Writer/Editor/Public Communicator
Pro Euthanasia Speech delivered to the AMA 2005 Annual Meeting
With the advent of the controversial Terry Shiavo case in the US
earlier this year, the issue of euthanasia is once again in the
spotlight.
Typically, euthanasia creates a passionate polarization of
beliefs and zeitgeists, where both sides of the 'Right to life
and death' camps fight fierce public relations battles, not only
win the 'hearts and minds' of their populations, but more
importantly to procure their votes.
Nowhere is this battle fought as hard, or as bitterly as it is
within the medical community.
The position currently taken by the AMA is one where medical
practitioners may not assist terminally ill patients commit
suicide, or euthanize them at their request.
The AMA also states that a doctor has the right to a) withdraw
treatment at the patients request, with the full knowledge that
such an action will result in their death; and 2) administer
pain killing medication which, although will also result in the
patients death, is permissible if administered with the primary
intention to relieve pain.
Regardless of how these practices may be protected by slippery
legal language and vague, fundamentally undeterminable notions
as 'intent', many doctors agree that technically these actions
still classify as euthanasia. A non-action is still an action,
it still has a cause and effect, and it still has the final end
result of death.
Research shows that although other all forms of voluntary
euthanasia are criminal offences, there is widespread evidence
of these illegal practices regularly taking place.
In the absence of any independent 'end-of-life' associations to
watchdog over these areas of medical care, the issue is neither
these legal or illegal euthanasia practices are taking place out
in the open under careful legal scrutiny. They occur in the
shadows, existing under the radar in uncontrolled, unregulated
and potentially insidious environments.
The palliative care units and other end-of-life medical
environments are the darkened corners of the medical world,
corners where without proper supervision both patients and
doctors are vulnerable to pressures and manipulations of parties
whose vested interests may not be in-line with the patient's
desires.
We only need to look to the UK and the horrific case of Harold
Shipman a.k.a. "Dr Death" to see the dangers of inadequate
supervision and policing in aged palliative care.
I believe the only way to avoid such abuses taking place is to
take the issue of VE out of the hospitals and into in the open
court rooms, where precise and stringent procedure and screening
can take place.
Opinion polls prove 70-80% percent of people approve of VE, yet
governments continue to vote down bills which propose its
legislation. Why? Whose interests are really being protected? We
must bond together to fight for legislative changes, and we must
fight to get this done now.
What evidence is there of euthanasia already going on?
Surveys repeatedly show that around 95% of all medical
practitioners have been asked at some point in their career to
euthanize a patient. Out of this 95%, 15% admit to have
fulfilling their patient's or their patient's family's 'illegal'
euthanasia requests in some form or another.
This means that out of the 61,261 or so registered medical
practitioners in Australia, 9,189 doctors have actively
participated in illegal euthanasia over the last 20 or 30 years.
The bottom line of such statistics means that at least 9,189
Australian citizens have died as a result of illegal euthanasia
practices to date.
It also means that over the next few years, at least 1 in every
2,176 people will die at the hand of a doctor. In order to
protect the welfare of our patients and to professionally
protect ourselves we must:
1. Not only rethink what are and are not the medical professions
responsibilities in end-of-life decisions, but also move to
define and set in legislative concrete these responsibilities.
2. Consolidate this shift in authority through establishing a
specifically trained 'end-of-life' ethics committee in the
courts and specialized 'end-of-life' medical units in each state
created with the sole purpose of supporting eligible euthanasia
requests. These two bodies will be autonomous agents,
independent of governmental influence or interest group pressure.
These ethical structure and mechanical workings of these bodies
will first and fore mostly be informed and formed by the
people's desires; secondly be guided by the pragmatic and
ethical concerns of the medical profession; and thirdly be
effectively and stringently safeguarded and defended by the law.
3. To decriminalize, then legalize medically assisted suicide
and amend the section 13a of the 1983 Amendments to the Criminal
Law consolidation Act 1935 to read rather than "a person who
aids and abets or counsels the suicide of another ... shall be
guilty of an offence."; to read 'a person other than an
appointed VE medical practitioner who aids, abets or counsels
the suicide of another... shall be guilty of an offence.'
The fact of the matter is the majority of the existing
anti-euthanasia arguments made by the AMA are not based solely
upon concerns for the welfare of our patients. Although the AMA
shares broader societal considerations regarding the potential
of a 'slippery slope', the majority of protests are based around
the negative impact VE would have on the medical practitioners
themselves, not on the patients.
When viewed in the light that VE could be performed by any
registered medical practitioner, here are the four top medical
objections, which I have complied from a wide range of health
care surveys and literature.
1. Palliative care can meet the needs of hopelessly ill.
This is simply not true. Some diseases and subsequent pain and
suffering are beyond the scope of medical intervention. Medicine
is not infallible, and many palliative workers acknowledge its
shortcomings.
Also, access to adequate, or indeed any sort of palliative care
is difficult for many Australians, either because of poor
proximity or cost, but mainly due to a severe lack of facilities
and properly trained staff.
