehicle collision which she personally witnessed as he was driving his motorcycle ahead of her on a fast road. Along with multiple fractures and serious open wounds, Sam has suffered a crush injury to his fourth cervical vertebra – he faces the rest of his life as a permanent quadriplegic with a tracheotomy, requiring a raft of medication to keep his body functioning.
When he emerges from oblivion and is able to comprehend the desperate situation, Sam begs Julie to help him die.
‘I can’t live like this … You’ve fought for death with dignity for years, now fight for me.’
She’s appalled by the idea when it applies to the man she loves, but he throws her own words back at her:
‘The best care should be made available to every patient, but a patient deserves the right to hasten death to avoid inhumane suffering or escape from a life turned unbearable.’
Now, on the other side of the situation herself, Julie does an about-turn, arguing passionately against all the speeches she’s made, all the papers she’s written, all the arguments she’s employed for mercy killing – for continuing life.
But then something inexplicable happens. Sam suddenly collapses and dies. Julie is acutely aware that something isn’t right. He might have wanted fiercely to die, but he was incapable of doing anything himself to induce death. She didn’t help him, so … what happened? Was this a medical anomaly or did someone do something to cause his death? She starts asking questions, challenging results, and piecing together a bewildering picture. Because the autopsy results indicate a very rare stress phenomenon: takotsubo cardiomyopathy, an instant reaction to an extreme stressful stimulus resulting in an abnormal surge of adrenaline, constricting the coronary arteries, and diminishing blood flow. It seems Sam was literally scared to death.
Julie begins to investigate. She unearths other similar deaths, and gradually a picture emerges of skull-duggery beyond belief. Her search takes her to interview a convicted murderer in prison, to talk to ardent campaigners for life, and experts in many branches of medicine and science. The common link between all the unexpected deaths initially seems to be this enlargement of part of the heart: takotsubo cardiomyopathy … or is it? Why did all these people develop hives just before death? Could it be an acute allergic response? If so to what? And who is behind it?
Administrators desperate to stop the rapid drain of money from the hospital?
Doctors with reputations to maintain?
Parents wanting to avenge their dead children?
Aggrieved staff looking for revenge for dismissal?
Someone with their own personal agenda?
Who?
Still more patients die. When their lab results come back they make no sense; no, more than that, they’re downright sinister. Allergic cardiac events, tics, massive overdoses …?? And a common feature seems to be that all the victims are very ill, severely incapacitated, or at the end of their lives – some even asking to die. It looks on the surface like a macabre version of mercy killing.
It’s now no longer a case of finding out who or what killed Sam; it’s a race to stop more people dying.
But what Julie doesn’t know is that with every piece of the jigsaw she discovers, she’s putting herself in greater danger. Her every word, every movement, is being monitored by a paid assassin who’s simply biding his time. One by one her supporters are picked off. And her own previous high profile in relation to assisted dying becomes a weapon in the hands of her adversaries. She herself becomes a prime suspect.
We’re kept in suspense until the very end, and I for one did not suspect the person who actually killed Sam, though I was suspicious of some of the administrators charged with balancing the books. A thriller in the best sense, and one in my own field of interest! Wahey!!
[NB. Meticulous research went into this story but just for the record, it’s not sparrows but starlings that form murmurations! (pp222-3) But in a work of this calibre it’s actually quite comforting to note a tiny human chink in the overall brilliance!]
Between Sisters
It’s a long time since I read and reviewed Kristin Hannah‘s bestseller, The Nightingale. But it’s one of those exceptionally accomplished works that haunt you long after you close the covers. And such masterpieces make one wonder, how can this author possibly follow that?!
So, I wasn’t surprised to discover that Between Sisters didn’t reach such dizzy heights.
Meghann Dontess and Claire Cavenaugh are now polite (sometimes!) strangers who share a mother, a blood type and an ugly childhood. They grew up in a broken-down trailer, abandoned at a vulnerable age by their shallow actress mother, who is obsessed with celebrity and image. She has since lurched from husband to husband, making no move to be a parent beyond an occasional phonecall.
