EUTHANASIA AIDED BY A RELATIVE

THE WILLIAM TELL FACTOR

By Alan G. Cock

Were I the son of William Tell, I should most fervently hope, for my father's sake as well as for my own safety, that some other expert marksman - anybody but my own father - should be ordered to shoot the apple from my head. Compared with voluntary euthanasia, the roles of life and death are reversed, but the analogy remains valid.

Early in 1961 (before the 1961 Suicide Act came into force) my first wife, aged 39, died in a London cancer hospital. She had terminal cancer of the colon, and had taken (with my foreknowledge) an overdose of barbiturates. The main point of telling the story now is that it illustrates, with especial poignancy, a very common and serious practical difficulty. Although suicides done "on impulse" are often fully "solo" efforts, it is rare for somebody to plan and carry out an act of euthanasia entirely on their own. At the very least they are likely to have a confidant and, much more often, somebody who gives them more or less active help and support. Ideally this would be a medical practitioner, but in the present state of the law it is often difficult to find a doctor willing to help in this way (thirty years ago it was even more difficult). One is, after all, asking the doctor to commit a criminal offence and to put their own career at some risk - a lot to ask. So the role of helper usually falls to a close relative - spouse, parent, sibling or child. There are several dangers associated with acting as a lay helper.

Clearly, there is the risk of being eventually prosecuted - a traumatic experience, even if one is not convicted. The lack of sufficient medical expertise is perhaps not so serious a drawback as is commonly supposed. (I am a biologist, and had used barbiturate drugs as an animal anaesthetic many times. So, as far as sheer technical knowhow goes, I was much better equipped for my role than the average layperson. Yet our 'conspiracy' very nearly failed, and hovered on the brink for over 24 hours.) By far the greatest danger comes from the close emotional involvement of the helper with the patient; helping a loved one to end their life is not easy, and one is continually in a state of being "pulled both ways". The need for secrecy adds a further layer of emotional stress. In such emotionally fraught situations one's judgement tends to be seriously impaired, leading to mistakes or oversights that would rarely be made in an emotionally neutral context.

We should take heed of what doctors do when there is even moderately serious illness in their own family. Rather than treat the case themselves, a colleague is called in. It is not that the doctor reckons his colleague more skilled: he simply knows that the colleague, from his more detached position, is better placed to make a calm and balanced judgement.

Over the past 3 1/2 years my wife had had two major and two minor surgical operations, and by the end of 1960 we knew we had reached the end of the surgical road. At one point I discovered, to my great disgust, that her surgeon and our GP had been conspiring to deceive us (me, mainly) as to her condition: the surgeon wrote to the GP the precise opposite of the reassuring message he had given BO. (I know, because I later saw their correspondence. ) Fortunately, labelled [sic] by instinct, I insisted (against rather strong opposition from the GP) on calling in a second opinion. As a result, she had a further operation which (although only palliative - not all the cancer could be removed) was enormously beneficial. It gave her an extra 18 months of very worth-while life, most of it comparatively free of pain. Although I do not think that - as things turned out - that episode of medical deception had much effect on the course of my wife's illness, it did, naturally, seriously impair our degree of trust in the medical profession, and leave us both with a stronger sense of being isolated (hardly conducive to rational judgement).

Six months before she died, my wife told me that she had accumulated over 50 barbiturate capsules (prescribed as sleeping-pills - she had been taking them only on 'bad' nights). We went together over all the usual issues and emotions associated with euthanasia, and I could not find it in me to try to dissuade her. From me she wanted just two promises: that I would do nothing to thwart her plan, and that I would verify that she had enough of the drug for her purpose. (According to the British Pharmacoepia, she had over ten times the lethal dose - a reassuringly large margin. ) Her intention was to keep the drug always by her, and not to tell me in advance when she decided to take it. That lifted one burden from me: in the event of a farewell meeting ("I shall take the drug tonight") I know I should have felt an overwhelming pressure to persuade her to postpone it for a few days, and then for a few days more ... .

In the first days of 1961, by a prearranged plan, I took our two daughters, aged 6 and 8, to stay with their aunt and cousins in Austria (my wife's native country). Besides affording them some shelter from what was to come (a new and exciting environment can work wonders), it left us free to move away from Edinburgh. We had been offered the chance of having chemotherapy in London. Neither of us saw that as amounting to other than clutching at straws. (For technical reasons, the various anti-cancer drugs are far more effective against rapidly growing kinds of cancer than against the slowly growing type that my wife had.) Indeed, our London doctor was admirably frank, saying only that some of the newer drugs had shown "a degree of promise" with that type of cancer. In that situation, even clutching at straws seems preferable to waiting passively for the inevitable. So we moved to London, where she was placed in a two-bedded side-ward. In retrospect, the benefit of moving to London lay far more in the better standard of care and much quieter atmosphere there, than in any specific medical treatment.

