Voluntary Euthanasia Bill

November 20, 2011 at 12:54 am Leave a comment


The other day, on the day it occurred, I heard about a forum being held at Parliament House, Sydney called “Rights of the Terminally Ill in NSW”.  The organiser was Cate Faehrmann, a Greens MLC, who intends to introduce a bill seeking to legalise euthanasia into the NSW Parliament in 2012.  And at the same time, there is news of a terminally ill woman in British Columbia, Canada, going to court to have the right to ‘assisted suicide”.

This got me thinking! And researching, in order to understand the issues better.

At an intuitive level, I have believed in euthanasia for many years: why should people have to suffer when there is no possibility of improvement – we ‘put our pets out of their misery’ don’t we? was the basis of my opinion.  At the end of her life, I watched my Mother (suffering dementia and heart failure), be in pain, become totally incontinent, almost unable to move or comprehend, or eat or drink, and it was a dreadful thing, and she clearly had no quality of life or likelihood of improvement.  Just as I found it incredibly hard to watch her, I would not anyone to suffer that, including myself.

So, I am not an impartial writer.  However I will try to examine the issue fairly, beginning with a little history and then some of the terminology.

In almost all parts of the world, (Switzerland, some states in the USA and the Netherlands and Belgium excepted), euthanasia is still illegal. No one can ‘help’ a person die, whether the person wishes to die or not. Generally, if a person does assist, this still is murder.  By the way, euthanasia comes from the Greek meaning ‘good death’, and in my mind, that’s a key phrase to keep in mind as the aim of those who promote euthanasia.

Euthanasia has been discussed for over 50 years around the world at different times, and I am guessing that the views of many religions that suicide was a sin probably was a major consideration in not supporting euthanasia. However, many societies are more secular now, and in my view, even when they aren’t, surely it should be the right of the individual to decide (within certain criteria which I’ll go into later).  Whilst discussions went on, the Northern Territory actually passed a bill to legalise euthanasia and doctor-assisted suicide in 1996! However, the Commonwealth over-ruled the NT government in 1997.  In the same year, the State of Oregon (USA) legalised physician-assisted suicide, followed by the Netherlands and Belgium in 2002.

I believe things are changing. On Cate Faehrmann’s blog, she quotes a Newspoll figure of 86.5% of Australians as now being in favour of euthanasia.  In fact, Cate’s post on the subject of the bill covers the issues which  need consideration very well and I will mention  most of them shortly.

Now, let’s look at some of the words and phrases used in the debate.

Perhaps the first should be ‘Euthanasia’  itself.  The British House of Lords Select Committee on Medical Ethics defined it thus: “a deliberate intervention undertaken with the express intention of ending a life to relieve intractable suffering.”  There are several very important elements to that definition. Firstly, that the action is deliberate, secondly that there is an intention to bring about death, and thirdly that that intention is to relieve suffering.

Assisted suicide‘ can be said to be when the person is given help to bring about their death, but they actually take action themselves.  One of the most famous people who support and work in this area is Dr Philip Nitscke, who devised a machine that would administer a fatal drug dose to a person (when they pressed a button, I think). He continues to travel the world, lecturing on euthanasia. He is a founder of an organisation now known as Exit International, and their website is worth a look. There are countries (such as Mexico), where such drugs (Sodium-Phenobarbital and Nembutal for example)  can be obtained – but then they have to be smuggled into the country where the person wishes to die.

Slightly different is ‘Active euthanasia‘ which is when a second person actually administers a lethal injection to someone else, who consents to this happening.

There is ‘voluntary refusal of food and fluids‘ (also known as ‘patient refusal of nutrition and hydration‘ [PRNH]), which is self-explanatory, but can be slow and distressing for all. (A lovely older friend of mine chose this in early 2011 when faced with inoperable/untreatable total kidney failure, and it took about a week for her to die and it was not a particularly ‘good’ death.)

The ‘Doctrine of Double Effect’ may be mentioned and it is a rather complicated ethical argument, which I will try to explain. It is about consideration by a person/s of the effect and intent of their action.  If the intention and end result is a ‘good’ effect, then the action may be acceptable, but if the result is a ‘bad’ one, then the action is not.  An oft-cited example is that of bombing an enemies’ headquarters in a war.  If the bombing leads to the opponents giving up, thus preventing further casualties – even if  some civilian casualties accidently result from the bombing, then the greater good has been served. However, if part of the purpose of the bombing was to kill civilians, perhaps to increase fear, then it is not acceptable, the Double Effect has occurred and the greater good has not been served.    One of the examples of this is that of a doctor who administers increasing doses of, say, morphine to ‘relieve suffering and pain’ knowing that this will lead to the death of the patient. The up-front intent is to relieve pain, and the effect is the relief of pain, and this is laudable and good, but the doctor also knows that the ultimate effect is that of death.  Since 1957, when a Dr John Adams was found not guilty of murder for such an action in the USA, it has tended to be an unspoken course followed by some doctors.

