This article appears in the Feb 2006 edition of the Catholic Medical Quarterly

The "Allowed to Die" Game

In my earlier article on what I had called the "best interests" game, I suggested that such labelling could be a deceptive ploy as well as a euphemism for certain types of euthanasia. The game could be played by both medical and legal professionals, sometimes in unison. I now suggest that a related situation is the "allowed to die" game.

Like "best interests", "allowed to die" can be considered as a psychological game because of its double meaning. `Both games are often played in response to the growing number of people who are brain-damaged in some way but who can nowadays be kept alive almost indefinitely by modern nursing skills, medical technologies and medication treatments.

Double messages

The "allowed to die" game is easily recognisable in journal articles as well as in everyday conversation. Some radio and television programmes are devoted entirely to its presentation for public approval. Like the "best interests" game it often involves the same familiar sequences of words such as "dying with dignity", "futile care"and "managed death".

"Allowed to die" has an easily recognisable double meaning. On the one hand, it suggests a paternalistic form of permission-giving, like a father allowing his children to stay up late. On the other hand, within the euthanasia scenario, it implies an expectation, perhaps even a duty, for someone to meet up with their death, preferably as soon as possible.

Game analysis

Psychological games also involve a certain amount of discounting or ignoring of some aspect of the situation, in such a person as a vulnerable patient, although sometimes it will be the problem identified, the context of that problem or the solution to that problem. Games also include a sudden switch in behaviour that can be unexpected and even absurd.

It is helpful if a game or other form of trickery, once it has been identified, can be given what Schopenhauer has described as "a short and obviously appropriate name so that when a man used this or that particular trick, he could at once be reproved for it". With many such games we are already familiar. They simply require a quick and easy form of identification.

The Tony Bland Case

The case of Tony Bland, the brain-damaged patient whose nutrition was legally ended in 1993 with the result that he died, provides examples of the various themes associated with being "allowed to die". Some people, including it seems, members of his own family, regarded the tragedy as a form of "mercy killing". Othersconsidered it blatant murder.

What gives the game away is that when his feeding was stopped, the judge reportedly commented "may his soul rest in peace", a phrase disturbingly similar to "may God have mercy on your soul". The latter is what judges customarily used to say when sentencing someone to death. The chilling similarity between the two phrases cannot be coincidental.

Left to die

In my home city of Portsmouth, a city that is no stranger to threats of euthanasia (c.f. DavidGlass, Charlotte Wyatt etc.), a cancer patient discovered that her hospital physician had ordered that she be "left to die" if she suffered a stroke or a heart attack. The decision had been made without any reference whatsoever to her own or her husband's wishes.

Furthermore, she had never even met the doctor who had composed this death warrant. When interviewed some months later, she commented that there were "a few good years left in me yet!" The reporter added that this was just one of a growing number of "often horrendous" episodes of maltreatment of elderly people that had recently been uncovered.

Nurses and the unborn

Caring for brain-dead pregnant women provides a new critical care challenge for the nursing profession. Rather than the usual life and death scenarios involving catastrophic events, critical care nurses have the added burden of caring for "a life in suspension" to maintain the viability of the foetus.

Nurses struggle with keeping the brain-dead mother alive, yet know that as soon as the infant is delivered, the mother will be "allowed to die". Studies of nursing articles on the subject have revealed how members of the nursing profession are therefore expected to develop "coping strategies" to deal with such difficult situations.

Permissions in general

Some permissions have strings attached. When we are permitted by another person, organisation or government to do something, we may find that there are hidden expectations of our own responses. We may have a duty to behave in a certain way. We may even be expected to be grateful for the permission given.

Thus the recently-introduced 24 hour drinking carries with it the belief system that people want to drink all day, that such drinking is socially acceptable, even desirable, and that we should all be thankful for such new and as yet unexplored freedoms. However, it will be seen that such permissions for individuals do not exist in isolation but can profoundly affect others.

Catholic Medical Quarterly