THIS euthanasia debate is our debate and we have not yet been fully engaged in it. This is our debate because we will be the ones expected to write the scripts, to administer the medications and to make the final decision within the boundaries of the law. We will be the ones to be considered lacking in compassion if we refuse a patient’s request or to feel pressurised by patients when nobody else is available. How do we feel about this?

The debate on euthanasia has troubled the medical profession, the parliament and the public for several decades. What is clear is that this is a multifaceted problem, with many shades of grey and no clear answer that serves everyone, but it engenders passion in both advocates and those opposing it.

What troubles me is that I feel that there is a presumption that euthanasia and physician-assisted suicide (PAS) are a doctor’s role – indeed, could it morally, ethically and legally be performed by any other professional? – but that somehow the question of whether we would want to play this role and how it should be regulated has not been fully discussed with us.

Legalising euthanasia/PAS

Recently a bill supporting PAS was passed in the lower house of the Victorian State Parliament. It will now go for debate in the Victorian Senate. NSW is also preparing to debate the subject.

There are several countries which have legalised voluntary euthanasia and others, including Canada and some American states, which have legalised PAS. The Netherlands was the first country to do so, introducing euthanasia in 1984 and fully legalising it in 2000 under strict guidelines, so there is extensive literature about the practice of euthanasia. In Australia, euthanasia was legalised in the Northern Territory for a short period before the bill was overturned. There have been robust and recurrent debates in many states. In South Australia alone the Death with dignity bill was rejected for the 15th time in November 2016.

Both in the media and in the Parliament we have heard highly emotional stories. These indeed invoke compassion in us all, but they do not lead to the informed debate on this subject that we need.

The bill passed in Victoria has very strict and included well formulated guidelines limiting the availability of PAS to those in severe pain — but only if over 25, not cognitively impaired and likely to die in the next 12 months. Of concern is how these conditions could be expanded over time – the slippery slope. There are ethical concerns in the Netherlands because of an increase in the number of people choosing euthanasia because of mental health issues. In 2010, two people with insufferable mental health conditions chose euthanasia. By 2017 this number had increased to 56.

What constitutes “unbearable suffering” is very subjective and making such decisions would be very complex. In other countries which have brought in euthanasia laws, while the initial laws have been tight, they have subsequently been expanded, for instance to cover patients with dementia, disability and mental illness, and also to cover children. This is what we risk if euthanasia becomes legal in Australia.

Where do Australian doctors stand?

Just as there is a diversity of opinion within the community so there is division within the medical profession.

Internationally, surveys of doctors’ attitudes to voluntary euthanasia and PAS have found that a higher percentage of the general public agree to euthanasia compared with doctors interviewed. They found a different attitude among doctors working in different specialties. Importantly those working in palliative care, perhaps at the coal face of dying, were least likely to agree. In a German survey of palliative care specialists only 5.3 % said they would be willing to carry out euthanasia and this number decreased when asked about assisting patients who were not terminally ill. One hundred and seven of 109 national medical associations affiliated with the World Medical Association have statements opposing PAS.

In a 2016 AMA survey 38% of doctors thought euthanasia should be legalised. So, there is a depth and complexity to this debate. In Australia there is an acceptance that death hastened by treatment to alleviate symptoms does not constitute euthanasia – indeed this is what is currently practiced in palliative care in the final phases of life. However, the AMA statement on euthanasia says clearly that “doctors should not be involved in interventions that have as their primary intention the ending of a person’s life”.

Where do I stand?

I know where I stand. While my head may ask some questions, there is a resounding “no” from my heart, a very strong negative reaction in my body. I believe in the sanctity of human life and that this underpins the oath I took when I first qualified. It is not something that I could do, nor do I think I should be expected to do it.

If that is the case, how could I ask another practitioner to do it?

I chose this profession to attempt to bring relief to suffering in life, not to take that life. That is a power I did not ask for, am not trained for, nor do I want.

It has been generally accepted by the public, by the government and by the profession itself that doctors are the appropriate professionals to work with patients who wish to die prematurely to relieve their pain, be it by euthanasia or by PAS, but how do we, as doctors, feel about taking on this role?

I have over the years cared for many people dying. I have clear memories of a 4-year-old dying of leukaemia, who I treated as a junior doctor, who had a good laugh at me riding my bicycle – a doctor on a bicycle, and a lady doctor at that! The little fellow laughed so merrily, and later that week died peacefully. More recently, I helped in the care of a 2-year-old with an inoperable brain tumour. He loved cows and whenever he was well enough he would say “cows” and his family would take him to the fence where he seemed to find those creatures in some way healing. Did I prescribe pain relief when it was needed? Yes. Could I have even considered euthanasia for those two little people? The very thought sends shivers down my spine.

