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

"Reported media comments of the Premier show he has missed the point on voluntary euthanasia and palliative care according to the Australian Democrats. The Party's Health Spokesperson, Sandra Kanck, says it is unfortunate Mr Olsen imagines that palliative care replaces the need for people gripped by terminal illness to control their own destiny. It is not an either/or situation: palliative care and voluntary euthanasia are not mutually exclusive. ... There are some conditions where the best palliative care available is not able to relieve pain or provide the dignity a suffering patient is seeking. ...

"Now, in a backward move, the South Australian Government is to investigate whether or not a doctor who truthfully answers the questions of dying patients is breaking the law. If our laws are such that it is an offence to simply tell a patient which drugs will allow a peaceful death then the law is unjust and should be changed. We should heed the words of Nelson Mandela:

"To break an unjust law is a moral imperative, not to break an unjust law is to collaborate in that law."

"If our politicians - our lawmakers - are not prepared to remove an unjust law and to make laws that will allow for voluntary euthanasia they should step aside for those who do have the courage to enact the laws our society needs."

1. Our case has been set out fully in our written submission and accompanying documents. We are grateful for this opportunity to draw attention to key aspects and comment on opposing views.
2. "Voluntary euthanasia" refers to the termination of life, or the hastening of death, by a doctor, at the informed request of a patient whose quality of life has fallen irreversibly below an acceptable level. It is an act of medical judgement, performed out of compassion, respecting the autonomy of both patient and doctor.
3. There is a strong moral case for voluntary euthanasia:
• it respects the right of individuals to make decisions about their own lives;
• it upholds human dignity, respecting life in terms of its quality; and
• it shows compassion by offering final relief from pointless suffering.
Dr John Fleming has argued that "compassion would rob us of our rights", but in fact it is compassion - the capacity to respond to the suffering of others in a way that is meaningful to them - which ensures that our rights will be respected.
4. Surveys have shown that both requested and unrequested (i.e., non-voluntary) euthanasia are not uncommon in medical practice and that possibly a majority of doctors are sympathetic to the concept. While this is clear evidence of a felt need among patients and their doctors, any action taken is covert and subject to no guiding principles. Voluntary and non-voluntary euthanasia are conflated by some opponents who speak only of "euthanasia" - an example of loaded language in the debate; another is reference to "killing". We do not support non-voluntary euthanasia and we expect its incidence to be reduced when voluntary euthanasia becomes legal.
5. Since voluntary euthanasia is morally sound, meets a felt human need and has majority community, and significant medical, support it should be encompassed in law. As it is morally wrong to allow people to die in unwanted suffering, and to treat as criminals doctors who provide the relief they ask for, it cannot be politically right to perpetuate the harm resulting from unmet need and unregulated practice. The prohibition on voluntary euthanasia should be replaced by legislation that ensures careful regulation and public scrutiny
6. Opposition to voluntary euthanasia comes most strongly from church leaders. Yet a survey of churchgoers found that this is not supported by most of them, while the major public opinion survey in Australia has shown that some 75% of people, including those claiming affiliation to the mainstream churches, consider that voluntary euthanasia should be allowed. Despite much Christian support for voluntary euthanasia, opposition by church hierarchies remains a major obstacle, although in recent years it has been expressed in secular terms.
7. A voluntary euthanasia law has to strike a balance between imposing too many controls and too few. The issue is one of trust that doctors who participate will exercise sound medical judgement in the interests of their patients. This is no more or less than we expect of them now, when our lives are in their hands.
8. SAVES has examined proposed and actual voluntary euthanasia legislation over many years and considers that the Voluntary Euthanasia Bill 1996 is workable and can achieve its aims. However, the addition of a clause prohibiting publication without consent of the names of doctors, or locations, involved in the practice of voluntary euthanasia should be considered.
9. We assume that once legislation is in place, the Medical Association will issue guidelines, provide advice and training where required, and monitor its implementation as will the Medical Board. SAVES has published a set of guidelines for discussion.
10. There remain several misconceptions. In particular:

 

 

(a) Voluntary euthanasia contravenes an internationally recognised inalienable right to life.

This is devoid of substance. If I have a right to life that I cannot be deprived of, nor transfer to anyone else, it follows that my life can be no one's property but my own. So I am entitled to make decisions about it, even to end it and ask someone to help me do so, provided that I do not harm others. We reject the implied concept of a life devoid of human quality that must be preserved. Voluntary euthanasia does not deprive anyone of a life that holds any value for them.

(b) Palliative care provides the answer.

