Honesty First Victim
The following article first appeared in The Advertiser of
5 July 1995.
Debate on a proposed law to allow voluntary euthanasia will resume
in State Parliament this month. DR ERIC GARGETT, vice-president of the
South Australian Voluntary Euthanasia Society, examines the issue.
Truth has been an early victim in the debate over voluntary euthanasia.
It is time to set the record straight. The headline above a recent article
(The Advertiser, 4 April 1995) read: "Dangerous to give doctors
power to kill". In fact, a voluntary euthanasia law would not give doctors
a new power. It would simply bring under regulation and close supervision
the power they already have to hasten or cause the death of a patient.
A similar distortion of the debate occurs in such slogans as "Kill the
pain, not the patient". Apart from the fact that voluntary euthanasia is
not primarily an issue of pain management, the use of the emotive word
"kill" conjures up the image of a victim of aggression. Yet there is no
victim and no aggression. It is a carefully regulated act of mercy undertaken
for the sake of the patient. Talk of giving doctors "a licence to kill"
is unwarranted.
The most vociferous opposition to voluntary euthanasia comes from religious
sources. Thus "Priests in nationwide attack on euthanasia" (The Australian,
15 May 1995). Those who believe in a God who has determined the span of
each individual life hold that it is always morally wrong to shorten that
span, while some maintain that suffering should be endured because it has
merit in the eyes of God.
They are entitled to this opinion and to make their choice accordingly.
But they also seek to deny the option to others by positing that it offers
a threat to society, to many who would not request it - and truth suffers.
In order to make this claim, they commonly omit the word "voluntary",
so that the crucial element of the free choice of an individual in a democratic
society is obscured. Omitting "voluntary" subtly implants the notion that
euthanasia might be administered against someone's will, or without consent,
"putting at risk all those people whom others would think better off dead".
Invalid comparisons can then be drawn with situations that do not allow
freedom of choice, such as capital punishment. A similar furphy is that
if voluntary euthanasia were legalised, it would harm vulnerable people
who had made no request, or had been pressured into doing so - victims
of their doctors. No evidence is offered for this, because there is no
evidence.
A society that cannot trust its doctors cannot trust itself. There is
no benefit to society in fostering the myth that doctors are awaiting their
chance to knock off their patients and only a legal barrier prevents them.
If you believe that to be the case, then note that a voluntary euthanasia
law would not remove the barrier; it would strengthen it. The Universal
Declaration of Human Rights can be stood on its head to deny our right
to control our lives. If, as most of us believe, we are free to make decisions
about our lives, whether to live them well or badly, whether to press ahead
with them or end them, it is our inalienable right to do so. That right
carries the responsibility which attaches to all rights - not to exercise
it in such a manner as to harm others. An article (The Australian,
21 July 1994) was headed: "Euthanasia undermines the rights of the sick".
Why not let the sick decide that? The choice should be theirs.
Without evidence, or despite contrary evidence, claims are made that
the situation in the Netherlands is out of control, or getting that way.
Actually, we do not know whether there has been any change in the Netherlands,
nor if the situation is different in Australia, because there has been
only one such study there and none here.
A widespread misapprehension that in the Netherlands 55 per cent of
cases of euthanasia are carried out without the consent of the patient
seems to have arisen from a calculation by Dr John Fleming (The Australian,
2 February 1995); News Weekly, 25 February 1995; The Advertiser,
4 April 1995). He referred to "10,558 cases of medical decisions at the
end of life which involved the explicit intention to hasten the
end of the life of the patient by act or omission", of which "55 per cent
were non-votuntary".
This is equivalent to 4.5 per cent of total deaths in contrast to the
official finding of 0.8 per cent cases of "life termination without explicit
request". Although these should not be condoned, they were patients near
death, 86 per cent of whom were incapable of making a request although
65 per cent had earlier made their wishes known. There were only two cases
where the patient could have been asked and wasn't; both occurred in the
early 1980s.
The 55 per cent figure is obtained by adding in cases of administering
pain-killers, or withholding or withdrawing treatment, without an explicit
request by the patient, with the intention of shortening life. Such cases
were not classed as euthanasia in the official report.
When Dutch doctors were asked whether or not they intended death to
result from their actions, they answered truthfully, because it is regarded
in the Netherlands as sound medical practice, not euthanasia, to withhold
or withdraw treatment, or increase opioid doses, in order to hasten death,
if it is the only means left to relieve the suffering of a terminally ill
patient. These are cases where the patient is no longer capable of giving
consent. The doctor has to take the decision.
In Australia, the doctor would have to claim that the intention was
only to relieve suffering or to avoid burdensome and futile treatment,
not to shorten life. Whatever the claimed intention, the action is the
same and so is the result. The Dutch are simply more honest about it.
Opponents of voluntary euthanasia should stop playing with words
and figures, confusing the issue with versions of what did or might happen
in the Netherlands, or constructing alarming scenarios. They should face
voluntary euthanasia on its merits as a compassionate response to the doctor's
dilemma when the preservation of life is not compatible with the relief
of suffering and the patient wishes only to die.
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