|
Handbook of the South Australian Voluntary Euthanasia Society (SAVES)
THE RIGHT TO CHOOSE: THE CASE FOR LEGALISING VOLUNTARY EUTHANASIA
4. THE NEED
The great progress in medical science over the last few decades has led
to a marked increase in the number of people who live to advanced years.
There has been a corresponding increase in the number of those who are
faced with a terminal, painful and often prolonged illness, or with the
certain prospect of decline into totally dependent senility. Medical science
has also improved the chances of a person's survival in the event of severe
accident or disease; survival not infrequently accompanied by permanent
gross disabilit- ies. An increasing number of people, particularly the
elderly, and latterly those afflicted with AIDS, are claiming the right
of access to a quick and peaceful death when, in their view, life is no
longer worth living and its quality cannot be restored [5].
The Push for Law Reform. These developments have been accompanied
by growth in the number and membership of voluntary euthanasia societies
throughout the world, starting in England in 1935. The World Federation
of Right to Die Societies, formed in 1980, now encompasses some 33 societies
in 22 countries with a total membership in excess of 500,000. There are
societies in all Australian States.
Public Opinion Polls (See also Fact Sheet 2). Since 1946 the
Roy Morgan Research Centre has sought the opinion on assisted death of
a representative sample of the Australian people. In 1996 the question
was:
"If a hopelessly ill person,
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 ?" |
The percentage of respondents answering "yes" to that or a related
question has risen steadily over the years from 47% in 1962 to 78% in 1993.
It was 76% in 1996, only 24% answering "no" or "undecided" [6].
Polls conducted in Britain, Canada and the United States all show support
at a similar level. Even allowing for the limitations of public opinion
polls, there is no doubt of widespread and growing support for legalising
voluntary euthanasia.
The percentages by religious persuasion answering "yes" to the question
in a Morgan poll (Finding 2911) conducted in May 1995 were:
Anglican . . . . . . . . . 81%
Methodist . . . . . . . . . 76%
Presbyterian . . . . . . . 73%
Roman Catholic . . . . . . 69%
Uniting Church . . . . . . 73%
No religious preference . . 85%
In a random sample study of some 310,000 attenders at 6,700 congregations
of twenty denominations in Australia, 42% agreed that "people should
be able to choose to die to relieve suffering from an incurable illness";
28% were uncertain; 30% disagreed [7].
Medical Opinion. (See also [8](f)(g)(h), Fact Sheets 3, 21).
A questionnaire posted to 2,000 medical practitioners in New South Wales
and the ACT in 1993 included the question, "Do you think it is sometimes
right for a doctor to take active steps to bring about the death of a patient
?" [8(a)]. It was determined that the questionnaire was seen by 1,667,
of whom 1,268 (76%) responded with 59% saying "yes".
47% (754) of the doctors who responded advised that they had been asked
by a patient to hasten his or her death. 28% (219) of these had taken active
steps to bring about death. To avoid ambiguity this part of the questionnaire
was preceded by the statement: "In the following we wish to focus on
the use of active steps to bring about the death of a patient, as distinct
from the withdrawal of life-sustaining treatment."
When asked, "Do you think the law should be changed to allow doctors
to take active steps to bring about a patient's death under some circumstances
?" 58% of all respondents said "yes".
The results were similar to those obtained in a 1988 survey of doctors
in Victoria [8](b).
A survey in 1991 of doctors and nurses in South Australia reported that
45% of doctors and 60% of nurses who replied were in favour of legislation
permitting voluntary euthanasia: 19% of responding doctors had taken active
steps which brought about the death of a patient [8](c).
A University of Queensland survey conducted in 1995 revealed conflicting
medical and community views on end-of-life decision-making. Of those responding,
community members supported greater choice and control, but doctors were
less supportive of some of the options canvassed. Asked: "Do you think
the law should be changed to allow active voluntary euthanasia for terminally
ill people who decide that they no longer wish to live?", 33% of doctors
said yes, 20% were not sure and 47% said no; 70% of community members said
yes, 13% were unsure and 17% said no [8](e).
