Death, Physician-assisted

Ethics are trickier than they appear

The doctor gazed down at the old woman on the bed. He had been her physician for over thirty years and had delivered her daughter Alina, who now sat clutching her hand tightly, tears streaming down her face. The old lady had been handsome once - tall, strong and full of life, but now was just a wisp of her former self.

Alina stretched out her hand and stroked her mother on the cheek. Her eyes opened and she smiled faintly. Her mouth moved but only fragments of words whispered out, so softly that they could barely be heard.

"She tries to talk, but makes no sense", the daughter offered. "She doesn't know who I am. I don't think she understands anything I say."

"Your mother has dementia." the doctor replied. "I don't know how you have managed to look after her for so long. Her mind and memory have been gone for some time, and now her body is shutting down too. Have you had difficulty feeding her recently?"

"Yes. She started choking on food last week and I had to mince it up into small pieces. It takes the best part of an hour to get her to swallow a few bites."

The doctor looked at Alina quietly. "You know her better than anyone. How do you think she would have felt about this illness?"

"She would have hated it", the daughter replied instantly. "She was always such an active woman. She would have wanted an end to her suffering." The daughter brought her mother's hand up to her lips and kissed it softly. "But this..", she added. "It seems so ——— final." She hesitated for a moment. "Are we doing the right thing, doctor?  Could she recover?"

"We discussed this, Alina", the doctor replied gently. "Dementia is a progressive, fatal illness. There is no cure. If we leave her like this it will only get worse. But it doesn't have to be done here", he added. "I can transfer her to hospital if you prefer. The procedure is routine there."

The daughter shook her head. "She always said that she would like to die in her own bed."

"Then we are agreed", replied the doctor. He opened his bag and removed a glass syringe. He began to fill it from a bottle containing a clear blue-green liquid.

He looked at the daughter, who was clutching her mother's other hand tightly to her lips. "Are you sure you want to stay Alina? You don't need to be here."

"I'll stay", replied the daughter quietly.

 He tapped the syringe several times, making sure there were no air bubbles, although he knew that their presence would make no difference now. Sitting on the bed beside the old lady, he applied a tourniquet to her left upper arm, then gently stretched the skin of her forearm with two fingers. Expertly, he guided the needle into a vein and released the tourniquet.

As soon as he began to depress the syringe, he noticed the old lady staring intently at him. Her eyes were the same clear blue as her daughter's. He paused for a moment, caught slightly off-guard, but quickly regained his composure and increased the pressure on the syringe.

Then it was over. She relaxed, and with a long sigh, her last breath slid quietly from her body.

The doctor removed the needle and began to clean and pack away the syringe and the rest of his equipment.

"She looks so peaceful", the daughter whispered.

"It was a blessing", the doctor sighed. "Her suffering is over."

Alina cried quietly for a few moments, then began to recover her composure. Her mother would not have tolerated tears. She placed her mother's hands together over her chest. "The world has certainly changed", she observed. "This would not have happened a few years ago."

"You are right.", he replied thoughtfully. “Medicine and Society have progressed. Some lives are just not worth living.” He slipped on his jacket and fastened the buttons. “Thankfully, we no longer live in the dark ages. It is, after all, 1940."

"Yes", she agreed. "It is."

The doctor came smartly to attention and saluted crisply. "Heil Hitler", he observed.

The daughter stood up straight at the bedside. "Heil Hitler", she responded dutifully.

Then the doctor opened the door and disappeared into the busy streets of Berlin.