A week later, I returned to Edinburgh for a couple of days, partly to ensure that our house was properly shut down and secured, but also to collect various papers and books from my place of work. Colleagues had urged on me some very sound advice. Don't, they said, let life became just a sequence of hospital visits; take down some work to do, and that will help divert your mind. To that end, I had already arranged to borrow a room to work in at London University. My car broke down during the journey back from Edinburgh, so I had to leave it at a Yorkshire garage, for a reconditioned engine to be fitted, and complete my journey by train.

Three weeks after our first arrival in London, I had still not begun any work: two hospital visits each day and a lot of time spent in travelling (I was staying with my father in the outer suburbs) did not leave much time to settle down to work. By wife's condition had seemed fairly stable over the past few days, so I decided to tell her that afternoon that I would skip that evening's visiting session and do some work at the university. It was less the value of any little work I might get done than that the attempt at "business as usual" would help the morale of both of us.

That afternoon there was very bad news. The doctors had decided to discontinue chemotherapy: the treatment was destroying too many of her blood cells. They wanted me to arrange, within about a week, for her transfer to a nursing home - probably one of the Marie Curie Memorial Homes. Despite the news, I persisted in my original plan of not coming again in the evening. As I left, saying "see you tomorrow afternoon", I had not the least idea that that would be the last time we should speak to each other.

Once outside the hospital, the impact of chemotherapy being stopped sunk more deeply into me. I felt too upset to concentrate on work, so I went to a cinema instead, in an attempt to relax. Early next morning, my father took a telephone call: as soon as he said it was from the hospital I knew what had. happened, and was amazed that I had not guessed that yesterday's news might trigger off her plan. They said that she had seemed normal the previous evening, but was found to be in a coma in the morning.

The journey across London took nearly two hours. I hardly expected to find her still alive, but alive she was, lying peacefully and breathing steadily, if rather slowly and shallowly. Her room-mate had, of course, been moved elsewhere. From my wife's handbag I took two empty bottles, and transferred them to my pocket for eventual disposal outside the hospital. One had contained the barbiturate; the other was a miniature of brandy. The brandy had been my idea - partly to make the draught more palatable, but also because alcohol strengthens the action of barbiturates. Somebody asked me to go along to see the doctors. There were two of them - a man and a woman, both quite young, and new to me. They said they suspected that my wife had taken an overdose of something. It would help to know which drug it was. Did I know anything which would throw light on that? I firmly denied any knowledge, but added emphatically that if I did know anything I certainly would not tell them. They knew her condition and prospects, I pointed out, and if she had taken something, she was fully aware of what she was doing. With all the passion I could mister, I begged them not to take any steps to resuscitate her.

There followed a long, embarrassed silence, ended by my leaving the room. I had not expected an explicit promise not to attempt resuscitation that would have implicated them in a criminal conspiracy. I had hoped for oblique assurances that they understood the situation (I am quite sure they grasped my message) and would not intervene. Perhaps a more experienced doctor would have found a more sympathetic and supportive way of handling this tricky situation.

Back at my wife's room, I found to my alarm a nurse at her bedside, syringe in hand. I put out my hand to restrain her, but she explained that she was intending only to take a blood sample. Realising that the syringe was indeed empty, I let her proceed. Then began a vigil that was to last 27 hours. For the first few hours I saw myself as being "on guard", lest the hospital take active steps towards resuscitation, though what I could or would have done in that event, I cannot imagine. It gradually became clear that the hospital was intending simply to let things take their "natural" course, but as that fear subsided another, deeper, alarm came to the fore. My wife had taken one of the quicker- acting barbiturates, which should have maximum effect within a few hours. Seeing that some 12 hours must have elapsed before I reached the hospital, that time was well past. What I had now to expect was that, as the effects of the drug wore off, she would slowly recover, and eventually regain consciousness.

Of course, there was part of me that did not want her to die just then, but the alternative seemed far more alarming. On recovery, she would be bound to have feelings of disillusionment and despair, of an intensity that I could only guess at. As for me, how could I face her, knowing that - somehow - I had failed her In her last and most important request? To organise another attempt would be extremely difficult: the hospital staff would now be alerted to the danger and, understandably, would see it as their duty to frustrate any attempt. Even obtaining a fresh supply of a suitable drug would be a formidable problem, though that would not have been quite so difficult back in Edinburgh. I did not spend quite all the time in her room: I made short trips outside for meals; I disposed of the bottles, bought a newspaper. Occasionally I went down to the hospital waiting-room, or paced along the corridors. These were tension-relieving stratagems - successful up to a point.

