The Ottawa Citizen from Ottawa, Ontario, Canada • 2

NEWS SUNDAY, NOVEMBER 23, 1997 A2 THE OTTAWA CITIZEN Ottatcv ercys 'One of the jobs of a doctor' 7 VANDESHILDE KEIZER Continued from page Ai Over the course of his career, Dr. Smook has helped nearly 40 patients. (In Dutch medical circles, the verb "to help" is commonly understood to mean euthanasia.) The great majority of Dr. Smook's cases have been instances in which the patient is enduring the final, agonizing stages of some horrible cancer, usually of the throat or bones, and has only days to live anyway. The patients have had a long, trusting relationship with Dr.

Smook; they have made repeated requests for death; they have involved their families in the decision to die. "But then," sighs Dr. Smook, 59, "there are always a few cases that are a little more complicated." A friendly man with a gentle voice, Dr. Smook was confronted with such a case one night seven years ago. He was on call in the emergency department.

A 93-year-old woman was admitted with a broken hip. Other than her injury, she was in good health and possessed all her mental faculties. The woman also knew she might never walk again and, fearing the loss of independence, asked Dr. Smook, her surgeon that night, to kill her. "I was not her regular doctor, and felt she should discuss this matter with him," recalled Dr.

Smook. "I also told her that she was in pain at that moment and might not be speaking with a (clear) head. I said, 'Wait until you get home and have time to heal, then we'll But the hip did not heal properly and after her release she consulted with her general practitioner, who agreed to perform euthanasia his first. On the appointed day, however, as he was setting up the intravenous drip, the doctor suddenly burst into tears, incapacitated. Dr.

Smook happened to be present and it fell upon him to finish the job. Afterwards, he and the other doctor were so shaken by the latter's unexpected breakdown that they shared a bottle of liquor. As required by law, Dr. Smook duly reported the euthanasia to government authorities. Although the coroner found nothing amiss, a committee of bureaucrats that reviews all assisted deaths decided the case warranted a murder charge against Dr.

Smook not so much because the woman's death seemed sloppily planned, but because a broken hip did not constitute unbearable suffering. Dr. Smook made three court appearances before the case against him was dropped and another precedent set. Fifteen years ago, Pieter Kousemak-er was struck with a liver disease that nearly killed him. An ordained minister with a doctorate in theology, Mri Kousemaker had always been interested in the great metaphysical questions, but his illness compelled him to think about death with more intensity than ever before.

Now 50, he works as pastoral counselor at the Antoni van Leeuwenhoek hospital, the largest cancer institute in The Netherlands, where 10 to 15 patients are granted euthanasia every year. "The Bible does not expressly condemn euthanasia or the taking of one's own life," observed Mr. Kousemaker in a conversation at his home. He chewed a piece of sweet almond cake 1 -Mil KOUSEMAKER to cause hallucinations. It was a few days before Christmas when he grabbed me as I stood over his bed and started crying.

He had fought enough, he said, and he was ready to die." Mr. van de Shilde, a 44-year-old financial consultant living near The Hague, begins to weep as he recounts what happened next. The specialist who had promised months earlier to perform euthanasia was out of town. It took two days, while the emaciated patient lay in bed fighting off delirium, for the hospital to track him down. "When the specialist finally entered the room, he suddenly wanted to begin the discussion fresh, as though he wasn't convinced my father was serious.

My father starts screaming, 'Doctor, please, don't let me and I threatened to get the director of the hospital when the doctor finally agreed." The euthanasia was scheduled for 10 am the next day. According to Mr. van de Shilde, the doctor arrived three hours early and refused to see any other patients before the appointment with Mr. van de Shilde's father. As the hour approached, all hospital staff on that floor were advised of the situation and told they could leave their posts temporarily if euthanasia made them uncomfortable.

