My parents were both very supportive of euthanasia. They have a strong urge to end your life when you feel it no longer meets your own standards. They made this known in 2014, when they were both in good health and in their sixties, by signing a declaration of euthanasia with their general practitioner. They agreed that euthanasia was an option in cases of intolerable suffering, terminal illness and dementia.
It was in the Netherlands, where euthanasia has been legalized for capable adults and emancipated minors since 2002. It is the same in Belgium, where I grew up, where I met my Irish husband and where are born our children. Each year, less than 5% of deaths in these countries are due to euthanasia, and 85% of them are patients with terminal illness. General practitioners are actively involved.
In 2018 my mother was diagnosed with bowel cancer and received excellent care. The surgery to remove part of the intestine was successful and she started chemotherapy. Six weeks later, she developed pain radiating to her spine that prevented her from sleeping. It took some time to get a final diagnosis. At first, it was thought that this pain was due to the operation and not the cancer. After weeks of uncontrollable pain, however, it became increasingly evident that the cancer had spread throughout her body. In early 2019, he was told that the treatment could only be palliative. It started with morphine patches.
This news was a blow, for her and for my father in particular, but also for my brothers and sisters, whose lives have changed dramatically. My two sisters are registered nurses and lived near my parents. They decided to take care of her. From that point on, my mom became a full-time patient, with my dad and sisters providing round-the-clock care so that she could stay at home. Living in Ireland I have only observed this from afar, with infrequent visits and regular phone calls.
My mother’s health gradually deteriorated. Yet on another level, she had the time of her life. She always liked to be the center of attention. It was something she had wanted since she was sent to boarding school at the age of eight, a traumatic experience. Her cancer, strangely enough, gave her a shameless approach to getting that attention, both from my father and my sisters.
My brother took care of all the practical arrangements. He also showered her with flowers. The house was always full of them – and she loved it. Yes, my mother, battling cancer, certainly got the most of the attention, and she loved every moment of it.
In June, the pain started to take hold of her and the morphine patches could no longer control the pain. She was provided with a morphine pump and the dose was slowly increased each week. Her belly began to show cancer growth. Although other parts of her body lost weight, her stomach swelled.
Throughout her medical journey, her general practitioner was very close and guided her every step of the way. He contacted her weekly in person and whenever necessary by phone. She loved him very much and that helped her to be very young. She liked it. But at the end of July, her conversations with him changed from “What can we do next?” To “it’s getting too serious”.
They talked about passive euthanasia, which would mean increasing her medication, stopping her food and water intake, and inducing a coma so that she died peacefully. Considering the amount of water retention in her tummy, however, it could take weeks, if not longer, and was rejected. Passive euthanasia would lead to secondary ailments, such as bedsores, and the care required – without her being mentally present – would weigh heavily on her whole family. Her condition was bad and my sisters and my father were tired. A decision was made to hire a night nurse, so that everyone could at least get a good night’s sleep.
A few days later, my mother summoned the general practitioner. After talking to her, he called a meeting. My mom wanted to start the conversation about active euthanasia. She was on the maximum dose of morphine, her pain was increasing all the time, and relief was only occasional. She was in real pain. It was decided to initiate the process of active euthanasia.
His declaration was in place with the general practitioner, but to proceed with euthanasia, an independent SCEN doctor (accompaniment and consultation of euthanasia) must meet with the patient to confirm his will. These doctors have been trained in the legal aspects of euthanasia, to support general practitioners and provide independent observation of the patient’s wish to die.
My father called me on a Friday afternoon, a call that I had been waiting for a long time but which caught me off guard at the same time. He told me that they had decided to start the procedure and asked me if I still supported this decision. Even if it is not the family’s decision and they cannot override or change the patient’s wishes, it is important to have their support.
As in many families, we often have different opinions, but in this we all recognized my mother’s wish and supported her. My dad called back on Saturday and told me the SCEN doctor would come on Monday. He was worried because my mother was taking such a high dose of morphine that it was difficult to counteract it with another drug, Haldol, to keep her present. He feared that she might not be able to tell her story coherently, thus stopping the process. You had to trust the process, and the doctor SCEN, who would have seen many patients in his condition. I booked my flight.
