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MERCY KILLING Enabulele A Painless Death From An Incurable Disease

Not Our Culture, Illegal in Nigeria –Medical Professionals

There are times when keeping a sick person alive at all cost may not be a kind gesture, particularly when the patient is distressed from an incurable or a very deadly disease, suffering pain and having no prospect of improving. In that instance, can help be sought in ending such lives? Would it be considered an act of mercy? Is there really a right to death? These are questions this report by ISIOMA MADIKE attempts to answer

Regina Nwabuya lay on her back in the delivery room of a private hospital in Lagos, as she laboured to give birth to her first child sometime in 2019. Incidentally, that was the last. She never again got up in her life, neither was she able to eat, drink nor talk. She could not also cry over her pathetic, numbed state. Something went terribly wrong. Instead of the epidermal anaesthetics administered during childbirth easing her pains, it transformed Regina from a young woman with a great life ahead of her, to a vegetable, paralytic and completely dead to the world around her. She lost all nerve and muscle functions, which made her incapable of doing anything that sets the living apart from the dead. For all two years, she remained in this immobile state.

Her hands contractured while her arms and legs curled up in a fixed position. During the period, her husband, Franklyn, told the doctors to ensure that his wife had her life back. He as- sured the hospital’s medical director and his team that he would regularly replenish her medical supplies, which included special food and large-sized diapers to hold faeces, urine and menstrual flow over which she had no control. The advance payment of N180, 000 for nursing care agreed at N6, 000 a day convinced the hospital staff that her husband was capable of taking on the burden of medical costs. A year later, that burden amounted to approximately N2.2 million as Franklyn disappeared, never to be seen or heard from.

By that time, the visits by other family members had reduced from what used to be a monthly affair to almost never. However, a source close to the hospital that admitted her, who begged not to be named, told Saturday Telegraph that her relatives should not really be blamed. “What good was visiting someone who you cannot hold a conversation with and who was totally unaware that you were even there,” she questioned. Though from observation, according to another source, it appeared Regina could see and hear but could not respond. “Whenever her family visited and approached her bedside, her head tilted slightly, and her eyes would dart back and forth. Her mouth would drop open and then she would start grunting, spewing mucous from the tube that was permanently inserted in her throat. “From all indications, it seemed she was trying to say something.

Perhaps, she was tired of living a life that was marked only by breathing,” the source added. Could she have wanted to die? No one ever got an answer to that. But many hospital-bound patients, faced with physical handicaps, unending pains and condemned to living their lives totally dependent on respirators and other medical machinery, have, over time, asked their doctors to help them die. Yet, Regina, whose consciousness was greatly impaired, could not talk. Franklyn, her husband, was her voice for those horrible years. He was the one that took decisions concerning her care. And, perhaps, Regina’s husband, either desiring it himself or sensing his wife’s yearning to end her life, may have set out to kill her by abandoning her in the hospital.

But, even if Regina could herself express such a desire to die, the hospital, Olaitan Soyannwo, a consultant and professor of Anaesthesia with special interest in pain relief, hospice and palliative care, would have had nothing to do with it. According to her, “it goes against the ethics of the profession and the law of God.” Nevertheless, such a step was practically inconceivable. There was an approximate N2.2 million unpaid bill and doctors, the world over, have withheld treatment on account of unsettled bills. “There is an understanding that one must pay for the treatment he or she receives,” concedes Soyannwo, “but this was a peculiar case. Refusing treatment would have amounted to condemning her to death,” the professor clarified. Euthanasia, she explained, raises many ethical questions though, which make it difficult to draw a line.

“You also need to ask what the capacity of the person wanting to end his or her life is. If a patient is really sick, and there is no sign of improvement, the family may decide to save cost and ask that the patient be allowed to go,” Soyannwo said. She, however, added that the decision has to be something the patient desires. For instance, “if a patient has to undergo surgery, he or a family member must sign a consent form. Without that document, the doctor cannot perform the surgery. “And if a patient or his family does not refuse, say a respirator or other life-sustaining treatment, the doctors are duty bound to apply it. “So, if a patient has a right to accept or refuse treatment that implies that he has a right to his life. Even so, a patient wanting to die has to be evaluated to determine his or her capacity to make coherent decisions.

“In most cases, this cannot be determined, especially if such patients can’t speak. “So, the right to life has its limits and its loopholes. Though there is legislation against suicide but the constitution does not really set out conditions on mercy killing,” she said. Perhaps, this may be why most women, who just delivered but discovered that their babies have one form of deformity or the order, would approach medical personnel in hospitals to help them “pack” such babies. “Yes, it happens frequently these days. Most mothers would be ashamed of such babies and they would pay anything to get rid of them. In most instances, the nurses are the ones who ‘finish’ such jobs without even the consent of the doctors,” a nurse, who does not want her name in print, said. She added: “Others approach doctors to help end the sufferings of their aged parents so as to save cost.”

This was the case of Madam Eunice, who lived with her last child at Magodo Estate in Lagos. She had asked, according to her son who refused his name in print, to be helped to die. This was in 2021. She had leukemia (cancer of the blood) which had dragged on for about three years. “Because she was aware of the fact that it was a terminal illness, she started complaining after sometime of being tired of ingesting drugs. In many instances, she openly begged us to relieve her of the pains. “When that became an anthem of some sort, I had to summon my siblings; we deliberated on the issue and arrived at a conclusion that it was better to grant her wish. We then approached a doctor friend who helped to do the needful. It was a painful decision but it was also soothing as that not only saved us cost but helped in ending what seemed like a perpetual agony for her,” the man told this paper.

