Health Check: Choosing not to go gently

FOR ABOUT the first 20 years of my adult life I was an uncritical supporter of euthanasia. Then I read a report that changed my view. It pointed out what I still consider to be a key fact in the debate: opinion polls show that support for euthanasia declines with advancing age.

In other words, as death approaches, the prospect of being dispatched simply, easily and without pain loses rather than gains in appeal. The very people whom euthanasia is intended to benefit show least support for it.

I offer this as a general observation, not a specific comment on the activities of Dr Jack Kevorkian, who is due to be sentenced in the US this week after being found guilty of second degree murder, or those of Dr Ken Taylor, found guilty by the General Medical Council last week of starving a stroke patient to death. I am not against euthanasia and I recognise that each case must be judged on its merits.

But the decline in support for the practice as the prospect of encountering it draws nearer seems to me to demand attention. At first sight, it seems strange. Surely, you might think, advancing age and disability would increase people's enthusiasm for euthanasia. Who, after all, would choose to spend their last days disabled, bed-ridden or incapable?

The surprising answer is: most people. When the light is dying, very few go gently or willingly into the night. They hang on, grimly if necessary, to the last little drop of life.

My father had a horror of ending his days as an invalid. He suffered from heart disease and would remark sotto voce whenever we visited anyone who happened to be incapacitated: "Don't, for goodness sake, let me end up like that."

Yet when the end came he was ready to have kidney dialysis in the hope that it would buy him a few more days or weeks of life, even confined to a hospital bed. He died before the machine could be rigged up but, had he lived, those few extra hours or days might have provided him with the opportunity for a reckoning, a saying of goodbyes.

A more striking example was provided by the experience of my sister- in-law's father, a man of immense energy who found himself in his eighties totally incapacitated by a creeping lung disorder that led to growing breathlessness.

He had been a public servant, and in retirement took up the violin, travelled all over the world living in a camper van, and served on a clutch of voluntary bodies. In the last year of his life he was virtually bed-ridden, sustained only by a constant supply of oxygen piped up his nose.

To many younger, healthier people, that might have seemed a fate worse than death. There were, indeed, family discussions about what should be done. But, to general astonishment, the old man adjusted to his new condition better than anyone had dreamed possible by employing his niece to record his memoirs. They spent hundreds of hours, spread over weeks and months, recalling the details of the family's history. It was a lesson to the rest of us that life can grow more, not less, precious as it dwindles.

The presence of pain, of course, would have altered the picture utterly. But is pain sufficient reason for ending a life? The official view, as put by the British Medical Association (BMA), is that there is no pain or suffering so great that it cannot be controlled with modern treatments, hence there should be no cause to end life prematurely.

A doctor who prescribes steadily increasing doses of morphine to ease pain in the knowledge that this will shorten life is acting within the law, provided the intention is to relieve suffering. But if he says that the intention is to end life, he has crossed a legal boundary and put himself at risk of arrest and prosecution. The BMA believes that this legal distinction must be upheld to maintain the trust that patients have in their doctors. Otherwise, doctors may come to be seen as agents of death. I think the BMA is right.