The family chose to wait outside the room as the doctor gave Mr. van de Shilde the injection. A minute later, the doctor emerged, expressed his condolences, and said he needed to take a walk. When Mr. van de Shilde entered the room, he found his father dead, although the corpse's eyes were wide open.

"I later learned that that hospital's lung cancer department has only about six cases (of euthanasia) a year and that the doctor did not have a lot of experience with it. At the time I was angry that my father almost had to beg for death, but I've since done a lot of thinking about how I would feel were I in the doctor's place. I also found out that, in his last moment, my father wished the doctor strength and that he should be at peace with himself." Mr. van de" Shilde has taken measures to ensure he will never suffer the way his father did during those final two days, when the family could not find the dying man's personal doctor. In the event of incapacitating illness or accident, any physician will be able to end Mr.

van de Shilde's life, for Mr. van de Shilde carries with him, wherever he goes, a signed document prepared by the Dutch Voluntary Euthanasia Society. The document states: "If I cannot die in a mild way as a result of the omission of medical treatment, I hereby urgently request the doctor treating me to fulfil my death wish by administering to me the means for a mild death." fpi Citizen ray HOW TO REACH US The Ottawa Citizen, 1101 Baxter Rd. Box 5020, Ottawa, Ont.K2C 3M4 Main Citizen number 829-9100 Newsroom: 596-3664 Newsroom fax: 726-1198 Want ads: 829-9321 Home delivery: 596-1950 Library: 596-3742 SUBSCRIPTION AND DELIVERY Reader Sales and Service: 596-1950 Weekdays: 6 a.m. to 5 p.m Weekends: 7 a.m.

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To make use of any of this material, you must first obtain the permission of the owner of the copyright. For further information, please contact Pat Hyndman, 596-3787. Happy Birthday! It's Twins! Happy Anniversary! -P Congratulations! To The Graduate! and looked thoughtfully at the rows of books lining his dining room wall. "Of course, some people argue that suicide is not expressly mentioned in the Bible because it is so obviously forbidden, but I've never accepted that, because for everything else that is forbidden, it is said so expressly." Mr. Kousemaker and like-minded colleagues in the Dutch clergy face a significant challenge because, as they recognize, suicide has never been accepted in the Judeo-Christian tradition.

Most famous to students of religion is the talmudic story of Rabbi Hanina ben Teradion, whom the Romans wrapped in straw and set on fire. Apparently, the Romans put water-soaked tufts of wool around the rabbi's heart so that he would die slowly. As the rabbi burned, his disciples begged him to open his mouth "so that fire may enter into thee" and death would come more quickly. But the rabbi refused to hasten his end in any way, telling his pupils: "Let Him who gave me my soul take it away." "It is true that in the western religions euthanasia has met some resistance," said Mr. Kousemaker.

"But here in the Netherlands, there has evolved a religious argument that the rule of love comes higher than the commandment not to take a life. If someone is suffering, it does riot violate God's law to help them." Some Dutch theologians even argue that Jesus himself actively pursued his own death and thus provided an early example of "self-termination." Besides, Mr. Kousemaker added, in his experience the overwhelming majority of dying patients who have discussed euthanasia with their doctor never actually, in their final days, require the procedure. "Ninety-five per cent of the time, patients simply want a promise from the doctor that he will help them if they need it. That promise gives them peace of mind, the knowledge that they won't have to suffer.

In that knowledge they find the strength to bear their pain and (euthanasia) is never necessary." 1 Dutch patients tend to discuss euthanasia early on in their illnesses because, as is common knowledge here, the courts have ruled that the procedure is permitted only if a patient makes "durable and persistent" requests. Thus, on a July afternoon two years ago, after he was shown x-rays of his cancer-filled lungsj Peter van de Shilde asked his doctor, Will you help me if I am suffering?" "My father was a big man, about 95 kilos (210 lbs)," recalled Paul van de Shilde. "Within a few months, he was down to barely 60 kilos (132 lbs). Every day he became weaker. By December, it was very bad.

