Starting the discussion on Euthanasia: The Difference Between Cows and Humans

Thre is a story in today’s Age by oncologist Ranjana Srivastava: “Family’s pain multiplied at pointlessly lingering death”. It tells the story of a dying 97 year old woman and the way her family dealt with the process of her dying. She fell into a coma and the family expected her to die soon, but she was still alive, still in a coma thirteen days later, and that’s where their patience ran out. Except for one daughter who remained with her (out of a sense of duty, it seems), the others all went home and said “tell us when its over”. Srivastava describes the following conversation with one of the woman’s sons:

Outside the room, I run into her son. A burly man, he is bleary-eyed from having slept in a chair for the past seven nights. He comes straight to the point. ”Doc, this is inhumane. I can tell you that if it was one of my cattle dying like this, I would have shot it, done anything to end its suffering.”

The analogy is a familiar one to many oncologists; although it makes sense on one level, I find it difficult to base my decisions by equating cattle to human.

”Surely, in this modern era, there is something you can do?” he pleads.

”I assure you that we are doing everything to keep her comfortable and nothing to prolong her life.” It sounds odd, an apology that says, ”I am sorry your mother won’t die.”

It is then, his voice muffled by wads of tissues, that he drives the point home.

”I started off feeling sad for mum. But we had talked about it and I really felt that she was ready to die. She misses dad and all her friends, there is nothing that she longs to do any more, and she just wants to go in peace.

”But here she is, something in her body just not surrendering when her mind is made up. And you know what this does to us as a family? It replaces images of a wonderful and rich life with those of aimless suffering and a drawn-out death.”

I desperately want to help. But this time, for a change, there is no life support to unplug or chemotherapy to stop. It is simply waiting for nature to takes its course.

”Euthanasia is against the law,” I say gently.

He chokes on his tears. ”I hate myself so much for being angry that mum won’t die. I should be sad, but I am not. This is not my mum any more, I want this to end.”

I find myself telling the truth, ”I, too, wish she would die.”

He looks up at me, as if suddenly he has found an ally. ”Doc, I don’t know how you guys deal with this stuff. This is painful. I am going home, call me when it’s over.”

Srivastava ends her article by saying: “Some days I muse about the slippery slope argument but today would have been a good day to discuss euthanasia.”

Well, yes, discuss it by all means. Let’s do that. Let’s start with the way that this story demonstrates so perfectly the difference between shooting dying cows and euthanasing dying human beings.

We shoot cows to put them out of their misery. We euthanase human beings to put them out of our misery.

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38 responses to “Starting the discussion on Euthanasia: The Difference Between Cows and Humans

  1. As if to drive the point home, the first comment following this article on the online version is by Katharine from Port Macquarie:

    “I too watched both my parents endure lingering and painful deaths from different cancers, long after they had indicated they wanted to end their lives with dignity and comfort.

    How dare the Christian right in parliament impose their views on us all. And prosecute the lie that pain can be controlled.”

    Note where the real pain lies here. It isn’t a question of controlling the pain of they dying; it is a question of the pain that their dying causes us.

    The push for euthanasia comes from two directions:

    1) those who have or who fear having a terminal disease. They fear the experience of a painful death and therefore wish to have the option of euthanasia.

    2) those who have had or are having painful experiences surrounding the dying process of loved ones and wish to minimise this pain.

    In both cases, the euthanasia “solution” is not really about relieving the pain of the other, but ultimately about relieving the pain that we ourselves inevitably suffer when confronted by death, either in ourselves or in our loved ones.

  2. Matthias

    Very true Schutz and when I have given a painkiller for a dying person i am fully aware of what is called Double effect.
    The main aim is to relieve pain and not to shorten their life, however analgesics especially opioids do affect the respiratory system and the person can die as a result fo the injection .
    My mother who had dementia-a very stauch Christian- stopped eating and died a month later , and it was only after a injection of morphine had been given to relieve the pain she was experiencing from a large abdominal mass,and pneuomonia.