Meghann has emerged from her early years and troubled adolescence to become a successful lawyer, living alone in an expensive condominium in downtown Seattle, surrounded by the trappings of wealth and achievement. She has no desire to ‘settle down’, but has developed an unhealthy penchant for one-night stands with younger men. Now 42, lonely and scared of the future, she’s receiving psychiatric counselling, which highlights issues she had with her younger sister, Claire, when Meghann was 16.
Claire (35) lives more simply as assistant manager on her father’s 16 acre holiday resort, and loves her job. She shares her tiny cottage with a hotchpotch of renovated secondhand furniture, and her daughter Alison (5), lovingly supported by Claire’s biological father, Sam. Unlike Meg, Claire has a strong social metwork that includes a sisterhood of close friends.
But when she’s told that Claire is about to marry a country singer she’s known for a matter of mere weeks, Meghann rushes to her rescue. Thrown together in such circumstances after twenty years apart, the sisters discover truths about themselves as well as each other, and when tragedy strikes, they together fight for a future.
For me, the ends are tied up rather too neatly, but regardless of its relative literary merits or demerits, the themes of love and abandonment, estrangement and forgiveness, mercy killing and family crises, would make this a potential candidate for a book club discussion.
The Revenant
Even when I make a conscious effort to switch off my brain and just relax, life somehow has a habit of steering me back into work-mode!
I’m at the stage of being utterly absorbed in the lives of my fictional characters (no, I do not want another cup of coffee/lunch/a break/to pack up for the night!! … please do not ring/call/interrupt/challenge/speak to me in any way or by any means until I emerge from my fictional world and readjust to yours!) and at the end of a long writing stint I feel pretty zapped. I know my subconscious can be relied on to work on issues during sleep and I can safely leave it to do so, but sometimes I crave a real switched-off complete break. That was the case one night this week so I decided to watch a DVD I bought many moons ago: The Revenant. (Just in case this word has escaped your personal lexicon, it means a person who has returned, especially supposedly from the dead.)
It’s a raw, brutal, stunning film. (Click on the picture for the official trailer.)
‘Everything screams primal in “The Revenant” – the lethal force of a wild animal, the savagery of man against man, the sustaining power of revenge, and the beauty of vast, snowbound lands seemingly untouched since the Creation.’ (Wall Street Journal)
It won three Golden Globes and considerable acclaim from critics and the public alike. Loosely (I use the word advisedly) based on a true story, and a work of fiction, about the main protagonist, a legendary explorer on a quest for survival and justice, it’s not an authentic documentary of a hero’s life, but I wasn’t looking for verifiable reality or hard facts, just some escape. A subject, then, far removed from my usual interests, so it should fit the bill perfectly. Settle down in a comfy chair, pick up the knitting, here goes …
A brief synopsis of the story line first. While exploring the uncharted wilderness of the Rocky mountains in 1823, frontiersman Hugh Glass (Leonardo DiCaprio) sustains life-threatening injuries from a brutal grizzly bear attack. A treacherous member of his hunting team (Tom Hardy) kills Glass’ young half-Pawnee son (Forrest Goodluck) and leaves Glass himself for dead. His beloved native American wife has also been murdered, and, grief-stricken, fuelled by vengeance, the legendary fur trapper treks through the snowy terrain to track down the man who betrayed him. (The real Hugh Glass really did crawl to safety for 200 miles over 6 weeks.)
Some reviewers have been pretty sniffy about the effects but I, in my naivety, was lost in admiration of the stupendous cinematography. And how the actors coped in the deep snow and freezing glacial rivers – yes, really in – I can’t begin to understand. But, I can vouch for the authenticity of the setting; it was mostly filmed in the Rocky Mountains in British Columbia where we were recently. The filmmakers have captured the essence of Glass’ struggles, and the sheer grit needed to survive in this vast uncharted terrain, incredibly well. And the footage of him climbing inside the still-steaming carcass of a newly-dead eviserated horse for warmth, or being driven off the edge of a cliff, or being ripped and shaken by a grizzly, or guzzling raw buffalo liver, vividly convey the desperation that drove such pioneers, and the sheer forces of nature they faced.
