TALKING ABOUT DEATH AND DYING – We can choose so many of our life experiences, but it seems we can have no say in whether we die in pain or at peace. Today we consider why we don’t have a policy on physician-assisted suicide.
It’s often said that the only certain things in life are death and taxes. In reality, of course, if you’re willing to pay lawyers and accountants enough, you might be able to avoid taxes. But no matter how much you spend on doctors, the best you can do is prolong your mortality. And for some, the cost of extending life isn’t financial, it’s the pain and anguish associated with delaying the inevitable.
Most people would like a quick and painless death, but unfortunately that’s the exception. Death is more likely to come after a long medical struggle with an incurable illness. While death is certain, its timing isn’t, partly because medical science can now prolong the dying process considerably.
For some, “fighting to the end” provides purpose. For others, it can seem painfully pointless.
False choices
Some people face unbearable suffering at the end of their lives, suffering in the form of physical pain, mental anguish, or both. The realisation that, in some circumstances, there’s no hope of a cure, let alone any respite from pain, can understandably result in feelings of despair. In these circumstances, it’s not surprising that some people want to die.
If an Australian gets to this point, he or she has three main options.
The first “choice” is to ask that life-prolonging treatment be withheld or withdrawn. This is sometimes called passive voluntary euthanasia and may involve terminal sedation.
The second “option” is to ask for an increase in the medication designed to alleviate pain, even if such an increase may shorten the patient’s life. Legally, it’s necessary for a sympathetic doctor to deny any intention of hastening death.
The third “choice”, which is not a legal option in Australia, is to obtain medical help in administering a life-ending drug. This is called voluntary euthanasia, or physician-assisted suicide.
Growing debate
Despite the historically strong opposition to terminally ill people being able to take responsibility for the way their lives end, the issue is subject to increasing debate, both here in Australia and around the world.
The power of the church is declining and cultural values are changing. And, after decades of being told that individuals, not governments, are best placed to make decisions, it’s understandable that a growing number of people want to take responsibility for one of the biggest decisions of all.
Public opinion polls on voluntary euthanasia are becoming more frequent and they show that public support for physician-assisted suicide is overwhelming. Over 80% of Australians believe in the right of the terminally or incurably ill to obtain medical assistance to end their lives.
This strong level of community support reflects the reality that doctors already act to relieve suffering by helping terminally ill people die peacefully. But despite public opinion and medical practice, doctors risk prosecution in Australia if they assist someone to commit suicide.
Current laws condemn people to needless suffering, deny individuals the right to make the most personal of choices and ignore the reality that doctors are already helping people to die.
Opposition
Surveys show the public wants legislative reform to give terminally or incurably ill adults the choice of a medically assisted death. So why isn’t anything being done?
Opponents of physician-assisted suicide are articulate, determined and well-funded. Some opponents of change fear abuse of the vulnerable and an inevitable descent towards involuntary euthanasia, while some have strong beliefs about how other people should live and die.
There’s institutional opposition from some churches on the basis that physician-assisted suicide is simply wrong because their faith tells them so. But it seems that it’s elements of the religious hierarchy, not ordinary Christians, who are opposed.
A 2007 Newspoll found that 74% of those respondents who claimed to belong to a religion agreed that doctors should be allowed to provide a lethal dose to a patient experiencing unrelievable suffering and with no hope of recovery. A more recent poll showed that 65% of Australian Christians believed in legal voluntary euthanasia, with 73% aged more than 65 in favour.
So from a democratic point of view, the case for voluntary euthanasia is unassailable. The vast majority of people want it, and the leaders of the groups that are the most strongly opposed to it are at odds with those they claim to represent.
Ideologically, it’s hard to see how a society that increasingly questions the ability of government to make better decisions than individuals can continue to avoid a parliamentary debate about whether the government or the patient should have the final say in whether a treating doctor can assist suicide.
While the Greens support the legalisation of voluntary euthanasia, the stated policies of both major parties are completely at odds with majority opinion. No doubt this will change in time, but the longer that takes, the more people will suffer unnecessarily.
Imaginary slippery slope
Protection for the vulnerable will be central to any serious debate about legislative change in this area. Opponents of voluntary euthanasia regularly voice their fear of a “slippery slope” that could lead to the killing of vulnerable people.
Similar laws in other countries are designed to address this concern, and a number of government and independent reviews have demonstrated that the laws works as intended.
Legislation for medically-assisted dying exists in the Netherlands, Switzerland, Belgium, Luxembourg, and two American states – Oregon and Washington State. It’s also legal in Montana as a result of a court ruling.
The standard legislative safeguards that exist in these countries include requirements that the patient is acting voluntarily and is not being coerced, that he or she is mentally competent (and not suffering from depression), and that the patient makes a fully informed decision.
In response to the fear of abuse of the vulnerable, research conducted in 2007 found that “rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured, … people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS.”
The most recent comprehensive study of the subject is the Royal Society of Canada’s Expert Panel report on end-of-life decision-making, which was published in November 2011. One of its conclusions was: “The evidence does not support claims that decriminalizing voluntary euthanasia and assisted suicide poses a threat to vulnerable people”.
Stepping up to the challenge
There are lots of reasons for people, and politicians, to be squeamish about this issue. It’s obviously easier to ignore it and hope for the best. But it’s not the job of our representatives to avoid hard issues, it’s their job to confront them.
