Sir Stephen Wall, former principal adviser to the Cardinal Archbishop of Westminster, 2004 - 2005, is 62 today, according to The Times. Happy birthday, Sir Stephen. "Last week, the Church in our own country was arguing that giving same-sex couples access to in vitro fertilisation (IVF) was wrong, because of the harm to be done by bringing fatherless children into the world. Yet this is the same Church which, by proclaiming the iniquity of artificial contraception, wills into the world millions of children who will never know true parental love of any kind ... The Church makes another mistake by giving pre-eminence to its concept of law and disregarding its duty of love. In the case of IVF, we are talking about couples who would not go through the heartache of the process unless they wanted, out of their love for each other, to bring a much-loved child into the world ... "
The Tablet, Letters, 20/27 December 2008
Palliative care has limits
My sister, Mary, died from cancer in early December. The day after her death there was a renewed surge of public interest in the question of assisted dying because of the first such death to be shown on British television.In February 2006, at the age of 67, my sister was found to have fluid in the lining of her lung and the fluid contained malignant cells. For the next two and a half years she underwent successive courses of chemotherapy, with little respite. She suffered hair loss, loss of feeling in her feet (makingwalking difficult), nausea and insomnia. But she did not lose her will to live and, when she was feeling well enough, she pursued her life as normally as anyone can who has a death sentence hanging over them and whose life is geared to the rhythms of a nasty disease.
At the end of November, my sister was found to have a perforated bowel. She was not strong enough to undergo a repair operation and, on the advice of her doctors and with her consent, treatment was stopped because it would have been pointless and painful and she was admitted to hospital for palliative care. She said that she hoped she could go out "on a pink cloud"and the palliative care team said they would do their best to achieve just that. In the event, she died exactly two weeks later.
Ever-increasing doses of morphine and other sedatives kept my sister's pain under control. But she was not at all times pain-free and she was certainly not free from distress. Some days before her death, when she was still able to whisper, she asked me, "When is this going to end? I cannot bear it much longer". At that point, had her carers had the power to give her an amount of morphine, or other drug, that would have peacefully ended her life she - and we - would have accepted with gratitude. Yet all of us were powerless under the existing law.
There is something hypocritical about the present law. It allows ever-increasing doses of morphine, which are undoubtedly a contributorycause of death, however precisely and clinically they are measured. Yet it does not allow the combined consent of the patient, family and medical advisers to foreshorten the period of pain and anguish. Is that the will of a loving God? I cannot bring myself to think so.
(Sir) Stephen Wall, London SW18
The Tablet, Letters, 3 January 2009
Yes to care, no to killing
Even those of us who are very inclined to agree with Clifford Longley’s arguments (20/27 December) about the dangers of autonomy as far as physician-assisted suicide is concerned cannot but be moved by Stephen Wall’s story about the sad death of his sister (Letters, 20/27 December). Nonetheless, Sir Stephen’s suggestions must be challenged.
Sir Stephen accepts that medication kept his sister’s pain under control, but goes on to say that she was not always pain-free and "certainly not free from distress". He says he cannot bring himself to think that this is the will of a loving God. He is right that we are confronted by a difficulty here, but it’s not one confined to palliative care. It’s the problem of evil generally: how does the loving God will any of the enormous suffering that occurs in the world? If we cannot answer this question, and understand to some degree the role of suffering in our lives, there are difficulties for our belief in the idea of a loving God.
Secondly, Sir Stephen suggests that ever increasing doses of morphine are "undoubtedly a contributory cause of death". Palliative physicians would rightly respond that morphine, when used for pain, even in high doses, does not cause death. And there is still the doctrine of double effect, that it is licit to do things, foreseeing their bad consequences, but intending good. This is a cause of much philosophical dispute, but the doctrine underpins quotidian medical decisions: I foresee side effects from all drugs, but I aim at some sort of good when I prescribe them.
Sir Stephen asserts that there is "something hypocritical about the present law". But the prohibition on ending innocent human lives remains a cornerstone of civil society, which would be removed by Sir Stephen’s call for euthanasia. My suggestion would be that we need better palliative care, not intentional killing.
In saying this, however, I suspect that the line between the two is often thin and indistinct in practice. Clinical judgements have to be finely made with a good deal of practical wisdom, courage and compassion. One fear about a change to the present law is that it would undermine the basis of such virtues.
(Dr) Julian Hughes, Newcastle upon Tyne
