Thursday, 30 July 2009

Is there a Pagan thealogy of assisted suicide?

All 5 Law Lords agreed that a clarification of the law on assisted suicide is required following by Debbie Purdy’s successful challenge in the House of Lords today. The Director of Public Prosecutions made some very clear and very compassionate statements on the issue taking into account people who will wish to die between now and September when there will be a public consultation. It’s not a change in the law, it’s an understanding that the law is unclear and needs clarity.

Off on a slight tangent my friend Jane in intensive care is in a pitiful state. When we last visited I had a dreadful memory of the Little Brown Dog, a mongrel in 1903 who was passed illegally from vivisector to vivisector and eventually killed, again illegally, in front of a room full of medical students. The suffragists, Louise Lind-af-Hageby, and Leisa K. Schartau, were there too, the only women allowed into the vivisection lab and the only people who objected. Riots occured, statues were erected.

We were with Jane less than 5 minutes when a team of people in scrubs arrived and ‘asked’ us to leave. 4 of those people, all women, none of whom had any ID or name badge, didn’t meet our eyes and seemed entirely disinterested in our existence. The one that spoke to us smiled, but her smile didn’t reach her eyes. Jane, meanwhile . . . well who knows, she can’t speak or move anything apart from her head, and she’s under light sedation so that she doesn’t remove all the lines and tubes. What I felt from her was profound disgust and sorrow. They may be my feelings. Knowing that Jane has consistently discharged herself from hospital whenever she’s been able it’s very hard for both of us to observe the activity of whomever the scrub-clad people might be, and increasingly maddening to watch her other visitors maniacally bounce around talking about getting better and coming home and going on holiday and all the other fantasy.

I know they’re fearful and I’m losing respect for their feelings. Their feelings have always taken precedence over what Jane might want. I don’t know what Jane wants and no one seems very interested in finding out. 7 years ago Jane was given months to live, the will to live through a shocking childhood now seemed to preserve her and I’m sure the medics find her very interesting and a fascinating challenge. I asked what their plan for her might be: “When she comes off the ventilator she’ll be moved to a medical ward.”

No one can see into the future but I think there’s a fairly good chance that Jane will not leave that medical ward and I don’t see what’s been achieved other than the absence of death which will reassert itself in short while, perhaps as soon as Jane becomes able to take some kind of control over the matter herself. She won’t be able to discharge herself now; she’ll not walk again. Is the absence of death a satisfactory result?

I’ve spent some time thinking hard about a theology of a Pagan response to assisted suicide and it seems to me that at the heart of the matter is the use and abuse of power. Jane-the-person disappeared as soon as she was made mute, all of us are projecting our interests on to her. I fear my own loss of power over my own life and death, I fear the clinical interest and the personal disinterest that I saw in the blue-clad ones. I fear that the people I love will not do what I want them to do when I begin to die but will treat the event with terror and denial and in doing so, abuse me.

So I have to relinquish all desire when I visit Jane and visiting has become very difficult. Perhaps the theory is that I will pass through some kind of trial and find resolution after which I will feel relaxed and enlightened. I’ll let you know. But right now I’m watching a woman, mute and paralysed, in a state of terrible physical and emotional distress, and there seems less interest in her as a person than there was in the little brown dog.

Saturday, 25 July 2009

Love without need

I visited intensive care today to see a woman who I’ll call Jane. Jane’s life has been a tragedy from the word go. Born into very unromantic misery, brought up by uncaring people in a harsh environment, working full time aged 9. In Britain in the 20th century. Seeing this person in the street – prison and facial tattoos, staggering about and often incomprehensible – you might cross the road, but like many roaring, frightening people she’s very sensitive and exposed and I feel tearful when I think of the life that was wasted by the adults whose only vaguely gracious act was not to forget to feed her.

This person isn’t Pagan and I don’t visit her in a chaplaincy role, she’s part of our community, she’s appallingly ill and so we visit. I spent about 10 minutes there today and was struck by the strangeness of it all, of every individuals’ need, including my own, being focused through this reclining, semi-conscious lens of a person. The excellent, professional nurses yelled at her in that loving, patronising manner than many nurses have: “Hello darling, I’ll just aspirate your tube.” Her lover, Dan, has miraculously and instantly cleaned up his own problems while he spends as much time as he can at her side. He’s terrified of being left alone. Dan has found status and purpose since Jane has been in hospital. People who would not normally give him the time of day are now treating him kindly and with respect.