  3. Tony

    We shoot cows to put them out of their misery. We euthanase human beings to put them out of our misery.

    One thing I’ve learned about people at the coal face of dying is that they never reduce the issues to this kind of pithy, heartless, damning, catchphrase.

    In both cases, the euthanasia “solution” is not really about relieving the pain of the other, but ultimately about relieving the pain that we ourselves inevitably suffer when confronted by death, either in ourselves or in our loved ones.

    Who says, David? Who deliniates there lives so neatly in situations like this?

    This is what I fear most about this whole issue. A narrative is created, it’s ‘simple’ and it deliniates the good guys from the bad guys. The bad guys become easy fodder for vilification and the good guys motives are never questioned. A ‘your are either with us, or against us’ momentum, is generated; people bang drums and engage in a righteous clamour.

    In the meantime, in a darkened room somewhere, ordinary people, who are not philosophers or theologians, face tough decisions. I’m thankful that there are people like Dr Srivastava who know the narrative is not that simple, who avoid pithy catchphrases and damning judgements, and who listen.

    This is the kind of insight Dr Srivastava comes to in another article:

    Ultimately, the lesson I learn from her illness is far too simple. Drugs might outgrow their use but not compassion and respect for the sick. It is human for doctors to feel and admit sadness at the struggles patients’ face, even therapeutic to recognise our limitations. Patients understand that we do not possess all the answers. What they expect however, is a partnership founded on empathy and respect. To listen closely to patients, to heed their suffering has little to do with the science of medicine and everything to do with the art. If I remember this for the next 30 years of my practice, her death will not have been in vain.

    • Gareth

      Tony,

      As per our conversation on the matter yesterday Tony:

      a) Your suggestions to avoid anything along the lines of ‘you are with us or against us’ or don’t turn things into ‘black’ and ‘white’ as the situation is often ‘grey’ would be helpful if you could actually point us to a situation where your approach has been taken and actually does work.

      Do you have any examples of similar issues where there was a good result taking your own approach?

      b) Such an approach as suggested by yourself would actually work if things were actually that simple for those advocating euthanasia.

      I think you would find that many people that are opposed to euthanasia or support the pro-life position would really like to come ‘half way’ and have a reasonable middle-road conversation, but it is those that actually support euthanasia that take a hardline ‘us’ and ‘them’ approach to begin with.

      In my experience, I have had many conversations and debates with people on other sides of the fence and was actually surprised that often they were as every bit as closed minded and unwilling to listen to my points as the way they had portrayed their opponents.

      Ever listen to the way the Greens portray Christians or people that are opposed to their environmental policies?

      They are simply too bigoted, unwilling to compromise or listen to ever have a proper conversation to begin with. Most people that support euthanasia are too caught up in their own propaganda to even consider alternatives such as palliative care, so I am not sure how we are meant to take such an appeasement approach to begin with.

      C) Your suggestion yesterday to hasten one’s death is a logical decision that many people have to make misses the point that as Christians there is no ‘logical decision’ – hastening someone’s death is intentionally killing them and nothing else.

      I fail to see how intentionally killing someone can be made into a ‘grey issue’.

      Often in life we make things ‘grey’ or try to seek a ‘middle road alternative’ when things are actually in fact are in ‘black and white’ and need a clear-cut action.

      • Tony

        Re ‘a’: My approach, Gareth?

        I aspire to the ‘approach’ taken by the Dr Srivastavas of the world, and it ‘works’ everyday outside the glare of those who think they know better.

        Re ‘b’: I’m against simplistic approaches by anyone.

        Re ‘c’: I made no such suggestion, Gareth. Read what I wrote, not what you think I meant.

        • Gareth

          But you are continuing accusing pro-life people of something that generally speaking they do not do (e.g. vilfying the enemy and turning the debate into ‘us’ and ‘them’).