I have been reading The secret diary of Hendrik Groen, 83 1/4 years old. He writes of life in an aged care facility in the Netherlands. While written with a wry humour, it also touches on the indignities of ageing. In the book, he mentions euthanasia several times and, at one point, he mentions a local clinic where people can go if their GP is “uncooperative”. Would I, under those circumstances, be an uncooperative GP? Such a thought made me grateful that I have never had to explain my own beliefs to my patients, but have been simply been able to say it is illegal. In our roles as doctors, there are other times when we may be considered uncooperative, but few of these, apart from pregnancy termination, invite a moral and ethical stance.

Prioritising adequately funded and more effective palliative care

The proponents of euthanasia would say that those opposing it are disrespectful of patients’ autonomy and dignity, and that choosing their way of dying is a basic human right. They would say that to deny this right is lacking in compassion because we are asking that patients continue to suffer in pain.

As one of many who have been witness to numerous deaths from medical causes, some of those prolonged, some accompanied by severe pain and many by loss of autonomy, I still feel there are other ways to bring dignity into dying, and euthanasia is not the way.

One of the other important ethical problems facing medicine currently is the so-called “futile treatment”, where life is prolonged for inappropriate reasons. There are times as doctors when we share in hard decisions to withdraw care and allow the dying nature has decreed. Debates on euthanasia and ways of reducing futile treatment may both have their answers in effective, accessible palliative care.

The science of palliative care increasingly understands ways to effectively treat pain and other symptoms associated with dying, which in the past have had the potential to cause untold suffering and generate fear for both the patient and their carers.

Pain control in palliative care is not euthanasia. It aims to improve the quality of life experienced in the process of dying and to help patients to retain their dignity. In my experience, doctors are not afraid to give increasing levels of pain relief or sedation to reduce suffering. Doctors are grateful if there has been discussion in the form of advanced care directives that can assist in their decision making, but these need to be more effective, universal and readily accessed, perhaps through a central, controlled and confidential data bank. Priority needs to be given to researching and funding effective symptom control for people who are dying, so that some of the fear may be removed, making euthanasia less needed.

Can dying be a time of healing?

Dying can bring healing even when pain and other symptoms are overwhelming. Families may come together, forgiveness may be given, solace may be found in caring. The patient may be able to connect with the essence of themselves in ways that they may otherwise not have found, and may experience love such as they have never felt.

People professionally caring for the dying often have the capacity to bring true compassion when there are no others to bring it, and it is of utmost importance that they be given the time and space to do so. I have also been involved in care for several patients where a whole community has come together to care for the dying. Sometimes this has been formalised, sometimes it has been spontaneous, as in a group who knew each other through Alcoholics Anonymous. In all these situations, the giving and receiving of love was beautiful to experience and healing for the carer and patient alike.

I found this piece written by a woman who had died from a sarcoma, had been in a lot of pain and reacted badly to chemotherapy. Her husband wished it to be read by those debating euthanasia in the British parliament.

“Contemplating mortality is not about being prepared to die, it is about being prepared to live. And that is what I am doing now, more freely and more fully than I have since childhood. The cancer has not made life more precious – that would make it seem like something fragile to lock away in the cupboard. No, it has made it more delicious …”

In bringing compassion into requests for euthanasia, first and foremost, we need to take time to listen. There is a strong association between depression and requests for euthanasia, as indeed there is between chronic disease and depression. Listening fully in a compassionate and non-judgmental way will help to bring clarity to the reasons behind the euthanasia request. Although the public tends to think of such requests as being in response to intolerable pain or fear of such pain, in fact studies in Oregon showed that the most common reason behind such a request was loss of the ability to do the things they enjoyed and loss of autonomy. In many ways it is brought by fear of the unknown, though in my experience, it is dying that people fear and not death itself. Taking time to explain how the patient may be helped and to answer questions as truthfully as possible may allay fears. Interestingly the JAMA article says that despite legislation the take up of euthanasia remains relatively low.

The suffering of those with mental health issues cannot and should not be underestimated. The suffering of those who feel lonely and isolated should not be underestimated. The suffering of carers watching their beloved partners, children and family in their illness should not be underestimated. Could the answer to these problems truthfully be in euthanasia, or is it not time that we as a profession and as a society find more compassionate solutions?

While I fully respect other physicians’ beliefs, for me, it is simple – the answer to the question “should euthanasia be legalised” is a resounding “no”. I personally cannot do this because I do not feel that it is right, and I do not believe that I should be asked as a doctor to do it. It is not that I lack compassion; rather that I believe that there are more loving ways to support the dying.

Dr Jane Barker has been practicing as a GP in northern NSW for 30 years. She is a GP academic at the University Centre for Rural Health based in Lismore and a GP at the local Aboriginal Medical Service. Her interest in global health problems comes from growing up in Zambia and later working in Papua New Guinea.

