The story of Mr C

I first met Mr C in March, when he was admitted for the third time with anaemia. His story was ominous – he’d lost weight, had trouble eating and intermittently vomited. He was one of those eighty year olds with a handful of medical problems that had troubled him for a long time, and it looked to me that something big was just about to be discovered.

Given that he had severe anaemia, we asked the surgeons to investigate his gastrointestinal tract with scopes. They agreed but thought that regardless of the diagnosis, he wouldn’t survive a big operation to fix it. Then the anaesthetists refused to put him to sleep for the procedure, arguing that it would make no difference to the outcome.

That day, I talked to him and his daughter about what was happening. I explained that he was probably losing blood from a cancer but we aren’t going searching for it because he may not survive the operation to fix it anyway. We will transfuse him with blood whenever he needed it, but he might die soon regardless. They were understanding and accepting, and he was keen to go home, so I let him go.

A few weeks later, he came back vomiting blood. He’d vomited endlessly at home and some of it had gone into his lungs. He was really unwell this time, and the surgeons and anaesthetists put aside their previous weariness and looked in his stomach, where they found a big tumour completely obstructing the stomach outlet. The cancer came as no surprise to the whole family, and we started him on palliative radiation therapy. He also got a stent across the obstruction so he could still eat something, but we all knew that this was palliation.

Even with the diagnosis clear, Mr C stayed in hospital for ages, getting the stent placed and the feeding regimen adjusted, being treated with antibiotics for his pneumonia, and having so many other miscellaneous things sorted. Somehow he remained cheerful through all of it, and everyday when I went in to see him I would be struck by how bright and hopeful his eyes were, despite all the pain and suffering he was going through. One of his daughters had brought in a photo of him on his favourite daybed at home with his dog, who he loved dearly.

One day I went into his room and for the first time in several weeks of being in hospital, he didn’t smile at me when I greeted him. Instead he looked down at his bedcovers, at his distended stomach, and told me “I’m sick of this, I just want to die.” It wasn’t a particular thing that had happened, but it had all just caught up with him – the pain, the nausea, the weakness, the inability to get out of bed. At that moment I resolved to get this man home, even if he were just to spend one day in his own home with his family and his beloved dog.

So we had a family conference around the bed with all the staff involved in his care, and after that we put in place the final arrangements to let him go home. The community palliative care team were going to visit him, he would have oxygen and feeds as he had in hospital, his family would learn to manage his medications through the feeding tube... everything seemed to be going well, and we were so happy for him when he finally left hospital, though I knew then that I probably would never see him again.

Another few weeks later, I saw his obituary in the newspaper. I heard from other doctors that once back at home, his condition got much worse and he constantly asked the palliative care doctors to give him something to go to sleep forever. But of course that is illegal (though it was once upon a time legal in the Northern Territory), and we are left with symptom management.

It is easy enough to say if someone has physical pain, or nausea, or constipation, or secretions, or any medical complaint, we have medications and treatments that may help alleviate those symptoms. But what about emotional suffering? If someone has reached the end of their life and no longer wishes to live, but has no ability to take their own life, then what can we prescribe for that? If it is unethical or unmoral to prolong one’s physical suffering, then is it not cruel to prolong one’s emotional suffering?

These are difficult questions, and thus euthanasia has been debated fiercely all over the world. The arguments against euthanasia inevitably revolve around the sanctity of life (with many religious variations) and the potential for abuse of the system if euthanasia were allowed. Others argue that in the terminal stages of illness one loses the ability to assess with a clear mind one’s overall situation, and thus is not competent to make the decision.

I feel that all these arguments have their weaknesses. Life is indeed precious, but quality of life is of paramount importance, and cannot be judged by anyone other than the individual themselves. Doctors and others can make some guess at what one’s quality of life is, but ultimately everyone has to live their own life. As for the potential for abuse of the system, is there not such a possibility with everything in life? This should not be used as an excuse to run away from the issue. I agree that euthanasia should be tightly controlled so that the potential for disaster is minimised, but I do believe there is a role for euthanasia for some selected patients.

All that aside, to Mr C – I know you have gone to a better place, I hope you rest in peace.