Anonymity poses questions in "right to die" debate

THE Irish Times is doing the Irish people an invaluable service by facilitating public debate on allegations of sexual abuse in the Roman Catholic Church and of physical and emotional abuse in Goldenbridge orphanage by specific, named individuals.

But can it really foster public debate on what constitutes the best management of profoundly and permanently handicapped persons in this country?

This is the question that struck me forcefully following the publication of the article by the mother of the "Ward of Court", the woman in the so called "right to die" case (The Irish Times, February 2nd, 1996). Two things in particular are a cause of grave concern.

First, the article was published anonymously. It contained a catalogue of allegations against nameless persons in the medical profession. The individuals in question have no right of reply and, although nameless, have to endure "trial by media".

Is the public well served by the publication of an anonymous article which puts the entire medical profession in the dock to be tried in this manner? This is actually the second anonymous article published in The Irish Times concerning the "Ward" case. The first was written by a theologian who gave evidence in court on behalf of the woman's family (The Irish Times, September 4th, 1995).

Neither the mother's nor the theologian's name could be revealed in the press because Mr Justice Lynch in the High Court ruled that the judgment in the "Ward" case could be delivered in public, "but in a manner which preserves the anonymity of the parties, that is to say, the war, the applicant and the members of the family, the witnesses and the institution."

Is it possible for any newspaper to foster public debate on a matter of national significance when one side has to be presented anonymously because of a High Court ruling? This is a strange way to participate in public debate. The usual practice when "going public" in print is to sign one's name.

The "Ward" case is a matter of national significance because there are many other families in this country who endure great distress when a member continues to survive notwithstanding tremendous physical and mental handicaps.

In addition, the ward herself represents many incapacitated people throughout the country who have greater or lesser degrees of cognitive capacity.

If the quality of cognition is taken as the measure of who should be allowed to live and who should not, then it endangers the lives of countless other incapacitated people who could be described in similar terms to the ward.

The second aspect of the article by the ward's mother that was so disturbing was the assurance that the ward's "eight days of dying were more peaceful than the previous 23 years of so called living".

Yet in a similar case in the United States (Brophy v New England Sinai Hospital) the trial judge found that if nutrition and hydration were withheld from Brophy (the patient), he would suffer terribly for a period of time ranging from five days to three weeks before dying of starvation and dehydration. During that time this body would be likely to experience the following effects from the lack of food and water:

1) His mouth would dry out and become caked or coated with thick material.

2) His lips would become parched and cracked and fissured.

3) His tongue would become swollen and might crack.

4) His eyes would sink back into their orbits.

5) His cheeks would become hollow.

6) The mucosa (lining) of his nose might crack and cause his nose to bleed.

7) His skin would hang loose on his body and become dry and scaly.

8) His urine would become highly concentrated, causing burning of the bladder.

9) The lining of his stomach would dry out causing dry heaves and vomiting.

10) He would develop hyperthermia, a very high body temperature.

11) His brain cells would begin drying out, causing convulsions.

12) His respiratory tract would dry out, giving rise to very thick secretions, which could plug his lungs and cause death.

13) Eventually his major organs would fail, including his lungs, heart and brain.

In her article, the ward's mother referred to the Tony Bland case as one that influenced her decision to apply for the withdrawal of the gastrostomy tube from her daughter.

However, in a report on the Bland case, Mr Alexander McCall Smith, Reader in Law at the University of Edinburgh, made the truly perceptive comment: "Death when artificial feeding is withdrawn will come only after 10 days or more of admittedly sedated, starvation". (The Times, November 11th, 1992).

"Sedated starvation" is an interesting phrase. What does it mean? Is the patient to be given only sedatives in place of food and water until he/ she dies? Why sedatives? Is it to prevent the patient exhibiting the distress and suffering brought on by the withdrawal of nutrition and hydration.

Who is to administer this "treatment"? Medical doctors? Nurses? Will "sedated starvation" become part of medical care, or is it already upon us?

In my view, anyone from whom food and water is withheld and to whom sedatives are administered instead is not merely allowed to die, but rather is not allowed to live.