Other people's lives: reflections on medicine, ethics, and euthanasia.

• Author: Fenigsen, Richard
• Position: Medicine versus Euthanasia, part 2

Part Two: Medicine Versus Euthanasia

Chapter XXVII. Death in the Gray Zone

The Death of Gene McC. (461) Shalom Newman was on the phone.

Shalom: I can hardly believe what Halina told me about Gene's last days. Do you think it can be true?

Richard: I see no good reason to doubt the story. Unfortunately, nowadays those things are being done."

S: But if this is true, it was murder!

R: You can call it so, but it would be difficult to prove. The doctors and the nursing home personnel say they had to stop the feeding

and the fluids because it was no more benefit to the patient and his body no longer accepted it.

S: This is a lie! The feeding ran smoothly, Gene was in good mood, making plans for the summer vacation--and then the feeding bag and the stomach tube were removed. On the next day Halina found him dull and mumbling, a few hours later she could no longer awaken him. He was comatose for another two days, and then he died.

R: Yes, after the removal of the tube he was heavily sedated, and they will say that since fluids had been stopped they had to sedate the patient to prevent suffering due to dehydration. Of course, you know Halina was remonstrating, begging, and shouting, but all that was no avail. She had no standing, being just a friend, while Gene's children repeatedly called from Florida insisting that their father "be allowed to die." They had demanded that again and again: five years ago, when he had his first surgery for bursting aorta, and when the aneurysm recurred. When another recurrence of aneurysm compressed Gene's esophagus, the children tried to prevent the insertion of stomach tube.

S: A remarkable man he was! He used to joke about his tube, said his usual portion of white wine should be added to the meals.

R: Oh, he was a great guy. Quietly proud of his war-time colonel's rank, on first name terms with all Boston's politicians, his shirts always impeccably white, his belt buckle a work of art, his car perhaps a little battered but always a Cadillac; and while keeping up all those appearances he remained such a simple and friendly man, and so patient and brave while facing his illness. I shall miss him badly.

S: But say, why did the children wish his death? He had adopted this boy and this girl, raised them, supported them all his life. Inheritance? Gene hardly left anything worth while.

R: I think they wanted to get rid of the psychological burden, the sick father lingering somewhere in a Boston nursing home. And, above all, power! Power! There is no greater sense of power than that derived from putting a human being to death. They now know how to express such wish in socially acceptable terms, they speak in modern lingo.

S: You know, Richard, I am all for the right of a competent person, acting under no constraint, to choose the time of his own death and to be assisted in committing suicide. But that was not what happened to Gene. He did not want to die, he was murdered!

R: What you support is an ideal concept. What happened to Gene is the reality. (462)

What is happening to elderly persons in hospitals and nursing homes has alarmed public opinion in several countries. In hundreds of cases there have been clear indications that medical personnel acted to cause or at least hasten old people's deaths.

In Britain, the deaths of fifty elderly hospital patients were being investigated by police and health officials in January, 1999, "amid allegations of a creeping tide of backdoor euthanasia." (463) At least five hospitals were at the center of police inquiries as a result of relatives' complaints or nurses' whistle blowing. The number of deaths under inquiry soon increased to sixty. (464) The published reports and case histories illustrate the various ways the deaths of older people were induced by the staff. The nurses at Kingsway Hospital in Derby claimed that forty people with dementia were starved and dehydrated until they became so weak that they died from infections. Nurses alleged that their senior colleagues were withdrawing food and water from patients; they placed them, without proper authorization, on "nil-by-mouth" regimes, claiming that they were at risk of choking. (465) Mrs. L.C. was admitted to Eastborne Hospital with a mild stroke: her left arm was somewhat floppy. She was fully conscious. The next day her daughter discovered above the patient's bed a sign saying "nil-by-mouth." "I'm gasping for something to drink, my mouth is so dry," said Mrs. L.C., and drank avidly the orange juice brought by the daughter. The next day the daughter was told not to disobey the "nil-by-mouth" regime. The drinking cup had been confiscated. An I.V. drip was started but it caused swelling in the arm. The drip was removed and never replaced. Still no doctor had seen the patient. Three days later Mrs. L.C. died. (466) After several strokes, Mrs. O. was in stable condition and could swallow quite well small gulps of liquid food. But then Dr. K.T. ordered withdrawal of the high-protein supplement essential for her nourishment. Mrs. O began to lose weight "until she looked like a victim of Belsen"; she died weighing fifty-four pounds. (467) Mr. W.H., 78, was admitted to Royal Oldham Hospital after falling and cutting his head. He quickly began to lose weight; "when nursing staff brought his food they left it out of his reach and did not help him cut it up or eat it." When the family complained, hospital staff told them: "Your father is not the first priority on this ward." Mr. H's death, five weeks after admission to the hospital, was apparently not due to his injury or any disease but to starving and neglect. (468)