He also acknowledged that many people do it in Nigeria nowadays but would not want to talk about it because they feel it is a taboo and against the law of the land. A consultant and professor of chemical pathologist, Taiwo Adewole, will not support euthanasia, for any reason. He recalled how the debate over mercy killing and the right of people to decide their own mortality raged in the United Kingdom some years back. One British doctor, who frequently administered euthanasia, was in the news. The doctor did not feel remorseful about it because he felt he was helping his patients, even though the British Medical Associations did not, at the time, endorse it. But, Adewole believes that no Nigerian doctor would do what the English doctor did. He thinks one reason why doctors abroad breach the ethics of the profession and kill their patients is that “culturally, they have always been emotional.

Even when a dog doesn’t feel comfortable in its kennel, they feel for it; they feel concerned.” In his opinion, it is not really surprising to see some doctors abroad helping their patients die, out of pity for them. But, “it is bad,” he concludes. Just like Adewole, a Chief Consultant Family Physician and immediate past president of World Medical Association, Dr. Osahon Enabulele, frowns at euthanasia, which he described as a painless death from an incurable disease. He said: “Basically, it is still considered illegal in Nigeria. To that extent, any practitioner found wanting in that direction will be made to face the law. “Apart from that, it negates the professional ethics doctors are sworn to. Even World Medical Associations frowns at it as well. It is evil and should not be condoned in whatever guise. Personally, I would never of- fer any assistance on that because the whole essence of the profession is to assist and not to take life.

“In medicine, you are expected to do good, and not to do any harm. This is why I also do not think the profession should go the way of mercy killing. If patients know that euthanasia is an option, it puts a doubt on the practitioner. “Everything must be done to preserve the sanctity of the profession and not to erode the confidence reposed on it by patients. That is my position on this matter.” However, some of Adewole and Enabulele colleagues in the medical profession may not agree with them. They will argue among other reasons that a time comes when treatment is useless; when such treatment cannot halt the eventuality of death. “What use is it keeping someone who ultimately is going to die from a terminal disease?” a doctor, who declined to be mentioned, asked.

In her reaction, president, Women Arise and Campaign for Democracy, Dr. Joe Okei-Odumakin, believes the issue of assisted suicide in the Nigerian context is not that straightforward. She asked: “Are our country’s hospitals sufficiently equipped to keep people alive?” According to her, one can only talk of keeping people alive where there are sufficient medical resources. “If someone is in agony, say of cancer, ours is a society where nothing positive can be done for such a person anyway,” she argued. Euthanasia may amount to loving enough to let go. When it happens between man and wife who have vowed to be there for each other “for better or for worse, in sickness and in health,” it puts it in another light. A Chinese, Liu Shabo, years back reportedly killed his wife by giving her food containing pesticide. So much in love, the couple had been together for 30 years and he could not bear to see his wife, who had incurable liver cancer in terrible pain. She too had reportedly asked that he help her end her suffering.

Yet, he still went to jail, as Chinese law holds that helping someone to commit suicide is murder. “The man had received punishment meted out by man. He should get that of God’s.” For, according to Monsignor Gabriel Osu, former Director of Social Communications, Catholic Archdiocese of Lagos, life is so sacred to God’s creation and no one is entitled to take what he does not create. “Anyone who takes life, which does not belong to him,” as in euthanasia or mercy killing, “has not allowed God’s natural plan to run its course and will face punishment,” he stated. Osu added that there is an end to everything, even suffering, according to the will of God. “When you terminate that which you do not create, you have done your own will instead of God’s,” he said. The Reverend’s position corroborates religious stance on the right to die. The official Roman Catholic Church is against euthanasia and says it is a crime.

Protestants toe this line while Hindus think that, even though helping a person end a painful life may be good, it interferes with the cycle of death and rebirth. In Islam, all forms of euthanasia are forbidden as well. For Rev. Josephine Edeme of God’s Word Ministry, Sapele, Delta State, the Bible is the standard of living a righteous life. “So, it prescribed that no man shall kill. Therefore, assisting someone to die is unacceptable to Him. And if He is the standard, it means then that such an act is also not acceptable to man and should not be encouraged in any form. “Those that are involved in this will surely receive their punishment both from man via the constitution and from God on the last day,” she said. Yusuf Ali, Senior Advocate of Nigeria (SAN) told our reporter that in Nigeria, it is a criminal offence, only when it fails. “Right to die has no place under the Nigerian law.

But, from a personal perspective, I do not support it because no one has the right to take what does not belong to him. “If anybody applies or seeks euthanasia, it simply means taking what belongs to God. That will not only offend man but God’s sensibilities as well,” he said. Like other terms borrowed from history, euthanasia has had different meanings depending on usage. The first apparent usage of the word belongs to the historian Suetonius, who described how Emperor Augustus, “dying quickly and without suffering in the arms of his wife, Livia, experienced the ‘euthanasia’ he had wished for.” The word, however, was first used in a medical context by Francis Bacon in the 17th century, to refer to an easy, painless, happy death, during which it was a “physician’s responsibility to alleviate the ‘physical sufferings’ of the body.” In current usage, euthanasia has also been described as the “painless inducement of a quick death”.

One country that many sees nothing wrong in “assisted suicide for the dying” is Australia, which believes that people should take life and death into their own hands. “Life is about choice, death should be about choice also,” said Jeff Kennett, one-time Australian Victoria State Premier. In some other countries, there is a divisive public controversy over the moral, ethical, and legal issues of euthanasia. Those who are against it usually argue for the sanctity of life, while proponents of its rights emphasised alleviating suffering, and preserving bodily integrity, self-determination, and personal autonomy. Jurisdictions where euthanasia or assisted suicide is legal include the Netherlands, Colombia, Switzerland, Japan, Germany, Belgium, Luxembourg, Estonia, Albania, the US states of Washington, Oregon, Montana, Vermont and, recently, the Canadian Province of Quebec.

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