So, a completely different scenario from my usual medical ethics work, huh? You’d think. But you’d be wrong. As was I!
Glass sees one of the trappers attempting to kill his beloved son. Would he be justified in killing the attacker if that would save the boy’s life?
When Glass is severely injured in the brutal grizzly bear attack, the trappers consider leaving the dying man behind to save their own lives. Would this be morally defensible?
Some of the men feel it would be a humane thing to shoot Glass to put him out of his suffering after the bear attack. Would it be ethically right to do so?
Glass can’t speak but his eyes are open. One of the trappers tells him to blink if he wants to die. Glass stares back wide-eyed for ages but eventually blinks. Would this be deemed informed consent?
The chap deputed to actually shoot to kill, says someone should put a rag over the dying Glass’ eyes; he can’t do the deed looking into the face of a man he knows. What does this say about mercy killing?
When Glass eventually catches up with his son’s killer, a bloody fight ensues, but in the end Glass leaves vengeance to God, as one of the indigenous Indians taught him. Does this translate to today’s issues?
Just a few challenges to give you a flavour. But hey, it’s an absorbing film anyway. Enjoy!
One True Thing
Early May it may be, but summer has arrived with a vengeance in my neck of the woods, so I seized the opportunity and took a fresh book into the garden to soak up the vitamins. One True Thing by Anne Quindlen. It’s about mercy killing so very much in my field of interest; just the ticket, then. Hmmm. I note that it was published in 2011 so I’m not sure why it’s taken so long to come to my attention. Anyway …
We know from the outset that Ellen Gulden is arrested and sent to jail accused of willfully killing her terminally ill mother, Kate. We also know that she didn’t do it. First person narrative: ‘I only wished I had.‘
Ellen is a journalist (like Quindlen) living an independent life when her mother is diagnosed with untreatable cancer. Under pressure from her father, she returns home to help look after her, resentful that her Professor-of-English father sees no need to give up his life, annoyed with herself that she still seeks his approval. Nor is he the one to offer bail to free her while the case is prepared; her erstwhile English teacher not only does that but offers her sanctuary too.
Caring for her mother isn’t any easier than Ellen anticipated. Kate Gulden’s deterioration is swift and brutal; the author doesn’t skimp on the unsavoury detail. She has to take large doses of morphine to deal with the pain. When the oncologist orders an autopsy, no one questions the means – the morphine was there in large doses, legitimately supplied by the visiting nurse. And the odds seem stacked against Ellen. It’s common knowledge that she is in favour of mercy killing; her prize-winning schoolgirl essay is trumpeted far and wide in the press. Plus she was the last person to see Kate alive. And she wanted this phase to be over, to get back to her old life; plenty of people can and do give testament to that. The evidence appears damning.
So, if Ellen didn’t administer the overdose, who did? And that’s what the book explores. Ellen herself is pretty sure she knows, but I’m not going to spoil it for you by giving away any more of the plot.
However, the book offers more that a whodunnit. It challenges the reader with some profound thoughts.
‘We cry to give voice to our pain.’
‘It’s so much easier to know just how you feel about things, what you believe, when you’re writing it on paper than when you really have to do anything about it or live with it.’
‘And knowing I could have killed her was nothing compared to knowing I could not save her.’
‘When your mother’s gone, you’ve lost your past. It’s so much more than love. Even when there’s no love, it’s so much more than anything else in your life.’
Would I have ended that awful pain, indignity and suffering if someone I loved begged me to help?
Oh and I loved this sentence: ‘My father’s regular features had lost flesh in some places, sagged in others, his rather thin mouth becoming more of a liability as the parentheses of middle age appeared around it.’
So no new arguments for me personally, but a very readable rehearsal of the old ones.
Disability and desperation
Remembrance day. I’m writing this in the last fifteen minutes of it. So it’s perhaps right that I’m feeling sombre, reflective. But it’s more than 11.11.09. I’m thinking of unsung heroes from another kind of battle.
