‘My mother died by euthanasia. For my family, that day is a positive memory’ – Independent.ie

My parents were both very supportive of euthanasia. They felt strongly about ending your life when you feel it is not up to your own standards any more. They made this known in 2014, while they were both healthy and in their 60s, by signing a euthanasia declaration with their GP. They agreed that euthanasia was an option in case of intolerable suffering, terminal illness and dementia.

his was in the Netherlands, where euthanasia has been legalised for competent adults and emancipated minors since 2002. The same is the case in Belgium, where I grew up, where I met my Irish husband and where our children were born. Every year, fewer than 5pc of deaths in these countries are from euthanasia, and 85pc of these are patients with a terminal illness. GPs are actively involved.

In 2018, my mother was diagnosed with bowel cancer and she received excellent care. Surgery to remove part of the bowel was a success and she began a course of chemotherapy. Six weeks later, she developed pain radiating from her spine which stopped her from sleeping. It took a while to get a final diagnosis. At first, it was thought that this pain was due to the operation and not the cancer. After weeks of uncontrollable pain, however, it became more and more apparent that the cancer had spread throughout her body. At the start of 2019, she was told treatment could only be palliative. It started off with morphine patches.

This news was a hard blow, for her and for my father in particular, but also for my siblings, whose lives changed dramatically. Both my sisters are qualified nurses and lived near my parents. They decided to take on her care. From that moment on, my mother became a full-time patient, with my father and sisters providing 24-hour care so she could stay at home. Living in Ireland, I only observed this from a distance, with infrequent visits and regular phone calls.

My mothers health got progressively worse. Yet at another level, she had the time of her life. She always loved being the centre of attention. It was something she had craved since she was shipped off to boarding school at the age of eight, a traumatic experience. Her cancer, strangely enough, gave her an unapologetic approach to get this attention, from my father as well as my sisters.

My brother was in charge of all practical arrangements. He also showered her with flowers. The house was always full of them and she loved it. Yes, my mother, fighting her cancer, certainly made the most of the attention, and she loved every moment of it.

By June, the pain started to take hold of her and morphine patches could not control the pain any more. She was provided with a morphine pump and the dose was slowly increased every week. Her belly started to show the growth of the cancer. Even though other parts of her body showed weight loss, her belly swelled.

Throughout her medical journey, her GP was very close and guided her every step. He would check in with her, weekly in person and whenever necessary over the phone. She was very fond of him and it helped he was very young. She liked that. But by the end of July, her conversations with him changed, from What can be done next? to This is getting too bad.

They talked about passive euthanasia, which would mean increasing her medication, stopping her food and water intake and inducing coma so she would die peacefully. Considering the amount of fluid retention in her belly, however, this could take weeks if not longer and was dismissed. Passive euthanasia would result in secondary conditions, such a bed sores, and the care required without her being mentally present would weigh on all her family. Her condition was bad, and my sisters and my father were tired. A decision was made to hire a night nurse, so everyone could at least get a good nights rest.

Only days later, my mother summoned the GP. After he talked to her, he called a meeting. My mother wanted to start the conversation about active euthanasia. She was at the maximum morphine dose, her pain was increasing all the time and relief was only occasional. She was really suffering. It was decided to trigger the active euthanasia process.

Her declaration was in place with the GP, but to proceed with euthanasia, an independent SCEN (support and consultation with euthanasia) doctor has to meet the patient to confirm their wish. These doctors have been trained in the legal aspects of euthanasia, to support GPs and to provide an independent observation of the patients wish to die.

My father rang me on a Friday afternoon, a call that I had been expecting for a long time but caught me off guard at the same time. He told me they had decided to start the procedure, and asked if I still supported this decision. Even though it is not the familys decision, and they cannot overrule or change the patients wishes, having their support is important.

As in many families, we often have different opinions, but in this, we all recognised my mothers wish and supported her. My dad called again on Saturday, and told me the SCEN doctor was coming on Monday. He was concerned because my mother was on such a high dose of morphine that it was difficult to counteract this with another drug, Haldol, to keep her present. He was worried she wouldnt be able to tell her story coherently, thereby stopping the process. We had to trust the process, and the SCEN doctor, who would have seen many patients in her condition. I booked my flight.

