MERCY KILLING

Euthanasia: Why some people would consider it

Most terminally sick patients and especially those who have cancer live a low-quality life during their last days, while others are put on life support with the precept that life is too precious to be diminished

In Summary

• Euthanasia is where a doctor is allowed by law to end a patient's life by painless means 

• While illegal in Kenya, in some countries like the Netherlands, a patient who has no chances of survival has the right to ask for it

Doctor Esther Munyoro, head of palliative care and pain unit at KNH
Doctor Esther Munyoro, head of palliative care and pain unit at KNH
Image: courtesy

Samuel Kamau watched his mother's health go from bad to worse as she fought pancreatic cancer four years ago.

Her eyes and nails had turned yellow. Anything she swallowed came right back. Doctors had broken the news that the cancer was spread throughout her body and there was nothing they could do about it.

 
 
 

Theirs was to wait for the day she would breathe her last, but what broke them was the pain she was in each passing day.

 

"I watched the once-strong woman get frail. She dwindled before my eyes with nothing to do," Samuel said.

He remembers the day his mother told him she would rather die than be in such kind of pain for another day. "She was in too much pain. It broke my heart. While praying that night, I asked God to relieve her of the pain and take her. After all, the doctors had told us she had no chance," he said.

Four days later, she was wheeled to the ICU and Samuel knew there was no way she was going to leave that room alive. The doctors asked them if it was okay if they disconnect the life support machine on the second day in the ICU, which Samuel and his siblings agreed to.

"We walked into the ICU as the doctor unplugged the machine and I watched her gasp in her last seconds of life," Samuel said.

He balanced tears while telling the story, not for losing his mother but for the pain he watched her go through before she died.

For him, given the option, he would have opted to have her rest in dignity than go through so much suffering and pain.

 
 

ILLEGAL IN KENYA  

 
 

In Kenya, most terminally sick patients and especially those who have cancer live a low-quality life during their last days, while others are put on life support with the precept that life is too precious to be diminished.

In some countries like the Netherlands, a patient who has no chances of survival has the right to ask for euthanasia, where a doctor is allowed by law to end their life by a painless means, as long as the patient and their family agree. However, euthanasia is illegal in Kenya.

A physician or doctor who conducts it is liable for manslaughter or murder, according to Section 213(d) of the Penal Code Chapter 63 of the laws of Kenya. It does not matter whether the person requested euthanasia or not.

Jane* (not her real name) wishes euthanasia would be legal in Kenya. She would gladly have her grandmother have it. The grandma has lost her memory, cannot walk, cannot feed by herself nor answer the call of nature. 

Jane feels that at 104 years, her granny does not deserve to go through such suffering. "Yes, life is precious but I wouldn't like to live such a miserable life," she says.

"When it gets to a point where you cannot even recognise your children and you are ever in pain, such things like euthanasia should be considered."

Jane cannot say it openly before her family, but she quietly wishes her grandma would rest. She agreed that it would be a very difficult decision to reach, and noted that it would be looked at as inviting a curse.

But she maintains it would be better to do it if there is no chance of survival. "She is just there at her bed, waiting for her day; it is sad," Jane said.

LIFE IS PRECIOUS

In Kenya, it is taken that life in whatever state is too sacred to be cut short. Pastor Joseph Kinyanjui says God is the giver of life and the one who preserves it, and no one has a right of taking it away, despite the medical condition.

"In fact, life is protected within the law of God as the sixth commandment: 'Thou shall not murder'. One day in 1 Samuel 31, King Saul requested his bodyguard to kill him before the Philistines could get him, but he could not," Kinyanjui, who ministers with the Voice Of God Church and Ministries, said.

"Our God cares for the sanctity of life. He can even raise the dead, so why think that the person has come to an end and finish him?" 

Kinyanjui agrees with the use of palliative care but not euthanasia.

Esther Munyoro, head of Pain and Palliative Care Unit at Kenyatta National Hospital, says in her practice, she has had patients who wanted to end the pain by death.

"Usually all they need is for the suffering to be dealt with. We need to deal with total pain," she said.

"A big number also need a psychiatric assessment and usually do well with psychiatric treatment, but I would never opt for euthanasia."

Esther says a doctor's job is to preserve life at all costs, so euthanasia is a contradiction and she wouldn't think about it even for herself. "It is against my faith, what guarantee do I have the next stop is not worse than earth?" she said.

She says clinical care should be changed to become more patient-centred so as to alleviate patients' suffering. "In countries with good palliative care, euthanasia is rarer; this is what we need," she said.

VIEWED AS TABOO

Apart from being illegal in Kenya, the topic is also viewed as taboo. Many people we spoke to said they would not even give it a thought.

Dr Joseph Aluoch, a long-serving physician and chest specialist in Nairobi, spoke about life support in his book, 'Fifty years of health service in Kenya: 1968-2018'.

He noted that some people are against life support, especially when they feel these efforts are not improving the medical condition of their loved ones.

"Life support systems are meant to be lifesavers, and for most people, these are beneficial. However, there have been a number of issues raised in situations where people are in conflict over belief and moral views," reads part of the book.

He also noted that people believe it is morally wrong to allow someone to suffer indefinitely or keep them alive without consent. 

Speaking to the Star, Aluoch said if he was suffering from a deteriorating terminal illness like cancer, he would not even want to be taken to ICU or put on life support drugs.

"These technologies prolong death, putting poor days in one's life, and for me it's about good living and good dying. If its an accident, a heart attack or stroke, I would be fine with life support technologies, but not cancer. I would eventually die," he said.

Aluoch is always honest with his patients and their families about end-of-life care. "Why would a person be on life support for a year and eventually die? Such expenses can be avoided," he said.

He said Kenyans should appreciate the fact that no one will live forever. "Europeans have realised it's not only about living, it's the quality of it," he said.

Although largely illegal across the world, some countries like the Netherlands, Belgium, Colombia, Luxembourg, Canada, Germany, South Korea, Japan, some states in the US and India allow it.

Switzerland is the only country with centres that offer assisted suicide to foreigners. 

As people got used to the new law in the Netherlands, the number of Dutch people being euthanised began to rise sharply, from under 2,000 in 2007 to almost 6,600 in 2017. (Around the same number are estimated to have had their euthanasia request turned down as not conforming with the legal requirements.)

Also in 2017, some 1,900 Dutch people killed themselves, while the number of people who died under palliative sedation (in theory, succumbing to their illness while cocooned from physical discomfort, but in practice often dying of dehydration while unconscious) hit an astonishing 32,000. Altogether, well over a quarter of all deaths in 2017 in the Netherlands were induced.