When prolonging life becomes prolonging death
The case of one doctor this week illustrates an agonising dilemma
Melanie Reid
A hundred or so years ago the birth of a premature baby was just one small, visceral moment of everyday suffering.
Nature swiftly took its course; the doctor uttered grey, commonplace words; the mother turned her face to the wall.
Today the same event makes a deep ethical and economic imprint upon our society. The baby hovers between life and death, dependent on machines and drugs. Its mother and father spend months in limbo; its doctors inhabit a prison created by technology and parental expectation.
I wonder if modern doctors ever envy the less complex lives of their antecedents, men who never had to face the intellectual battle about prolonging life: that tyranny of “when”. When to switch off the machine, when to withdraw one drug, when to administer another, when to acknowledge that all that is left to do is to alleviate suffering.
Actually, it’s worse than that. Modern medicine is not just about prolonging life, it’s increasingly about prolonging death. The plight of Dr Michael Munro, 41, a consultant neonatologist accused of hastening the deaths of two terminally ill babies, goes directly to the heart of what is, I believe, the most pressing issue this ageing, baby-sparse society of ours faces.
We possess immense medical technology, but have not studied the moral consequences of having it. We are incapable of addressing the concept of a good death. And we are failing disastrously to nurture doctors who, to those ends, seek only to reduce the suffering of dying patients.
The case of Dr Munro, whose hearing before the General Medical Council’s fitness to practise panel runs all this week in Manchester, has big implications both for the profession and for the terminally ill: a condition that, as far as I aware, is universal enough to make the need for some compassionate pragmatism all the more pressing.
The consultant was caring for two very premature babies. Both Baby Y and Baby X were unable to breathe independently. One suffered significant heart problems, the other had a big brain haemorrhage. In both, separate, cases at Aberdeen Maternity Hospital the difficult decision was made, with the parents, to withdraw treatment.
The breathing tube was removed and a course of morphine was begun. The babies began to struggle to breathe, a normal part of the dying process known as agonal gasping. Were we Victorians, we would know this.
These days, however, how many of us are well versed in the dying process?
And how many of us imagine we could calmly nurse our child as it gasped its way to death, without crying out for succour?
Baby X’s parents asked Dr Munro to alleviate his suffering. The GMC was told that the doctor administered a drug that he told the parents “was on the verge of what society finds acceptable”.
In Baby Y’s case, Dr Munro did the same, injecting 23 times the normal dose of a muscle relaxant called pancuronium. Both babies died soon afterwards.
So was this “tantamount to euthanasia”, as the GMC’s lawyer has alleged? Or was Dr Munro merely a good man acting from the very highest motives to spare distress at the inevitable end of life?
What is very telling is that the mothers and fathers of babies X and Y “fully supported the doctor’s actions and were grateful to him”. The whistle-blower, significantly, seems to have been the nursing staff.
Within individual members of the medical profession, there is said to be considerable sympathy for Dr Munro. But the GMC, once aware that he stepped over the ethical line that divides the withdrawal of treatment from that of active intervention to hasten death, had to be seen to act. This is the harsh reality in postShipman times, where a vocal minority lurks, ever ready to portray doctors as potential murderers.
Among some in the profession, there is a feeling that Dr Munro made the mistake of treating the parents’ distress, rather than the child’s condition. He should, in an ideal world, have worked harder to prepare the parents for the process of dying.
Which may be true, but doctors do not live in an ideal world. They live in frantic, demanding real time.
The silent majority, past polls suggest, would not punish a doctor for reducing the suffering of someone who was going to die anyway. Most of us support some kind of compassionate euthanasia for terminally ill people who have made clear their wishes. Or – in the case of infants, who cannot make their wishes know – then we support the authority of their parents.
Very few people take the view that life, any sort of life, is always better than death, yet the latter approach is what is institutionalised in medical ethics, largely as a result of the blame society.
Doctors should, in general, conform to society’s wishes; I’m not at all certain they do so over the concept of not prolonging death. This is a divergence that will grow as the babyboomer generation faces up to decrepitude and dementia; and realises that undignified, lingering dying is far more terrifying than death itself.
We may detect some moves in the right direction. Fifteen years ago Dr Nigel Cox was convicted of attempting to murder a terminally ill patient who was howling in distress. He was reprimanded by the GMC and allowed to return to work. Today, significantly, Dr Munro’s case was not dealt with by police in the first instance, but by the GMC. We must hope that he too is allowed to continue his invaluable work.
More importantly though, we must start a debate, with the GMC and many others, to pin down the meaning of a good death.
Posts
