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The case against the “dying with dignity” bill

Christian healthcare charity Hammondcare is campaigning against proposed laws to legalise voluntary euthanasia.

A senate inquiry has tabled a report in federal parliament this week, colloquially named the ‘Dying with Dignity’ Exposure Draft Bill 2014. The senate committee received over 4,700 submissions from members of the public. Of those submissions (which asked for indications ‘yes’ or ‘no’ for support of the Bill), 54 per cent expressed support, 44.7 per cent opposed. The remaining were undecided.

A further 700 submissions were invited from academics, medical professionals and organisations. In its submission, Hammondcare, a major palliative care service provider in NSW, says its primary objection to the Bill is the potential “to undermine drastically the respect for and quality of life for people in vulnerable circumstances.”

Hammondcare’s lead academic for palliative care, Professor Rod MacLeod says we can judge a society by the way it cares for its most sick and vulnerable.

This attempt to codify a ‘right to die’ or a ‘right to be assisted to end one’s life’ represents a significant deviation from current laws both in Australia and internationally.

“If we’re saying let’s just put these people on one side and allow them to be killed, I fear for the development of that society,” said Professor MacLeod.

The ‘Dying with Dignity’ exposure draft was prepared by Greens senator Richard Di Natale and purports to recognise the right of a mentally competent adult “suffering intolerably” from a terminal illness to request a doctor to provide medical services that allows that person to end their lives. The Bill would also grant the medical practitioner immunity from liability in providing such services.

But Professor MacLeod, who has worked in clinical practice for 37 years and spent 25 years exclusively in palliative care, says in a society engulfed in a rights debate, no legislation to his knowledge has ever said that we have a right to die.

“This attempt to codify a ‘right to die’ or a ‘right to be assisted to end one’s life’ represents a significant deviation from current laws both in Australia and internationally,” he writes in Hammondcare’s inquiry submission.

Recent news about the death of 29 year old Brittany Maynard in the US, a euthanasia campaigner diagnosed with terminal cancer who chose to end her own life on 1 November has added flame to the Australian debate. Maynard died after taking lethal drugs prescribed by her doctor. She posted a video on YouTube explaining her decision to die, which received worldwide attention.

Professor MacLeod says Maynard’s experience focused attention on the fact that it’s not just old people seeking help to end their lives.

“As a society, we generally get very upset when young people commit suicide,” he said. “Now that a young person has committed suicide, but she had an advanced malignancy, that all of a sudden seems to change things. But I still think it’s a tragedy.”

Professor MacLeod concedes that he cannot prevent a person from committing suicide. But when asking a doctor to assist in taking someone’s life, things get much more complicated.

“I think that’s a sad indictment of the society that we live in, that we’re not prepared or able to make those sick and vulnerable people feel they belong to the society we live in.”

“Medicine is based on a commitment to trust between patient and doctor. If a patient for whom I was caring thought that I may be the one to end their life, trust would be harder to gain and maintain,” he said. It also contradicts what palliative care is all about.

“One of the guiding principles of palliative care is that we neither hasten nor postpone death… the idea of hastening somebody’s death really runs contrary to everything that palliative care stands for,” says Professor MacLeod.

He believes that more can be done to ensure the most sick in our community are valued and supported.

“I think the public perception of palliative care is that we deal with death, rather than life. People are fearful. We see them come along in a very vulnerable, fragile situation. And it’s not uncommon for people in the beginning to say ‘Look, Doc, I know you’ve got something… can’t you just finish it off now?’

“But what they’re saying is, ‘I don’t want to live like this.’ If we listen to their fears, their anxieties and physical complaints, and help them work through that, then the desire for death goes away.”

Professor MacLeod says in the 25 years he has worked in palliative care, he has never had a patient persistently ask to die.

“We can accompany people in this time of great need and help them to feel less frightened. We can’t take away the fear altogether. We can’t take away anxiety or anguish, but we can do our very best not to abandon them and to support them as well as we can.”

In Hammondcare’s inquiry submission, the organisation says that “in almost all cases, doctors can provide effective pain relief to people with terminal illnesses”. But what about the cases where that’s not possible?

Professor MacLeod believes it is possible to change the perception of pain. Some people’s pain will never go away. But he says that’s the case even with people who aren’t suffering a terminal illness.

“The pain of separation, of leaving your family can manifest itself as a physical pain. I can’t [as a doctor] necessarily remove that… that’s the pain we carry as human beings. I don’t think that shortening somebody’s life is a way to deal with that.”

The focus on pain also unhelpfully simplifies a complex issue. Terminally ill patients experience many other symptoms that prove a lot more challenging than pain. Like breathlessness, fatigue, persisting nausea.

“The idea that pain is the only symptom that’s hard to relieve is misleading. We try to minimise all the symptoms. Does that mean to say that just because medicine can’t get rid of every symptom that people should die? No, I don’t think it does.”

Hammondcare believes the Bill also leaves the most vulnerable open to abuse. It argues that permitted assisted suicide will put “significant emotional and psychological pressure” on many older people and those with severe disabilities to end their lives. It cites research that suggests a quarter of older people who are dependent on carers already report abuse.

“If you’re living in a world where you’re being abused… or when you already feel a burden on the system, on society and on your family… it would be easy to opt to die,” says Professor MacLeod.

“I think that’s a sad indictment of the society that we live in, that we’re not prepared or able to make those sick and vulnerable people feel they belong to the society we live in.”