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Euthanasia and the ‘duty to die’

It has been thirteen years since I first wrote an article (in Quadrant magazine) along the lines of the one published today in the Courier Mail, and nobody in the intervening years, including various exchanges with Dr Nitschke and other advocates for mercy-killing, has given me reason to change the argument.

The subject is politically topical again, as Green’s Senator Bob Brown has a Bill in the Senate which would overturn the Andrew’s Bill from 1997 (which itself overturned the NT Rights of the Terminally Ill Act 1996 and prevented the Territories from legalising euthanasia).  Brown knows that the Australian Capital Territory legislature, the permanent libertarian legislative laboratory for the nation, would bring in euthanasia tomorrow if his Bill succeeds, even if the Northern Territory legislature appears to have lost its appetite for euthanasia (now that it has some decent palliative services, which it lacked in 1996 under its euthanasia regime). Thereby, a legislature no more sizeable than a city council would determine a profound change in the law and culture of Australia, where State after State has rejected such changes – most recently Western Austrlia and South Australia in the last few months. No, Territories are not demographically substantial enough to carry such a revolutionary change as euthanasia for the whole of the country; leave it to the States to decide.

As to the core arguments against euthanasia, as opposed to the arguments against an abuse of national legal process by tiny Territories, the article below was requested by the paper as a balance to a piece by the Oped Editor herself, Margaret Wenham. Hers was a distressing account of her own brother’s recent death, and shows the signs of sincere thinking overwhelmed by raw grief and anger; the reader does not know at the end whether she wanted her brother to suicide according to his wishes, or why he did not suicide at home when he had the chance, or whether she is directing her anger at the doctors for failing to relieve his symptoms (including treating possible depression) or at legislators for failing to allow doctors (who fail to relieve symptoms) to kill her brother upon his request… Obviously the way out of this is to have doctors relieve symptoms and treat depression better, even if imperfectly – but the suggestion that a hospital should agree with a patient’s request to get a gun for him to shoot himself is not a serious one. What is serious and powerful  is her grief over the very recent death of a loved one – but as always with euthanasia, policy cannot be decided because of individual hard cases. Euthanasia might increase the ‘liberty’ of some to control the time and manner of their dying, but the overall cultural effect will be to impose a subtle intimidation and loss of liberty to many more, and more vulnerable, people… but that is the argument in the article following:

Euthanasia debate: Priority is to protect the vulnerable

Courier Mail 23rd December 2010

THE heart of opposition to euthanasia is that the so-called “right to die” would come to be felt by the frailest more as a “duty to die”.

During the last national debate on euthanasia one moment crystallised this fear. In 1995 then governor-general Bill Hayden urged doctors to support euthanasia as both an individual right and a positive duty to society.

He described past cultures in which the elderly would commit suicide when their usefulness had passed and declared of our own culture: “There is a point when the succeeding generations deserve to be disencumbered of some unproductive burdens.”

This astonishing message from our head of state was supported by other opinion leaders and captures the corruption in social relations that would come with a culture of mercy killing.

A year earlier, a British House of Lords inquiry reached the opposite conclusion, saying: “The message which society sends to vulnerable and disadvantaged people should not, however obliquely, encourage them to seek death, but should assure them of our care and support in life.”

Consider also the corruptibility of doctors if given the power to administer death.

This corruption is evident in the euthanasia experiment in Holland, where the Government’s confidential surveys showed that doctors put to death several hundred patients a year without any explicit request – even when the patients were competent to give or withhold consent if asked.

These illicit killings have not improved since the Dutch legalised voluntary euthanasia in 2002, which debunks the idea that bringing euthanasia “out into the open” will reduce such practices.

The 2007 official report states that the rate of patients killed “without explicit request” since legalisation is “not significantly different from those in previous years”.

 Doctors who considered themselves above the law when euthanasia was illegal would be even more relaxed about non-consensual killing once euthanasia was socially accepted.

 To clarify: unless a doctor intends to kill a patient, the act is not euthanasia. There is no intention to kill when a doctor gives adequate pain relief or sedation to relieve suffering, or ceases futile life support, so that is not euthanasia.

By contrast, a lethal injection is intended to make the patient die, so that is euthanasia.

Brisbane psychiatrists Frank Varghese and Brian Kelly have warned of the impossibility of protecting patients from “the doctor’s unconscious and indeed sometimes conscious wishes for the patient to die” – once doctors are allowed to be involved in a patient’s suicide.

Professor David Kissane, a psychiatrist and palliative care specialist, reviewed the deaths presided over by euthanasia advocate Dr Philip Nitschke under legalised euthanasia in the Northern Territory in 1996-1997.

He found the so-called “safeguard” of compulsory psychiatric assessment failed because the system was “preoccupied with meeting the requirements of the Act’s schedules rather than delivering competent medical care to depressed patients”.

I have urged Nitschke to study palliative medicine – to learn what can be done for depressed people with advanced disease – because when we look after such patients well, thoughts of euthanasia often fade.

In the words of one hospice patient who had asked me for euthanasia only the day before but was now pain-free: “It’s a different world.”

Even so, I would not use the argument against euthanasia that “palliative care can stop all suffering”. We cannot stop all suffering in dying any more than we can stop all suffering in childbirth, although we have made great progress.

Rejection of euthanasia is not dependent on perfecting palliative care for all patients. Rejection of euthanasia is always on the grounds of oppression of the weak: the insidious corruption of the relationship between doctors and their most vulnerable patients, and between the state and its most “unproductive burdens”.

Dr David van Gend, a Toowoomba GP and a committee member of the Family Council of Queensland, is also a senior lecturer in palliative medicine, University of Queensland. This article does not purport to represent the view, if any, of the university.

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