          It is those that are advocate euthanasia and the Greens you should be directing your concerns to.

          Like I said, either do something productive and join the cause or tell your miscued judgements to people to people that care.

          • Tony

            But you are continuing accusing pro-life people of something that generally speaking they do not do (e.g. vilfying the enemy and turning the debate into ‘us’ and ‘them’).

            I disagree. There are plenty of examples of that on this blog!

            It is those that are advocate euthanasia and the Greens you should be directing your concerns to.

            I’ll keep that in mind … always love someone telling someone else what they ‘should’ do.

            Like I said, either do something productive and join the cause …

            Again with that. I have joined the ’cause’, Gareth. I’ve been a hospice volunteer for over 10 years. Given this is the second time you’ve come out with this, what have you done?

            … or tell your miscued judgements to people to people that care.

            You forget again, Gareth, this is not your blog.

          • Well, at first I wrote here that I had no problem with “vilifying” those who are truly enemies of society (which I believe that all who actively working for the legalisation of euthanasia are). But Tony pulled me up on this point, so I have had second thoughts.

            I checked out an online dictionary definition of “vilification”, and got:

            Noun 1. vilification – slanderous defamation, malignment, smear, a false accusation of an offense or a malicious misrepresentation of someone’s words or actions
            2. vilification – a rude expression intended to offend or hurt

            I certainly don’t want to do any of that.
            But I do believe that strong language is quite in order here. The dangerous arguments of the pro-Euthanasia lobby should be exposed and condemned out of hand in no uncertain terms.

        • I do not regard Dr Srivastavas as an “advocate” for euthanasia. It does not appear as if she is, even though that is how The Age has used her writing. However, fuzzy thinking in her article opens the door to dangerous ideas. This must be nipped in the bud. Nevertheless, I have every reason to suppose that Dr Srivastavas is herself a caring and compassionate doctor. We need doctors like her who are caring and compassionate AND (as she has indicated herself to be in her article) law-abiding.

          • Tony

            I do not regard Dr Srivastavas as an “advocate” for euthanasia.

            Neither to I. I suspect she’s not an advocate for any simplistic, catch-phrase driven position.

            • The Church’s position on Euthanasia is simple, Tony, but not simplistic. And if “catch-phrases” can get our message across, I will use them.

    • One thing I’ve learned about people at the coal face of dying is that they never reduce the issues to this kind of pithy, heartless, damning, catchphrase.

      Two comments:

      1) I know that this is a “pithy, …damning catchphrase”. Heartless? I’ll come to that. But the reason I came up with the catchphrase was precisely because it was “pithy” and “damning”. We know that arguments on complex matters are often won or lost on whose “catchphrase” gets into the psyche. Take “Get your rosaries off my ovaries” for example. Equally “pithy” and “damning” and very effective, whatever else may be said about it. It’s time we had a few easy and summary catchphrases to communicate our opposition to euthanasia and the reason for it.

      2) as for “people at the coal face” – you seem to assume I have no experience of death and dying. We all have experience in this area. The point is that good laws should never be based on the powerful emotional drives and pulls of the “coal face” experience. Some objectivity is required here. The reason the law against euthanasia exists is to guide and govern and limit the actions of those who might otherwise, in the heat of the moment, be motivated to act in ways that are not for the good of society as a whole.

      • Tony

        It’s time we had a few easy and summary catchphrases to communicate our opposition to euthanasia and the reason for it.

        Really? For me this is where the church’s commitment to being counter-cultural comes in. Catchphrases are the tools of those who don’t like complexity in their lives. I think this is one issue where we should not fall into that trap.

        … you seem to assume I have no experience of death and dying …

        Where?

        The point is that good laws should never be based on the powerful emotional drives and pulls of the “coal face” experience. Some objectivity is required here.

        That would be fantastic. I don’t see much evidence of it, but I live in hope. I certainly don’t see that snappy catchphrases help in that project.

