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Does mercy killing have a place in the modern Kenyan society?

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Originally Published: March 21, 2010

As debate on the emotive subject of when life begins rages, one father in Nairobi is grappling with the question of when and how life should come to an end.

And, unlike the various groups engaged in the right to life debate, the man’s dilemma is borne out of a personal experience that has put his family in a helpless situation.

It all started when a family member was involved in a road accident that left her seriously injured and in a coma. After a prolonged stay in hospital, the patient was declared brain dead.

Science says she cannot recover any of her functions. But faith and belief make the family members hold on to her through the marvels of modern-day medicine.

When does one accept the reality that a loved one may never recover and ask the doctors to switch off the life-support machines? This is the dilemma the father finds himself in.

Members of the National Council of Churches of Kenya (NCCK) argue that life begins at conception and ends due to natural causes. But, for some, this natural end comes with great difficulty, prompting them to think about ways to hasten the inevitable end.

Life of torment

Some Kenyans are opting to secretly “liberate” their loved ones from a life of pain and torment. This “assistance”, some doctors say, might be in the form of a pill, an injection, or an overdose of prescribed drugs.

In extreme cases such as that of a former BBC journalist, it may be in the form of a smothering pillow held by a trusted companion.

No questions are asked, and no answers are offered. Mercy killing remains a tightly guarded secret, and everyone but the dead goes on with their seemingly normal lives.

Indeed, “active euthanasia” is legal in some countries like The Netherlands and Belgium. Locally, it is argued that mercy killing is practised in one form or another and was part and parcel of life in several African communities.

However, the responsibility that comes with deciding whether a loved one dies or lives is not an easy one and has left many in a quandary.

Former Nyeri Town MP Wanyiri Kihoro is a man who has been through such uncertainty, living each day in a dimension different from that of a loved one.

For two-and-a-half years he held on to nothing but hope that one day his wife, Dr Wanjiru Kihoro, would finally emerge from a coma after she was involved in a plane crash in 2003.

“She never did. After years on life support, God’s will was done, and she left us,” the former lawmaker told the Sunday Nation.

Despite what doctors told him, Mr Kihoro would not let go. But not everyone is strong enough to hold on to his or her dear one at such times.

Psychiatrist Frank Njenga explains: “The time one allows a loved one to stay on life support depends on a number of things. Most important is the bond between the two. The closer the bond, the harder it is for an individual to perceive mercy killing as a possible end to his journey.”

Only when the emotional attachment between the patient and the relative or friend is not significant will mercy killing be an option. Many think about it, but few are willing to take responsibility for it.

“Culturally, death has always been mystified. In some quarters, talking about it is seen as an open invite for death to visit your home. So inasmuch as people will see their loved ones suffering and in pain, they will not openly propose mercy killing,” said Loice Okello, a counsellor at Amani Counselling Centre.

But, she said, if someone makes that proposal to them and agrees to assume the responsibility of switching off the life support machine, administering that pill or giving that lethal injection, they may accept it.

“Whichever way you look at it, ending the life of someone who has a chance of regaining his life can never be right. God gives life, and only He has the right to take it away,” said Reverend Peter Karanja, the NCCK general secretary.

This, he said, should not be misunderstood to encourage people to hold on to dead people.

Medical opinions

“If it has been medically proved that an individual’s vital organs have failed, and there are no chances of recovery after several medical opinions, then you should let them go. Switch off the machines. It is not murder; you are simply letting nature take its course,” he added.

Dr Njenga said there are a number of factors that may force one to accept such a decision. Among them is the cost of having a patient on life support for months on end without any visible change in their health, and the age of the patient.

“Faced with terminating the life of a four-year-old or a 90-year-old, many would find it easier to terminate the life of the older person. People will have the opinion that the older patient’s life has somewhat run its course,” he said.

Mr Kihoro, however, said that as a human being, one cannot bring himself to make the decision to end another person’s life.

“We are not God. We cannot determine when life should end. Anyone opting for the seemingly easier option of terminating another person’s life is a coward, afraid of what the future has in store for him,” he said.

But some say such decisions are made every day, either consciously or subconsciously by individuals who have exhausted their options for providing for loved ones.

