The offer of mercy - a personal view by David R. Matthews

Prof. David R. Matthews, Medical Tutor and Dean, Harris Manchester College, Oxford.

End of life experience should be embraced as part of life. We want to live in a society that cherishes and respects all without calculating worth or usefulness, and where ageing and death are managed and supported. High-quality care homes and well-equipped hospices are paramount. Drugs, medical interventions, infrastructure support, physiotherapists, occupational therapists and aids to daily living should be readily available. We need to continue research into cancer and ageing, into chronic and debilitating diseases. We must never develop a society where life, and the right to it, is denied in any way or at any stage.

In my own working life as a physician, I have seen many people die. I have seen the brave and the fearful. I have seen quiet death while I was sitting by the bedside, and I have seen calamitous death in the hubbub of emergency medical facilities. I have many times prevented death by medical intervention, including rushing a patient to an Intensive Care Unit or Coronary Care Unit. Death after an acute catastrophe or a carefully diagnosed condition can, with modern medicine and surgery, be avoided in the near-term, and often postponed - perhaps for months and years - with the maintenance of a good quality of life. Suffering and pain can be alleviated and loss of capacity can be compensated by good and appropriately-delivered care.

Nevertheless, we have to recognize that human suffering can become unbearable in ways that cannot be addressed even by the best of our caring or interventions. Death may come, for many, more as friend than as foe. And, for a few, the actual process of dying comes as a brutally protracted assault involving a prolonged, pitiless attack on the sufferer, families and carers, day after relentless day.

Some chronic degenerative diseases lead to terrible loss of autonomy and dignity, progressive dependence and degradation of quality of life. Cancer can be quick and quiet but can also lead to long-drawn-out suffering, both mental and physical, well beyond the power of any drug intervention. And some diseases - of which Motor Neurone Disease is a particular example - inexorably and slowly deprive the sufferer of capacity to the point where they will die of respiratory failure or choking just because the muscles can no longer function. It is a slow asphyxiation; to witness the process is shocking. Ventilation is pointless though it has been undertaken, disastrously, on some who then became entirely ‘locked in’ with loss even of eye movement.

Death is often unpredictable in its exact timing but all doctors know there is a point of no return. When we are unable to offer the ideal of comfort and dignity, we surely must offer mercy. So I think we should consider that, when death is considered both certain and imminent, a compassionate judicial dispensation to allow assisted dying could be appropriate.

It would be for a very few. It could be for specified conditions. It would need to involve agreement between the patient, the family, physicians, lawyers and judges. We read in Ecclesiastes that there comes a time to die; we should be mature enough to recognize it. We must be able to support and pray with everyone in Simeon’s words (Luke 2: 29): ‘Lord, now lettest thou thy servant depart in peace’.


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