Missions of mercy that get lost in the twilight zone

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The Independent Culture
THE DOCTORS had a terrible problem with my grandfather. He was too healthy. After a week in the ward, they told us that he'd probably die of an infection. After a month, they told us that even though he hadn't died of an infection in the early stages, he was bound to die of one soon. In fact, a second round of infections would attack him at any moment. After six weeks, we had an optimistic call - he had an infection] We waited. Not long now, surely. And then, a few days later, we were told the bad news - he'd survived the infection. He wasn't going to die. And everybody was confused. We wanted him to die. Or did we? He was comatose; he wouldn't recover. So we wanted him to die. In a sense. But did we want him to be killed?

No, we didn't. We didn't want people to kill him. We wanted bacteria or viruses to kill him; we wanted his assassins to be too small to be accountable. We felt guilty that we wanted him to die, but we wanted him to die so that we could be sad that he had died, so that we could pretend that we hadn't wanted him to die. In fact, as time went on, we sensed that we were entering a problem area - pretty soon, if he didn't die, we were going to have to admit to ourselves that we wanted him dead. We couldn't keep on going to the hospital and saying to each other: 'Well, you never know . . .' We knew. So there was only one thing for it. Somebody was going to have to kill him.

The rules are very clear on this matter. If you're a doctor, you can kill people. That's fine. Just don't shout it from the rooftops. And use a discreet method. Here is the British Medical Association's interpretation of the law: 'A decision to withdraw treatment which has become a burden and is no longer of continuing benefit to a patient has a different intent to one which involves ending the life of a person.' I think that's medical jargon for: 'For God's sake keep quiet about it. And make sure you don't hire a Catholic nurse.'

But what does it really mean?

What it means is: 'Like you, we're confused, but we're trying to do the right thing.' Actually, the BMA's statement doesn't make sense. It's logically fallacious. It seems to be saying, or at least trying to say, that passively killing someone (letting them die) 'has a different intent' from actively killing somebody (finishing them off). But surely that's nonsense. The intent is the one thing that's the same. The intent is for the person to be dead. You want them dead. You want to get rid of them. It's not very nice, but there it is. It's just the method that's different.

So what method can you use? Basically, you can leave a patient to die, and you can poison him under special circumstances. The clearest thing is that you're allowed to kill a patient by non-intervention. This is a pretty good tool; non-intervention has a wide application. If you want to kill somebody, for example, you can not intervene by not giving them medicine which they depend on to live. But say your patient can't move. Then you can not intervene by not giving them food and water. They can't very well get it for themselves, can they? A lot of sick babies need respirators. But you can suffocate them - that's fine, as long as it is done by switching something off, by omission, and not by commission. As the BMA says: 'There are circumstances where the doctor may judge correctly that continuing to treat an infant is cruel and that the doctor should ease the baby's dying rather than prolong it by the insensitive use of medical technology.' That's the point. You're not exactly killing somebody. What you're doing is easing their dying.

So what happens when a doctor like Nigel Cox goes too far and gets convicted of attempted murder? The judge practically congratulates him. Dr Cox didn't just ease Mrs Boyes's dying - he tried to kill her with a potassium injection. The judge said to Dr Cox - the convicted criminal - 'I have no doubt that for you it has been a terrible ordeal.' Have you met a single person who doesn't admire Dr Cox for what he did - for trying to kill somebody who wanted to die? Almost nobody thinks it was wrong. But we still have a residue of moral uncertainty. We don't think it's wrong. But we would feel uneasy if we thought that nobody thought it was wrong. That's why the rules are so confused.

How confused are they? About this confused: you can give someone a painkilling injection in the knowledge that it will hasten their death, but you can't hasten anybody's death to relieve them of pain. This is such a fog of confused beliefs that, until Dr Cox, a doctor had never been convicted. Cases come up every so often: in 1981 Leonard Arthur, a paediatrician at Derby City Hospital, prescribed 'nursing care only' to a Down's baby whose parents didn't want the child; he was acquitted of attempted murder. In 1990, the case was dropped against Stephen Lodwig, who had injected a patient in Reading with a mixture containing potassium chloride; Dr Lodwig's defence was that potassium chloride, used in conjunction with a painkiller, might have had a palliative effect.

As Colin Brewer, who tried unsuccessfully to kill a patient with a mixture of sedatives and painkillers, says: 'My advice to doctors is always to steer clear of insulin or potassium. It makes life difficult for the DPP. If you are going to kill a terminally ill patient, stick to a large dose of heroin.' So that it will be easy for the DPP, right?

The call we were waiting for came after 11 weeks. My grandfather would die the next day. Mid-afternoon. We felt bad - my God, we'd wanted him to die, and now they were killing him. Would they be killing him if we hadn't wanted him to die? They even knew what time he would die, because they knew exactly how long it took to starve a comatose patient to death. I thought: 'They must be starving him now]' Frankly, a lethal injection would have been better. But, since he wasn't in pain, it would have been against the law. He died, just like they said he would, on the dot of half-past three. -