 

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Poll

I am in favour of euthanasia/PAS under strict conditions
  • Strongly disagree (54%, 196 Votes)
  • Strongly agree (25%, 89 Votes)
  • Disagree (12%, 42 Votes)
  • Agree (7%, 26 Votes)
  • Neutral (2%, 7 Votes)

Total Voters: 360

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43 thoughts on “Euthanasia: an emphatic no from this GP

  1. Ron Pirola says:

    We doctors need to remind the public that euthanasia involves giving a drug with the intention of causing death and that if the patient does not die, the dose increased. Palliative care involves giving a drug until pain/distress is relieved, even when there is a risk that this will also result in death; if the pain/distress is relieved, no more is given.

  2. Anonymous says:

    Thank you Jane Barker, for such a great explanation.

  3. Anonymous says:

    watching someone die can also be an experience of great fracturing of relationships, it’s not always ‘healing’ and can be incredibly painful and difficult. palliative care aims to relieve symptoms but doesn’t always do this well. The emotional symptoms of dying can be excruciating for the patient and not recognizing these as requiring care can be a huge mistake. Palliative care done poorly is cruel and inhumane, it’s not necessarily neglectful and therefore the consequences are not deterrent enough to change systems. Offering euthanasia can for some (not all) offer a good death, the end result is the same, it’s the journey that can be improved. like all specialisms, palliative care is not for all Dr’s and nor should euthanasia be an expectation of all GPs.

  4. Anonymous says:

    How do we interpret the (reasonably common) comment by doctors that they would like the option of PAS for themselves, but do not agree with and/or would not be involved in it for others? It is observed in other countries where PAS is available that some patients appear to benefit from having the drugs available in their possession, to use at their discretion, but in fact die from their disease without using these. It would seem that ‘having control’ is important to many.

  5. Dr Robert Marr says:

    I have been a GP for over 40 years and strongly support the right of terminally ill people to have the legal right to chose Voluntary assisted dying(VAD) if their suffering becomes too much for them.
    I accept Jane Barker has a right to her beliefs but she has no right to deny terminally ill people their right to chose VAD.
    As Dr Barker states even in the AMA survey 38% of doctors support the legalisation of VAD and in other surveys up to 60 % of doctors support VAD .Many doctors rightly see VAD as a part of palliative care.
    As a member of the AMA I am appalled that the MJA has only published anti VAD articles, at this important time ,with no balancing article from doctors who support VAD.Whenever such controversial issues are being debated in parliament and in the public the least a so called scientific medical magazine should do is publish both sides of the argument at the same time to present both sides of the argument.

  6. Paul Jenkinson says:

    I think the Oregon study referred to is so important to consider in this debate.By far,the reason that most people chose to suicide was because of their emotional distress about what might happen in the future.
    Only a very small minority chose suicide for physical symptoms.
    Are we as a caring profession not listening and doing enough to relieve this existential suffering?
    Thank you Dr Barker for your article.

  7. Peter Bradley says:

    Why do those who oppose this evolution in current culture, which is surely just that, always feel they not only don’t want to be involved, but want to be able to prevent others. Why not just say no, I don’t feel comfortable with this step, and would not be involved, but I respect the rights of others who may not believe as I do..?
    It’s basically the same type of debate as that currently the subject on the survey re same sex marriage. If you are straight, no-one is going to expect you to marry or officiate at, the marriage of someone of same sex.

    This issue which will also not go away, surely falls into the same camp. Basically it is an idea whose time has come. Why? Because the majority in our current society now want it to be so. It is but an evolution down the pathway of the right of the individual to make this type of decision as to their wish to die, something that is sanctioned, instead of looked askance at, once being illegal, like suicide used to be..?

    Right now, anyone can kill themselves, but it is usually violent, messy, or extremely traumatic to others involved. And many, (the ones this debate is most relevant to actually), reach the point of wanting to depart in a state where unassisted suicide is no longer an option for them. They need help..! Isn’t that still the most common reason a person gives for doing medicine, including the author of the above article – to help others..? This makes it possible for someone who so wishes to manage it in a more civilised way, and at a time, place, and with those present of their choosing. Surely any civilisation that calls itself that, should accept the rightness of this request..?

  8. Paul Jenkinson says:

    Here is the ref to Oregon Study

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2265314/

  9. Anonymous says:

    I used to be adamantly opposed to euthanasia and voluntary assisted dying but as a doctor who is not yet considered “old” but who has been diagnosed with a condition that is highly likely to result in my earlier than anticipated demise under less than pleasant conditions, I now support euthanasia and voluntary assisted dying. It’s amazing how one’s own experience and circumstances change an opinion (or perhaps it isn’t that strange).
    Doctors and nurses mean well but many remain hesitant to give adequate doses of pain-relieving medicine just in case that is perceived as hastening the dying process and I suspect the potential legal ramifications. I observed that very hesitation a year ago as I watched my mother die while receiving “palliative care”. She was clearly still in pain and despite top-ups of medication, I do not believe enough was done to keep her comfortable. Had the decision been left up to me, I would have hastened the process.
    I struggle to understand how a society that allows animals to be humanely euthanised cannot offer the same dignity to ourselves, of course under strict conditions. When the time comes I will make sure I have my dose of Nembutal handy just in case-“Anonymous” above is correct-it is about having some element of control over the circumstances of dying. And no, I am not depressed (quite the opposite actually, as enjoying my life and current good health fully) and also have a loving, supportive family.

