Book – The Power of Choice

Author: Julian Kingma with Steve Offner
Publisher: New South Books
Reviewer: Brian Morgan

This is a book which explores VAD or voluntary assisted dying as told through the eyes of a number of terminally ill people who chose this means of ending their lives.    

Upon turning over the front cover, I was presented with an article by Andrew Denton, a person whom I have never met but for whom I have had a high regard since his days conducting interesting and intelligent interviews on ABC television. Later, he has, I believe, become a euthanasia advocate which, perhaps, explains why he has made this contribution.

He wrote a 6 page article, headed “To Life”.

His article was followed by one headed, “Where is the song?” written by the Tasmanian author, Richard Flanagan, which includes a story involving VAD and his own brother in his role as a Country GP assisting the terminally ill.

Those articles open the door for ten thoughtful stories, accompanied by appropriate photographs, all concerning the struggles and thoughts of VAD candidates, their families and those involved in the medical profession with the VAD process.

The titles of these stories are:    “A good death”; “The power of choice”; “Suffering”; “Clearing the hurdles”; “The carers”; “It can ask a lot”; “The guiding lights”; “How do you say goodbye?”; “The final word”; and “The last intimate thing”.

The book concludes with a short explanation of the VAD process which varies somewhat between the States; a timeline of the introduction of VAD laws in each State; a discussion of how they work; and a glossary of terms used and whom to contact.

I say this, in relation to all contributors, that  each of them , in their own way, shines a specific light on the decisions made by their loved one, reveals  the support offered to and by the person dying and gives us unique opportunities of seeing, almost at first hand,  how VAD can bring comfort and peace in the face of imminent death of a terminally ill person terminally.

I know, at first hand, having spent much time with a friend who was terminally ill with pancreatic cancer and had no family in Australia, that they seem to give us courage, whilst we are trying to be supportive of them in their final days.

The Power of Choice displays their stories in words and in dignified and beautiful photographs.

One photograph, in particular, is worth mentioning as it demonstrated to me a patient doctor relationship somewhat different to the norm and the accompanying article explains why this is so.

Here we have a doctor removing her shoes and sitting on a lounge, next to her patient as they discuss the VAD process.

 “Finding a connection is important” (Dr. Bu O’Brien agrees): “It is such an intimate thing when you are doing assessments and potentially administering the VAD medications”. (text page 91).

The photo accompanying this story shows the doctor and her patient sitting next to each other with the doctor’s arm around her patient’s shoulder.

Through The Power of Choice ,  we can recognise why this process is not every doctor’s cup of tea and how much it must take out of them, psychologically, but, also, how many of them are comfortable with their involvement in a process of choice, that is, the choice of the patient whether or not to die at a time and in a manner of their choosing.

I had subconsciously wondered whether everyone who was accepted for VAD went through with the whole process.  Some of the stories demonstrate that many people obtained the chemicals with which to end their lives but did not use them immediately, or, I infer, at all, as having the means of doing so, in some cases, gives them the comfort to  delay taking the final step. There are many references to the relief felt by some terminally ill people through knowing that they can use the chemicals, if and when they want to, once they are at hand.

There are some references to palliative care which, until VAD, was the process of permitting people to die with some degree of dignity and which remains the process of choice for many. Perhaps, some of us have been told to say goodbye to a dying friend in palliative care as he or she will not be with us in the morning to find that the person has, indeed, died overnight.

This is a wonderfully illuminating picture and word exposure of voluntary assisted dying, the process; why some people with terminal illnesses choose to use it; the involvement of family and loved ones in supporting the decision; and the extent to which close friends, spouses, etc, come to accept the decision to take the opportunity to die with one’s loved ones by their side.

This is a most thoughtful and appropriately named book.