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

Handbook of the South Australian Voluntary Euthanasia Society (SAVES)

THE RIGHT TO CHOOSE: THE CASE FOR LEGALISING VOLUNTARY EUTHANASIA

5.   MEDICAL OPPOSITION

The proposal to legalise voluntary euthanasia raises personal, moral and practical problems for doctors and nurses because of their necessary involvement. While some are opposed and others supportive, many feel ambivalent about the whole question. The purpose of this section is to examine medical objections and clarify some of the issues.

The Medical Ethic

The doctor's duty is to preserve life and relieve suffering, acting always in the patient's best interests. A dilemma arises when the preservation of life is no longer compatible with the relief of suffering and the patient wishes to die. The withholding or withdrawal of "futile and burdensome" treatment, or increased dosages of drugs for symptom relief, which may hasten death, are generally accepted as sound medical practice. But doctors are not agreed on whether it can ever be right for them to take action with the intention of ending life. To some it just does not feel right and voluntary euthanasia is opposed because "medical intuitions are against it" [13].

The medical ethic is commonly spoken of as if it precluded voluntary euthanasia and the Hippocratic Oath may be quoted in support. But the oath was devised long before medicine developed the knowledge, techniques and skills that exist today and it is no longer accepted in its original form as a definitive statement. The modern version is the Declaration of Geneva adopted by the World Medical Association in 1968 and amended in 1983. The relevant portion reads:

"I will maintain the utmost respect for human life from its beginning even under threat and I will not use my medical knowledge contrary to the laws of humanity."

Its significance depends upon how one understands "respect for human life" and "the laws of humanity". In the absence of consensus among doctors, the World Medical Association has accepted that therapeutic abortion is a matter for the conscience of the individual doctor. It is not easy to understand why a different interpretation should apply to voluntary euthanasia, given that doctors are similarly divided on this issue.

Other Medical Concerns

Several objections commonly raised against voluntary euthanasia are examined in the next section. However, there are some of particular medical concern. It has been claimed:

1. that palliative care can meet the needs of the hopelessly ill for a dignified end to their lives, so that none would reasonably wish to be helped to die. The claim is less widely made now than it used to be. Many palliative care workers have come to accept that it is not achievable, either now or in the foreseeable future [23]. It is not only pain which has to be combated. There are other more intractable and distressing symptoms as discussed in Section 6.
2. that the legalisation of voluntary euthanasia would lead to loss of patient confidence in doctors. The "best interests" principle suggests the reverse. The knowledge that in the last resort a compassionate doctor would be willing to consider a request for a medically assisted death would be a source of comfort to those who think that they might one day need that help, but need pose no threat to those to whom it is unacceptable.
3. that doctors would abuse the trust placed in them; euthanasia would become an "easy fix". This ignores both the extent to which a practice which is now unregulated would be safeguarded by law and carefully monitored, and the nature of the experience for the doctor of ending a patient's life. The action requires delicate medical judgement, compassion and a degree of courage. It is no "easy fix" and the suggestion denigrates doctors.
4. that financial stringency would put pressure on doctors to administer euthanasia without proper justification, as a cost-saving measure. Like the previous concern, it takes no account of the high standards of the profession and ignores the strict supervision that the law would require and that the public would demand.
5. that there would be less effort devoted to finding cures, or improving standards of palliative care. It is far more likely that research to combat disease and improve health care would proceed unaffected. Indeed, it might well prove an added spur to research in order to reduce the occasion for voluntary euthanasia.
6. that it would create a division between participating and non-participating doctors. Voluntary euthanasia is likely to remain a controversial issue for some time. Resolution will come, we believe, when the supposed harmful consequences do not eventuate. It will then be possible to accept the practice as a legitimate option in final clinical care, always voluntary for the individual doctor, and without stigma.
7. that it would place an unfair burden on doctors, who should not have to decide whether a patient lives or dies. In voluntary euthanasia, however, it is the patient who decides that death is preferable to continued existence. The doctor then makes a professional assessment and if the patient is capable of rational choice, advises the patient accordingly.

If the medical assessment is appropriate, is supported by a second opinion and the patient continues firmly to request a medically assisted death, or had completed an advance request to this effect, the doctor has only a moral decision to make. That decision concerns the doctor's conscience, not the patient's fate.

8. that the medical profession is not yet ready to take this step. This is unfortunately true, so the possibility exists that when legislation is eventually passed it will find the profession unprepared, its members without the training opportunities and support services they need for the task.


There are signs that the profession is more open to serious consideration of voluntary euthanasia. It is no longer a shunned topic and has become increasingly the focus of articles in journals of medicine and ethics [14].

It is not to be expected that the Australian Medical Association will endorse voluntary euthanasia in the near future, but perhaps it may come to see wisdom in abandoning its outright opposition in favour of a neutral stance. This would recognise the division of opinion among its members and, as with therapeutic abortion, respect the conscience both of those who oppose the practice and those who support it.

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