Comfort in the option of a dignified death

Kathryn Powley farewelled mum Isabelle in January, 2005. Photo / Supplied

As the country debates the rights and wrongs of assisted suicide, Kathryn Powley remembers the death of her mother - and asks how it might have been different - while Susan Edmunds looks at the proposed euthanasia bill.

Two or three months after my mother died of cancer, I packed her scrawny, old ailing ginger moggie, Huckle, into a cat-carrier. I took a deep breath and drove him to his last vet's appointment.

Huckle had been my kitten and I'd named him after my favourite Richard Scarry character. Mum - Isabelle Powley - had inherited him when I went overseas about a year later.

He'd been a fearless fighter, a good mouser and a loud purrer. But he was now 15 and had developed a fatal condition, hyperthyroidism. To survive he had to be tricked into taking a little yellow pill every day.

Out of loyalty to Mum and Huckle, and because I didn't want to part with him so soon after losing Mum, I tried smothering those devilish pills in Marmite. That worked for a while. Then I wrapped them in camembert cheese, I even smeared pate over them but, in the end, that cat was simply too cunning and stubborn to take his medicine.

Slowly but surely the disease was getting the better of him. He was extremely skinny, had no energy and slept most of the time.

I was dealing with Mum's estate, selling her house and business, sorting out her belongings and coping with my own intense grief, while holding down a full-time job. I had little energy left for Huckle. His time had come.

"Would you like to be with him?" the receptionist asked.

"No thanks," I said, automatically. It hadn't even occurred to me to share his last moments. Then: "Um, yes, I would actually."

I carried him into the room, took him out of the carrier and put him on the table. The vet drew a syringe full of fluid. It was unreal. And it was sad.

I stroked him as he lay there calmly. I held his little paw as the needle went in, and I kept holding it as he closed his eyes for the last time. And that was that.

I felt relief and was surprised that Huckle seemed to feel nothing. He just went to sleep.

There was no dying gasp. No nothing. Just there one minute, gone the next. It was one of the best decisions I've ever made, and whenever I think of that moment I wonder why my lovely Mum couldn't have had the luxury of such a calm, peaceful passing.

* * *

Mum died in North Haven Hospice, in Whangarei, 3 months after a sudden, out-of-the-blue diagnosis of terminal bowel cancer. It had spread to her liver and nothing could be done.

She had been a school teacher, farming leader, world traveller, avid reader, consummate cook, enthusiastic walker and great friend to many.

That September, after three nights in hospital with a strange bloating in her abdomen, she was sent home from Whangarei Hospital to die.

It was a steep learning curve for us all. I have two younger siblings, Sarah and Andrew, who lived out of town. Fortunately, I was living nearby already. Sarah was pregnant with Mum's first grandchild. She rushed north, returning to her home in Auckland when she could. Andrew dropped everything to move in with Mum. Our parents were separated, but Mum and our Dad, Don, were still close.

The hospital gave no referral to the hospice, offered no support and showed not a lot of compassion. We were all reeling.

Mum lay in bed with Huckle by her side, her abdomen slowly filling with fluid leaking from her liver - an awful condition known as "ascites". It was making her uncomfortable, sleepy and in pain as she grew bigger and bigger and her skin tightened.

Her GP came for a home visit. He was sheepish and apologetic. He didn't mention hospice but he'd be back if we needed him. I dropped by the Cancer Society wondering if they might have some helpful advice. Nope. Wigs and makeup sessions were mentioned. Fat lot of good that would be for us.

A friend of Mum's visited and was so shocked by what she saw - Mum hardly able to move and this just days after her diagnosis and discharge from hospital - that she got straight on the phone to a friend who was a hospice nurse.

She came straight away, and was a godsend. It turned out ascites can be drained. A big needle goes in, and up to 5 litres of fluid comes out. The difference in Mum was instant. She could get up and go for walks, talk to us, stay awake. But the cancer wasn't going anywhere and, as it progressed, draining the ascites got harder.

The hospital had sent her home saying "nothing can be done", but we sought a second opinion from an Auckland specialist. Mum gave chemotherapy a go, despite there being only a 30 per cent chance of getting another 18 months to live.

But how she would have loved to live to meet her first grandchild. The chemo didn't work, though. In fact, it weakened her and made her terribly sick. There's only one way to describe how Mum felt about all this: pissed off.

She had so much to do, so many plans, so many trips overseas she had yet to take. She'd worked and saved so hard. Now this? "Just knock me on the head," she'd say. And she meant it.

