Let them go in peace

I VISITED a sick friend in Budapest last month. She was in the sort of hospital that Florence Nightingale would have recognised. Despite the old-fashioned buildings, however, the medical care was the best that limited funds allowed. The huge wards had been divided into units of four, and in the bed across from my friend lay a woman, infinitely old, chalk- white, and dying.

Her son, old himself, and another woman sat by the bed, gently stroking her unconscious face. The dying woman's neck was extended, her head back, mouth agape. She had been like that, my friend told me, for a week, the process of death intolerably drawn out.

Her death - three days later - and others that have affected me recently, set me wondering about the medical practice and ethics which determine such painful and unwanted prolongation of life. It is harrowing for all concerned, not least the dying person, and certainly for the relatives. It is unwanted, in every case that I know of, by the dying person, who often asks pitifully why it has to take so long, and even apologises for the distress and inconvenience he or she is causing.

The aftermath, for those who loved the dead person, is the harder to bear because of the suffering they have witnessed; the humiliating, interminable decline, mitigated but not hastened by all that today's drugs can do.

I know a young woman who, having witnessed her mother's excruciating death from cancer a year ago, is still so distraught that she cannot pick up the threads of her life. She has been brought to a halt by grief; by images of her mother reduced to a crumbling shell of friable bones, kept alive in this state for several months by the miracle of modern medicine.

In previous centuries, fewer people lived to a great age, and those who did were vulnerable to infection or the gentle, midnight ceasing of the heart. I can find no accounts in literature of ordinary people - kings and prelates were different, of course - being subject to the prolonged agony that characterises today's deathbeds.

No working-class household, in the 18th or 19th century could afford to divert the labour of its productive members into caring for the dying for months on end. A strong pair of hands was too valuable to be spared for very long.

What happened in such cases? Surely the process, once its inevitability became clear, was hastened with a pillow. A lingering invalid would have been stifled: a swift and probably merciful end. It is true that I can find no evidence of this beyond common sense, but then, who would have recorded it?

Medical practice today is well meaning but less merciful. Why, for instance, implant a heart monitor in someone over 75? It ensures only that the gradual, natural slowing down and stopping of the heart cannot occur. Each time it misses a beat or two, it is kick-started with a ruthless electronic bleep, and must pump on relentlessly.

Death will thus require harsher means, but even those means are often frustrated. Why intervene with antibiotics when flu or bronchitis - the old man's friend, as it used to be known - tries to end an already overlong life?

The consequence is that people nowadays have to die of something truly cruel and horrible: cancer, perhaps, emphysema or gangrene. And death occurs only after it has been pointlessly delayed by every kind of medical intervention. The General Medical Council conceded that Dr Nigel Cox was merciful, not murderous, in curtailing the last hours of his patient's life.

By the time medicine is helpless, the pain is likely to have become so unendurable that the dying person must be given huge quantities of mind-muddling morphine. Thus last words are likely to be imprecise and important things may be left unsaid.

In the past, people talked of a dying hour or a dying moment; one never heard about dying weeks or months. In 1965, when Elisabeth Kubler-Ross (a specialist on death and the dying) was looking for dying persons to interview, the heads of the hospitals and clinics to whom she addressed herself protested, 'Dying] But there are no dying here]' There could be no dying in a well-organised institution. They were most offended. Now people are kept alive beyond their natural span and, more to the point, beyond their wishes.

By all means let doctors do everything in their power to save young lives: children who have had an accident or young men hurled from a speeding car or bike. They have lives ahead of them to live. But in the case of the old, whose lives have been accomplished, for good or ill, what is the point? I know the dangers of hastening death - the coveted fortune, the unscrupulous doctor - but surely there is a middle way?