source : the age
I have three close friends living with progressive illnesses. Despite my 45-plus-year career as a psychologist, I’m grappling with how best to navigate the likely conversations about voluntary assisted dying (VAD). It’s daunting.
Sam* was diagnosed with Parkinson’s five years ago. After this bombshell, we discussed the options ahead, and I asked whether he’d considered “Plan B”. Sam knows me well enough to comprehend what I was alluding to, such is the shorthand between intimates. But feeling optimistic about treatment breakthroughs, he demurred.
Cut to now, and his condition is deteriorating. Sam understands that, because he is unlikely to die soon, he may be ineligible for VAD in Australia. His alternatives include travelling overseas, perhaps to Switzerland where the criteria are less restrictive. I’m now getting worried, however, that time is running out for him to fully investigate these possibilities and, if he decides to proceed, to finalise all the necessary arrangements.
This time pressure is a common experience. A 2023 Australian study of VAD patients’ loved ones described their sense of “a race” to complete the process before the person died, became too unwell, or lost decision-making capacity.
So, what should I do? I have to recognise my own tendency to plan, organise and initiate action. I’m a bit of a control freak, so I’m strongly inclined to raise it again. But I also have to let Sam arrive at his own conclusion in his own time frame, not mine. This is his journey, after all.
Do I wait until he brings up the topic again and then offer assistance however I can? Or should I tentatively suggest, “Would you like to talk again about the Plan B we discussed, or would you prefer I leave it alone?”
I’m 90 per cent decided on the second option. It’s respectful and sensitive, yet it doesn’t avoid the issue.
Then there’s my dear mate, Jackie.
She has multiple sclerosis, which, even though it won’t kill her any time soon, may eventually land her in a nursing home. Her understandable terror: a stranger wiping her bum.
She’s raised the “Plan B” option with me on numerous occasions recently. Like Sam, she is probably ineligible for VAD in Australia, so she is actively researching similar alternatives. But her intentions seem equivocal. She fluctuates between guarded enthusiasm and avoidance. Patience on my part is paramount.
How should I respond? So far, it’s been by listening, sitting in silence and showing empathy. And critically, by making space for whatever view she’s expressing, even if it’s the opposite of last week’s.
I ask Jackie how her family members are coping with her deliberations. She sighs and rolls her eyes, for not everyone is on board. There are philosophical differences between her children on the morality of assisted suicide, which are rekindling long-suppressed sibling rivalries. These are leaving Jackie understandably hesitant. This is not uncommon, but family therapy is a plausible way to address it.
I mention this to Jackie, and she seems relieved. I caution her that while universal agreement may not be attainable, a trained facilitator could help relatives understand her wishes, express their own reservations and prevent any disagreement from paralysing her. It’s one step forward, one back, one sideways.
Finally, there’s Sue, who has advancing motor neurone disease. She’s adamant that she wants to access VAD in Australia before her symptoms become unbearable. She also feels strongly that, apart from avoiding pain and suffering, she doesn’t want to burden her caregivers or disrupt her loved ones’ lives.
Conundrums abound here. How do you support someone wanting VAD if you question their reasoning? Does supporting Sue validate her view that she’d be a burden?
My own approach is to respect and support Sue’s right to make this decision while clearly communicating to her that she remains wanted, valued, and loved.
I’ve come to the conclusion that raising the option of VAD – or other forms of assisted dying – morphs into pressure when we ignore our loved one’s values, agenda and timeline and, instead, impose our own.
In these delicate conversations, your role as a friend is neither to promote VAD, nor to avoid it. Instead, we should ask whether the person wants to talk, help source accurate information if it’s requested, sit with the inevitable uncertainty and, crucially, recognise when to step back.
This excruciating decision must remain theirs, but they shouldn’t have to contemplate it alone.
*All names and details have been changed.
Peter Quarry is a retired psychologist and writer.
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