"I could drive the car off a cliff," she'd say. And she meant that, too.

* * *

By now she was hardly able to get out of bed, was prone to falling, needed someone to help her dress, toilet and shower her, and she hardly ate. She was hooked up to a morphine pump. She was weak, hurting and sad. Her cocktail of pills included Prozac and an anti-anxiety medication, to try to help stop her sinking into despair.

But she was 61 years old and she didn't like what was happening to her. Mum didn't want to face this kind of existence any more and she was asking us to help her. But we couldn't.

Yes, we had morphine in the house, but only a low dose. And the thought of her taking matters into her own hands and driving off a cliff horrified us all.

One day, about three weeks before the end, and making sure she could hear me, I phoned the Euthanasia Society. We were staying in a bach at Sandy Bay on the Tutukaka coast.

That afternoon we'd watched a dozen dolphins ride the waves alongside surfers. But even that spectacular sight had hardly perked her up. I can't remember what I said on the phone, but I think I just left a message asking for information. Then I went to sit with Mum. Despite everything she was going through and how the disease was destroying her, and despite her talk of ending it all, Mum said: "I don't think it's come to that, do you?"

Although she hated what she'd been reduced to, she never made peace with the fact she was dying. She simply didn't want to leave us. Her will to stay was battling with her desire to go.

Mum breathed her final, laboured breath on January 11, 2005, in the wee hours in North Haven Hospice with me, Sarah and Andrew beside her.

It was sad, but it was a relief. But I will always wish that her passing, with her blessing, could have been as peaceful and dignified as her beloved Huckle's.

- Kathryn Powley

* * *

"She has to do it herself because if I help I'm looking at 14 years' jail."

Don Grant knows his wife's death is coming. She's terminally ill and her condition deteriorates each day.

He doesn't know when the end will be, all he knows is that it will happen when he's not there.

"She has to do it herself, because if I help, I'm looking at 14 years' jail."

I'd much rather be there and hold her hand. It's bloody awful."

Wife Yoka de Houwer is so adamant Grant can't be involved she has told him he won't even know when she's planning to do it. It'll be one day when he's out of the house.

It's a situation most people dread ever encountering, but several high-profile cases are drawing attention to the problem of euthanasia.

Dunedin professor Sean Davison made headlines last year when he was sentenced to home detention for helping his mother die.

She had been on a hunger strike for 33 days when he realised he would have to step in. The Herald on Sunday revealed an unpublished manuscript, in which he revealed how he had crumbled a dozen morphine tablets into her water glass and lifted it to her lips.

Davison wrote: "This is ghastly ... too unbelievable. What kind of sane person would keep their mother in a bedroom to rot to death?"

Cases like these have spurred Labour MP Maryan Street to submit a private member's bill to decriminalise euthanasia.

At present, it is illegal to help someone else commit suicide. And although doctors can give treatment such as morphine for pain, knowing that it may hasten death, they cannot do it with death as the intended outcome.

Street decided the time had come for another attempt to change the law when she saw an outpouring of compassion from Nelson people in response to a spate of suicides among elderly people in their city.

So far, the support has been extraordinary, Street says. But the bill has not been without critics. Right to Life NZ is worried it may mean people who feel they are a burden will be coerced into euthanasia. And the New Zealand Medical Association says euthanasia is a breach of medical ethics.

National MP Maggie Barry, leading a discussion group on palliative care, says New Zealand's facilities to ease the suffering of the dying are good enough that euthanasia is not necessary.

Tetraplegic Rhett Brown says he wanted to commit suicide after breaking his neck.

"Had I been able, I would have signed the papers. No question. What lay ahead was not a consideration," he says.

"The fact that I went on to thrive, write a book, travel extensively in Europe, develop a successful career as a professional work place safety speaker and live a happy life with a new partner was at that time unknown."

But Street says those are different issues. "This is about whether any human being has the right to determine the method and time of their death in the event of a terminal illness or irreversible condition that makes their life, in their view, unbearable."

Her bill would require checks to protect people from being coerced into euthanasia. Street points out that people can already refuse medical treatment as a human right, without any of those checks.

"People talk about slippery slopes but we already have options that allow people to die through the refusal of medical treatment."

Sean Davison says New Zealand is ready to have the conversation. "The present law doesn't reflect the mood of the country. I had numerous calls and letters from people in a similar position to mine . I think people are more willing to talk about it than they used to be."

- Susan Edmunds