On the way out

I balanced all, brought all to mind,

The years to come seemed waste of breath,

A waste of breath the years behind

In balance with this life, this death.

William Blobster Yeats.

An Irish Airman foresees his death

I've put rather a lot of words down in The Blob about end of life issues. But in balance with this death, I've also written a million words on life, the universe and everything, so don't accuse me of being morbid. I think we have a richer engagement with death in Ireland than across the water in England where the process seems to take forever and where my father was 10 days in limbo between dying and going up the chimney. Thanks be that the modern British funeral director has cold-storage! In Ireland we have an almost Islamic time-scale where it is normal to die of Monday, waked on Tuesday and buried of Wednesday and a jolly good time is had by all . . . especially if you like ham sandwiches and tea.

But post-mortem is not the problem; it's pre-mortem that too often is not handled well.  Here's a 6000+ word essay on How to have a good death by Maggie Fergusson. Among the key issue she addresses is the one epitomised by "“I am mourning my mother, though she is still alive”.  Because we are all living longer, more of the late-onset diseases stalk across our ken, and indeed, kin. My mother, now 96, has seen many couples among her friends separated by dementia. The lucid survivor is required to live with the shell of a spouse who/which is no longer responsive to anything much at all. The lines of Arthur Clough are often cited, because they trip off the tongue, when issues of continued palliative care are broached "Thou shalt not kill / But need’st not strive / Officiously, to keep alive.".

Many doctors find it in their hearts to finish off their patients if they are in distress and /or pain and there is no hope of recovery. They justify their actions to themselves, and if necessary to the relevant medical council if pulled up on it, by invoking the Principle of Double Effect: I administered an awful lot of pain-killers because my patient was so distressed and the consequence was that my patient died . . . but that was not the intention, that was a by-product of the analgesia. You'll need to be a philosopher to drill down into the nuances of this almost on a case by case basis. This is why it is so difficult to legislate for assisted suicide or euthanasia.  No matter what scenarios you may imagine or have encountered to help you write the clauses of when and when-not termination of life is allowed, there will be a case beyond experience or imagination that will not fit the criteria. And it really really doesn't help to trot out anecdotes about the chap who was in a persistent vegetative state for months or years and then came back to earth. For each one of those there are a thousand people who are kept breathing under circumstances that their healthy self would not have countenanced.

This essay sets out most of the end-of-life issues, with a helpful smattering of UK case law and enough detail to make the reader familiar with the language and key findings of those who have been through the mill of a dying relative before. There is nothing really new here, we have been dying for much longer than there have been people to write down their thoughts on the process. If you read the links (above and below) now, you'll thank yourself later when you get there yourself. Nobody, that's nobody, lived for a day longer by not thinking about The End.

Links: Exit (Australia and wider) - The Hemlock Society (US) no longer exists under that name. Assisted suicide and euthanasia are illegal in Britain but the NHS sets out the issues here. In Ireland your Advanced Healthcare Directive has no legal standing whatsoever: Doctor knows best what you need.