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

South Australian Voluntary Euthanasia Society(SAVES)

The RSL case against euthanasia

An article under this title appeared on page 15 of the "Southern Cross" November 1997. This magazine, formerly the SA Catholic, is published by the Catholic Communications Centre in Adelaide. The stated purpose of the article was to present secular arguments to explain why the RSL (The Returned Services League of Australia) is opposed to legalising voluntary euthanasia.

There can only be rational debate over voluntary euthanasia if there is a common understanding of what is proposed: ie, very briefly, that the law be changed so that under carefully prescribed procedures it will no longer be a criminal offence for a doctor to assist the death of an incurably ill and hopelessly suffering patient who has requested this. It is an assertion of freedom of choice and conscience, applying equally to the doctor and the patient. The RSL case presents only one side of the debate, thus making it difficult for most readers to arrive at an informed conclusion. In what follows we provide each RSL statement in the article and follow it with our response.

SOCIAL AND FAMILY PRESSURES - Social acceptance of physician assisted suicide would tell the elderly, disabled and other dependent citizens that their lives are not valuable. Elderly war veterans would be vulnerable to such social pressures. A right to die would soon become a duty to die. Senior, disabled or depressed family members could be pressured or coerced into ending their lives.

SAVES responds - Voluntary euthanasia tells everyone that their lives are their own and are too valuable to be squandered at the end in irremediable suffering. The measure is not directed at "dependent citizens" but is an option for independently minded individuals. Doctors would require to be satisfied that the patient is incurably ill and intolerably distressed; that there is no other relief acceptable to the patient; and that the request is freely made.

TRUST AND THE MEDICAL PROFESSION - The AMA's position should be supported. Doctors who propose death by assisted suicide for a terminally or chronically ill patient communicate hopelessness, not compassion, and this could lead to wider lack of trust between patients and their doctors. The RSL has strongly endorsed the role of GP's in managing the health care of elderly veterans and would not wish to see that relationship endangered by a lack of confidence in the profession.

SAVES responds - Even when legal it would remain unethical for a doctor to propose euthanasia to a patient. Initiation of discussion must come from the patient followed, at some later stage, by a firm decision freely made before witnesses. Options for palliative care must have been considered and rejected by the patient. Patients in the Netherlands have great confidence in their doctors, knowing that their wish will be granted if the worst happens. Voluntary euthanasia is already practised in Australia by compassionate doctors who risk their careers for the sake of their patients. It would be better done openly under regulation.

FUNDING AGED CARE - Escalating health-care costs and a growing elderly population set the stage for governments to reduce funding for aged care and palliative care, in particular. Given the recent cuts in subsidies and capital grants to War Veteran's Homes and a requirement for greater resident contribution, this is of particular concern to the veteran community with its higher than average level of financially disadvantaged residents. Death may come to be seen as a reasonable substitute to treatment and care.

SAVES responds - A voluntary euthanasia law would not make euthanasia "a reasonable substitute to treatment and care", nor would doctors use it in this way. Voluntary euthanasia would be relevant only to those who are beyond any treatment or care that would restore a quality of life that is meaningful to them.

PALLIATIVE CARE - a better alternative - Terminally ill patients do not need to suffer a painful death as current pain and symptom-management techniques can provide relief for most patients and lessen the pain for all patients, offering true death with dignity. Palliative home or hospice care is a preferable alternative because it addresses the physical, emotional and spiritual needs of dying patients and their families.

SAVES responds - Voluntary euthanasia is an option of last resort, an option only when all possibilities for palliative care have been considered and rejected by the patient. Palliative care cannot relieve all distress. In extreme cases "terminal sedation" - foregoing life-sustaining measures and rendering the patient unconscious until death supervenes - may be used. This is simply "slow euthanasia" and for many not a reasonable alternative in these circumstances to a quick and peaceful death.

FREE CHOICE? Physician-assisted suicide could ignore what may be a legitimate cry for help. Accurate diagnoses are difficult and offer no guarantees that even the most elaborate safeguards will protect some people from themselves. Suicidal tendencies are often associated with the presence of severe depression. This is not uncommon among terminally ill veterans who need treatment and protection, not assisted suicide.

SAVES responds - A request for euthanasia obviously indicates that treatment is not meeting the patient's needs. The doctor's first responsibility would be to consider and discuss with the patient, other treatment options, should they exist. If satisfied that the necessary criteria were met for voluntary euthanasia, a second opinion, independent and confirming, would be necessary. The possibility of a treatable depression would be closely examined.

LEGAL COMPLEXITIES - Legalised active euthanasia would make it impossible, in practice, to secure the conviction of any health professional who causes the death of a patient by the administration of an overdose of a pain-relieving drug. It would also make it extremely difficult for any health professional to refuse to administer more pain relieving drugs on demand when the drugs might inevitably cause death.

