SHOULD we have the right to end our lives at a time and in a way of our own choosing, and what role might the medical profession play if we did?
I wrote recently in this blog about a philosophical argument that sees no valid ethical distinction between allowing someone to die by withdrawing medical treatment and actively killing them.
In countries like Australia, where both euthanasia and assisted suicide are illegal, medical guidelines and the law take a different view.
Earlier this month, the NSW Supreme Court ruled that a patient’s decision to refuse medical treatment could not be considered suicide, “even in the knowledge of certain death”.
The ruling related to a young man, known to the court as JS, who had quadriplegia from age 7 years and was seeking to have his mechanical ventilation turned off on his 28th birthday so that he could die.
JS had described his deteriorating medical condition as “intolerable”. Doctors said all reasonable treatment avenues had been exhausted for his autonomic dysreflexia associated with episodes of acute respiratory distress.
The local health district operating the hospital where he was an inpatient sought the court declaration to ensure staff would be acting within the law if they complied with their patient’s wishes.
The court heard that late last year, JS was the author of a letter to his doctors, nurses and other carers addressing “a very difficult and upsetting topic”, which he had thought about for some months.
“As you know, over the past two years, my body has begun to deteriorate rapidly and because of this I have also begun losing my quality of life”, the letter said.
“There have always been difficulties and compromises that I have met, but now that degeneration is outpacing the counter measures … it is my wish that the life sustaining mechanical ventilation which has kept me alive for the last nineteen years be ceased soon at an agreed time and place. Please give me the control over the care that I receive that every other patient is afforded, and I know is my right.”
Although JS wished to have the ventilator turned off on his birthday, the court heard he was prepared to delay if necessary to ensure his organs could be donated. Fairfax Media reported that he died soon after his birthday and his wish to donate his organs went ahead.
This young man was able to choose to end a life that had become intolerable to him because he was dependent on mechanical ventilation to stay alive.
Euthanasia advocates might argue he should have been able to make that decision regardless of whether he was able to breathe independently or not.
I say “might” because not all euthanasia advocates believe the same things.
I recently chaired a session at Adelaide Writers’ Week with long-time campaigner Dr Philip Nitschke, who goes further than most in arguing the case for legal change in this area.
“I believe that every rational adult should have access to a reliable, peaceful and lethal pill that one keeps at home,” he writes in his recent memoir, Damned if I Do.
As he made clear in Adelaide, he believes each individual should have the right to make this decision , without needing the approval of the medical profession or courts.
It’s a controversial view and Dr Nitschke has frequently come under attack for espousing it. He is currently facing several challenges to his medical registration and has been criticised from within and without the euthanasia movement.
Opponents of legal euthanasia often make the “slippery slope” argument. If you allow it in the most clear-cut cases — terminally ill people whose discomfort cannot be relieved, for example — you will soon find it being extended into more murkier situations.
There’s no doubt that the potential for abuse is there and that laws can have unexpected consequences, but does that justify not even attempting to find a way through?
I don’t know the answers, but I do know that if I ever have to face a similar situation to that of JS, I would want to be able to decide my fate — whether I could breathe on my own or not.
Jane McCredie is a Sydney-based science and medicine writer.