“How many people are abandoned on a daily basis at public hospitals, clinics or by the roadside? Some of them are only claimed when they die, after spending long periods in hospitals or on streets,” said Mrs Okello. “This might be perceived as an exit strategy from a tumultuous life by others.”

The fact that people remain silent about mercy killing does not mean they are against it.

“Abortion is illegal, but it is happening. In the same vein, mercy killing may be going on, but we don’t talk about it,” the counsellor said.

Others think deciding whether one dies or lives courtesy of machines does not constitute playing God.

“It’s true that all forms of killing are illegal. But in cases where the individual in question has been medically proved to be brain dead and in a vegetative state, he should not be mercilessly kept alive by machines,” said Rev Timothy Njoya of the Presbyterian Church of East Africa.

Anthropologists say mercy killing has been an African practice from time immemorial.

“Almost all African communities practised mercy killing in one form or another. In some communities, the terminally ill were taken to forests away from their villages and left to the mercy of the elements. The community could not bear the pain their kinsmen were undergoing,” said Mr Mbataru Wanjiru, an anthropologist based in Nairobi.

But he said that back then there weren’t many options to sustain life, making the decision easier on the conscience.

“In today’s world, the war between science and faith is not one that can easily be won,” Dr Njenga said.

From this war, Mr Kihoro emerged a scarred man, but he says he is happy he never gave up on his wife.

“Doctors might tell you your patient is brain dead with no sign of recovery. For me, as long as the heart was still pumping, I vowed to stay by my wife’s side till the very end,” he said, adding that he could not have lived with himself had he decided to prematurely end her life.

“What if you pull the plug and the next day a miraculous cure is discovered?”

It is such questions that make it hard for people who have played a part in another’s mercy killing to live a normal life.

“There is always the ‘what if’ aspect. What if you kept him on the machine for a few more days? What if you tried something different instead of giving up? These questions will always keep knocking at your moral compass. It is not an easy burden to bear,” Mrs Okello said.

Others see the question from a different perspective.

“What if he never wakes up? What if a family exhausts all their income hanging on to an already departed individual, and life is never the same for those left on earth?” asks Dr Mbataru.

On average, a bed in a private hospital’s High Dependency Unit (HDU), where patients are normally put on life support, can cost up to Sh15,000 a day excluding surgical, drug or any other costs that might be incurred.

If one prefers specialised care and treatment while at the HDU the costs may be as high as Sh30,000 a day.

Rev Njoya says making the decision to end someone’s life is too heavy a burden for an individual or a family to bear. As a result, he says, a panel made up of psychiatrists, doctors, lawyers and the clergy should be formed to determine whether individuals’ lives should be terminated on passionate grounds.

Lift the guilt

“Such a body will lift some of the guilt off the shoulders of the victim’s close relatives since the committee and the victim have little emotional attachment to each other,” he said.

Those who have been through the pain insist matters of life and death lie in the hands of the Creator.

“No one has the right to take away the life of another. Every moment with them counts,” Mr Kihoro said.

Mental health experts say the decision to terminate a life is not an easy one to make, and whoever chooses to do so should be ready and willing to bear the burden that comes with the action.

“To yourself and close relatives, the pain you have gone through might be a reason for your coming together in making that decision. What will stop others from thinking of you as a killer? You will need to live with both these perceptions,” said Dr Njenga.

And, as the debate on the beginning and end of life continues, somewhere in a Nairobi hospital ward a father is still in search of an answer. He is still waiting for the slightest movement of his daughter’s eyelids.

Doctors express little hope, yet he holds on to fading hope. Maybe tomorrow she will wake up and tell him of all the places she has visited in her dreams.

Every day, a family member walks into her room twice a day to keep her company while expecting a miracle. Some want her to speak, others want her to move a limb. Some want a simple smile whereas others just want her to open her eyes and see the world one more time.

In her existence, the line between life and death is no more. In its place is a little switch on a life support machine. Some of her family members say if it were up to them, the switch would be flipped the other way, and with the silence that comes with the death of the machines would also come a peace they and their daughter badly need.

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