SAVES is not affiliated with Exit International / Dr Philip Nitschke and opposes the public availability of a 'peaceful pill'.

REACTION TO A STUDY OF END-OF-LIFE MEDICAL DECISIONS IN AUSTRALIA

The following comment by Peter Baume and Helga Kuhse appeared in the Medical Observer of 21 March 1997

A recent study published by us in the Medical Journal of Australia (1997;166:191-196) found that about a third of deaths in Australia occur after doctors decide intentionally to hasten the deaths of their patients. Included in the sample of 3000 medical practitioners nationwide were more than 1000 general practitioners. The response rate was 64%.

It is the first research in Australia to calculate the number of deaths in this country which involve end-of-life decisions, and the first in the world which can be compared with similar studies conducted in the Netherlands in 1990 and 1995/96 where voluntary euthanasia has been practised openly for two decades.

The study reveals that Australian doctors intentionally hasten the death of twice as many patients as their Dutch colleagues, and are far less likely to discuss their decisions with their patients or to seek their consent. The findings undermine so-called slippery slope arguments, which suggest that allowing voluntary euthanasia to be practised openly makes it more likely that doctors will end the lives of their patients without their consent.

The main findings of the confidential survey include:

• 30% of all Australian deaths involve a medical decision (5.3% where drugs were supplied and 24.7% where treatment was withheld or withdrawn) that is explicitly intended to hasten death or not prolong life. This figure compares with 16.6% in the Netherlands.
• 3.5% of all Australian deaths result from the injection of drugs explicitly intended to end patients' lives without their consent. This figure is five times higher than in the Netherlands.
• There was also an additional 6.5% of cases where doctors prescribed opioids (such as morphine) with dual intention - to relieve pain and symptoms and to hasten death.

The study arose from a grant given by the NHMRC to Professors Kuhse, Singer and Baume to investigate end-of-life decisions in Australia. Senator Harradine, a well known right-to-life advocate, wondered on radio how an NHMRC grant could be given to three people so publicly identified with voluntary euthanasia and another critic described our study as "ideological".

It is partly a question of values, although medical practitioners did tell us what they were doing and what their intentions were.

The value differences surrounding approaches to voluntary euthanasia seem almost irreconcilable. On the one hand are those who believe that revealed knowledge (usually religiously based) should guide human behaviour. They have a long tradition of people taking the same view. On the other hand are those who place a high value on human autonomy in matters affecting people themselves. They too can call on a long tradition of philosophers and authorities to support their viewpoint.

It is because of these value differences that some people fight even objective empirical research in public when it disagrees with what they think the research should produce in terms of their own values and beliefs.

Our paper demonstrates that there is an unexpected incidence of decisions taken at the end-of-life that will, in the view of the treating doctor, hasten the patient's death. In 30% of these cases the practitioner undertook the decision with the explicit intention of shortening life.

These decisions were more often (seven times more frequently) taken without informed consent under laws that generally prohibit euthanasia than in the Netherlands.

A plausible reason for Australian doctors so frequently acting without the patient's consent, especially in situations where the patient is competent and could be consulted, presents itself; because existing laws prohibit the intentional termination of life, doctors are reluctant to discuss medical end-of-life decisions with their patients, fearing that these discussions could be construed as collaboration in euthanasia or in the intentional termination of life.

All human medical research relies on volunteers. Our 64% response rate is extremely good for a postal survey, and is almost the same as in a recent survey (MJA, 3 Feb 97) in Queensland. The conclusions of our study were based on detailed information on 1361 deaths in the 12 month period considered. In contrast, most opinion polls are based on responses from 1 in 6000 voters. Nobody questions the conclusions drawn from opinion polls yet, in terms of sampling fractions, our study was 60 times as good as the best opinion polls.

It makes us wonder about the vehemence of some of our opponents.

The results should give reasonable people cause to hesitate - if current laws lead to this result, do we really want to perpetuate those laws and the present situation? (emphasis added)

We understand that policy is in the hands of elected governments - including territory governments - and we seek to inform the debate, not to tell elected representatives how they should vote.

The whole exercise shows once again that it is often easier to attack the messenger than to worry about the message - if the message is disagreeable.

[Professor Peter Baume, School of Community Medicine, University of NSW, Associate Professor Helga Kuhse, (Director) and Professor Peter Singer (Deputy Director), Centre for Human Bioethics, Monash University, were joint authors of the MJA study, along with Malcolm Clark (Senior Lecturer, Monash University) and Maurice Rickard (NHMRC Research Officer).]