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The first “choice” is to ask that life-prolonging treatment be withheld or withdrawn.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