Do Your Euthanasia at Home

S.Q. Lapius was in his smoking jacket, rolling a lean Havana between puckered lips.  “The Smith family will be here shortly, Harry.  Empty the ashtrays.” He slurred without removing the cigar.

“Who are or is the Smith family?” I asked.

“A vexing case.  They comprise a husband, son and daughter-in-law.”

“And what pray tell is the occasion.  Is this related to the bicentennial?  Are they related to Captain John Smith of Pocahontas fame?”

“No. They are related to complete heart block.  I admitted Mrs. Smith the elder to the hospital this morning.  Her pulse rate was 40 per minute, hardly enough to keep the blood circulating.”

“Shouldn’t pose a problem to an old master such as yourself.  I should think a pacemaker would do the trick.”

“So it would, Harry, so it would, except there is a catch.  It seems that the family doesn’t want a pacemaker.”

“What do they want?  Are they confusing the heart pacemaker with the boat?  Perhaps you should be more explicit when talking to them.”

“Even when you try to be humorous, Harry, you fail to even be droll.  It is simply that the old lady has been failing.  She is almost ninety years of age, and they apparently think it would be kinder to all if she passed away quietly.”

“Then why didn’t they just allow her to pass away quietly?  I mean why bring her to the hospital?”

“My point exactly.  But when I asked them, they said that she was too difficult to handle at home.”

“And they would like you to preside over the final moments.  Lend your expertise to the dignity and comfort of her ultimate demise.”

“Precisely.  They wouldn’t sign permission for the installation of a pacemaker.”

“Sort of leaves you in the middle, Simon, doesn’t it?”

“Well, it does raise problems and questions.  The patient is disoriented and incontinent.  I must treat her medically.  I can’t allow her to simply wither away.  Yet, I suspect that without a pacemaker that is just what will happen.”

“Your hands are tied then?”

“Not exactly.”  The bell chimed.  “That must be they,” Lapius waved me to the door.

Mr. Smith entered on a cane assisted by his son and daughter-in-law.  We shook hands all around, and I immediately forgot their first names, which was important because they were all named Smith.

We sat in a semicircle around Lapius who had refused to budge from his recliner, but who, as a concession to hospitality, sat upright.  The young Mr. Smith said, “We are appreciative that you consented to see us Dr. Lapius.”

“It’s no problem, sir, but I don’t see how I can help you.”

“Well, you understand our position.  My mother is on her deathbed.  Even before the attack she was weak and failing.  We feel it would be just as well if no heroic measures were taken.”

“I am not a hero, sir,” Lapius said modestly.  “I would have nothing to offer her but routine medical management.  If that fails, I will have to introduce a pacemaker.  We will giver her 48 hours to see how she responds to treatment, and then we will have to make a decision.”

Mrs. Smith spoke tartly.  “I am a nurse.  I know about these things.  What will a pacemaker do but prolong her miserable life.  It is useless, and we will not sign permission.”

“Then, madam,” Lapius said softly, “you should have kept her at home and let nature take its course.  I can’t be made a cat’s paw for your intentions, however honorable and compassionate they might be.  Let us assume, for the sake of argument, that I allow her to die, virtually unattended, medically.  I would be liable for a malpractice suit.  Perhaps there is another member of the family someplace who would object and say we had no right to make such an important decision?  Suppose there is some lawyer representing a person who feels that one of you might make some financial gain from the death of the patient.  Why should I become involved in this sort of shenanigan?”

“Well,” Mrs. Smith said sharply, “We had hoped you would be considerate and understanding and help us in this matter.  Surely you must understand that alive, she becomes an unbearable burden for my father-in-law.”

“I do understand that, Madam,” Lapius said sympathetically.  “I am not unmindful of the consequences of her recovery.  But surely you can’t ask me to participate actively in her death.  You are trying to make me a partner in what legally could be a crime.  For all I know, if a pacemaker were inserted and enough blood were pumped to her brain by a properly beating heart, all this confusion and disorientation you speak about might be corrected, and she would become relatively self-sufficient.”

“Come on, doc,” Mr. Smith junior intoned.  “All she wanted to live for was her granddaughter’s wedding.  Well, that’s over so now she doesn’t care.  Why don’t you help us out?”

Lapius billowed some smoke into the room.  “Why don’t you help me out, and either take her home, or allow me to do my job to the best of my ability?”

“We are not taking her home,” the nurse said.  “She is too sick to be discharged, so you are stuck with it.  We won’t sign permission for a pacemaker, so your hands are tied.”

Lapius sprang from the recliner.  “In a moment Harry will show you to the door, but not before I make one point.  My hands are not tied.  Here you all are talking about the right of a person to live or die, unanimously voting that she should die.  But the most important vote has not yet been solicited.  That of the patient.  When the time comes, I will explain her condition to her.  I will ask her whether she wants to have a pacemaker implanted.  If she does, she will sign the permission, and the deed will be done.”

“You can’t do that.  She’s senile.”

“If that’s the case,” Lapius said stonily, “You had better rush to court and have her declared legally incompetent, with yourself named as guardian.  Otherwise, she is the only one who can make the decision, providing she is conscious and apparently competent.  Good day.” I showed them to the door.  They were upset.

“Actually Simon, you know damn well they have a point.” I said when I returned.

“Of course they do,” Lapius conceded, “But in each case I must make private decisions as to where to start, where to stop, how much is humane, and how much is cruel.  But whatever my decision, I can never agree to conspire to something of this sort.  I really don’t know the facts of this case.  Apparently everyone wants her dead, but the truth of the matter may be that she wants to live.  We’ll try to find that out during the next day or so.”