"I have witnessed doctors who want to keep the bed clear by withdrawing treatment or actively assisted in deaths," Dr. Rita Pal told the London Times. "An 89 year old stroke patient was unable to speak ... [He] was actually conscious and could hear us. The doctor said, "We need the bedstop all his medication." They stopped the medication and about 9:30 p.m. he started getting short of breath. I held his hand and said, "You will be all right." I was sickened by the whole episode." (469)

Once families of elderly patients came forward, relatives of young British patients with disabilities also began to speak out. When 12 year old David G., who has cerebral palsy, was admitted to St. Mary's Hospital in Portsmouth with chest infection, doctors ordered that he should be given diamorphine and a DNR order and left to "die with dignity." (470) The doctor's expectations (or hopes?) did not come true: David survived his hospital stay and his mother is taking care of him at home.

In February, 2000, the British Medical Association issued guidelines intended to prevent "back-door euthanasia." (471)

Austria. The heart of darkness seems to have reached Austria, at Vienna's Lainz Hospital, where four nursing aids killed forty-nine, (472) and possibly 200 elderly patients. (473) The preferred method was administering high doses of the sedative and anti-hallucinatory drug Rohypnol or what the nurses called "oral hygiene" ("Mundpflege"): the murderess poured large amounts of water into the helpless patient's mouth while the accomplice held tight the victim's nose. (474) The killings were going on for several years and at least some doctors and hospital officials must have been aware of them: autopsies were mandatory, and the test of lung floating, routinely done at the post-mortem, must have shown that the patients died of drowning. (475) During the inquiry, some suspects claimed to have acted out of compassion; there were, however, clear indications of malevolence. One of the nursing aids was known to have boasted that "there is no such thing as 'no beds available' at my ward." (476) The code words for killing were "sending him up to the Lord" or "down to the cellar" (where the morgue was located). (477) One of the suspects admitted that she resorted to killing when a patient aggravated her. (478) At the trial, two defendants were sentenced to life in prison, one to twenty years, and one to fifteen years. (479) The psychologist who studied the events at Lainz Hospital came to the conclusion that society and the medical profession are now more tolerant of euthanasia and that has influenced the barely literate nursing aids who had very insufficient schooling as caregivers. Having witnessed some doctor's decisions to let patients die, they lost all ability to discern what was permissible and what was not. (480)

In the Netherlands, a number of deceased patients' families complained in 1997 that their loved ones had been deliberately starved and dehydrated to death in nursing homes 't Blauwborgje, De Plantage, and De Weerde; (481) the police and the public prosecutors launched inquiries in some cases, but often were reluctant to intervene. (482) The study conducted by nursing home physician, Dr. E. Fischer, showed that twenty-two percent of non-demented persons dying in nursing homes, and forty-six percent of the demented die as a result of "versterving"; (483) the word had been used in a variety of meanings but now came to denote deliberate withholding of food and liquids with the aim to cause death. Targeted are patients who seem to refuse eating and drinking, those who are unconscious or otherwise unable to feed themselves, and often those who crave food and drink, but are too weak to demand it loudly. The list does not include tube-fed patients because this method of feeding is virtually never used in Dutch nursing homes. As a rule, families are not informed of the intended withdrawal of food and fluids, but in some cases the relatives noticed or suspected what was going on. Since the personnel are feeling righteous about this policy, assured that they are helping the sufferers die an easy death, remonstrations and protests of the families are usually disregarded. Some ethicists justified the versterving, arguing that "quality of life outweighs its duration," (484) while others protested...