What are my reasons for visiting? They’re complex and not fully conscious and I hope that my main impulse is compassion. Jane and I are not intimate friends, there’s a limit to how much time we want to spend in each others company and we don’t have a great deal to talk about beyond having a bit of a laugh. Jane hasn’t got a religious bone in her body but my own needs incline me to offer something that isn’t fear or determinedly, superficially, upbeat. My need to make sense of this situation is as present as anyone else’s, but I hope – I really do hope – that my need is not so desperate that I impose it on Jane.

Jane is dying. She’s not physically alone and there’s a great deal of intense feeling in her room. I wonder, through my own clouded lenses of understanding, about peace. Everyone knows she is dying and no one close to her can bear it, it’s just such an unmanageable, fearful prospect for them. They’ve informed the funeral director, a wake at the pub has been arranged, but these are practical matters, the right and proper actions of responsible friends making forthright plans. There’s a mismatch between what’s being planned and what is being felt. There is no peace in the room.

I stood where Jane and I could make eye contact and spoke quietly to her, saying that she was safe, that she was loved. It’s impossible to know absolutely what is ethical or right or wrong when speaking with someone who can’t speak back, who is in extremis and I would, I believe, feel very desperate if a priest came to me as I lay dying and began imposing his view of the world on me. I know I would want quiet, centred people around me who would not want to hold me back or push me on. But I have a developed personal understanding of how I might approach my own dying and the dying of the people I love, I have a foundation for how I approach the dying of people who know what I do and who deliberately want me present. I have little idea what is right and wrong when I’m with Jane.

What I want to do is to shift the focus of practical support onto Dan, to get him some professional, hospital-based emotional sustenance so that he can begin to reduce his desperate need for Jane not to die. I want to find some impossible compromise with the miraculous, brilliant machines that do more than keep Jane alive, they’re making her body comfortable and safe. And they’re so noisy: the technical mattress and covers hiss, the ventilator whispers, alarms blare.

I want, for my own comfort, to speak to the part of Jane that is not a devastated human being, which is nevertheless intimately joined with every part of her human experience, to remind that most vital part of her that everything is as it should be, that it is safe, that there is nothing to fear. And so on. I want to make it familiar so that I no longer feel helpless.

My husband is so much better at this. He visits more than I do and Jane knows him better. He feels no need to do anything other than hold her hand for 10 minutes a day, to talk about the mundane which is precisely what Jane would wish to talk about most of the time, at the same time as bringing transcendent love with him. In the room he’s not as grounded as I am but he has much more capacity to simply bring Jane love without need. What a journey this is, what learning.

Wednesday, 15 July 2009

For pity's sake, get involved.

ast week the House of Lords rejected an attempt to relax the law on assisted suicide so that people who accompany their loved ones to the Dignitas clinic don’t have to face 14 years in prison. Britain is pretty good at fudging and it may be that this is one of those situations where fudge is uncomfortable but useful. 120 British people have gone to Dignitas so far and not one of the people who went with them has been prosecuted, there’s a tacit understanding between the police, the Crown Prosecution Service and the courts that people who go to the trouble of arranging a Dignitas ending are not likely to be murderers. Lord Faulkner who sponsored the most recent application to the Lords noted that there was a ‘legal no-mans land’ around the subject, which indeed can be dangerous. It means that the police are choosing what they will and won’t prosecute. As it is the situation is being allowed to evolve, the law following public debate rather than public debate being forced to change the law. I foresee a time in the next 5 or so years when an individual is put on trial as a way of testing public opinion. It would be a very blunt, shortsighted move to put the Downes children on trial today when public debate is raging.

A century ago, a policeman would turn up to arrest someone who had attempted suicide. Never mind the circumstances, the law was the law and a person who was actually dying from their attempt would be put in a cell and treated as a criminal. British society, which was fairly universally Christian, eventually found this intolerable and the law was changed so that the suicidal person was viewed as mad rather than bad. But still, suicide was perceived as something that must be prevented at all costs. This remains the case today. I remember babysitting a depressed elderly man who had cut his own throat so extensively that he severed his trachea. He was caught, pounced on, dragged to surgery and spent the rest of his time folded up in a chair. Nurses weren’t there to care for him, we were there to make sure he didn’t attempt to kill himself again.

Chaplains and counselors are very mindful of a clients right to confidentiality, but should the professional believe the client to be at serious risk of suicide we are bound to break that confidentiality. Other times when confidentiality must be broken are when a child is at risk and when a client is planning or admits to terrorism.

I find it absolutely extraordinary that finding ones own life intolerable is judged to be the same as raping a child or blowing up a train full of people. This is solely a religious hangover and it’s worth noting that the 3 most powerful religious leaders led the Lords rejection to a change in the law. Individual religious people may feel that their suffering demonstrates trust in their god but there’s a dangerous madness in the monotheist approach to end of life suffering. Modern hospices were set up by religious people who recognised that palliative care was not, is not, good enough; sadly, religious people don’t contribute anywhere near the sums required to maintain existing hospices, let alone building enough for everyone. When they do, I’ll be more inclined to take their anti-suicide debate seriously.