Monday has come. I left Galway on the airport bus while the SCEN doctor sat with my mother for over two hours. She left without speaking to the rest of the family. The general practitioner confirmed the next day that the SCEN doctor had approved active euthanasia. My mother asked for a priest. The general practitioner ordered the medicine. The day and time have been set: Wednesday at 1 p.m.
It was decided that only her children and my father would be informed of the timing. We agreed that his grandchildren, his sisters and brothers, all the other families, would not be informed until afterwards. My mom had spent the last few months saying goodbye to everyone, and she had had enough. We needed our energy and attention to sustain her and we are grateful for this decision: no distractions.
The GP returned on Tuesday and had a brief conversation with my mother, once again confirming his wishes. My dad wanted to be alone with her that night and it was decided that we would meet again at 10am the next day. Each of us had a task. My older sister was taking care of the medication. She spoke to the nurses who maintain the morphine pumps, about how to keep my mom present without panicking. She got it right. My younger sister would dress her. I had to wash her and prepare food. My brother got the flowers.
Wednesday morning. My mother was surprisingly calm and happy. My father was trying very hard to stay the course. He made a rule. The room in which my mother’s bed was placed was going to be a “dry room”. What he meant, you’re crying out there; once inside, you are there to support your mother. Fair enough. He also wanted to have coffee and a piece of cake at 11am, after which they would go to my mom’s room and set him up. We then had to join them. The plan was established.
The job is done, 11am came, coffee and cakes were served. Only my mother ate the cake. Her cancer had kept her appetite roaring all along and now was no different. She even completed some of the other installments, commenting on how good it was. We must have laughed.
So my dad stood up and said, “It’s about time. It was an intense moment, fighting against tears; memory still brings them even now. We found ourselves sitting with the leftover cake, a little stunned. Half an hour later, we were called into the “dry room”. By then we were all settled. The atmosphere was positive. We checked with each other, with my dad, and then for the last time, with my mom. Mom, are you sure? She was calm and together, holding my father’s hand. Yes, she was sure of it.
Sometimes situations just throw you away. The GP and his colleague, in the Dutch manner, got on their bikes and locked them. The bike lock hit me with a surreal feeling; it was such an ordinary thing to do in such extraordinary circumstances.
It was a beautiful sunny day. They came in and we were asked to leave the room. The GP was alone with my mom, briefly, I guess to confirm with her again, to be sure. He called us back and started to settle down. My father took a seat on the bed, holding my mother in his arms. My older sister was holding it. My brother and younger sister were on the other side of the bed, holding her hand. I was at his feet. Earlier today, the nurse inserted a port. Everything was ready.
Then the GP broke down. It was his first euthanasia, which is why his colleague was with him to support him. My mom got the nicest response – it’s amazing what these situations bring – and she told him to take her time, that she really enjoyed all of her time with him and that she was ready when he did. was. He apologized, but we all laughed and asked my dad, “So this dry room thing doesn’t apply to him?” My father smiled and shrugged. The GP has regained control of his emotions. We all said a final goodbye and my mom confirmed for the last time. He first gave her something to put her to sleep. Her head fell against my father’s arm and she gave a last loud snore. He then administered the drug to stop his heart. At 1:03 p.m., she was gone; we closed our eyes.
The GP left for a moment and we slowly took in the situation. He returned to confirm his death and then called the police, who had been notified in advance. Euthanasia is still classified as an unnatural death and a coroner must confirm it and ensure all paperwork has been completed as part of the legal process. Once that was done, and after sitting there for a while, still stunned, we informed the rest of the family. The grandchildren started coming, the funeral directors came by, many phone calls were made.
We were lucky, not only because my mom had this option, which she chose, but also because we all supported her in this decision. But, in saying this, neither of us could have stopped the process. It was his decision and his only. Having a united family surely made this experience a shared experience, but without her strength and conviction, it would not have been possible.
My mother was brought up in the Catholic religion and has remained loosely tied to the church. She always watched the Pope at Easter and made sure to hear her Urbi et Orbi, but she didn’t go to church. Many candles lit in churches must have made up for this. She was also a practical woman, who understood that the end of her life would become more and more painful. And finally, she loved the attention and the drama, but realized that she was too tired to enjoy it. For her, euthanasia was an option. This is not the case for everyone, but we are grateful to him for having been able to take advantage of it. For my father, sisters, brother and I, strange as it sounds, it is a positive memory.