In 1996 the Royal Australian College of General Practitioners surveyed
a randomly selected sample of its Fellows, Members and Associates. Among
the findings from this survey were that more general practitioners (45%)
"would personally wish to have the option of voluntary euthanasia"
than not (36%). A majority (56%) would not be distressed if euthanasia
was available for others; 68% believed that euthanasia can be an act of
caring; and a majority considered that the present arrangements for the
care of the dying were not adequate [8](d).
Surveys overseas have produced similar results [9](a)-(e).
Major medical associations in Australia and overseas, except in the
Netherlands, reject voluntary euthanasia as a legitimate measure in medical
practice, despite the clear evidence of support from a great many doctors.
SAVES considers it is time for the Australian Medical Association to recognise
the division among its members and enter the debate more constructively.
Speaking on the ABC's 7.30 Report on 21 February 1995, Dr Brendan Nelson,
then President of the Australian Medical Association, said:
"In the end we will continue to do what we believe to be best. We
don't, we won't, treat people according to the law. People can pass all
the laws they like, perhaps with the best of intentions, but in the end
our profession and I certainly will advocate that doctors do what common
sense, what good medical practice and complete knowledge and understanding
of their patients' desires dictate."
We agree that whether or not a doctor provides voluntary euthanasia
in a given situation should be a matter for the conscience and medical
judgement of the doctor concerned. But doctors should not consider themselves
above the law, nor be expected to make criminals of themselves in the interests
of their patients.
Nursing Opinion (See also Fact Sheet 14). The opinions of Australian
nurses were tested in 1991 in a survey carried out in Victoria [10](a).
A questionnaire was sent to approximately 2000 nurses with current practising
certificates and 913 (49%) responded. 55% said "yes" in answer to the question:
"In the course of your work, has a patient ever asked you to hasten
his or her death (whether by withdrawing treatment or by taking active
steps to hasten death)?"
95% of those answering "yes" to that question considered that a patient's
request to have death hastened can sometimes be rational.
75% of respondents supported the introduction of voluntary euthanasia
under conditions such as apply in the Netherlands (see Fact Sheets 4 and
17); 68% would be willing to be involved in the practice of voluntary euthanasia
under those conditions. The stronger support for voluntary euthanasia among
nurses compared with doctors may reflect the closer relationship they often
form with incurably ill patients.
In 1995 the results were published of a survey of palliative care and
oncology nurses of whom 171 (45%) responded. The same questions were asked
as in the 1991 survey, but descriptive information was also called for.
The authors concluded that nurses were less favourably disposed towards
voluntary euthanasia than previously claimed. In reply to this it was pointed
out that the two surveys sampled different populations and were not comparable
[10](b),(c).
Strong support not only from the general public, but also from doctors
and from nurses, is a clear indication of need.
The Human Aspect. In her introduction to a book containing many
moving accounts of needless suffering, Dr Helga Kuhse writes:
"If one of the main obstacles to the public recognition of the right
to die comes from those who object to suicide and voluntary euthanasia
on philosophical or religious grounds, another perhaps even more important
obstacle is, I believe, the widespread ignorance about death and dying,
and a failure to understand how a civilised society might sensibly and
responsibly deal with the requests of the hopelessly ill who want to die.
We must add to the abstract philosophical discussions about the right to
die the experiences of those who have dealt with death and dying at first
hand, and provide a sketch of a professional and social response appropriate
for a liberal and pluralist society." [11]
Many people of middle age, and some younger, have known of a relative
or friend who was forced to endure a distressful illness or condition to
the bitter end when their plea for a quick and peaceful death should have
been respected. For those who are not convinced there is a wealth of published
accounts of such cases [12].
The need for the option of voluntary euthanasia in human terms alone
is overwhelming.
background reading |
references |
contents
|