He was still alert mentally, but the morphine was beginning sold out. But those were landscapes and portraits of people. When he underwent a dramatic religious conversion and began to paint Byzantine icons and scenes from the Christian Gospels instead, galleries refused to give him a showing. In 1978, he submitted a novel to a first-novel competition, and was one of seven finalists. Normally, his novel would have been published with those of the other finalists, but it was rejected because of its Christian theme.

He submitted it to other publishers, but was told time after time, "It is very well written, but the reading public is no longer interested in this world view." The only publisher willing to give him a break was Ignatius Press, a small and conserative Catholic publishing house in San Francisco, which doesn't normally publish fiction. But it had published a book of some of his art works, and took a chance on publishing Father Elijah last year. The novel has since sold 18,000 copies in hardback, with virtually no advertis Although Dutch doctors are required to file a report whenever they perform euthanasia, some don't. These typically are doctors who are involved in the estimated 1,000 or so deaths every year in the Netherlands where a patient is killed without having given explicit consent Since 1995, at least two cases of nonconsensual euthanasia have come before the courts, both involving newborns with serious birth defects. In each case, the doctors, acting on parents' orders, gave lethal injections to the children.

In both cases the courts ruled that the doctors acted properly. Most non-consensual euthanasia, however, is performed on adults. Tve done it myself a few times where there has been no request," admitted Dr. Pieter Admiraal over coffee recently. "You have a patient who has cancer and he slips into a coma.

So you give him morphine and hope he will die normally. But with some of these cancer patients, their bodies have become so used to morphine that the drug doesn't work anymore. Well, that means that he has to die from the lung cancer; you can hear him all through the hospital corridors gasping as he tries to get oxygen into his lungs. Then the family comes to me and says, 'Please, we are a civilized society. Does our loved one have to suffer like And so I have ended the Over the course of a 30-year career as an anesthetist, the recently retired Dr.

Admiraal estimates that he performed at least 100 euthanasias. It was early on his training at a Catholic hos? pital that he realized a small percentage of cancer patients perhaps 10 per cent experience pain that can; not be controlled with medication. "A healthy person cannot under; stand this kind of pain," he explained! "The suffering is completely senseless. These are people who have acr cepted completely that they will die, They don't even cry anymore. Some; thing inside tells them that it is over." Consequently, Dr.

Admiraal was helping patients long before the Dutch courts began, in 1981, to elucidate conr ditions under which euthanasia is permissible: "In those early days at my hospital, we worked as a team of two doctors, one nurse and a priest." The doctor shook his head incredulously when told about Nancy Morrison, the Halifax doctor charged with first-degree murder after the death of a patient this year. (The charge has since been reduced to manslaughter.) While the case has not come to trial, speculation is that the patient, dying from throat cancer, was euthanized. The public arrest of Dr. Morrison and seizure of hospital files greatly disturbed Dr. Admiraal.

He reached across the table, grabbed his interviewer by the throat, and squeezed, "You see? This is what throat cancer is like. The air is cut off and you suffocate." He let go. "The surgeon can do a tracheotomy (cut a hole in the throat)' but the tumour grows and soon blocks the airway again. Throat cancer is the most awful thing." He shook his head again. "I would congratulate this Dr.

Morrison on her wisdom. Helping a patient to die is one of the jobs of a doctor." Leonard Stern writesor the Citizen. there really is a God. He is alive and well and here." Mr. O'Brien was born in Ottawa, and graduated from St.

Patrick's College high school. But he and his family moved to Coppermine, a small village in the Northwest Territories when he was 12, and lived there until he was At 14, he flew to a residential school in Inuvik in the Western Arctic, where for 10 months he was the only European in a dormitory with 60 aboriginals. The man who ran the dormitory was later jailed for sexually abusing many of the boys in the dormitory. When Mr. O'Brien refused to go to the supervisor's room in the middle of the night, he says he and everyone who attempted to help him were subjected to months of strappings, mock; ery and other abuse.