Monday came. I left Galway on the airport bus while the SCEN doctor sat with my mother for more than two hours. She left without talking to the rest of the family. The GP confirmed the next day that the SCEN doctor approved active euthanasia. My mother asked for a priest. The GP ordered the medication. The day and time were set: Wednesday at 1pm.

It was decided that only her children and my father would be told of the timing. We agreed that her grandchildren, her sisters and brothers, all other family, would only be told after. My mother had spent the past months saying goodbye to everyone, and shed had enough. We needed our energy and attention to support her, and were grateful for this decision: no distractions.

The GP came by again on Tuesday and he had a brief conversation with my mother, confirming her wishes once again. My father wanted to be alone with her that evening and it was decided we would meet at 10am the next day. Each of us had a task. My eldest sister was in charge of the medication. She talked to the nurses who maintain the morphine pumps, on how to keep my mother present without her freaking out. She got it right. My youngest sister would dress her. I was to wash her and make food. My brother got the flowers.

Wednesday morning. My mother was surprisingly calm and content. My father was trying very hard to keep it together. He made a rule. The room in which my mothers bed was set up was going to be a dry room. By which he meant, you do your crying outside there; once in, youre there to support your mother. Fair enough. He also wanted to have coffee and a slice of cake at 11am, after which they would go to my mothers room and get her settled. We were then to join them. The plan was set.

Jobs done, 11am came, coffee and cake was served. Only my mother ate the cake. Her cancer had kept her appetite roaring throughout and now was no different. She even finished some of the other slices, commenting on how nice it tasted. We had to laugh.

Then my father got up and said: Its time. That was an intense moment, fighting the tears; the memory still brings them on even now. We were left sitting with the leftover cake, a bit stunned. Half an hour later, we were called into the dry room. By then, we were all settled. The mood was positive. We checked with each other, with my father, and then for the last time, with my mother. Mam, are you sure? She was calm and together, holding my fathers hand. Yes, she was sure.

Sometimes, situations just throw you. The GP and his colleague, in true Dutch fashion, arrived on their bikes and locked them. The locking of the bike hit me with a surreal feeling; it was such an ordinary thing to do in such extraordinary circumstances.

It was a beautiful sunny day. They came in and we were asked to leave the room. The GP was with my mother on his own, briefly, I imagine to confirm with her again, to make sure. He called us back in and started setting up. My father took his place on the bed, holding my mother. My eldest sister was holding him. My brother and my youngest sister were on the other side of the bed, holding her hand. I was at her feet. Earlier that day the nurse inserted a port. Everything was ready.

Then the GP broke down. It was his first euthanasia, which was why his colleague was with him for support. My mother had the kindest response it is amazing what these situations bring and she told him to take his time, that she really appreciated all her time with him and that she was ready when he was. He was very apologetic, but we all laughed and asked my father: So this dry room thing does not apply to him? My father smiled and shrugged his shoulders. The GP got his emotions under control again. We all said a last goodbye and my mother confirmed for the last time. He first gave her something to put her to sleep. Her head fell against my fathers arm and she gave one last loud snore. He then administered the medication to stop her heart. At 1.03pm she was gone; we closed her eyes.

The GP left for a moment and we slowly took in the situation. He came back in to confirm her death and then moved on to call the police, who had been informed in advance. Euthanasia is still classified as an unnatural death and a coroner has to confirm it and make sure all the paperwork has been done as part of the legal process. Once that was done, and after sitting around for a while, still stunned, we informed the rest of the family. The grandchildren started dropping in, the funeral directors dropped by, many phone calls were made.

We were lucky, not only because my mother had this as an option, which she chose, but also because we all supported her in this decision. But, in saying that, none of us could have stopped the process. It was her decision and hers only. Having a supportive family surely made this a shared experience, but without her strength and conviction, this would not have been possible.

My mother was brought up a Catholic and remained loosely connected to the church. She would always watch the Pope at Easter, and make sure she would hear his Urbi et Orbi, but she did not go to church. Many candles lit in churches had to make up for this. She was also a practical woman, who understood that the end of her life would become increasingly painful. And finally, she loved attention and drama but realised she was getting too tired to enjoy it. For her, euthanasia was an option. This is not the case for everyone, but we are grateful she could avail of it. For my father, my sisters, my brother and me, however strange this may sound, it is a positive memory.

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'My mother died by euthanasia. For my family, that day is a positive memory' - Independent.ie