Another oft-used point in this debate is the ‘Slippery Slope‘ argument. This proposes that if a society permits voluntary assisted suicide, it will naturally lead to involuntary death: let’s just kill her because she’s costing health resources which could be used elsewhere etc etc.

A ‘Living Will‘ or ‘Advanced Care Directive‘ is a way of recording before any such time occurs, one’s wishes in regard to treatment or lack of treatment in specific ill-health/illness circumstances. Professor Colleen Cartwright has developed one which is very simple to use.  I have had difficulty getting a link to it to work, but a Google search of her name will quickly lead you in the right direction.

When the discussion starts, it seems that me that certain stances are likely to be taken: there will be people like me who advocate for assisted euthanasia. My argument, and that of others, is really very straightforward: we should respect the right of each person to choose, when possible, the time and manner of their death, provided that no other person is injured in the process. We also will  likely talk about a lack of quality of life and no hope of improvement. We may or may not talk about whether someone must be terminally ill or not. By the way, most current and proposed legislation around the world applies only to those who are terminally ill, not to those who are, say, quadriplegic or suffering dementia or some other devastating condition from which there is no cure. I hope that, eventually, our collective compassion will lead to changes which do account for and include those whose quality of life is so diminished by such conditions.

A very strong argument against euthanasia will revolve around religious beliefs, and suicide being a sin and therefore assisted euthanasia being similarly wrong.  I have no wish to disagree with deeply held convictions, and I totally respect the right of a religious person not to contemplate such an action, but my response revolves around the over-riding right of the individual concerned to choose, not to be bound by the beliefs of others.

Another very relevant argument against euthanasia is that of involving a Doctor (or indeed someone else) in the action.  That person may philosophically or ethically feel it is against their code  (the Hippocratic Oath), or against their religious beliefs.  It seems to me that this is a sound argument, but does not preclude the patient finding someone else who does not feel thus constrained.

There are arguments also which revolve around the timeliness of an act of euthanasia: “what if a cure is found in the next 10 years?” This is very fair, but what about the quality of life of the person while they wait in hope or perhaps in vain?

Others argue that palliative care can alleviate pain and suffering, and so euthanasia is not necessary.  Again, this seems fair, but palliative care is not available universally, and tends only to be available for the last few weeks of a person’s life.  Although pain management can be effective, it also often leads to side effects such as reduced consciousness and lack of coherent thought, and incontinence.

Another very valid point is that of whether we can be sure that the person has made – or indeed is capable of making – an informed and voluntary decision. Is the person competent (ie, of sound mind), is this a wish or belief that they have held for some time, and  not just an immediate response to a situation (ie, is the decision enduring)? Does the person truly understand what all the options are? and finally, is the decision theirs and theirs alone, not coerced or imposed by others (who might, for example, seek to gain as a result of their death)? All of these factors are very important, but they can be accounted for – and most actual and proposed legislation does just that.  1. Is the decision made by a competent person?  This can be ascertained by doctors – and if the person is not able to indicate their wishes, but has made a Living Will or Advanced Care Directive, this should be considered as representing their wishes.  2. Is the decision an enduring one? Again, the evidence of a Living Will would certainly indicate that the person has thought through the issues in advance. Alternatively, a history of the patient expressing such a wish over time  to different people should also count.  Thirdly, the presence of a ‘cooling off’ period in the procedures would provide for changes of mind. 3. Is the decision voluntary?  Again, this can be ascertained by discussion with the patient over time, and without the presence of relatives etc.

In a very good summation of the whole debate, the Stanford Encyclopedia of Philosophy lays out the issue  far better than I, and I am indebted to it for much of the background of this post. I rely upon this again in listing the usual 5 conditions which  legislation tends to require be satisfied for an act of euthanasia (or assisted suicide) to be legal:

* the person must have a terminal illness

* it must be unlikely that there will be cure in the foreseeable future

* the person must be suffering intolerable pain or that the condition is “unacceptably burdensome”

* the patient must express an enduring,voluntary and competent wish to die (or to have expressed it previous to losing competence

* the person must be unable, without assistance, to commit suicide.

In conclusion, then, I believe we should support the NSW Bill, by making our state MP aware of our feelings. If the Bill becomes law, it will obligate nobody: no one is forced to decide on assisted suicide, but it does provide the legal framework for those who wish to die.  I would also suggest taking the personal step of  completing a Living Will/Advanced Care Directive, and letting friends and family and our doctor know of our wishes.

Entry filed under: Ethics. Tags: .

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