I’ve just been watching the programme aired yesterday on BBC 1 about parents of severely disabled children; awed by their courage, profoundly moved by their desolation. Glimpsing something of the harrowing lives they lead. Hearing how close many of them have come to taking desperate measures. Feeling helpless and overwhelmed myself.
And before that I listened to an interview that sent shivers down my spine – literally. It’s a podcast of an interview with a Canadian farmer, Robert Latimer, for whom the burden became simply too great to bear: he killed his 12-year-old daughter. (Sorry, can’t give you a link. The recording was sent to me by a friend who obtained it through Robert Latimer himself. So I’ll tell you about him.)
Tracy Latimer suffered from cerebral palsy, severe seizures and horrendous pain. She was on loads of medication, and had endured several mutilating operations. More were in prospect. But eventually Mr Latimer got to a point where he felt enough was enough. One day, while his family were at church, without discussing his decision with anyone (including his wife), he took Tracy out to the cab of his truck and connected it to the exhaust. He waited for her to die. Then he carried her back into the house, into her bed. When the family returned he said she had died in her sleep.
That was in 1993. It took seven years of legal wrangling before he was eventually sent to jail. He served seven years inside and is now out on parole in a half-way house 1,000 miles away from his wife and other children.
What can I say? My heart bled for that poor man. You could reach out and touch his pain as he stumbled through his responses to questions about his feelings and motives. And yet the consequences for him seem not to have featured in his calculations; it was Tracy’s suffering that was paramount. Oh, and the children’s finer feelings: he couldn’t use one of his guns, he said, because her siblings would be traumatised by the messy scene … and … well … he just couldn’t bring himself to … shoot his own daughter.
OK, obviously we can’t have people going round killing others, but surely, surely, surely, there’s a case here for compassion. Just listening to his flat, understated comments I wanted to wrap him up and put him in a warm soft place.
He seems to have been astonishingly naïve about medicine and the law; I’m not. He isn’t religious, I am. He’s appalled by the bigotry religious people can display; so am I. He’s incredulous about the workings of the legal system; so am I. He just wants a fair trial by jury and the chance for the truth to be heard and understood; so do I.
I wax passionate about cases like this. After all, I did spend the best years of my research life looking into parents’ emotions and experiences and opinions about allowing their babies to die. Is the law here in the UK more compassionate? The BBC programme I’ve just watched reminded me of the cases here where mothers, driven beyond endurance, let down by a deficient system, have been jailed for ending the lives of their children after years of relentless caring. So no, it isn’t always.
And then there’s the case making headlines in the papers this month: 13-month-old Baby RB. Baby RB was born with a rare neuromuscular disorder, (congenital myasthenic syndrome). He’s been in hospital his whole life. Now his case is being debated in the courts and we all know about it. Why? It’s making legal history. The medical team, and his mother, believe his interests are best served by withdrawing the medical support that’s keeping him alive. He’s suffering unbearably, they argue. His father disagreed.
We’ve been there before, you might be thinking. But no. There’s one vital difference in this case: Baby RB is not brain damaged. He can’t breathe independently, so he’s reliant on technology to stay alive, but his brain is unaffected. The parents aren’t at war; they both just want what’s best for their baby. But the case went to court because they perceived ‘what’s best’, what constitutes an acceptable quality of life, in different ways. Heartrending. At a time when they needed each other most, they were pulling against one another.
Normally, with time and careful explanations and demonstrations of clinical realities, parents can be guided by medical teams, and a consensus decision reached. If not, the only recourse is through the courts. Nobody wants this kind of action. And it must take the wisdom of Solomon (of the two-mothers-one-baby-judgement) to decide. It took hearing the weight of medical evidence against his son presented in court, to persuade Mr RB to change his mind this week, and agree that treatment should be withdrawn.
All during this case I found myself swithering, profoundly glad it wasn’t my responsibility. I’m not an advocate of life at any price; an active, discerning mind in a completely unresponsive, pain-wracked body, must be a living hell. But I do believe life is special, and there must be compelling reasons to deem it not worth saving. The balance of burdens over benefits has to be pretty overwhelming.
Remembrance day is officially now over for 2009. But battles are being fought behind closed doors around the clock, 365 days of every year. Let’s not forget.