        • You are still under the false impression, Tony, that this is a complex issue. Nothing could be further from the truth. Just because death is a hard reality, and just because some people might not like the clear limit we have on killing people, doesn’t mean that the issue is not simple.

          … you seem to assume I have no experience of death and dying …

          Where?

          Well, in constantly pointing out how much more experienced you are in all this than the rest of us, as if that gives you a superior position from which to approach this issue. That’s where.

    • To listen closely to patients, to heed their suffering has little to do with the science of medicine and everything to do with the art.

      Absolutely. Palliative care and pastoral support are appropriate ways to respond to the needs of the dying, needs which medicine alone cannot provide.

      My opposition to euthanasia is precisely based on this concern. Where “listening” and “heeding” are required, the euthanasia lobby propose killing.

      Killing someone is not a way to limit or end their suffering. It is killing. It is destructive, rather than creative, and for that reason can never be regarded as “loving”.

    • Tony,

      “One thing I’ve learned about people at the coal face of dying is that they never reduce the issues to this kind of pithy, heartless, damning, catchphrase.”

      Having gone through this myself with my mother (lung cancer, chemotherapy, a stroke and then two weeks of palliative care), I didn’t see this as pithy, heartless nor damning. It goes right to the point, however, and that’s not bad. I know how exhausting it felt to look at an indefinite period of waiting. Some people might indeed succumb and desperately wish for an out.

      Strangely enough, given that I was pumping that respirator (we didn’t have a machine) for all it was worth, I might have been at the wrong end of this debate then: hoping to prolong her life so that she didn’t have to go just yet. Was that heartless too?

      I think both ends of that spectrum of thought need a good dose of knowledge. If we truly understood death in light of our Christian Hope, then we should neither grieve ourselves raw during the wait, nor should we desperately cling to every minute of life when death is inevitable. I think the former is crucial in the euthanasia debate. People can go for it in the absence of faith and hope, so they don’t know what death really means, just as perhaps they don’t know what life really means.

      So I think David was spot on: some people see euthanasia legislation as a way out of the misery of waiting for your loved one to succumb to death. Just as they would concerning their own deaths. The next question is why, and I think that has to do with the loss of the Christian perspective on life and death.

      I don’t think David was excluding other motives, for it is certain that many see euthanasia as truly something merciful to those who are in pain, whether terminal or not. And again, the question should be delved into: what causes this misappropriation of mercy?

      And an interesting thought came to mind about pithy catchphrases: it’s arguably a potent literary method to start discussions, but we might also consider that there are many euthanasia advocates out there who latch on to catchphrases without an ounce of reflection to go with it. I think the people in these comment boxes are reflecting just fine though.

  4. Salvatore

    “Well, yes, discuss it by all means…”

    But how? Given that all the other side is going to offer are tear-jerking anecdotes and a steadfast refusal to consider the philosophical implications of their position, how can anything be discussed? One simply comes across as heartless and pettifogging; and I can’t see how to get ’round this. Thoughts?

    • Well, partly that is why I offered my “pithy, heartless, damning catchphrase” (as Tony put it): to unmask the “tear-jerking anecdotes” and “steadfast refusal to consider the philosophical implications”.

      We have to ask the question: Whose pain is really the problem here? The patients or ours?

      Death and suffering is distressing to experience and behold. That is a fact of nature. It is not a proper human response to end suffering by ending the life of the sufferer. We need to regain a sense of the importance of death in our lives and in our community. We need to relearn how to die and how to accompany others in their dying. We need to learn patience. We need to learn fortitude. Euthanasia is a cop out on all counts.

    • Tony

      Perhaps by not coming across as ‘heartless and pettifogging’?

      The way to do that is to treat people with respect and not give in to the easy way out: vilification, catch phrasing and pretending that this issue can be dealt with by demeaning people’s emotions.

      Even the ‘cow/human’ perspective in this particular context is flawed.