Now Mr. O'Brien has forgiven the supervisor. He says he's even grateful for the experience. "It gave me a glimpse into the human heart, into the unspeakable selfishness and degrada; tionofMr.H." LOTTERIES 6-49: 10, 15, 25, 31, 33 and 35. Bonus: 8.

Encore: 9 8 29 2 6. Ontario 49: 21,22,28,36, 48 and 49. Bonus: 4. Bonus: 27. Early bird: 12, 20, 21 and 28.

it Keno: 2, 9, 12, 13, 21, 23, 26, 32, 35, 36, 40, 45, 46, 50, 53, 56, 57, 60, 61, 66. Super 7: 6, 7, 20, 22, 29, 34 and 38. Bonus: 14. Encore: 615146. Stuck with a spare tire around the middle? Novel: Author's message is, 'There really is a God' ing, and few reviews.

"It's a best-seller in the Catholic world," said Tony Ryan, of Ignatius Press. The only mainstream publication to review it was Books in Canada. Critic Michael Coren described Father Elijah as "a well-crafted and biting "radically different and so uncluttered, performed in timeless melodies and by an intensely talented musician." By comparison, a major Canadian best-seller such as Alias Grace, by Margaret Atwood, gets many reviews, and enormous exposure and will sell about 30,000 hard-cover copies in Canada. This year Ignatius published Mr. O'Brien's second novel, Strangers and Sojourners, the tale of an English immigrant's adjustment to life in theinte-rior of British Columbia.

That has since sold 7,000 copies in hard-cover. Ignatius Press will publish two more of his novels in 1998, and another two in the year 2000. A sly twist of humour sneaks into Mr. O'Brien's voice as he says the message of all his books is, "Well, readers, Continued from page Ai Writing is Mr. O'Brien's second career.

He is also a self-taught artist and has made a living for more than 20 years primarily by painting murals and other works of art for Catholic churches and monasteries in both Canada and the U.S. Mr. O'Brien, his wife Sheila and their six children live in a rented rectory in Brudenell, about 150 kilometres west of Ottawa. The O'Briens home-school their children, have no television set, pray together every day, and accept their subsistence-level lifestyle as the price of their religious calling. "From the beginning, my wife and I agreed it would be a life of of sacrifice and poverty," said Mr.

O'Brien. "We felt very strongly that this is what the Lord wanted for our family in order to assist in a restoration of Christian art." For years he has struggled for recognition as both a writer and artist. His first art show was accepted by a major gallery in Vancouver, and all his works LONDON TIMES SOLUTION Puzzle is on page B7 CROSSWORD SOLUTION Puzzle is on page B7 UP pHn jJK iIeJs JhIe RMh I 141 JN JfjC sQr IllE 1 rTeJc tjo Ja iJoM jIsIe Ef ZSL TtgJa 1 I rfojNjG sThJo eMaInt: FDli-lJltL JtPGncME isl 1 NpQpRlcHll jD i It pHNkNu jljML slPEilDYl I LI A In! Isl IeTr li.A tt 8 tfL LElt.l. Al OUTERJEP I ClJS I DlJO TTiR wrTnklesshoul bps tress Oet a TrfflTTToffii a 7fl I A "flw 0 JL ILti jD-Ci A 1 1 7 0 A fj5 Ml 6 OR A JO Ai All 1 SjD 0 Nllb j. A 0 je a rTTT JJTc a 8 TaT dHh osi "fM I MJN AjT Tl 0 1 eD 1 a srziA PCZiA MART I nQT TF A TlC ARTE 0 LjF A EjC A jj jjA DIAL LEDjQEO0E jjA SQl 0 0 JJa I kHm HY r-H Irr h'r' 0 Trr-y a roh IOl i .11.21 A Alii lijr HI.

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