  10. Peter Bradley says:

    Interestingly Paul, many folk, yourself included, quote this study (and other similar ones), as support for opposing this move, yet I find exactly the opposite, and refer you to my closing paragraph above. It has always been my contention that this is why palliative care has severe limitations for many. It is not the issue of maintaining relief from just pain, but much more to do with loss of all quality of life.

    Summed up well in the ‘results’ part of that survey, which for some reason won’t allow a copy/paste of the relevant part, so those interested should look it up. It essentially found that the strongest concerns of those requesting assisted death with dignity were those of loss of quality of life, becoming totally dependent, with associated loss of dignity, and feeling they would be too much of a burden all round, to the point – which could well be summed up, and this is the really important bit – as that they no longer found any joy in remaining alive whatsoever, and wanted out. It is the height of arrogance for another to say, “ah well, we know more about the quality of life than you, so we say you should just hang in there”. Which is what those who oppose this right are effectively saying in my view.

  11. Andrew Watkins says:

    ” I cannot do this because I feel that it is not right ”

    Is this our rôle as doctors? Few of us are formally trained in ethics and are at best lay people in matters of morality, so why do our moral views trump those of our patients?

    Surely our rôle is to hold a space in which whatever knowledge and wisdom we may have is brought to bear in helping the ones taking the consequences of the decisions ( patients ) to make the best of their own imperfect lives in their own terms. What will inevitably follow from any honest process is that some patients will reach a decision with which I may be morally uncomfortable. If I then invoke the right to block the decision, the whole process has been a farce, as the outcome has been predetermined by my views.

    We doctors have a long and ugly history of behaving in this way, one only has to think of the ongoing abortion and the earlier contraception debates ad the harm done by many to women making such decisions.

    I would respectfully suggest that any doctor who has not done something with which they feel morally uncomfortable in their career is either practising in a particularly boring area, not paying attention or is a dangerous zealot. I certainly plead guilty to having participated in decisions with which I disagreed, in many cases because they were in that space in which no knowledge of mine could trump that of the patient or parent. This is what we sign up for – to hep other people with their lives in their own terms and to bear the moral distress which we will from time to time encounter.

  12. Anonymous says:

    “Palliative care involves giving a drug until pain/distress is relieved” Comment: yes indeed all pain goes away only when you are dead. What is the difference then between euthanasia and palliative care. Doctors please explain to the public.
    Andrew’s government can not decide on our lives with out clear mandate from public to do so. A referendum should be on this issue.
    There are clear indications that medical lawyer and board of medical team should be involved in implementing the rules not the MPs.

  13. Graeme Burger says:

    “Right to die” is promoted as the ultimate autonomy, however, we need to make clear that whilst the terminal phase of life is tragic and difficult it also a very precious time of life.
    To anchor the patient and relatives in the moment and make the most of each moment until the last breath expires is the challenge of Palliative care.
    Should symptoms be unendurable then palliative sedation and allowing the terminally ill to sleep for the last days of their life is entirely different and is always extremely valuable time for relatives.
    To deny the value and meaning of life even in its terminal stages is to dehumanise us all.

  14. Paul Jenkinson says:

    What you describeDr Bradley is the life of many thousands of disabled in our community.
    How should they value their life?

  15. MStewart says:

    Euthanasia: an empathetic yes from this GP

    To allow people to die with dignity, with the people they love surrounding them and with lack of physical or psychological distress is the basis tenet of palliative care. In the right circumstances, euthanasia is a subset of this provision of palliative and end of life care.

    Lack of provision of euthanasia forces terminally ill patient to hide their choice to “say goodbye early” in order to protect their families from prosecution.

    Having to make that decision autonomously prevents the peaceful and prepared farewells that we know helps the patient and their family in palliative care; causes distress to the family in “not knowing”; triggers police enquiries causing further distress to the grieving relatives. We can only presume that making the choice on their own is lonely and onerous. I would rather that the patient and their family are supported in a non judgmental, legal and medical supported way through this instead.

    I believe that it is our ethical duty as doctors to act in our patients best interest to provide the best quality of end-of-life care as chosen by our patients, and if that is a planned “saying goodbye early”, then we should respect that wish.

  16. Hamish Foster says:

    Death is an inevitable part of life for all of us.

    As physicians we intervene in the course of our patients’ diseases for their benefit. Intervening in the dying process to benefit patients is not new.