So the situation we’re left with is delicate. I heard a man tell the story of his dying mother today, in hospital, suffering, exhausted. Her family asked for a meeting with the doctor who said that surgery would extend their mothers life by two weeks. The family said they didn’t want their mother to suffer any more. “You know what you’re saying?” said the doctor, the family nodded and a morphine drip was set up to run rather more quickly than it should have done. Everyone’s heard a similar story. Nothing is said, everyone knows. It seems to me that this is no bad thing when it comes to illegally killing a person in unalterable extremis.

Doctors and nurses hold enormous power over the lives, deaths and suffering of the people in their care and the anti-assisted suicide theory is that they are there to save lives rather than kill people. But they do no harm, which is very different from not killing. It is very harmful to slice someone open or give them drugs that will kill parts of their body, and that’s what we expect surgeons and oncologists to do. When they do kill people as a criminal act they are generally caught, as Beverly Allitt and Harold Shipman were. Shipman is the only British doctor convicted of murdering patients and 23 nurses worldwide have been convicted, so it’s not something that health professionals tend to get up to. Anti-voluntary euthanasia campaigners make a lot of noise about the likelihood of abuse should VE become law, which is a disgraceful insult to the health care professionals and the people who create the safeguards around such a procedure.

It is, of course, probable that abuses of the system will very occasionally occur. Emergency services are allowed to run red lights and exceed the speed limit and very occasionally a pedestrian is killed. Does this mean that the emergency services should wait for a red light to change and tootle along at 30mph? No system is perfect, there will always be an individual who feels above the law but, as with organ transplantation, policy safeguards and transparency will prevent the vast majority of abuse and catch it when it occurs.

Practice already embraces voluntary euthanasia and assisted suicide, precedent is being set, assisted suicide is presented to the Lords every couple of years. Those people who are firm in the knowledge that any positive change in the law will open the door to euthanasia on the grounds of economics seem blind to the fact that it already occurs in catastrophic numbers. If you’re poor you’re much more likely to die miserable, alone or in a crap human storage facility. Private elder and disabled care is already a goldmine and abuse is commonplace.

I haven’t spoken with one Pagan who has a theology around keeping themselves or their loved ones alive in pain. But we haven’t begun to realistically discuss the alternatives. Some of us know about advance directives and that’s about as far as we go. A small number of us will have an idea about hoarding up a store of drugs or leaping from Beachy Head, but these thoughts are hesitant, fearful or more bravura than realistic. We really do need an open debate about the Pagan approach to what will certainly become law within the next 20 years. Judy Harrow began the debate in 1997 ‘Coup de Grace: Neo-Pagan Ethics and Assisted Suicide’ an extended version of which can be found in the Pagan Book of Living and Dying

Take a look here for some different views and opinions.

What is the British Pagan approach to suicide, voluntary euthanasia and assisted suicide? If Boudicca killed herself to avoid dishonour, is suicide OK? In which case, is butchering children and destroying Colchester OK? We need a coherent, intelligent debate based on 2 things: our theology, and what we as individuals are prepared to live with in order to balance our lives as Pagans living in a non-Pagan world. The vast majority of us are recreational Pagans, we take up the cosmetic bits of it and use it when we want some recognition but really we’re like the rest of the country in which we live: culturally Christian and just trying to get on. There’s nothing wrong with that, but it’s not a conscious decision, it’s a default position. That’s just about OK if it helps us make choices about whether to eat meat or not and nowhere near good enough when we know people who are in psychological or physical agony and we have no tools to help; not safe when practice is moving, along with the law, towards voluntary euthanasia and we find ourselves just mooching along with it.


Tuesday, 14 July 2009

Taking ownership of our last great adventure.

Lady Joan Downes and her husband Sir Edward Downes are in the news today for their joint assisted suicide at Dignitas. He was 85, going deaf and blind and she, at 74, had cancer. They’d been married for 54 years. The clerics are rolling out their doleful moaning about how very, very sad and sinister it all is

(please cut and paste this addy, I don't have a hash key!)

I know nothing at all about the Downes’ but my fantasy is that they took their time getting their affairs in order and being with their families, then got on a plane for their next-to-last great adventure. I hope they were with people they loved before going to Dignitas to peacefully, quickly and painlessly die together.

