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Handbook of the South Australian Voluntary Euthanasia Society (SAVES)
THE RIGHT TO CHOOSE: THE CASE FOR LEGALISING VOLUNTARY EUTHANASIA
APPENDIX A
The Practice of Voluntary Euthanasia
Voluntary euthanasia will need to be regulated both by law and by professional
guidelines. The requirements, an important part of the case for voluntary
euthanasia, have been largely neglected in the debate. For the purpose
of the following proposals, which are offered as a basis for discussion,
voluntary euthanasia is defined as:
"A quick and peaceful death brought about under medical supervision at the request of and in the interests of a patient in which prescribed safeguards are followed."
Proposed Legal Requirements:
(a) The patient must be suffering from an incurable condition seriously
affecting the quality of life for which there is no treatment available
which is acceptable to the patient.
(b) Only a doctor may provide voluntary euthanasia.
(c) A doctor may refuse on any grounds.
(d) An institution may refuse to permit voluntary euthanasia within
its premises but must take reasonable steps to ensure a patient is aware
of this before admission.
(e) Only a competent adult may request voluntary euthanasia.
(f) The request may relate to a current condition, or may anticipate
a time when the patient is no longer competent, in which case the patient
may appoint a trustee, or trustees, to safeguard the patient's interests.
(g) A request must be made in writing, or made orally and reduced to
writing, and witnessed.
(h) The request may only be made after the patient has been fully informed
of treatment options and associated risks.
(i) A second, independent doctor must personally examine the patient
and confirm the circumstances.
(j) A patient may revoke a request at any time and in any way, whether
or not still competent.
(k) Euthanasia may be administered by withholding or withdrawing life-sustaining
treatment; prescribing or supplying a substance for self-administration;
or by administering a substance.
(l) The cause of death will be taken to be the underlying illness.
(m) Doctors practising voluntary euthanasia will incur no administrative,
civil or criminal liability.
(n) Insurance policies, wills and other contracts will be protected.
(o) A detailed report must be submitted to the Coroner and, ultimately,
the Minister for Health.
Proposed Professional Guidelines:
(1) The request for euthanasia must come from the patient.
(2) The reasons for the request must be thoroughly assessed to ensure
that no reasonable treatment option has been overlooked.
(3) Remediable factors, which may include depression, must be appropriately
addressed.
(4) Where possible, the request should be discussed with the patient
over a period of time and with those closely concerned with the patient's
welfare, while respecting the patient's wishes in this regard.
(5) The patient should be given the opportunity to seek counselling.
(6) Euthanasia should not be performed unless all treatments acceptable
to the patient have failed to produce a level of relief acceptable to the
patient.
(7) If a request is refused on conscientious grounds the patient should
be advised that another doctor may be prepared to help.
(8) The second doctor (the doctor invited to confirm the diagnosis)
should preferably be a specialist in the patient's condition.
(9) The patient must be consulted over the procedure to be followed
and over the presence of other persons.
(10) If a lethal dose is prescribed, supplied, or administered it should
be pharmacologically designed to produce a quick, peaceful death.
(11) The doctor should, where practicable, be present when death occurs
or on call.
(12) All steps taken must be clearly documented.
(13) In medically difficult cases, or if the attending doctor lacks
relevant experience, appropriate colleagues should be consulted.
(14) Disputes should be referred to the Medical Board.
Note: Once voluntary euthanasia is lawful, it is expected that a medical
advisory service will be set up to assist in (13) and (14).
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