      The first issue is Australian citizens rights to vote on an issue that other citizens have a right to vote on. The Greens may be using this a political strategy to get euthanaisia on the table again, but you don’t solve that by saying ‘don’t give them the vote’.

      The second issue is that this is about voluntary euthanasia so reference to a cow just doesn’t fit.

      • Gareth

        Does putting ‘voluntary’ in front of a word make it any less wrong?

        • Gareth

          Further more, I would be interested to hear the criteria for what constitutes ‘voluntary’?

          Will the Government send out notices asking whether people ‘volunteer’ or not to be euthanased once they reach a certain physical incapacity?

          If ‘voluntary’ euthanasia become law, would patients have to put notices on their beds stating that they are willing or not to ‘volunteer’ to be euthanased?

          Would a persons willingness to be ‘volunteer’ to be euthanased be based on hearsay or would they have to sign a legal document?

          Will another family member have to make an assessment on their loved ones death beds that they had previously ‘volunteered’ to be euthanased?

          What happens if their are contradictions between a family members decision and the patients previous opinions on whether they ‘volunteered’ to be euthanased once they reach a certain physical state?

          It all seems a bit of a greay area this voluntary euthanasia business.

          • Tony

            You could ask a proponent of the issue Gareth, if you’re really interested, or you could look at some example legislation, the WA private members bill for example, or you could just assume you know the answers and it’s all ‘grey’.

      • Even the ‘cow/human’ perspective in this particular context is flawed…. The second issue is that this is about voluntary euthanasia so reference to a cow just doesn’t fit.

        The story told by Dr Srivastavas had nothing to do with voluntary euthanasia. It had to do with hurrying the death of a woman who was in a coma in response to the distress her family was feeling.

        “Voluntary” euthanasia is no less an evil as “involuntary” euthanasia, however the argument that “this is just for those who ask for it” is clearly disproved by the article itself. No where in the article does the dying person ask to be killed. It is the family who want an end to the demands upon their patience.

        • The story told by Dr Srivastavas had nothing to do with voluntary euthanasia. It had to do with hurrying the death of a woman who was in a coma in response to the distress her family was feeling.

          And, as such, is irrelevant to any proposed changes I’ve seen.

          “Voluntary” euthanasia is no less an evil as “involuntary” euthanasia, however the argument that “this is just for those who ask for it” is clearly disproved by the article itself.

          Disproved? How so?

          No where in the article does the dying person ask to be killed.

          Which makes it irrelevant in terms of any foreseeable proposed legislation. The family would still not be able to break the law unless the mother gave them permission to do so voluntarily.

          It is the family who want an end to the demands upon their patience.

          Their ‘patience’? Oh boy, what a demeaning caricaturisation. They may be wrong, but not because they’re ‘impatient’.

      • Louise

        Even the ‘cow/human’ perspective in this particular context is flawed.

        I’d say it was rather apt, given that the man compared his own mother’s sad situation with that of cattle.

        All I could think was “gee, I’m glad he’s not my son.” I mean, it sounded like she was not in much pain, so it was just a big inconvenience that she wasn’t hurrying up with her dying.

      • The “voluntary” part isn’t very effective, sadly. Isn’t it the case in Holland, where it is indeed voluntary, where you have many involuntary cases anyway? Although in their case, the motivation might have been the shortage of beds. But my point is that tacking on “voluntary” is worthless if the perspective on ending life has already gone to the point where such an act, regardless of the perpetrator, is considered a good in itself. If one’s mind is made up that a deliberate act to end a life is a good thing if its quality has gone below acceptable levels, then it doesn’t quite matter so much who enacts the termination. Take it further: if legislation (and the weight of experts and hours of deliberation) exists on the basis of such principles, then again, who enacts the termination is not quite so important.