SAVES responds - Under present law, a health professional who causes the death of a patient by a drug overdose is free of criminal liability if he can claim to have acted to relieve pain or other symptoms and not to cause death. Under a voluntary euthanasia law, two independent doctors would have to follow detailed procedures and report comprehensively to the coroner. Over-dosing with pain-relieving drugs, although currently done on occasions, would not be condoned by the new law.

"HARD CASES MAKE BAD LAW" - Legislation to cover a few heart rending cases would inevitably lead to wider use of physician-assisted suicide. If the Dutch experience is mirrored in Australia there would be at least 15,000 cases a year of active euthanasia.

SAVES responds - Opponents often misrepresent the Dutch experience. A survey in Holland in 1995-6 showed that 2.4% of total deaths each year, (about 3,250) resulted from (legally sanctioned) voluntary euthanasia and 0.7% (about 950) from (illegal) non-voluntary euthanasia. A similar study in 1995-6 in Australia showed 1.8% of total deaths (about 2300) to be due to (illegal) voluntary euthanasia and 3.5% (about 4500) to (illegal) non-voluntary euthanasia. Doctors here are responding to a pressing need, but in the absence of an appropriate law they are doing so in an unregulated and arbitrary manner, with far less consultation with their patients, under the threat of criminal sanction.

MORAL CONSIDERATIONS - Most religious traditions regard life as a gift from God and the deliberate taking of one's own life as a rejection of God's will. Given that the majority of RSL members claim adherence to Christian principles, the moral stricture cannot be ignored even though many would claim it as a matter of personal conscience.

SAVES responds - Those who believe that God has set the term of each life will be unaffected by the law, but there are many committed Christians who do not share that image of God. They believe that we have been given full responsibility for our own lives and that a God of love and compassion would not wish any of us to end our days in needless, unwanted suffering.

OPINION POLLS - While the polls show that three in four Australians support euthanasia there are real doubts as to whether respondents understand whether the issue in question is active as opposed to passive euthanasia. Passive euthanasia - the rejection of medical treatment, turning off life support systems, or allowing the administration of pain relieving drugs at levels that might unintentionally cause death - is morally acceptable to most people and legally permitted now. The dubious results from public opinion polls need to be contrasted with the submissions to the Senate inquiry which showed more than nine in ten opposed to legalising active euthanasia.

SAVES responds - The question asked in the annual Australia-wide Morgan poll is: "If a hopelessly ill patient, experiencing unrelievable suffering with absolutely no chance of recovering, asks for a lethal dose, so as not to wake again, should a doctor be allowed to give a lethal dose or not?" It is an insult to the 76% who replied yes in 1996 to say that they did not understand the question and thought it referred to so-called "passive euthanasia". It is an insult to an internationally respected research organisation to call its findings "dubious". It is an insult to everyone to discount the results of scientific polling by counting the submissions to a select committee - these numbers merely reflect the relative capacities of proponents and opponents to marshal written submissions.

THE WRONG MESSAGE TO YOUTH - Given the League's grave concerns at the level of youth suicide in this country, it is felt that legalising physician-assisted suicide for the terminally ill would send the wrong message to the younger generation. Further "downstream" consequences could follow. Special interest groups would no doubt argue to extend the facility to disabled newborn, persons in a vegetative state, even mentally incompetent and so on. Once the culture is established, other unintended consequences may arise.

SAVES responds - The "slippery slope" argument, that harmful consequences must eventually outweigh any good consequences of a voluntary euthanasia law, not only ignores the harm resulting from the present legal position, but offers speculation for which there is no evidence. It is hard to see how allowing a hastened death to a hopelessly ill and suffering person under strict medical supervision would encourage the young to commit suicide. Our democratic form of government, independent judiciary and free media system provide powerful barriers against extending voluntary euthanasia legislation to other categories of persons.

INVITATION DECLINED

SAVES prepared the above material in January 1998 and forwarded it to the editor of Southern Cross and to the National President of the RSL, copy to State President. We pointed out that the RSL case presented only one side of the debate and asked whether they would be prepared to widen the debate by publishing our response or at least a general statement, either in the Southern Cross or the RSL Newsletters.

The editor of the Southern Cross has not replied to our letter. The National President of the RSL gave us the courtesy of a prompt reply. He said that the Southern Cross article reflected the National Executive's position although it had not been become "a standing policy". The National President acknowledged that points in rebuttal were well argued but declined to refer the matter back to the National Executive since they had already considered and rejected such arguments. He concluded, "While there is a wide variety of opinion on this matter in the League, as in the wider community, our National Executive believes it is acting in the best interests of our members and the Australian people in opposing legislative changes which countenance physician assisted suicide or voluntary euthanasia."

On the contrary, SAVES believes the National Executive is, in fact, failing its members, and the Australian people, by promoting only one side of the voluntary euthanasia debate. We respectfully remind them of the slogan in block capitals at the foot of their letterhead:

THE PRICE OF LIBERTY IS ETERNAL VIGILANCE

Our liberty is compromised if information necessary to reach an informed conclusion is withheld.

Further information on these and related issues is available from the SAVES.