    When a dying patient suffering intractable and intolerable pain and distress requests medical assistance to achieve a good/tolerable death, Physician Assisted Suicide (PAS) should be an option available to the patient without criminalising either the patient or physician.

    This is why the Victorian legislation on PAS is so important and long overdue in any humane society.

    Those who have religious, emotional, social or institutional objections to PAS are not compelled to become involved.

    On the other hand, these individuals and institutions should not impose their views on those who are in desperate need and may wish to have access to physician assistance with their death.

  17. Anonymous says:

    My diagnosis is pleomorphic sarcoma – pain 24/7; my body scared and ulgy from cancer and reconstructive surgeries and radiotherapies; my stamina and energy – a fight every day.
    On the wall at the foot of my hospital bed was a whiteboard with space at the top for patients to write a note. I picked up the marker and smiling wrote… little did I know what was to come. I wrote: “Get to know me. Keep me alive. Make me well”. Then CPR; two near-death experiences when I had a severe anaphylactic reaction to one of the anaesthetics – Rocuronium. Since then metastis.
    Inside, I feel as a teenager and 20 year old – of dreams yet to be fulfilled.
    I stir each day and do what I can. I want the years, months, days and the moments ahead.
    I am alive and there’s yet much to be done – ‘me’, yes ‘me’, yes, regardless of the beast within whose sole purpose is to kill me.
    Now I write: “”Get to know me. Keep me alive. I am a human being. I am not useless. I matter, each breathe I take matters. I want to live.”
    I am indeed blessed.

  18. Carolynne Bourne says:

    I just posed a comment beginning, “My diagnosis is pleomorphic sarcoma… ”
    and what my name noted.

  19. Paul Jenkinson says:

    Thank you Carolynne and I’m sure all the doctors who read your post wish you the best life you can have for the rest of your life.You are indomitable.

  20. Anne Malatt says:

    This is a very delicate subject which must be handled with the utmost sensitivity. It is difficult to say what is right or wrong here, and we can only go by what we feel to be true in our own hearts. I am thankfully not working in a specialty where I will be confronted with needing to make this decision (which is perhaps one of the reasons why I chose it!) and I don’t presume to know what I would want if I were a terminally ill patient, or their treating doctor.
    What I do know is that the pain that people suffer at the end of life is more than physical, and that palliative care needs to address the emotional and spiritual aspects of the dying process…the regrets, the said and unsaid words, the time not spent with loved ones, the fear of what is to come…life, in all its dimensions, before we can say that palliative care has failed.
    While there is life, there is life… and who knows what healing may come from whatever happens in those last moments, hours and days of life… who are we to cut it short?
    I love what Carolynne Bourne has shared here and what Jane shared in the quote from a dying patient… it is so important that we don’t write people off just because we would not want to be in their situation… and equally important that we do whatever we can to relieve their suffering, on every level.
    If palliative care physicians are largely opposed to euthanasia, what is their reasoning?

  21. Julie says:

    Thoughtful views, thank you everyone who has commented. I’m still in the process of deciding whether or not I can be for euthanasia. And whether or not I could intentionally cause someone’s death. I’d certainly be doing everything I could to relieve fear, depression and pain in the first instance. And perhaps we could wait a little until we can get good quality palliative care for everyone who needs it, when they need it. It can be horribly hard to get a bed sometimes. When everyone’s body and mind are looked after then we’ll know if we still need plan B.

  22. Rabid Dog says:

    An emphatic YES from this Doctor

  23. Dr Greg Mewett says:

    I was a GP (with a special interest in palliative care) for 22 years before I re-trained as a specialist palliative care physician 11 years ago. I feel as qualified as most to comment on this issue and have tried, over many years, to take a dispassionate view of this emotional and complex issue. My views have changed significantly as I have become even more experienced in helping patients and families in their death and dying struggles, and have read widely and deeply on these important issues.
    With all due respect to Dr Barker, who is clearly a caring, compassionate GP, her opinion piece is devalued somewhat by a number of factual errors and inconsistencies. This, I find, is not uncommon in various contributions to the debate about Voluntary Assistance in Dying (VAD).

    Firstly, Canada has legalised voluntary euthanasia as part of their Medical Assistance in Dying legislation (2016).

    Secondly, The Dutch Euthanasia Act was introduced in 2002. And yes, there is a wealth of robust, peer-reviewed literature on those practices in the Benelux countries which is very reassuring despite the inaccuracies and even scaremongering that arises from selective reading of the data from those jurisdictions. The cultural context, particularly around autonomy, death & dying in the Dutch-speaking regions of Europe is more liberal & vastly different from our own and the extensions of the euthanasia legislation is merely a reflection of the original intentions of the laws when first framed. This is quite different to the intended legislation here in Victoria.

    Thirdly, the legislation if enacted will apply to competent people over 18 , not 25!