        BTW I noticed this piece from The Australian:

        http://blogs.theaustralian.news.com.au/jacktheinsider/index.php/theaustralian/comments/let_the_euthanasia_debate_rage/P25/

        “.. those faced with terminal illness and the families and friends who must endure their suffering. ”

        So whose suffering is at issue here? The writer goes on about a terminally ill “colleague [who] continued to exist for another 18 months. It could not be called living.”

        So the writer then reveals his opinion *for* the terminally ill colleague, making that quick hop that spans about as much distance as there is between voluntary euthanasia to a motivation to euthanize — at least in principle.

  5. Paul G

    I was not sure whether it was misusing a cherished memory to share this on a blog, but I don’t think so.

    Three months ago, I had a very similar experience to the one in this article. My 92 year old Mother spent 2 weeks in hospital before she left this life. She lost consciousness the day after she arrived in hospital, and the doctors told me there was no hope, and she could die in days or up to a fortnight. Apart from 3 nights at home, I was in the hospital 24 hours a day, every day. An operation was out of the question, but my Mother had fluids, some nourishment, and wonderful care from the nurses and doctors, for which I will be eternally grateful.

    The blessing was that my Mother regained consciousness for a couple of hours on 3 days in the second week, and we had the chance to talk a little. Relatives and friends were able to come to be with my Mother, and the hospital chaplain, who my Mother would have loved and appreciated, visited her regularly.
    It was a distressful time, but my Mother was able to tell me that she was not in pain, and it was a passage that we both had to go through. I did very little for the 2 weeks, and I really felt my life was in God’s hands, and any wilful action on my part to change what happened would have been very wrong.

    • Tony

      I was not sure whether it was misusing a cherished memory to share this on a blog, but I don’t think so.

      Neither do I, Paul. I think our personal experiences inform the debate and I don’t agree with the sense that I’m getting that they ‘cloud objectivity’.

      Notwithstanding that, your experience would not have been any different if some sort of voluntary euthanasia was law — as I understand it — unless your mother had made a request within the terms of the law.

      Even then, you couldn’t be compelled to go against your own beliefs.

    • Thank you for posting this personal story, Paul. That you had those few precious moments is very beautiful. If we act to hasten people’s deaths, we cut off possibilities that only God can know of.

  6. In New Zealand – I do not know about Australia – doctors currently shorten the lives of dying patients by turning off machinery, by giving pain medication in large doses, by methods up to and including limiting fluids and nutrition.

    Taking extraordinary steps to keep people alive is no part of Catholic teaching – and if a medical measure to reduce pain has, as a byproduct, the risk of hastening death, it is not necessarily unacceptable. These are the gray areas, and we need to recognise that they exist.

    A law on voluntary euthanasia would add the right to take active measures to end a life. This is simply wrong. It isn’t a gray area at all.

    Obvious consequences of going down this track? Pressure on families and patients from the medical profession, just as there is now pressure for abortion. Pressure on patients from families, just as there is now for abortion. Pressure on medical staff from families and patients, just as there is now for abortion. And a loss of empathy and sympathy in the community, just as there is now for a woman who keeps a child against the odds.

    I have witnessed this last phenomenon many times. One of the worst was the case of my own daughter. Bedridden with a broken pelvis and seeking support from a government agency to care for her baby son after her husband deserted her, she was told by her case worker that she should have aborted when she realised the pregnancy could disable her.

    • Thank you for sharing our story too, JP.

      This is simply wrong. It isn’t a gray area at all.

      Tony doesn’t agree. He says it is “complicated”. What complicates the matter are the emotions involved. The issue is pretty cut and dry in itself.

      Part of the problem is that we have elevated personal “feelings” to the point of objective magisterium.

      Feelings certainly do make the world a complicated place, but they don’t change reality.

      • Tony doesn’t agree. He says it is “complicated”. What complicates the matter are the emotions involved. The issue is pretty cut and dry in itself.

        You are misrepresenting me, David. The grey areas I’m concerned about is the whole experience of, yes, emotions and conflicting choices in some dying situations. Even for those who agree with the church’s position — like myself — there are the potential grey areas that JP speaks of.

