Assisted dying: we all need to be happier to help

I recently read an interview given by the novelist Joanna Trollope who, speaking in favour of assisted dying, commented that, if necessary, she would take her own life were she to develop dementia. Hating the thought of becoming a ‘nuisance’, she said: ‘I have no intention of moving in with either of my daughters and ruining their lives.’¹

Such an attitude has implications for how we care for our patients. People in need who come to those in the caring professions are not simply nuisances who ruin the lives of those burdened with their care. Rather, they are those whose lives still have meaning and value despite the struggles they face. Furthermore, their lives have the potential to enrich, rather than ruin, the lives of those who care for them.

This is not to say that we should hope for hardships to befall others so that we can be needed. Nor am I trying to suggest that there is some perverse beauty in suffering. No — suffering is suffering and it is horrible — frequently terribly so. But suffering is a part of our human existence and must not be swept under the carpet with the assistance of, as Trollope suggests: ‘ ... a nice man with a pot of happy pills and a plastic bag to pop over [the] head.’ ¹

One can understand where she is coming from but it saddens me that a life that is given over to caring for somebody else is considered a life that is ruined. I can understand that nobody wants to be a ‘burden’, but it needs to be remembered that there can be deep satisfaction, and even joy, in carrying the burdens of another. And a burden carried joyfully is, of course, no longer the burden that it once was.

We hear constantly about the desirability of high self-esteem but Trollope’s comments raise the question as to what it is that we derive a positive self-image from. She is not alone in undervaluing a life given over to the care of another. Lately I listened to a young woman who felt her life was pointless despite the fact that she spent much of her time caring for the young child of her terminally ill friend. I don’t consider that a pointless life — far from it. As society becomes increasingly fragmented and individuals feel more and more isolated, we need to remember that humans are meant to live in a community, supporting one another. And if we all want to be needed then some of us are going to have to be those who have needs.

I wonder if we have forgotten what a real need is and what is of real value. In a celebrity culture which thrives on the superficial it seems too many of us want to be admired for our entertainment value rather than our character. It seems we all admire the work of Mother Theresa but nobody wants to be like her; preferring to dream of superstardom and the vast financial rewards that accompany such adulation. Perhaps such an attitude underlies the view that a life given over to the care of others is a life ruined since such a life threatens our pursuit of more superficial pleasures.

But caring for others need not be a dutiful burden, virtuous, but without accompanying joy. Far be it for me to suggest it but Immanuel Kant was wrong when he said an action was only truly virtuous when done out of duty,² with no associated gain for the one who acts. The truth is that there really is satisfaction and joy to be had in caring for those who suffer and, what is more, where there is that joy in caring, the sufferer is more honoured in the giving of the care than if it were done out of duty alone.

An illustration, for which I am indebted to John Piper,³ may help. Suppose I come home on my wedding anniversary and present my wife with 12 red roses. And imagine that, in her astonishment, she asks me why I should do such a thing. Woe betide me if I claim ‘duty’ as my only motivation. Giving my wife flowers on our anniversary because it is my duty to do so as her husband will not impress her and it certainly does not honour her; if anything it honours me. But consider her response if instead I was to reply that the reason I bought her flowers was that I couldn’t help myself, that nothing makes me happier than buying her flowers. I suggest that such a response, if true, far from being considered selfishness on my part, would add to her joy and honour her all the more.

Of course, loving someone is more than buying them flowers and is often hugely costly but it doesn’t always have to be a burden. A duty may be burden, a valueless job may be a burden, and, of course, chasing QOF points may be a burden, but it is a sad day if we’re saying loving someone, or caring for someone, is a burden. I recall arriving late at a party one evening some years ago having been held up at work admitting a patient with meningitis. Many at the party were sympathetic towards me, wrongly assuming that my long hours at work must have meant I’d had a bad day. They did not realise that, on the contrary, my long hours that day, doing something worthwhile, were a source of genuine pleasure. Worthwhile work done well is satisfying to the worker. It really is a joy.

So the next time a patient thanks you for some care you’ve given, remember that responding with a curmudgeonly ‘Just doing my job’ doesn’t honour your patient half as much as a heartfelt, ‘It’s my pleasure’.

And let’s stop imagining that those who want to die with dignity can achieve this best by being allowed to end their ‘inconvenient’ lives prematurely. Rather, we will dignify their final days and years most by loving them enough to find a joyful satisfaction in caring for them. We all need to be happier to help.

• © British Journal of General Practice 2015