Reviewed by Dr Kathleen Huxley
Rodney Syme has been a doctor and surgeon since 1964. Additionally, he is the president of Dying With Dignity Victoria, has a specialist and extensive experience in urology and an in-depth knowledge of, and acquaintance with, people who are experiencing terminal illness and suffering. In this moving account of dying he demonstrates that he has a level of expertise and insightfulness combined with a deep level of understanding in the complex issues involved in the title of his book A Time To Die.
Professional and personal experiences together with the stories of individual patients in this book, and those written about in his previous book A Good Death, have led this author to have a firm view on the possibilities, and ultimately the necessity, of assisted dying – ‘Each human death has its own special qualities and levels of unpredictability, because we are all individuals with different values, beliefs and life experiences, and, especially, different circumstances as we approach death’ . He began to comment publicly on these issues as long ago as 1987, and in particular after 1992, had an increasing number of people with illnesses outside his medical specialty who sought him out for advice on this difficult topic.
The first chapter of the book entitled “Is this the best we can do?” summarizes his thoughts on the current state of Australian legislature pertaining to this emotional minefield. Whilst his first book concentrated on people with terminal illnesses such as cancer and his involvement in their deaths, this latest book now also considers the reality of palliative care and the ideas of dying well or dying badly. Accordingly his concerns are expanded to include another group of people who are not actually dying and who he refers to as ‘the advanced incurably ill’.
His book documents details of an extremely diverse group of patients who are living with the issues associated with dying of a range of terminal conditions and who are actively looking for satisfactory and acceptable solutions to enact their end-of-life choices. His analysis reveals that the requests for assistance that he receives come from people who are suffering with cancer, neurological disease, chronic organ failure, chronic pain and psychological illness and include the frail elderly as well as the distressed relatives of dementia sufferers. The fastest growing groups, in his opinion, are the frail elderly and those who have dementia ‘whose voices are rarely heard in the end-of-life debate, largely because they have lost their voices and have no-one to represent them’.
His journey into counselling those who are suffering has brought him to the belief that people may not necessarily wish to die but they do wish to be relieved of their suffering in an effective and compassionate way, even if this does involve ending their lives. He supports his arguments by reference to various international studies which clearly demonstrate the palliative impact of being able to talk openly and legally with a medical practitioner about the possibilities of assisted dying – ‘euthanasia requests were not wishes for death, but more generally an insurance policy for the future’. In his discussion of palliative care, to which he dedicates an entire chapter, he describes the current state of affairs in the Australian context, putting forward differences of opinion between doctors and nurses and remarking that it is the nurses who give the palliative care, which he considers to be very good, and the doctors who give the palliative medicine, which he considers is not always so good.
The choices people are faced with when trying to die well are explained with sympathy and compassion and are condensed down into three important concepts – dignity, vulnerability and burden. He considers dying with dignity is to be free of suffering and with some sense of control which he feels also lessens the grief of those left behind following a death. His arguments are reminiscent of those identified by Atul Gawande in “Being Mortal” who asks for commitment to the creation of better options for those who are experiencing bodily decline and the ability for them to link their choices to the goal of a purposeful life.
This is an emotive book which engenders keen interest in the debate that is taking place worldwide on the rights and wishes of those who, for whatever reason, wish to end their own life through assisted dying. Rodney Syme has been intimately involved and engaged with these people for a very long time on many levels and in terms of the momentum for positive change in this arena he informs us that it is Canada that leads the field and that their progress has been made largely through the courts and legal system. Therefore, his wish is that this book, by providing the reasons for change and creating the emotions for change, will inspire people to engage with the debate on a humanitarian level and prompt them to seek a change in assisted dying laws via engagement with their political representatives.
By Dr Kathleen Huxley
Melbourne University Press
AUD $ 32.99 ; 187pp