Without this mercy, my Lize would have suffered much more

Rapport 23 June 2024

Article by Jacques Uys

The polemic discussion about mercy killing[1] surfaces regularly in the South African context exchange.

Being an avid supporter of free choice, I have been following this debate for many years.

However, I am afraid that the debate serves very little purpose in South Africa.[2] For decades South Africa has been following the example of Britain, as far as ethical issues are concerned, and has been and still is the case with the whole Anglo-Saxon world. Before Britain agrees to allowing mercy death, something that is extremely unlikely given the [non-elected] influence of the Anglican Church in the British House of Lords, it is almost impossible to imagine how South Africa will take an independent decision. South Africa, as a society, is most probably just not mature enough.

My dear wife and I emigrated to the Netherlands in 2022, a difficult and sometime traumatic experience, as all emigrants know. But in the midst of all the disadvantages, there are also a couple of advantages. One of these and which was extremely advantageous for my wife, Lise, was the fact that mercy killing was legal in the Netherlands, and still is,

A little background is necessary. At a very young age, Lise[3] became orphaned, tother with her younger brother, Frans. She was only nine years old when her mother died and eleven when her father died – both as a result of an sapping, destructive and, above all, painful cancer. She was still very young, but old enough to remember, and to know: This shall never happen to me.

For years she nagged that we should get our wills in order, and most of all the ‘euthanasia declarations’, as it is known here.

Why, I thought, we are young and have loads of time. Eventually I had myself persuaded, our wills were drawn, and the most important factor: We both signed a declaration in the presence of a notary, that we were of sound mind and that in the event of becoming terminally ill, we wanted to decide ourselves when we wanted to die by way of the administering of an injection.

Done and dusted, but this would certainly never be necessary.

I shall spare the reader the detail of what followed, almost immediately after the paperwork had been done. It is sufficient to say that there was a brief period of hope, but eventually a final report by an impressive team of professors and doctors, attached to the Erasmus Medical Centre, the leading academic hospital in Rotterdam  [and world leader in respect of the treatment of her specific type of cancer], a report signed by a whole team of specialists in the field, with one self-evident conclusion: Liza’s situation was hopeless, ‘uitzichtloos’.

It was almost as if Lise had spent her whole life preparing for this. A. complete system fell into place. The first contact was the family doctor, who was in possession of a copy of the ‘euthanasie verklaringen’ and understood that there was no hope whatsoever. He introduced us to a mercy death doctor [‘genadedood-arts’ in Dutch -FO], and Lize, without telling me, made an appointment to see him.

The duty of this doctor is to decide if there is really no hope for the patient, and whether the patient is of sound mind to take such a decision.

At this time, I was working half a day. That Wednesday I arrived home and found a house filled by people who had come to say good-bye, as had been the case every day the previous two weeks. During a quiet moment, with a lot of noise in the background, Lize pulled me aside, looked me in the eyes, and said that she had made an appointment for the coming Friday, at 16:00. Two days later.

Our trusty family doctor offered to perform the euthanasia. Not all doctors are willing to do this, for ethical or emotional reasons. To Lize it was a tremendous relief that her familiar and beloved doctor was willing to help her.

A date and a time had been set. Those last days were traumatic. On Thursday, Lize’s last full day, she asked Hester and Peet, our good friends and neighbours, whether they would be willing to be there. They agreed.

In the course of Thursday night and Friday afternoon, the last conversations followed.

This was in the time of Covid-19; nobody could come from South Africa to say their personal good-byes. On Thursday evening there was a chat with her best friend, Tanja. It took Tanya some time to recover and phoned back after a couple of minutes.

The simple statement: This is our last conversation; we shall never talk again. Good-bye, dear friend.

For our last meal together, she had asked me to prepare her favourite dish, fried salmon, with baby potatoes. I bought a bottle of Chateauneuf-du-Pape. Sadly, Lize could barely eat, one mouthful of salmon, and took a sip of Chateauneuf. I downed the rest of the bottle.

Friday morning, we woke up very early, for the last time sharing the bed, one more sharing of old memories, for the last time tell each other things and once more we declared our love for one another, asking the question: Is there something else you want to tell me? I had already told everything.

 I know that those days will come where I wish I had still told her this or that, and there are indeed still many such days, but at that moment everything was perfect and done.

The doctor was prepared to handle the mercy killing, but, he said, he would not insert the drip himself: sometimes he can’t locate a vein and people become very emotional. Because of this fact, he had arranged with an ‘ambulance brother’ to insert the drip.

The ambulance man arrived at 12:00. Liza pulled up her sleeves and the bald-headed Dutch brother, tall as a tree, inserted a drip in both her arms, as the doctor was scared that one might not work. That is why he wanted one in both arms. Just in case.

Then the last FaceTime conversations followed. First with her stepparents in Jeffreys Bay, followed by the last and most difficult one: with her younger brother who shared becoming an orphan so long ago, her only true relative. We had tried everything we could to arrange for Frans to come to the Netherlands, but the Covid-19 hurdle was unsurmountable.

There is an end to every conversation. And the parting words: ‘Goodbye my little sister,’ and, ‘Goodbye, my sweet brother, I love you.’

Press the red button, ‘Conversation ended’, the screen told her.

What was the strangest thing of all, is that Lize did not shed a single tear from the moment she had heard that she was beyond recovery, ‘uitbehandeld’, until she died. Every one else did, many of them, but it was as if she prepared herself for this moment her whole life.