Introducing voluntary euthanasia, rather than exacerbating these
pitfalls will in fact serve to do the opposite. Legalized
voluntary euthanasia will force the government to increase the
availability and level of palliative care to an acceptable
level.
How? In order to sanction a voluntary euthanasia case the court
must be convinced that every palliative care avenue has been
exhausted before sanctioning the termination. This will mean a
greater focus on standards of palliative care will be enforced
across the nation, and practices will be under scrutiny like
never before, which is exactly how it should be.
2. Doctors would abuse the trust placed on them. How can I trust
a doctor's primary 'intent' is to soothe my pain? There is no
way of measuring these intentions, and currently there is no
monitoring system in place to test the ethical or moral validity
of doctor's motivations.
Clearly, there must be a definitive line between those invested
with the power to facilitate such huge decisions, and those not.
Just as it would be 'unethical' to get a GP to perform brain
surgery, it must be unethical for any one other than an
appointed VE practitioner to perform these duties.
As the ultimate decision would be done via a democratic judicial
process, this takes the onus away from the doctors thus
eradicating the opportunities for abuse to occur.
3. Euthanasia would become a cost saving measure. As the legal
board to make the final decision would be totally autonomous and
independent of the medical profession, the government or any
agent other than the patient and his/her family, this would be
unlikely to happen. The only 'interest groups' the courts may
take into consideration are the patient and his/her family,
no-one else.
4. That it will place an unfair burden on doctors, and it would
undermine the fundamental therapeutic doctor/patient
relationship.
Yes, it would. And yes, it does. The way things are, even though
doctors may be legally protected by the 'double effect' maxim
and hazy concepts as 'intent', many doctors involved in these
decisions have expressed deep anxiety and concern regarding
their role. Such actions, despite being attractively 'cloaked'
in semantics still essentially run contrary to the medical
professions guiding philosophies of 'respecting and protecting
human life'. At least the patient and appointed euthanasia team
will not be in confusion over what the team's duties and
responsibilities are.
And finally, who is to say a doctor is morally equipped to make
such decisions in the first place? I mean really guys, if you
can pardon the pun, who died and made us Gods? Just because we
are the bearers of the instruments of death, what gives us the
right to make any intimate, personal and autonomous decisions
for other human beings? Our role should purely be a technical
one, and one that does not impede on our patient's autonomy in
any way.
The AMA states that a doctor's primary duties are to a) preserve
life; b) relieve suffering; and c) to always act in their
patient's interest; and they are to be enacted specifically in
that order. Failing the ability to preserve our patient's life,
we must then aim to relieve their suffering. Failing to relive
their suffering, we must respect the patient's wishes and should
the patient desire to die a 'good death' via a needle we must
represent their case honestly and ethically in a court of law.
We must do this without imposing our own individual religious or
philosophical beliefs and without acting in their own interests
or any other body. We must offer our expert, rational and
unemotional opinion on the state of our patient's health and
sanity, and nothing else. Anything beyond this simply is not our
responsibility.
Doctors, through their proximity to death and dying have
unfortunately and unfairly been given the role of judge and jury
for terminally ill patients.
In the current legal environment they have also been given only
two final roles to play: to either wear the heavy mantle of
jailor, or the darkened cloak of a back-yard executioner.
Like Prometheus we are the bearers of many technological and
medical revolutions to this world. However, we must remember
that it is not we who suffer the consequences of our gifts. It
is not we who remained chained for an eternity to Caucscus.
While we sit around in our comfortable consulting rooms
philosophically debating the intellectual and moral relativism
of voluntary euthanasia, it is not our bodies being unavoidably
mauled by creatures of death day in and day out, without an end
in sight, filled with pain and suffering, and without respite.
No. We must remember it is our terminally ill patients who
suffer, not us.
In light of the evidence I have presented today, we can't
pretend that there isn't a need for VE, or that illegal and
unregulated euthanasia practices don't take place. All this
evidence does is highlight the fact that such the matter must be
legislated in order to regulate these practices.
Voluntary euthanasia must be a decision for the courts; it must
be a group evaluation that is talked about, publicly and legally
debated, not shoved under the carpet because politicians believe
it is too hard to legislate or too risky a topic for elections.
It is not too hard to legislate.
Current protocol leaves too many grey areas between so called
passive and active euthanasia, leaving patients vulnerable to
abuse, and doctors wide open to legal malpractice suits.
Voluntary euthanasia requests from terminally ill patients is
not a 'problem' that will just go away by itself. We have to
admit truthfully and publicly that sometimes palliative care
just isn't enough.
I would like to end on the by reminding you all that voluntary
euthanasia for the terminally ill does not undermine the basic
tenet that human life, all human life is precious. It simply
does not enforce that it is an obligation.
The AMA clearly states that although they take the position that
it is unethical for doctors to contribute to voluntary
euthanasia, yet they do not believe it is unethical for someone
to take their own life.
As I have shown, yes it would be unethical for non-specialized
doctors to contribute to this act. However this does not mean
the medical profession as a whole does not have the
responsibility to ensure that when it is legislated, and it will
be legislated, it happens safely and painlessly, and solely in
the interest of the patient and no-one else.
Thank you for your time.