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

Between August and November 1999 a survey of Australian surgeons was conducted to determine their attitudes to assisted death, and the proportion who have intentionally hastened death with or without explicit patient request. Results have now been published in the Medical Journal of Australia. (1) There was a response rate of approximately 70%, or 683 out of 992 eligible general surgeons. Of these 247 (36.2%) reported that, for the purpose of relieving a patient's suffering, they had given drugs in doses considered greater than necessary to relieve symptoms, with the intention of hastening death. More than half the respondents reported that they had never received an unambiguous request for a lethal dose of medication.

Only 36 of all respondents reported giving a lethal injection, or providing the means to commit suicide in response to a clear request. While more than a third of surgeons surveyed reported giving drugs with the intention of hastening death, often in the absence of an explicit request, this may have involved the use of an infusion of analgesics or sedatives. Such actions may therefore be difficult to distinguish from accepted palliative care, other than by the surgeons' self-reported intentions.

The researchers considered that legal and moral distinctions based solely on a doctor's intention are problematic. They reported that doctors sometimes give large doses of potentially lethal drugs to terminally ill patients to treat symptoms, foreseeing but not necessarily intending a medically hastened death; an action which has been consistently shown to have the approval of more than 80% of doctors. However there may be considerable ambiguity about a doctor's intention, and some studies have indeed noted partial or dual intentions - to relieve pain and to hasten death. It was suggested that the intention to hasten death may best be determined by those instances in which drugs are used in doses greater than required for symptom control.

The researchers also noted that religious affiliation was a significant predictor of responses to questions on attitudes and practices related to intentionally assisting death. Roman Catholic doctors were four to ten times, and Protestant doctors two to three times more likely to give a negative response, than those who had no religious affiliation. The main survey question concerning experience with assisted death was deliberately written to include the use of infusions of drugs, with or without a request. Some doctors were prepared to hasten death by infusion rather than a lethal injection. Several respondents offered personal comments for clarification of their actions, such as:

"It is difficult to actually administer a lethal injection, but setting up a potentially lethal system allows a degree of psychological and physical separation from the actual event."

"I also appreciate the inconsistency between being prepared to 'up the dose', but not being prepared to give it as a bolus; but that's the way I feel…"

"I have frequently used large doses of morphine to hasten death…I can't see the ethical difference between this and an injection in a fully informed patient…but simply would not be capable of the deed myself."

The researchers claimed that surveys which only investigate the administration of lethal injections are likely to underestimate doctors' involvement with assisted death. They also maintained that it could be hard to distinguish many actions of the Australian surgeons from those of doctors in the Netherlands. At least 20% of the entire sample appear to have given drugs with the intention of hastening death in the absence of an explicit request. This is similar to 23% of Dutch doctors who report performing 'life-terminating acts without explicit request'.

This important research article is one of several in an edition of the Medical Journal of Australia (175:10 2001) dedicated to issues around death and dying. The editorial offers insight into the range of research, debate, ideas and personal perspectives addressed in this particular edition, by reference to several well known quotations which may be familiar to readers. One is especially pertinent to the ongoing work of SAVES, and the many other societies, organisations and individuals who advocate for choice in dying:

'It is not death, but dying, which is terrible.' (2)

The editorial then posed the question ''Was it this sentiment that drove Australian surgeons to respond as they did when asked whether they had ever intentionally hastened a patient's death?'

This edition of the MJA is highly recommended reading.

References:

1. Douglas, S.D., Kerridge, I.H., Rainbird, K.J., Mc Phee, J.R. (2001) 'The intention to hasten death: a survey of attitudes and practices of surgeons in Australia', Medical Journal of Australia, 175:10, pp 511-515
1. Henry Fielding 'Amelia' Book 3, chapter 4