Finally, everything was ready. What does one do then? We watched the second last episode of Boer soek ’n vrou on Showmax - sadly she would not see the final chapter, as it was not yet available. However, the last episodes of Schitt’s Creek on Netflix were and she wanted to watch the series to its end.

At 15:30, Hes and Peet entered at the back door and embraced Lize.

At 15:55, five minutes earlier than had been arranged, the front door bell rang. It’s the doctor, with a small case in his hand. Why could he not wait another five minutes, I thought.

Lize almost came running, true to her nature, worried that she would let people wait and inconvenience them, always putting other people first. Earlier the neighbourhood nursing team had brought along a hospital bed and placed it in our lounge, the back lifted rather straight. Lize went to sit on the edge of the bed and, almost surrealistic, shifted her slippers neatly next to each other under the bed.

Then she leans against the back of the bed, I sit next to her on the bed and she takes both my hands in hers. Hes and Peet is also sitting around her.

Once he had attached the infusion, the good doctor explains what is going to happen. The drug that will kill you, can be very painful and therefore he is going to anaesthetize her with a sleeping potion. Only when she is in a deep sleep will she  receive the fatal medicine.

On of the side-effects of the sleeping drug, might be a very bitter taste in her mouth, the doctor explains.

Lize, whose mind is still 100% clear, indicates that she understands everything.

‘Tell me when you are ready,’ the doctor says. ‘I am ready,’ Lize replies. One more time she says how much she loves us all, one more time she presses my hands, and then nods to the doctor.

Slowly the doctor injects the anesthetic.

‘Oh, it really does taste bitter,’ she said, her last words. Her eyes rolled back and she was gone. The doctor thoroughly checked whether she was in that deep state of anesthesia, then administered the fatal potion. Slowly her breathing slowed, before her heart stopped beating.

At 16:07, exactly 12 minutes after the front door bell rang, the doctor declared her dead, gently, without haste.

For a long time, I just sat there, in a place, a phase of deep mourning on the one hand and relief on the other, while Lize kept becoming bluer.

Our family doctor is one of the doctors attached to the biggest practice in our predominantly Protestant town just outside Rotterdam.

There, together, around the body of my wife, I asked him about how he experienced it all. Very soon, he confesses, when he arrives at home, he will also have a proper drink, a strong Dutch ‘borrel’. He also experiences it as traumatic, but he does it for his patients; not all his colleagues are prepared to do the same.

I ask him how often it happens, seeing that he is the only one prepared to perform mercy killing in his practice in a town with 30 000 inhabitants.

My expectation was that it would be a weekly occurrence, but to my great surprise he tells me that it almost never happens. Sometimes more than two years pass without a need to perform a euthanasia.

I found it difficult to believe, but his words were: ‘Everyone wants it, but nobody actually goes through with it.’

He told me that people in their final days will go to all extremes to arrange it, but when push comes to shove, people keep on postponing it, until they eventually die,  with the help of very strong anaesthetizing and effective painkilling. But they want the peace of mind, the freedom of choice to decide for themselves. Even if, in the end, almost nobody exercises the option.

It is not yet the end. An independent doctor must first come and confirm that everything proceeded according to the rules. He and the doctor who administered the potion, are not allowed to see one another, just in case the one influences the other. Our doctor had to leave,

The controlling doctor gave one look, signed a form and left.

Earlier on I had informed the funeral directors what time everything would take place and the hearse was already waiting, discreetly, at a distance. Within two minutes after the doctors had left, the hearse was at the front door.

Lize had hung her pretty black and white funeral dress on a hanger behind the door. Her friends, Hes and Lyanne, attended to her appearance and dressed her and we together lifted her into her coffin, one she had chosen herself and was brought to the house in the hearse.

Lize’s death clearly was not natural. She did not die from the cancer [the same type that caused the death of both her parents], but from the injection the doctor gave her. Therefore, there had to be a judicial inquiry, luckily just a formality, as long as all the paperwork is in order.

However, this meant that I had to wait two months for her ashes to be released and I could scatter it at all her favourite places, South Africa, Oud-Beijerland, Spain and Greece.

I am a huge supporter of the right to decide for oneself when you wish to end your life. After Lize’s death, and still today, I am convinced that it is a humane, merciful way to die. I, too, wish to do so.

Nevertheless, I wish to add a small remark, one that I have not yet come across in any debate in respect of mercy deaths.

It sounds a bit selfish to raise it, but do not underestimate the effect that a mercy death could have on those who stay behind. Quite by chance I met someone whose husband was also euthanized, within a week after my wife, but who had children present when their father passed away.

The children forced her to promise them that she would never do something like that to them again, so traumatic was their experience.

Perhaps it is easier in the case where it happens to someone who had had a long and good life, someone who is old and sickly. around 90 years old or so.

In the case of Lize and the husband of my friend, it happened to people who had not even turned 50, in the prime of their lives.

Had she allowed nature to take its course, Lise would have suffered immensely. Whether it would have been easier for the next-of-kin, I cannot say. I maintain and accept that it was better for Lize and when my time comes, I, too, would like to take the decision myself.

[1] Note by translator, Prof SP Olivier: self-administered or doctor-administered dying.

[2] This paragraph contains highly contestable assertions but they do not affect the central thrust of the account of the assisted death of former South African, Lize Uys, in the Netherlands – WA Landman

[3] Lize Erasmus: born 9 July 1971, died 21 March 2021.