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BMJ No 7102 Volume 315

Personal view Saturday 26 July 1997


A very special day

My grandmother died recently. She made the decision and chose the date and the place. She came to a point when she thought life was not worth living and, as the doctors agreed, she was allowed to die quickly and painlessly. As you may have gathered she died through active euthanasia, and this was made possible by the fact that she was Dutch. I am Dutch, and I am working on a geriatric ward in Yorkshire. I have seen many people die, but none have died as peacefully as my gran. My gran's death was my first encounter with euthanasia, and it has made a lasting impression on me. She died at home on the anniversary of my grandfather's death.

Once the decision had been made she relaxed and said her goodbyes. I asked her if she needed to rest while saying her farewells but she replied: "Why should I rest, I'll have plenty of time for that later." Finally, she fell asleep, totally exhausted.

The doctor came, talked to her again, and explained the procedure to us. Those who wished followed him to her room. The "second opinion doctor" had seen her a few weeks earlier, and all the paper work, which could have been arranged in advance, had been done. As it was a Sunday this was essential as otherwise her death would probably have had to be postponed. She decided at 8 am, and by 2 pm the procedure had taken place. A few days before she had told her general practitioner that she had no reason to carry on and wished to die.

My gran had carcinoma of the rectum with liver and lung metastasis. She was troubled by severe fatigue, but the loss of dignity was her prime concern. She was in no physical pain, and she was alert up to the last second.

Her life was ended actively, according to Dutch euthanasia laws. A public health doctor came after her death, saw the body, and discussed her case with the consultant who had attended her throughout her illness. The euthanasia declaration she had made 11 years ago and had renewed every five years since was handed over, copies of her notes made, and the legal document completed. It will take at least nine months for the consultant to hear whether or not he will be prosecuted, but as all the conditions given by law were fulfilled he is not concerned about the outcome.

All those that had watched her suffer - the long nights, the fatigue, the hopelessness - were incredibly relieved. We had seen her become very depressed. I am very proud of my grandmother. In Holland it is only certain people who choose to die this way.

Her consultant said afterwards that this was one of his reasons for being a doctor; to relieve suffering this way. Is there any reason why this is not part of my duties as an English doctor? Is this not the most dignified way to treat patients who openly ask you to relieve their suffering? Many are worried by the slippery slope, but by keeping it illegal, are we not forcing too many patients to suffer?

As both my grandparents were strong supporters of euthanasia, I am glad that my gran had the choice and proved her belief by making her death a very special day.

Frédérique Zwart,
senior house officer in Yorkshire


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