Feature Assisted Dying

A doctor who chose an assisted death

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4385 (Published 19 August 2015) Cite this as: BMJ 2015;351:h4385
  1. Richard Hurley, features and debates editor, The BMJ
  1. rhurley{at}bmj.com

A Belgian generalist’s family helped him through the assisted dying process once the pain from cancer had become unbearable, his daughter, a dermatologist, tells Richard Hurley

“Suddenly, when he knew that the exit was close, he was a different man.” On the day he had chosen to die, 8 May 2012, Veronique Bataille’s father seemed to have been freed from the increasing, persistent, and excruciating pain that had resulted from bone metastases secondary to prostate cancer.

“I think that it was because he knew exactly when he was going to go that he had four or five hours of amazing lucidity. He got up. He washed on his own. He shaved,” she said. He had even requested an outfit from his wife; “He really wanted to plan the day well. He looked amazing.”

And now, at his chosen time and looking his best, he sat on the hospital bed with his wife and four children around him. “Thank you for allowing me to go the way I want to go,” he told them.

Powerless to help his own patients

Henri Bataille, born in 1935, had spent his life as a family doctor in rural southern Belgium. He had often felt powerless to help his own patients who were dying in pain, and he welcomed Belgium’s legislation on assisted dying in 2002. “I will want it if ever I’m in that situation,” he told his family.

Henri Bataille had prostate cancer diagnosed in his late 60s. Treatment brought remission for five years. Then the discovery of metastases led Bataille to register for an assisted death, before the pain and drugs that were certain to accompany the end of his life would make such a wish even harder to bring about.

Uncontrollable pain was most likely what led to his admission to the local hospital, Bataille’s daughter said; but this was a Catholic institution, and when he mentioned assisted dying he was told that this was not possible. “Even in Belgium, where it’s legal, the nurses and doctors refused to acknowledge that he’d been through the process [of registering for assisted dying],” said Veronique, a dermatologist who has practised in the United Kingdom for 30 years. “It was traumatic.”

Others’ religious beliefs also impinged on Henri Bataille’s wish: his long time urologist unexpectedly declined to help with assisting a death because of Catholic teaching. “Imagine that a patient didn’t know the process or was shy to ask about it,” said Veronique. “If his or her oncologist is against it, it’s probably not going to happen, even though it’s legal.”

Once transferred to a non-religious hospital, Bataille looked to his wife and children to help him with the emotional and practical demands of planning his own death. “He was so happy that we were saying, ‘We will help you. We will do it with you. You are not alone,’” Veronique explained. “It was surreal. Suddenly I’m sitting on the edge of his bed going through my diary, booking the weirdest thing in my life. It also helped us to grieve, because we were slowly discussing his death.” The family found a suitable date when three accredited doctors could come, about a week later.

Bataille had warned his family of the intense instinct to survive that can kick in among patients very near to death. Veronique said, “He told us, ‘I will probably be frightened and completely forget and dismiss these forms and say that I want to survive and want every possible option given to me.’” She thought that he would change his mind and not let them do it. “But he said, ‘Go ahead.’ That was the hardest bit, knowing that he’d decided: ‘I’m going now.’”

Get on with it!

Bataille said goodbye to each of his family. In turn, each doctor asked him whether he wanted to proceed. By the third affirmation he became flippant, telling them, “How many times do I have to say it? Get on with it!”

The doctors administered the drugs. “Three bags: 1-2-3, done. He was unconscious as soon as they gave the first one,” said Veronique. Afterwards the family spent the day together, as well as some time with the doctors, which helped to “see them in a different light,” not simply as the people who had ended Henri Bataille’s life.

Religious conviction is not the only reason for healthcare professionals to be wary of assisting death. One of the doctors involved in the final process had known Bataille professionally for years; she had helped out of a sense of duty, but she admitted afterwards that it had upset her.

However, Veronique Bataille does not understand why some doctors and their representatives, such as the BMA in the United Kingdom, want assisted dying to be illegal. “Doctors are the closest to patients who suffer,” she said. “How can happy people who are in full health make a decision about whether another person should carry on living? A lot of people who are very vocal probably haven’t lived it.”

She would restrict assisted dying only to patients with terminal cancer or with conditions such as motor neurone disease, “when the end is obviously predictable.” Calls for assisted dying in other disease—including severe mental illness, as Belgium allows—may be counterproductive in the UK, she said, warning, “We may sabotage the real reason why this is being pushed: for the people who really need it.”

Coming from a small community, where her father had been well known, necessitated discretion from the family, admitted Veronique, and they didn’t mention that he’d had an assisted death unless people asked. “A lot of patients and the community would be upset, even by the words,” she said.

Did helping to organise her father’s death change Veronique’s view of assisted dying? “To see the relief on his face when he realised he could go was incredible. We underestimate how much suffering dying people go through,” she said.

And the alternative to an assisted death, as in the UK, she thought, would have been more pain and no predictability—“him lingering slowly, and suddenly dying at 1 am, in a dark hospital room with none of us around him. Instead, I’ve lived it, and I’m all for it.

“My father was so much in control.”

Assisted dying in Belgium

Including Henri Bataille, 1432 adults had an assisted death in Belgium in 2012.1

Belgian law allows a form of assisted dying in which doctors administer the lethal drugs—that is, voluntary euthanasia—unlike the law currently being proposed in England and Wales, which would see patients administer the drugs themselves.2

In Belgium, application for assisted dying is open to patients in a hopeless medical situation who report constant and unbearable physical or psychological suffering that cannot be relieved, caused by a severe and incurable accidental or pathological condition.

It can be provided only for patients who are legally capable and conscious at application and who make the request voluntarily, thoughtfully, and repeatedly, and not as the result of external pressure.

Since last year an amendment has meant that children of any age who have terminal disease and parental approval may also apply for assisted dying. The currently proposed law in England and Wales, in contrast, could apply only to mentally competent, terminally ill adults who want an assisted death.3

Recently published survey results show the rates of assisted death in Belgium4 and reasons why people have sought assisted death.5 The rate of euthanasia increased from 1.9% of deaths in 2007 to 4.6% in 2013, reflecting more requests (3.5% v 6.0% of deaths) and more requests granted (56.3% v 76.8% of requests made).4

More people with non-cancerous disease are requesting assisted dying—for example, the proportion of requests from patients with a diagnosis of cardiovascular disease, including cerebrovascular accident, rose significantly from 0.8% of requests in 2007 to 3.0% in 2013.5

Notes

Cite this as: BMJ 2015;351:h4385

Footnotes

  • Competing interests: I have read and understood the BMJ policy on declaration of interests and have no relevant interests to declare.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

References

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