I did seriously consider telephoning the Voluntary Euthanasia Society, but decided that that would be unfair (to the Society) and rather pointless. The purpose of the Society is to campaign for reform of the law, not to offer help or support to those engaged in an Illegal act. I tried to phone a scientific colleague, but he was out. Probably I phoned my father, to explain my prolonged absence. The only constructively comforting conversation I had during all that time occurred during one of my wanderings along the corridors. I act [sic] my wife's room-mate. She told me not to worry or feel guilty: it had been the only possible way. They had talked together about it the previous evening, and she (the room-mate) was fully determined to do the same when her own time came. None of this directly addressed what was my chief worry by then (i.e. what should I do if my wife recovered?) but just to talk sympathetically and openly with somebody who knew the circumstances was immeasurably supportive.

Twice during the final hours my wife moved her head very slightly. This alarmed me, as it seemed a likely prelude to recovery - but nothing further happened. At this stage I did very seriously contemplate smothering her face in a pillow. The risk of detection would have been very slight, but I just could not do it (am I a coward?). Then her breathing became progressively slower and finally ceased; the vigil was over.

I went out to register her death, then to the university, where I phoned my father, who drove in to collect me. Mercifully, the next few days were frantically busy. We found a printer who would produce, at very short notice, cards announcing her death. The wording followed precisely what she had written in her address-book: "... no flowers, please - donations to the Marie Curie Memorial Foundation... ." Although the hospital must have had very serious doubts, they issued a "clean" death certificate, so that I was able to arrange for her remains to be cremated. I addressed and despatched all the cards, and went up to Yorkshire to collect ay car. The cremation I attended absolutely alone, following her wish. As soon as I could collect the ashes from the undertaker, I took a night trainto Austria. Breaking the news to our daughters was not a task I could delegate.

After a few days in Stiermark with my daughters, I went on to Vienna. There, my mother-ln-law and I quietly interred her ashes in her father's grave. That was in a Roman Catholic cemetery: a double irony, since suicide and cremation are both anathema to that church. The marginal dishonesty of the procedure did not seen to bother my mother-in-law - a devout Roman Catholic -  so I saw no cause for it to worry me, an agnostic, nor did I think fit to burden her conscience by explaining how her daughter had died. I returned to Edinburgh to pick up the threads of work, to rebuild a life, and to find a housekeeper. After six months, I went again to Austria to bring my daughters back home.

What went wrong? That is now hardly more than an academic question, but there are several plausible possibilities. Given the ten-fold excess over the nominal lethal dose, it seems highly unlikely that, purely as a result of age, the drug's potency could have declined to that extent. It is conceivable that the residuum of the anti-cancer drug she had been taking in some way interacted with the barbiturate, reducing its effect. Perhaps my wife had failed to swallow the whole amount; I am confident that her room-mate would have cleaned up any spillage, rinsed out the tumbler, etc. Perhaps an antidote had been administered before I reached the hospital. But I strongly suspect that the fault lay in something I did shortly before we left Edinburgh.

My wife had faced me with a disturbing question: "How, when it comes to the point, shall I manage to swallow 50 capsules?" Well, some people swallow pills or tablets very easily, while others find it more difficult - she had always been in the latter category. If you are ill and debilitated, that tends to make matters worse, while gelatine capsules offer a special problem: unless swallowed immediately, they become sticky and tend to clump together. In desperation, I did the only thing I could think of. I took home the capsules, opened up each one, and tipped the contents into a quite tiny pill bottle, made tight the cap and put tape around it for extra surety. I was well aware that barbiturates lose their potency on excessive exposure to air (hence the very small bottle), but bearing in mindthe original 10-fold margin, and with the addition of the brandy, I felt confident we still had an ample margin. This, of course, was just the kind of point on which it would have been sensible to consult somebody more expert.

But to whom could I have turned?

Despite my comparatively passive role, I was very clearly guilty of being an accomplice in suicide (or murder), for which I could have been prosecuted and sentenced to up to 14 years' imprisonment. Thirty years later, prosecution, although still theoretically possible, is almost unthinkable. Prosecutions for ancient offences where the accused's confession is the sole evidence are now, quite rightly, out of favour (and I do not even have an Irish name). At the time, if the hospital had made any difficulty over issuing a death certificate, there would presumably have been a coroner's inquest, possibly followed by a prosecution. That would have been unpleasant for me, even if I had been acquitted. For our daughters it would have been horribly traumatic.

Southampton, October 1991