    Fourthly, the legislation does not mention “pain”. The eligibility clearly states that the person must ” be diagnosed with an incurable disease, illness or medical condition, that is advanced, progressive and will cause death; and is expected to cause death within weeks or months, but no longer than 12 months; and is causing suffering that cannot be relieved in a manner the person deems tolerable.”

    Fifthly, Dr Barker and many others including the AMA, clearly misunderstand the palliative care approach at the end of life. There is no evidence from anywhere in the world that the appropriate titration of analgesics and/or sedatives to control symptoms of suffering in any way hastens death. It is one of the great furphies of modern medicine and its presence in this debate is naïve and unnecessary. Some non-palliative care doctors might believe that is what they are doing but they are clearly not practising modern palliative medicine. Dr Barker seems to contradict herself when she later states “‘pain control in palliative care is not euthanasia”.

    Her heart-wrenching examples of young children dying of terminal disease are clearly totally irrelevant to, and have no place in, the current argument. This is not about children’s death!

    Dr Barker should surely be aware that she will be able to conscientiously object to involvement in legalised VAD should it be legalised. Her care and compassion as a doctor will not cease and indeed may need to be enhanced.

    She will get no argument from me about improved palliative care funding. Also her “dying can be a time of healing” observations are true for many people – but not all. There will always be a small percentage of people who cannot, or will not, be helped by excellent palliative care and who clearly have had enough of suffering. These people, I believe, deserve a legal option to end their life (and suffering) at a time and manner of their choosing.

    I respect people’s variety of views on this issue, especially if they are honest about their ethical/religious/philosophical stance of “the sanctity of life”. We can then agree to disagree. I do object, however, when these basic life beliefs are then dressed up as rational arguments intended to impose those beliefs on society in general.

    .

  24. Peter Bradley says:

    Replying specifically to Paul Jenkinson, where he says…
    What you describeDr Bradley is the life of many thousands of disabled in our community.
    How should they value their life?

    And to Carolynne Bourne, especially, where she states…
    “My diagnosis is pleomorphic sarcoma – pain 24/7; my body scared and ulgy from cancer and reconstructive surgeries and radiotherapies; my stamina and energy – a fight every day”….. and at the end….
    .Now I write: “”Get to know me. Keep me alive. I am a human being. I am not useless. I matter, each breathe I take matters. I want to live.”

    Because that last from Carolynne beautifully answers Paul’s query, where he asks, “how should they value their life?”

    That dear people is the answer. It is how the person (sufferer?) values their life that matters. It is not up to anyone else to make that call, which is why it is so right, that the person involved makes it. If they still feel the life they have is still worth waking up to each day – as Carolynne says – then so be it..!

    However, if the person involved does not feel that their existence contains any reason to live whatsoever, and that they would prefer to not linger, who are we to insist that they do, as if we can possibly know what they are going through, or what they feel..? And I am not just referring to pain, for heaven’s sake, but some sort of reward for staying alive, that makes it worthwhile to wake up in the morning. That surely is the ‘thing’ here.

  25. Horst Herb says:

    In my opinion, PAS is like TOP. If you don’t feel comfortable doing it, don’t do it. But do not force others to subscribe to your personal belief system or feelings.

    Frankly, I am sick of listening to people, especially health professionals, believing they have the right to deny people a dignified death of their choosing at the time of their choice.

    When we have thought we have left behind the artificial dichotomy of “physical vs mental” illness it rears its ugly head again in the context of PAS. What part of “unbearable suffering” do those crusaders against PAS not understand? Of course, it is not those who arrogantly postulate categorically who suffer. I have seen palliative care work marvels in some, and fail abysmally in others. In most domains of medicine we left behind the brush that tarred them all and are trying hard to customize our approaches according to a patient’s preferences and priorities – why not do the same when regarding the end of life?

    Oh, the hypocrisy. Those apostles of the sanctity of life waste no thoughts on spending tens of thousands of dollars if not more on futile end of life care, when mere cents could save an infant’s life in a different corner of the globe. If you can spend $5 on your latte while accepting that in some corner of the world a child will die for lack of the same amount, don’t pretend that you value life so absolutely that you cannot bring yourself to put somebody out of agony by a method of their choice! Don’t you even dare bringing pseudo-ethical arguments into the debate before you actually life what you so sanctimoniously preach.

  26. Dr. Kevin B. Orr, FRACS etc says:

    I am dying – but no pain. Just severe and progressive breathlessness for which there is said to be no cure. It is called right heart failure and is due to pulmonary arterial hypertension. Accompanying this is auricular fibrillation. I need oxygen much of the time and drugs to slow my heart rate. I use a walker at home and a wheelchair for the occasional outing.

