The Right To Die

Dr. Linden’s hands shook slightly as she scrubbed them with soap. She counted a full two minutes, then turned off the tap, dried her hands and looked in the mirror above the sink.

A light layer of makeup concealed the red splotches on her pale skin, but her eyes were still puffy. Steel blue, eyes that her interns would describe as intimidating, and were now rimmed with red, only brought down slightly with eye drops. She was a doctor, Dr. Linden reminded herself. It was her job to hold it together for the sake of her patient. Whatever she may be feeling, he would be feeling much worse.

She had administered euthanasia before, and she truly believed in it. She believed in a patient’s right to end their life should they so wish. But Canadian laws had become progressively looser, allowing not only terminally ill patients and elderly patients to end their lives, but patients with chronic pain, with mental illness, patients younger than herself. Dr. Linden knew that she was on the right side of history; euthanasia laws were just another way Canada was ahead of other countries. But any doctor would feel conflicted.

Dr. Linden walked to the end of the hallway where she took a moment to gather herself outside Sebastian’s room. Unlike most of her patients receiving end-of-life care, he was in good physical health. Early forties, strong build, handsome. A father to a young child, no less. No comparison to the other patients whom she had helped ease into permanent sleep. There was a reason it was Dr. Linden who had to take this patient; no other doctor would agree to it.

Primum non nocere. First, do no harm. Since her first day in medical school, the principles of bioethics had been drilled into her. Autonomy, beneficence, non-maleficence, justice. She knew sometimes one or more of these principles may conflict with another, but what if that conflict sliced deep through her very being? What if either choice had an unthinkable outcome, leaving her mentally frozen like a deer in the headlights? Then you do your job, and respect your patient’s decision, she told herself.

“Good morning, Sebastian.” Dr. Linden walked into the room, forcing her voice to remain steady. “Doctor,” he greeted her, his eyes taking in her scrubs, white coat, and braided hair. “How are you feeling?” she asked him. Sebastian met her gaze. “Ready as ever.” She could see that he was not afraid. His deep brown eyes, that had been troubled over the past months, were now at peace, and she hoped hers at least gave the same illusion.

Dr. Linden took a stack of papers out of her bag. “I know we have been through this many times, but it is important that you understand you can change your mind at any point. It will not affect future health care, and you will not be charged for a cancellation. If you have any doubts, you are free to change your mind or even put off this decision.” She had gone through the spiel so many times that at this point it was like reading off a script. “I understand,” he replied, his eyes skimming the consent form. She got out a pen and paused before offering it to him. “Do you have any questions?”

He shook his head, took the pen, and signed. Dr. Linden took the form and gestured to the next one. “You have consented to all your organs being donated. Should you wish to change your mind, your confidentiality will be protected. The organ recipients and their physicians will not know your identity.” Dr. Linden understood the dire circumstances of waiting for a transplant. It could be years before another genetic match was found, and the young boy scheduled to receive Sebastian’s heart would certainly die before then, but she had to say her piece. Sebastian shook his head vehemently. “I won’t change my mind.” He signed.

His decision. You’re not killing him; he’s ending his own life. You’re just helping him. Dr. Linden continued. “This next form says that I have explained all alternative forms of treatment, and you fully understand your other options. You have undergone the mandatory period of counselling, and you understand that medication and other psychiatric interventions have the potential to improve your quality of life.” Her voice shook slightly. “And you have been counselled on options for your family too.” Sebastian signed the form. “I understand.”

He looked up as she was trying to steady herself. “Freya,” he said gently. She stiffened, hearing him say her name, and forced herself to look him in the eye. “I know this is hard for you,” he continued. “You’re trying to hide it, but the fact that you care doesn’t make you any less of a doctor.” She shook her head. “This is my job, and I would want the same for myself.” But they both knew no doctor would do for her what she was about to do for him. It had to be her.

Sebastian placed a hand over her shaking, gloved hand as she unwrapped a cannula. “Just breathe for a moment. I’m not in a hurry.” Dr. Linden took a deep breath and slowly exhaled. “I’m sorry,” she said. “Don’t be,” he told her. “Freya, this is what I want. I understand my options, and I accept the consequences. You’re a good doctor, and you’re doing the right thing.” She nodded silently.

Dr. Linden tied the tourniquet around Sebastian’s arm and felt for a vein. His skin was warm, and she could feel his pulse beating against her gloved fingertips. She loosened the tourniquet, uncapped the bottle of sodium thiopental and carefully measured the dose into her syringe. “Before I proceed, is there anything else that I can do for you?” Sebastian’s eyes shimmered and he smiled through his tears. “Tell my son I love him,” he said.

Dr. Linden felt like she had been stabbed through the heart. She was a mother herself, of course she understood that there was nothing harder than leaving your child forever. Don’t cry, she ordered herself. This is the hardest thing a man can possibly do; it is your job to not make it any harder. Right now, you are a doctor. Not a woman, not a mother, but a doctor. She forced herself to breathe steadily. “I will tell him. I promise.”

She inserted the needle into his vein and pressed the plunger. It was done. She wanted to scream, and cry, and run from the room, but she sat down beside Sebastian and when he reached for her hand, she let him take it. His grip was strong at first and in seconds, it was limp in her hand and his eyes had grown still and glazed over. Dr. Linden turned her gaze to the monitor and watched him flatline. She recorded time of death on her paper and swiftly got up to notify the surgical team.

As the nurses wheeled Sebastian’s stretcher towards the OR, Dr. Linden shut herself in her office and locked the door. She tore off her white coat and used it to muffle a sob as she collapsed on the floor. What have I done. I took the life of a healthy young man. I’m not a healer, I’m a murderer. A wave of nausea flooded her, and she crawled to the bin under her desk and vomited. She then lay back on the floor and curled up in fetal position.

*~*~*

Hours had passed before Dr. Linden managed to haul herself off the floor and to her desk. She turned on her computer and printed out the papers from Sebastian’s file. Psychiatric evaluations, reports from the emergency department of overdoses and self-inflicted injury, all of them vivid.

And none of them truthful.

He needed to have a history of debilitating mental or physical pain to be considered for euthanasia, so Dr. Linden had forged medical records dating years back, with Sebastian’s help. She had stolen documents from other hospitals and signed off in the name of now-retired doctors, painting a picture of a man who was tormented by treatment-resistant depression and chronic pain from trigeminal autonomic cephalalgia, a man for whom death at her hands would be a mercy.

It was a stark contrast from the strong, healthy man whose dying hand she had held hours before, his muscular hand firm in hers, his eyes resolute and warm at the same time. You are the strongest woman I know, Freya, Sebastian had told her only weeks ago. Very few doctors would be able to do what you are prepared to do for your family.

A knock sounded at the door and Dr. Linden smoothed her disheveled hair and wiped her blurry eyes before opening. “Apologies for interrupting you, Doctor,” the intern said timidly. “I just wanted to let you know your son is out of surgery.”

Dr. Linden headed straight for the recovery room where she saw a nurse sitting beside her son’s hospital bed, his small body lying still. She ran over and the nurse rose to meet her.

“Everything is alright,” the nurse told her, placing a hand reassuringly on her shoulder. “The heart transplant went smoothly, and he should wake up in a few hours.” Dr. Linden let out a shaking breath, tracing the boy’s face with her fingertips. “Thank God. You’re going to be okay, baby. Mommy loves you so much.”

She touched her lips to the boy’s forehead. “Daddy loves you too. I promised him I would tell you.”