Curled up on a chaise lounge that had been adapted into a daybed, Bill was obviously not at peace. Pale and drawn, he moved slowly, grimacing, with the occasional twitch and jump in his limbs. As a community health nurse working in London for a Christian charity that ministers to AIDS patients, I had seen these symptoms before.

“How long has he been like this?” I asked Ian, a bespectacled man in his mid-thirties who had introduced himself as Bill’s partner.

“For the last couple of hours, really. More or less since he got home,” Ian replied, his anxiety and weariness barely disguised. “Can you do anything for him?”

There was plenty of reason for worry. Bill, who had an AIDS-related lymphoma, had just been discharged from a hospital where he had been admitted for a type of pneumonia common among AIDS patients at the time. The hard truth of the situation was that he had come home to die.

Ian told me that he and Bill had lived together for about ten years. Both worked in the media and had enjoyed successful careers. When Bill had been diagnosed as HIV-positive eight years earlier, they had coped and even thrived for a while. But once Bill developed AIDS-related illnesses, his freelance work had dried up, and Ian had had to be both caretaker and sole breadwinner. Those friends who had not dropped out of contact mostly lived too far away to lend anything more than moral support, while both their families wanted nothing to do with them.

Two hours later, I had set up a new diamorphine pump that would help Bill settle for the night and grant Ian a few hours’ sleep. Bill smiled as he held my hand and said thanks. Ian hugged me grimly and wordlessly as I left.

The next day I came by in the late morning to check that they were OK. Bill had slept through the night and appeared less drawn. Ian also seemed more rested, but I sensed that he was not at ease. As I set up a new syringe driver in the kitchen, he came in and gently shut the door so Bill could not hear. “Is he going to get more like he was yesterday evening?” Ian asked.

“As long as we can keep his symptom relief working, he will be comfortable,” I replied. “But he is going to get steadily weaker – I don’t think he is going to make any significant recovery from this illness.”

Ian drew a ragged breath. “Can you give him all the morphine in one go?”

“That would suppress his breathing and he could die,” I replied, suspecting what was coming next.

“I don’t want him to suffer. Can’t you just ... you know, fix it ... so he drifts off peacefully?”

Footnotes

1. Oregon Death with Dignity Act: 2015 data summary (pdf), page 4; Oregon Public Health Division, February 4, 2016. 
2. Scott Y. H. Kim; Raymond G. De Vries; John R. Peteet, “Euthanasia and Assisted Suicide of Patients with Psychiatric Disorders in the Netherlands 2011 to 2014,” JAMA Psychiatry 73, no. 4 (2016): 362–368. See also Steve Doughty, “Sex Abuse Victim in Her 20s Allowed to Choose Euthanasia in Holland after Doctors Decided Her Post-traumatic Stress and Other Conditions Were Incurable,” Daily Mail, May 10, 2016.