Euthanasia in the Oltrarno

Euthanasia in the Oltrarno

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Tue 27 Feb 2024 4:18 PM

When Hermione, a lifelong friend, invited me to lunch, the conversation turned, as it often does these days, to euthanasia. A much-loved member of her family was ill, had not improved on any treatment and was now dying. Hermione had done her best and eventually turned down an expensive stay in hospital for more intensive treatment on the grounds that it would only lead to more distress. The time had come, she said, to recognize the inevitable and stop pretending. I saw the patient and it was heartbreakingly clear that he was living with increasing pain and disability that would only deteriorate until he was released into a welcome death. Life was drawing to a close and had become an intolerable burden. Then, stupidly, on impulse, I offered to help.

The problem, I quickly realized, is not whether to kill, but how to do it. I am in favour of euthanasia when the time is right, but I had not thought through the practicalities. Of course, you can buy a butcher’s cleaver, a rope for garrotting or a pillow for suffocation. You can find a cliff or a high building, and let gravity do it for you. Violent death is easy and available, but a kind and gentle death is hard. History books and films give you plenty of poisonings, but are very short on detail. The final moments, when described, can be gruesome, with events you naturally want to avoid. Reports of nerve agents or plutonium for eliminating spies are not useful at all. Where on earth would you get such things? The local pharmacy would refuse and probably call the police long before you could get started. Anyway, we discussed the idea of bringing this treasured life to its conclusion. Hermione and I have been friends for most of our lives and, as a doctor, I have had some experience of death, so I agreed to do my best. Almost at once I began to have second thoughts. I was more than a little nervous about the details, never having actually done the deed before. 

My euthanasia anxiety got worse and began to interfere with sleep. I had to make sure that his death was painless and in no way upsetting for the family. Violence, however quick and efficient, was out of the question. He should die in his sleep with no fear, no trauma, no mess. In order to avoid any misunderstanding, it may be important at this stage to tell you more about the patient. His name was Micio. He was 10 years old and had been the senior family cat for most of his life. Previously affectionate, active and beautiful, he had wasted away and now could only crawl. He could no longer jump up on the sofa and was refusing all food, apart from a reluctant saucer of milk. 

Google was no help whatsoever.

There is more than one way to skin a cat. I never asked about skinning, but I guess Google was trying to be helpful, telling me that the phrase was first used in 1854.

There is more than one way to kill a cat than choking it with cream. Choking was never on the agenda anyway. 

A cat has nine lives. Discouraging for euthanasia until I learned the old English proverb was really about its three stages of a cat’s life: playing, straying, staying. (Similar to mine.)

10 household items than can kill your cat. At last, some practical advice? Sadly not. Chicken bones and dental floss are unreliable, bleach painful, mistletoe and cannabis hard to come by and impossible to administer, alcohol impractical due to dosing. How much to give and anyway I could never persuade Micio to progress from a few teaspoons of milk to a large slug of gin.

No, it would have to be a sedative, a barbiturate as used on death row. This might be straightforward in a human, but a cat that is only skin, bone and copious fur? I shivered at the idea of Hermione watching me as I tried to give an intravenous injection. First find a vein, then with the cat wriggling, hissing and scratching, keep missing the target until Hermione tells me to stop. The cat will have to swallow the medicine. Again, easy enough with humans who obey or reluctant children when you put the sugar-coated pill on the back of their tongue or flavour the liquid with syrup. I could not see myself putting a human-sized pill on the cat’s tongue and was sure that Micio would refuse barbiturate-flavoured milk, with or without syrup. 

Then there was the question of dosing. I looked up the lethal amount. Medical literature describes this as LD50, meaning the lethal dose in 50 per cent of people receiving it. Two problems: how do you scale this down from humans to cats and what is the dose for 100 per cent? When killing cats, you want to get it right every time: 50% dead, 50% alive will not do. It’s not good enough to put the cat to sleep, only to be called hours later to be told that he is waking up and could I come back and do the job properly. I decided on a very generous dose. The LD50 for humans should be enough, though this would mean persuading the cat to lap up a lot of spiked milk. I would cross that bridge when I came to it.

I wrote a prescription on my English doctor-headed paper and took it to a pharmacy using my name and address rather than Micio’s in order to avoid discussion. I have to write prescriptions in Italy quite often when friends and family have run out of regular medicines, and it never fails. This time was different. The pharmacy said they did not have any barbiturates in stock and that there would be a delay in ordering. This was odd as the drug is routinely used for epilepsy and is an effective sleeping tablet. It is so good that more modern sedatives are considered safer and now preferred. I went to another pharmacy. Here the story was the same, except that they said that ordering it would be very slow due to lack of demand. I tried a third. No more luck, but this time the senior pharmacist came out from the back of the shop to tell me that he would not honour a foreign prescription. He would, he kindly said, check up on this and would be happy to see me the following day, but he did not expect to be able to help. It became clear that barbiturates are not available for general prescription and are subject to special rules. I wondered whether I could claim that I needed them as a medical emergency, but I would either have to tell lies about an epileptic child or come clean about the cat. I abandoned the idea and went home.

The irony was that I could get as many routine sleeping tables, not barbiturates, as I wanted, but the dose needed would be far too high to get the cat to take them. I could get the butcher’s cleaver, the garrotte and the smother-pillow, but the only simple and reliable way of giving Micio a kind and gentle death was denied to me. That is how bureaucracy works. Sledgehammers are designed by committees to crack nuts without considering the unwanted consequences. How many people cannot sleep and how many epileptics have badly controlled disease just to prevent a few people from taking an overdose? Certainly, some unintentional overdosing may be prevented by restricting barbiturates, but these same unlucky people can unintentionally fall downstairs, have car accidents and smoke cigarettes. The state, when drawing up the rules, probably never gave a thought to cats like Micio. 

I called Hermione to explain the situation. She was very understanding. At least I had tried, while the vet, with all the means available, had refused and even suggested the idea of shortening Micio’s life and suffering was in some way immoral. We decided to do nothing until she had returned from a short stay in Saturnia. Off she went, leaving the cat in the care of a maid. While they immersed themselves in the healing waters, Micio curled up in his basket and went to sleep. He never woke up. 

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