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

South Australian Voluntary Euthanasia Society

The Problem with the Status Quo

In 1994, Dr Brendan Nelson, then President of the Australian Medical Association, admitted that he had assisted two patients to die during his ten years in general practice; he asserted that such decisions should be left entirely to the doctor and also that while such action was at times necessary, it should not be subject to legal guidelines. This is a common position among doctors who actually support the principle of voluntary euthanasia. It is predominantly based on medical fear of the legal process and on the perceived difficulty of legislation encompassing the context of medical decisions in this sensitive area. (This is the principal reason for the relative lack of reporting in the Netherlands). However, since doctors receive no training in the matter, and no official guidelines exist, practice may be haphazard to say the least - who would know! - and there is no certainly that the doctor's action was in response to the patient's explicit request. The consequence of this medical nihilism is that it forces the doctor either to act in a criminal manner or to fashion his practice in a quasi-legal manner.

If acting illegally, the doctor must act in a clandestine and covert manner. It is extremely difficult to obtain what should be an obligatory second opinion as it potentially involves the second doctor in a criminal action or, if the second doctor takes a dim view of the request, places the requesting doctor in jeopardy. An open process with adequate dialogue with patient, family and others with a valuable contribution is either impossible or extremely difficult. The provision of appropriate medicine for rational suicide (barbiturates) is extraordinarily difficult, leading to unsatisfactory, undignified or unsuccessful attempts with less satisfactory drugs. Some patients may make inappropriate attempts to end their lives when they are not terminally ill (mistaken diagnosis), when they are depressed and potentially treatable, or before it is really necessary. The ability to talk about these matters with an empathic doctor and obtain advice and reliable means allows a patient to approach death confident that they are in control and able to live without anxiety as long as possible. A doctor who might feel help is justified may refuse to help for fear of the law, leading the patient to an inappropriate and unsupported action.

The current situation does not encourage dialogue between patient and doctor and all too frequently leads to the most difficult situation where a last-minute request is made, often by relatives when the patient is no longer competent. There is no agent, and there is no advance directive. Moreover, requests from patients in hospital or nursing homes occur in public circumstances where it is virtually impossible to provide assistance except in quasi-legal circumstances. A doctor may administer treatment to relieve pain and suffering even if it should also hasten death. Given that voluntary assistance in dying should only ever be considered to relieve significant pain and suffering, the provision of palliative terminal sedation may act by double effect to hasten death. Alternatively, patients may hasten their own deaths by refusing all fluids, and it is probably legal for sedation to be provided in this process. Unfortunately both these courses lack dignity, and are both futile and inefficient. The status-quo is therefore quite inadequate, much as it is condoned and tolerated by government and the medical hierarchy. It is totally arbitrary. It depends on the beliefs (particularly religious) of the doctor, the commitment and courage of the doctor, the particular condition of the patient, and the current residence of the patient. It does not guarantee respect for the views of the patient, nor does it encourage informed consent and community overviews. Finally, it encourages doctors to behave in a dishonest, clandestine, covert and criminal manner while carrying out a compassionate act which a former AMA President and now Member of Federal Parliament believes is occasionally necessary. This is not acceptable for either patients or doctors.

Rodney Syme

Dr Syme, a medical practitioner, is President of the Voluntary Euthanasia Society of Victoria.

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