  27. Anonymous says:

    I am dying – but no pain. Just severe and progressive breathlessness for which there is said to be no cure. It is called right heart failure and is due to pulmonary arterial hypertension. Accompanying this is auricular fibrillation. I need oxygen much of the time and drugs to slow my heart rate. I use a walker at home and a wheelchair for the occasional outing.
    This is to show that pain is not the only symptom for which euthanasia could be indicated.
    KBO

  28. Anonymous says:

    Let us respect our colleague’s decision as I am sure and hope she does respect others’ decision as well. Let us not impose on others. If you opted to be involved in assisted dying , so be it. If you don’t want to , same as well. This is one of those topics that I believe if best left to the individual to decide. Whether you want your side known by everyone, that is your choice or you can remain silent and keep your decision to yourself.

  29. Paul Jenkinson says:

    Autonomy is important but no more important than justice for our community.Autonomy does not trump justice.
    The sole purpose of government is to maintain the health and happiness of our community.That is why we have a constitution (just ask our dual citizen parliamentarians) and consequent legislature.
    I,and many others,(eg 107 out of 109 registered medical associations)believe that allowing doctors (why doctors if this is a totally autonomous choice?)the right to decide who they can assist suicide/kill at a person’s request is a fundamental step to chaos and tragedy.

    The “selective reading of the data from those jurisdictions“ (the Benelux countries) that Dr Mewett worries about are real people -not data.

  30. Anonymous says:

    Legislate for PAS?
    Speaking as an experienced medical practitioner, I’d rather give up medicine than perform this act of PAS upon people.
    I can have a little sign made to place at Reception; “Dr X does not participate in PAS”. Then people who want this service can make an informed choice to see another doctor instead.
    Call me a conscientious objector, call me anything you like, I still won’t perform the act of PAS.

  31. Carolynne Bourne says:

    Further to my comments earlier this week – a ‘Reality Check’ – then read the following two papers.

    1. 17 Sub244_Bourne and Associates Replacement.pdf
    Paper to the Parliament of Australia Select Senate Committee’s ‘Funding for Research into Cancers with Low Survival Rates’.

    2. end of life choices • Submission_965_-_Bourne_and_Associates.pdf
    Paper to the Parliament of Victoria’s call for submissions into the Inquiry into End of Life Choices, 2015.

    NOTE: I do not support euthanasia.

  32. Paul Jenkinson says:

    Thank you again Carolynne.

  33. Sue Ieraci says:

    As others have pointed out, the change in legislation will be to make VAD, under specific conditions, legal – not compulsory. Much like TOP, individuals who conscientiously object are not required to perform the procedure. Like Same Sex Marriage – much of the community wants it to be possible for those who desire it, even if they don’t, personally.

    I appreciate the insights of Greg Mewett, who points out that, even in the best of worlds, palliative care may not relieve an individual’s extreme suffering – be it physical or existential.

  34. Anonymous says:

    I do not understand the binary positions in this debate. In November, 2016, the Supreme Court found for our colleague, Dr Rodney Syme and recognised that voluntary assisted dying was an integral part of good palliative care. Dr Syme has made his practice explicit and public whereas many palliative care physicians hide their practice of deep terminal sedation which is clearly a form of assisted dying.

    My own position is that the inability to exercise the right to choose the manner and time of my death cannot be palliated.

  35. David Pan says:

    ” I believe in the sanctity of human life and that this underpins the oath I took when I first qualified. It is not something that I could do, nor do I think I should be expected to do it.

    If that is the case, how could I ask another practitioner to do it?”

    No one is asking you to do it. If you don’t want to, then don’t.
    No one is asking you to ask another doctor to do it. What kind of odd straw man is that ?
    I’m willing to do it.
    I don’t need you to ask me to do it.
    I also don’t want you to stop me.
    Can we not allow the patient to chose what they want ?
    Can you not allow me to do what I want ?
    Can we not limit the effect of your personal decisions to just yourself ?

  36. Dr Greg Mewett says:

    In response to Anonymous No 34, as a palliative care physician who supports the VAD legislation but does not practice assisted dying as defined in the Bill, I totally reject the notion that so called “deep terminal sedation” is somehow “euthanasia by stealth”. If it is being used anywhere for the purpose of hastening death then it is certainly not being done by palliative care specialists.

    Palliative sedation to various degrees is occasionally required near the end of a patient’s life to relieve refractory, severe symptoms that have no other solutions. This is usually for agitated delirium (called “terminal restlessness” by some) or profound breathlessness and is merely good symptom management.

    There is actually no evidence that it shortens life if the drug dosages are used proportional to the symptoms, but does make the final few hours or days more bearable for all concerned. It does not require patient consent (the patient is almost always unable to be involved in decision making by this stage) although the relatives/family are always consulted.

    I urge people to try to understand the fundamental differences between Voluntary Assisted Dying and palliative care as it is currently practiced in this country. The intent is different, the techniques used are different but the imperative to relieve extreme suffering is common to both.

