Message from close to the other side

Elspeth McLean reviews With The End In Mind: Dying, death and wisdom in an age of denial, by Kathryn Mannix. Published by Harper Collins.

With the euthanasia debate in full swing here, With the End in Mind is a timely publication.

Author Kathryn Mannix is a palliative care specialist from the UK with 30 years experience, on a mission to impart further understanding about  dying.

She makes no apology for the sadness in the death stories she tells, but hopes they will enable readers to become "less afraid and more inclined to plan for and discuss dying".

The wide-ranging examples, drawn from Mannix’s own practice, also chart her transition from a "naive and frightened student to an experienced and (relatively) calm physician".

One of the stories is that of a UK-born man living in the Netherlands at the time he was diagnosed with a rare and incurable colorectal cancer, complete with an oozing infection that could not be eradicated, and other awful symptoms.

Since euthanasia is permitted in the Netherlands, doctors on their ward rounds kept reminding him it was an option.

He was afraid to admit to new symptoms in case euthanasia rather than symptom management was recommended.

"His conversations with his doctors developed a new tone: their sense of helplessness in the face of his symptoms, and hopelessness at his prognosis, communicated itself as reassurance that they would not abandon him, but rather that he would be accompanied — not into an unknown future, but to accelerated death."

He chose to move back home, living for two months in a hospice where staff pulled out all the stops to manage his symptoms as well as they could.

His cancer eventually obstructed his kidneys and he became comatose over a few days, before dying quietly while his young daughter played in the garden outside his room.

As Mannix puts it, he had "experienced an unintended and chilling consequence of an entirely humanitarian change in legislation".

Those on both sides of the euthanasia debate are motivated by compassion, conviction and principle, she says, but so often the discussion is polarised, noisy and alarming.

"Whatever your own view, it is likely to enrich your perspective if you listen and carefully consider the opinion of those whose view is different. Working in the reality of day-to-day dying many of us in palliative care roles are exasperated by the trenchant, black-and-white opinions of the campaigners for either view, when we know that the reality is neither white nor black, but a completely individual, ever-shifting shade of grey for each person."

Those politicians who have been particularly strident  in the End of Life Choice Bill debate so far, please take note.

Among the themes Mannix explores and encourages the reader to think about are the patterns of dying, denial, legacy, the need for good communication and the view that living is precious and "perhaps best appreciated when we live with the end in mind".

If you are frightened of using the "D" word with your family and friends, this book may give you some conversation starters, along with a much richer understanding of death.

- Elspeth McLean is an ODT columnist and former health reporter.

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