Why we had to help our Gran go: A doctor reveals the role he played to end the suffering of his terminally ill grandmother
22:01 GMT, 10 March 2012
I have seen many people die. I have watched as they slowly faded away on wards and seen them die dramatically after being rushed through the doors of Accident & Emergency.
When I worked with the elderly, I sat and held the hands of patients as they passed away, and on a children’s cancer ward I comforted youngsters in their final hours.
For me, death isn’t scary or troubling. I think about it often – not in a mawkish way, but as I have seen so many die, I contemplate how I would like my life to end when the time comes.
Max Pemberton as a baby with his sister Ellie and their grandmother Kathleen in 1982. A few months ago their gran died of cancer
I have also grappled with the ethics of euthanasia and assisted suicide but felt ambivalent about it. Then, a few months ago, my Gran died.
Kathleen was 85 and had terminal cancer, so it was expected. She slipped away quietly in hospital with my sister Ellie and I holding her hand and talking to her gently. It was a delicate, humane and peaceful death.
On her death certificate, under cause of death, it says septic shock, pneumonia and metastatic lung cancer. But that’s not what killed her. She was killed by a nurse.
Now, before anyone calls the police, what the nurse did was perfectly legal and precisely according to the plan my Gran had made clear before she was admitted to hospital.
In fact, my sister and I asked the nurse to do it.
As Gran slipped into unconsciousness, the medical team stopped giving her any medication. Her body began to fail over the next 24 hours. A consultant visited and we had ‘the talk’.
It is never easy talking about death but the doctor did it with compassion and finesse.
Euphemistic phrases such as ‘keeping her comfortable’ were used but it was clear what was really being said: there would come a point when, to ensure she was not suffering and remained sedated, larger doses of morphine would be used and this would have the side effect of depressing her breathing to the extent she would die.
Max with Kathleen, Ellie and grandfather Sidney in 1999
He was checking with us that we realised when the time came, the doses would kill her. Of course, he never said that but we understood what was being implied.
Later that day as Gran began to experience some distress, a nurse administered morphine. It didn’t appear to have the desired effect and Gran remained distressed.
‘We could give her another dose but . . .’ said the nurse, his voice trailing off. We understood what he was saying and nodded.
‘We promised her she wouldn’t die in pain,’ we said.
Another dose was administered. Five minutes later, she stopped breathing.
There is nothing unusual about this. Scenes such as this are played out up and down the country and I’m pleased they are.
After my Gran’s death, I was surprised by the number of people who approached me with similar stories.
Medicine’s aim is not to extend life at any cost but to alleviate suffering.
It is true that medicine has made great advances in caring for people as they approach death. It was never suggested there was any impropriety – it is legal to give medication to alleviate pain as someone is dying and sometimes the side effect is to hasten death.
'Medicine's aim is not to extend life at any cost but to alleviate suffering,' said Dr Max Pemberton
My Gran was haunted by the memory of her mother dying a slow, agonising death from mouth cancer.
I’m sure it’s because of this she was so clear with us that we must do everything to ensure she didn’t die in pain.
The debate around euthanasia and assisted suicide seems to be polarised. But it’s a fundamentally dishonest debate because so few doctors are honest about what goes on in hospitals.
A recent report by the Commission on Assisted Dying caused a furore from groups opposed to any change to current legislation.
Under the plans, doctors would be able to prescribe drugs to end the lives of terminally ill people who request it and are deemed to have the mental capacity to make that decision, providing they have less than 12 months to live.
To safeguard the vulnerable, those with disabilities, dementia or depression would not qualify for help in killing themselves.
Those opposed to changes denounced the Commission as a ‘self-appointed group’ that excluded anyone opposed to legalising assisted suicide.
This may be true but those who oppose assisted suicide are a self-appointed group taking it upon themselves to impose their beliefs on the rest of us.
Some of those who oppose a change in legislation are doctors.
They claim it is not necessary as there is now no suffering as we are so advanced in our pain-management. But this is patently not true.
People do suffer – physically through discomfort, and emotionally through a loss of control and dignity.
I think we should be cautious when it comes to considering such changes in legislation but I also think we need to be open about what is already happening.
Opponents say change represents the ‘thin end of the wedge’. Yet they fail to appreciate the wedge is already in place.
The fact this is rarely acknowledged publicly gives the false impression that the Commission’s proposals represent a significant shift in practice and that doctors aren’t already involved in ending people’s lives.
It is different, conceptually at least, for doctors to help terminally ill people die before death is imminent. But it’s not that different.
Ending your own life is legal. Those who would rather take this option are perfectly entitled to do so. But I’d rather a physician was on hand to help ensure things went smoothly than see, as I have, people experience painful or slow ends as a result of botched attempts.
At present, this option is only available to the physically abled who can go to Switzerland where physician-assisted suicide is legal.
For me, this is about the individual taking control of their lives by choosing when and how they will die and doctors ensuring this does not result in any suffering.
I don’t find that frightening. I like the idea of people feeling empowered at a time when so much can seem out of their control.
I want people with a terminal illness to have the kind of death my Gran had, when they choose it.
The Doctor Will See You Now, by Max Pemberton, is published by Hodder.