  37. John Lamb says:

    In Australia we have had widespread public support for a variety of suicide prevention programs, in an attempt to stem the tragic suicides which are endemic here, particularly in rural areas, and in certain professions, including my own profession of general practice. Several colleagues known to me have taken their own lives in recent years.
    The concept of physician assisted suicide implies a distinction between people who have intolerable suffering that is likely to continue, and those with intolerable suffering that is temporary or amenable to treatment.
    We are expected to facilitate the demise of the first group, and to prevent suicide in the second group.
    In reality suffering does not fall neatly into these two categories, and the definitions are arbitrary and fluid.

  38. Anonymous says:

    I was troubled by this from the opening line. This is not just ‘our’ debate because we are doctors. This is our patients’ debate. These are their lives, and these are their deaths. In an era of increasing patient-centredness, making this option unavailable for those who meet the criteria and who want it just because you personally don’t agree with it is, in my mind, completely unethical. We are not nor should we be the gatekeepers for something that may provide comfort, peace of mind and a sense of control in someone’s final days. We however can be the providers if we choose to be. I 100% chose yes. You can opt out, but don’t impose your views on others and deny them their choice.

  39. Stu says:

    Her article outlining the issue is very balanced. Her argument, however, commits the 3 most common fallacies in this debate

    1) Slippery slope fallacy. No. Any change in the restriction on who is eligible for euthanasia must be debated on its own merits.

    2) Red herring about palliative care delivery. No one disagrees with this. But it is not pertinent to those who chose a different route to end of life.

    3) The most egregious and erroneous fallacy, and definitely the most non medical and detached from actual reality – the conflation and imposition of her own view of what death ‘ought to be like’ based on her own ideals and a few cherry picked examples. ‘Dignity in dying’ and a lot of flowery movie of the week type language around what ever layman dreams of their ‘good death’ being like.

    No. No. No. As a doctor, you have no business foisting your platitudes onto a suffering, dying person. Far too many people undergo absolutely horrid prolonged deaths from cancer, MND, dementia etc and I sure as hell am going to support a patient’s right to autonomy over when they choose to pass from this life.

  40. Anonymous says:

    OK, so euthanasia/PAS gets legalised, let us get straight to the practicalities.
    A billing model needs to be devised.
    Assuming on the basis of current Medicare rebate trends, that a Medicare item number would be allocated for this service and that it would cover <50% of the actual cost of providing the service, either the cost will be absorbed by the private medical practice, or a co-payment will need to be be requested from the patient or their estate.
    As doctors I am sure that asking a PAS patient to pay a co-payment will be an ethical challenge to most of us, but private medical practice is not a charity and without keeping 'in the black' it will go out of business.
    For example, to euthanase a horse a local vet charges $40 travelling expenses + $260 for the clinical examination and the euthanasia drugs.

  41. JessB says:

    and GPs dont even have an MBS item for palliative care…

  42. Bruni Brewin says:

    Anonymous 40 considers practicalities, which is something it would be thought, we all should have to consider in our every day living. But, it is a fact of life that many people in our society, don’t. It is a reality, that many dying people, have no estate nor the funds to pay for this service. For some it may be that they have lived off society most of their lives. For others, they have worked hard and paid taxes for a large part of their lives, but through misfortune have lost what they had hoped would make a comfortable retirement and something to leave their children to make their lives easier. (Caused by happenings outside of their control.)

    Many years ago the Government took money from taxes for the extra need to cater for assistance of the dying. The reasoning for this at the time, was to put aside money that would be needed when the ‘Baby Boomers’ advanced in age and would need more medical care. I won’t go into the debate of where that money went to, or indeed if the deduction was intended for that purpose or a political ploy to take more money from the masses. I would have hoped that these deductions had been invested to accumulate funds to include care for others with various disabilities.

    But, I do believe that the government should pay for this, and it should not encumber as an extra charge to a doctors practice. No. I am not a doctor. I am also in the fortunate position that I am healthy and well despite advancing age. And yes, control over my life decision, whether to end my life or not when it becomes unbearable should be mine. You are keeping me alive for your sake, your beliefs, not mine – With the legislation proposed, I am going to die in a matter of months anyhow, am I not?

    Just as I wish to be the determinator that I should legally have the right to end my life, I think you should be equally be able to make your own decision as a doctor whether to abstain from providing this care.

    The patient desiring this service, with the legislation proposed – would the cost of this service not be offset by the considerable saving from what could be a lengthy cost of palliative care?

  43. Randal Williams says:

    I am pleased the AMA continues to oppose any involvement in legalised euthanasia. It is a slippery slope ripe for abuse and mistake. It also places doctors in the iniquitous position of having to determine eligibility and to assist in the processes. My advice is keep the lawyers and politicians out of it– they have been trying to come up with legislation that satisfies all requirements and safeguards for twenty years, without success. Doctors and nurses know how to manage terminal illness and we should leave it there. There is a fine line between administering increasing doses of narcotics/sedatives to maintain comfort, knowing it will hasten death, and actually administering lethal doses – but it is an important fine line that we cross at our profession’s peril.

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