Also today Labour are announcing a vauge ideaish kind of thing about care for the elderly. They’re calling the present system of care ‘a cruel lottery’ which it most certainly is. Unless you are a unspeakably rich with a devotedly loving family you’re very likely to end up sitting in a circle of high backed chairs lining the walls of a room where the telly is permanently on, having been forced to sell your home for the privilege. Which is perhaps better than being maintained, alone in your own home by people who have so little time that they will feed you while you’re on the toilet.

Suicide rates are high in the elderly population. Although people older than 65 years comprise only 13% of the US population in 2000 18% of all suicides are in this age group . . . The elderly generally have a stronger intent to die, plan their suicide more carefully and are more likely to use lethal means of killing themselves than are younger persons.

Many apparently very sophisticated philosophical and clinical treaties have been written about the terrible isolation and psychological pain that leads many people to kill themselves. It is always considered irrational, an aberration of mind, a madness that one can take some kind of pill or psychological treatment for. This is because they are all written by Christians or people acculturated to a Christian society. Most Pagans perceive suicide through a Christian lens too.

But life will end. Usually, the weeks, months or years leading up to death will be filled with misery and pain. Most of us don’t know that because our infirm disappear. It’s all very well for domineering Christians and people who are culturally Christian to insist that voluntary euthanasia can be avoided if only we put more money into palliative and elder care, but beyond wishful thinking is the fact that the very best palliative care often cannot deal with terminal pain; that palliative cocktails are often little more than heavy sedatives, so we can’t tell anyone we’re in pain. Ultimately, it’s the economy, stupid. There are too many elderly people and not enough money to even warehouse them let alone care for them. We voters have no social will to change this state of affairs and it is going to get worse.

Suicide can be an honourable act, as sepuku is, as it was for some periods of Classical Greece and Rome and as it was for the Jews trapped at Masada. It can be a perfectly accepted cultural practice, such as when an elderly person acknowledges that they can’t manage the usual winter river crossing and so stops on the bank, watching their tribe cross to the winter grounds, waiting to die of hypothermia. This has been called quasi-voluntary suicide, the implication being that the youngsters no longer want to care for their elders and so the elder has no choice. I wonder how those tribal people would view our more civilized stockroom approach.

Is there a Pagan theology of suicide? What we have so far seems to’ve come about as a result of our own reactions rather than in considered response to any understanding of Paganism. At the heart of all Pagan practice are two concepts: an immanent Deity, and the implications of our choices.

Deity is part of us rather than some external judge and that immanent part of our Selves cannot be harmed if our corporeal form drops away. If we have a theory of reincarnation – and many of us do not – then how does this affect a proposed journey of the soul? Too many Pagans just echo their dominant culture, somehow suggesting that suicide will mean that the person will just have to go back to the beginning like a naughty child or a sinful follower of a vengeful (but curiously undefined) god. If life is a process of gathering experience then the experience of taking ones own life is simply that.

Ending ones own life certainly can have a devastating impact on those who’re left behind but how much of this is to do with our cultures’ attitude to suicide in the first place? Shock rises from the secrecy and shame surrounding the act, secrecy and shame grows from its illegality. People who kill themselves often leave angry people behind, usually because there are so many pieces left to pick up, and that’s because most suicidal people who start putting their affairs in order are prevented from killing themselves. There’s also a lot of self-righteous gossiping, often in the guise of deep concern, which fuels the anger. A parent who adores their children can find the weight of sorrow greater than their love. They may indeed be psychiatrically ill, and for many depressed people psychiatric services do not help them, it just preserves them in pain. More often, they are alone in their suffering. Life is not perfect.

Many of the people I see in a chaplaincy role are in mental states so enduring and so dreadful that they will never be allowed out of an institution. They will have 50 years or more of living with other enduringly unhappy people, no control over what they eat, when they go to bed, when they wake. Most of them function in barely controlled panic and I’ve been asked a number of times to do a spell that will put them into another world or a picture in a book or back in time so that they can avoid certain behaviours that got them institutionalised. They’re diagnosed as having diminished responsibility – they’re not necessarily bad in the sense that an ordinary criminal is – and they have a life sentence in the absolute meaning of the term. They are in as much pain as the person enduring physical anguish.

Imagine a world where people who were in a permanent state of torment were treated with a compassion that suited them rather than those who have control over them. Imagine if they were given the option – by intelligent people without a budget in mind – to forgo the performance of being a good patient. This alone, paradoxically, might give them the freedom to live as a fully integrated human being for a period of time, something they will never experience on a locked ward, in a locked-down life or a locked-up body.

How much more wonderful would Joan and Edwards final days been if they could have their loved ones around them in their own home and garden, holding hands as they took the drugs that would peacefully and swiftly take away their age, infirmities, fears and pains. What an honour, what a privilege to be with these people in a moment of what could be ecstasy, peace and satisfied completion.