The public supports legalising assisted suicide, the medical profession is already doing it, and other countries have showed us that safeguards work.
If the only reason stopping us from ending the needless suffering of those approaching death in severe pain is the beliefs of a small number of leaders from a small number of churches, then maybe we should ban abortion, divorce and pre-marital sex as well.
This is the seventh part of Talking about death and dying. To read the other instalments, click on the links below:
Part One: Deadly censorship games: keeping a tight lid on the euthanasia debate
Part Two: End of the care conveyor belt: death in intensive are units
Part Three: Caring or curing: the importance of being honest
Part Four: Death and despair or peace and contentment: why families need to talk about end-fo-life options
Part Five: Body or soul: why we don’t talk about death and dying
Part Six: Planning your endgame: Advance Care Directives
Part Eight: A personal account of life with terminal cancer
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Comments (8)
Chris Harries
(logged in via Facebook)
From time to time governments set up an inquiry to look at this issue. The last time I interacted with such an inquiry it came home to me why government policy stays rock solid.
Who fronts up to give evidence to an inquiry into the right to die with dignity? Three institutions are well represented, the medical profession, aged care institutions and church leaders, all three emphatically opposed to liberalising the law. There is a solid Catholic church element within all three institutions. They…
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Colin MacGillivray
Retired architect (logged in via email @gmail.com)
Dignitas in Switzerland helps people to die assisted by medicos. Additionally, they provide assisted suicide for people. They have all the necessary checks and balances in place.
The only impediment to establishing a Dignitas in Australia is that the person who provides the lethal dose or the suicide method may be prosecuted.
If a complex random procedure was put in place in which the outcome was certain but the "guilty" party was wholly undetectable, no prosecution would be possible and no court would bother.
How about 10 drip bags with a fatal dose (that takes 10-15 hours to act) in only one of the bags? 10 relatives, medicos and others change the bag at 20 minute intervals one evening and destroy them afterwards and go home. And the patient dies next morning.
Any lawyers out there to scuttle this idea?
rob alan
IT Tech (logged in via email @bigpond.com)
Our govt franchise openly supports USA/Sweden encouraging assassination but not citizen's right to euthanasia?
Society for Cutting Up Men, SCUM - http://www.youtube.com/watch?v=9tQSOlF9ZZM
Tim Scanlon
(Climate and Agronomic Extension at Department of Agriculture and Food - Western Australia)
I don't want euthanasia. I want to go out as a blood coughing, bed ridden, anemic, bed sore plauged, bag of bones. Death should be so painfull and heartbreaking for your friends and family that they are scared whitless of death.
There really isn't a logical argument against euthanasia. The only risks are who ultimately decides and are they fit to decide. What vested interests are involved?
What concerns me the most is how religions influence this topic (amongst others) as though they have sole ownership of medical decisions. We only have to look at the debate that was held on this topic and abortion when Tony Abbott was health minister. His health policy decision was made by his bishop and not his department and advising doctors.
Adam Butler
(logged in via LinkedIn)
The author notes that the Greens are in support of the right to die with dignity. As with many so called "controversial" issues it seems the Greens are ahead of the times (again). I find the arguments against voluntary euthanasia a little perplexing at times given the safe guards that would be legislated into any potential system. The whole religious argument is nonsensical considering some of the statistics about the % of population that claim to be "religious". If you are religious and don't want to die with dignity then don't, simple...its called choice and at the moment there is no choice and I'd rather not be constrained by someone else's religion.
James Walker
(logged in via Facebook)
As *anyone who is qualified to talk on the issue is aware* (ie not the author) - the double effect, that is a patient being killed by a doctor adding sufficient painkillers to control their pain, has always been both legal and ethical.
A doctor would be equally allowed to deal with secondary effects of illness, frex using steroids to maintain quality of life at the cost of quantity. This basic understanding of their rights and responsibilities ensures that the medical community will continue to…
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Chris Harries
(logged in via Facebook)
It's not quite correct to use the term euthanasia in the context where a patient chooses to terminate their own life, with the assistance of those around them. Nearly all Australians would be totally opposed to euthanasia where there is no structured voluntary component to it. By contrast, a good 80 percent of Australians support the right of a person to choose to die with dignity at at time of their own choosing when conditions become too unbearable for them.
Various alternative terms are used for a legitimated process, one being voluntary euthanasia, another being assisted suicide.
Opponents of reform tend use the term euthanasia with intent to conflate the two meanings in the public eye.
Emma Anderson
Independant Researcher and Artist (logged in via email @gmail.com)
James that's assuming that the cause of death is determined by the coroner and that the laws are not changed.
Perhaps Colin's suggestion is appropriate if there are multiple parties asked to fulfill the wishes of the patient who are not comfortable with the wish, but nonetheless desire to respect it?
--more generally--
The biggest safeguard is the living will, written prior to falling ill.
But I am not sure how this would apply to minors with terminal illness, or to people who are legally adults but lack the capacity to express their wishes, even when they are clear of these.
The assumption seems to be elderly patients without any history of developmental or psychiatric issue. Or even that these elderly patients may not have comorbid illnesses, e.g. malignant cancer and dementia praecox. It may also be the case, even then that the person would have stated years earlier what they wish, but this may not be legalised recognised.