Advocates of voluntary euthanasia strongly support palliative care, maintaining that requesting patients must be informed of palliative options and these must be readily available. Legalisation of voluntary euthanasia in the Northern Territory, and in the State of Oregon, was followed by the upgrading of palliative care facilities. In the Netherlands, with a similar population to ours, a high standard of palliative care is provided and the service is freely available in hospitals, (where there are 60,000 palliative care beds), or at home.

But palliative care cannot relieve all suffering, unless by "terminal sedation", or "pharmacological oblivion" - rendering the patient unconscious and ceasing life-prolonging measures, until the patient dies. This is "slow euthanasia", a subterfuge that relieves the consciences of some doctors, meets the requirements of the law, can only apply in certain cases, and would not be regarded by most patients, or those who love them, as a good way to die. This apart, we must accept as fact that there are people who die lingering, distressful deaths. They are hard cases, but hard cases do not make bad law if there are enough of them. How many must suffer needlessly before we have the courage to act?

(c) The Consent to Medical Treatment and Palliative Care Act 1995 has made voluntary euthanasia unnecessary.

In fact, although the Act was an important advance, it unwittingly created two classes of patient. There are those who can be helped to die, because they are receiving life-preserving treatment which can be discontinued, or treatment for pain relief which can be increased - then there are all the others. This should not be glossed over as a "grey area", or excused as "double effect", but acknowledged as a "double standard".

(d) All societies disallow the intentional taking of human life, and voluntary euthanasia should be no exception.

In fact all societies make rules permitting and regulating intentional killing - and this is of people who have not even requested it, e.g., in war, police action, self-defence, and in some cases, capital punishment. It is said that the victims are not innocent people - they have forfeited their (supposedly inalienable) right to life. Yet requested medical intervention to end a patient's suffering is regarded as conflicting with society's respect for life. Is the requesting patient not an innocent person, but "guilty" of being hopelessly ill?

(e) A voluntary euthanasia law will be abused and/or descend on a "slippery slope" with undesirable consequences.

This is speculation at best and scaremongering at worst. Experience has provided no support for this:

• In The Netherlands, official reports and scientifically conducted surveys have shown that voluntary euthanasia is administered responsibly, benefiting 2.6% of those who die. As confidence in the system has grown, under- reporting has decreased. Community support remains high and the government is now proposing legalisation. Unfortunately, the picture has been distorted by massaging the statistics. This is examined in a SAVES' leaflet, "Honesty the First Victim". Dutch people trust their doctors and we should do the same and not treat them as potential miscreants.

 

 

By contrast, of those who die in Australia, requested euthanasia is administered to 1.8%, but unrequested euthanasia to 3.5%, five times higher than in the Netherlands, probably because our law prevents doctors and patients discussing the option. Withholding or withdrawing life-prolonging treatment and the administration of doses likely to hasten death are also significantly higher here. We do not say that the law should be changed because doctors bend or break it. They are making sound medical judgements in the interests of their patients and the law should be changed to respond to a demonstrated need and to institute control.

• Legalisation in the Northern Territory resulted in four assisted deaths which no one could reasonably argue were unwarranted. The Act was not over-ridden because it failed, but because it achieved an objective that others found unacceptable.
• In November 1997, medically assisted suicide was legalised in Oregon State, where there are about 20,000 deaths a year. In the next eleven months there were 350 enquiries, 51 requests from qualified patients, 10 prescriptions issued, and just 8 assisted deaths.
11. (f)The assertion that "intention" is the key to moral judgement when life is terminated, or death is hastened, is a major red herring.

 

 

Moral responsibility does not rest solely with intention, but also with foresight. If the consequence of my action was foreseeable, I cannot disclaim responsibility merely on the grounds that death was unintended. Nor is intention necessarily single minded - there can be double intention as well as so-called double effect. Intention in the mind of the doctor provides no basis for public policy.

An example of the unsuitability of intention as a moral arbiter is provided by the case of Tony Bland, 17 years old, crushed in a crowd at a football match in Britain. His brain was irreversibly damaged and dissolved to fluid during three years in a coma. He was otherwise in good condition and could be kept alive indefinitely by artificial feeding and evacuation of his wastes, but he was no longer a functioning being. Legal action had to be taken as far as the House of Lords to obtain permission to cease treatment for the express purpose of ending his life. If intention had been the criterion, he would be alive today, but he would still have no life.

12. In conclusion, voluntary euthanasia is based on sound moral principles and meets a genuine human need. The present law, on the other hand, is unworkable and causes harm.