        I believe, like the church, that taking steps that will knowingly result in death (rather than as a by product of relieving suffering, for example) is wrong. I also believe, like the church, that we don’t have to take extraordinary steps to keep someone alive. What is ‘extraordinary’ and what is not, is another potential grey area.

        The big difference is that I don’t believe in the kind of narrative that turns good people into bad people or people that have a different view into caracatures. That’s the stuff of emotions and catch phrases.

        It’s the kind of narrative that has been part of the abortion debate since the seventies and it has been singularly unsuccessful and divisive.

        Believing that doesn’t make me an ‘expert’, a lesser Catholic, a supporter of Bob Brown, or any other (emotional) ad hominem you want to sling my way.

        • Louise

          Actually, I think you’ll find that most of the ad hominems come from the pro-choice side of the abortion debate.

        • Gareth

          But, for people that clearly advocate euthanasia such as Bob Brown – should people of good will know the type of human being this man really is?

          For too long the Church has taken a soft apporach to this man and tried to find even ground to no avail.

          Would we be better instead of trying to find common ground (which there is probab;y none) to say it like it is as per the example of Cardinal Pell at the last election?

      • Louise

        Tony doesn’t agree. He says it is “complicated”. What complicates the matter are the emotions involved. The issue is pretty cut and dry in itself.

        Well, it’s not an “issue” David, it’s a “narrative.”

  7. Profound insight there, David. Spot on.

  8. Susan Peterson

    I was a nurse in a Catholic hospital, where we were carefully taught to give medications to relieve pain, but never deliberately to hasten the death of the patient. I have given a morphine shot when relatives told me their family member seemed restless and they thought she was in pain, telling them that it would suppress respiration and could cause her death. I was glad when it didn’t and she lived for another day. But even if it had, the intention clearly was to relieve pain.
    We did have doctors there who were not Catholic and who would write orders which were clearly intended to cause the death of patients. They would write them as p.r.n. (as needed) orders, which took the responsibility off of them and put it squarely on the nurses. So much morphine and so much ativan every half hour “p.r.n.” . We gave enough so the patient was clearly not in pain or restless, and no more. One doctor came in at 6 am at the end of my night shift and said “If you’d given her a tenth of what I ordered she’d be gone by now and I wouldn’t have to be here, and neither would her family.” One nurse, braver than I, said “We don’t kill our patients in this hospital, doctor.” He slammed the chart closed and stalked away.

    We did however participate in allowing a stroke patient to die by not hydrating her. She had been our patient many times and had expressed the wish not to be kept alive once she had no consciousness and could not communicate. When her electrolytes went haywire I called the doctor and of course he ordered an IV. This was before the statement from JPII that IV fluids were “ordinary care” , and the refusal of fluids was not controversial; it was considered part of the right to refuse extraordinary care when it was burdensome.
    I told the doctor I wasn’t sure that was what the family wanted, and would he like to talk to them?
    I then put one of the woman’s ten children on the phone. They decided to give her fluids for three days and see if she improved. I started her IV and started the fluids running. Three days later when there was no change, I was again on duty and I was the one who stopped the fluids and capped her saline lock. After that it took her ten days to die. Her family was there the entire time, helping to turn her and change her bed, doing mouth care, putting ointment on her lips. I could not see that she was in pain or discomfort; she had no expression on her face at all. Her family clearly showed her love. I really did not think we were doing a bad thing.
    I have been very conflicted about this issue since JPII’s statement, as I think fluids and tube feeding are often more harmful than helpful to elderly people in the process of dying. My tentative resolution of this has been to say that in these cases they “do not achieve their desired finality.”

    However I do think it is quite simple not to engage in deliberate active euthanasia. We had no difficulty in the hospital setting clear boundaries as to what we would do-give enough morphine to relieve pain and oxygen hunger distress, and what we would not do-give morphine to kill the patient.

    Susan Peterson