Euthanasia: what is the real question that needs to be answered?

"The Age is committed to the encouragement of community debate on euthanasia because we believe it is only through such full and informed means can there be wider understanding and acceptance. However, we remain concerned that changing the laws on voluntary euthanasia and assisted suicide could result in possible ambiguities or abuses: euthanasia, as we have said, should not be permitted to become a subtle form of murder. Care and consideration are therefore essential." 

This is an implicit assumption that a carefully crafted law can protect people from abuse. The editor provides no examples, nor any proofs that such risks can be adequately dealt with. While it is not the role of a newspaper to deal with such matters at length, it is nevertheless the question upon which the grave matter of changing the law hinges.

Be that as it may, the sentiments in the latest of such Age articles by Mr Peter Short (Let there be no doubt, I will decide when I die) clearly embody the gentleman's personal views and are therefore worthy of respect. It does, however, rely on a false juxtaposition between physician assisted suicide and palliative care in much the same way as has the discussion about the death of Steve Guest.

 
In an editorial piece on the 30th of April in The Melbourne Age newspaper (Euthanasia: the debate must start now) we find this curious statement:
 
Some sound observations here. However, the statement in toto, is actually a reversal of the standard of proof that is so widely accepted in community and political discussions across Australia these days. The assertion that 'ambiguities and abuses' can somehow be alleviated by 'care and consideration' is simply not good enough.

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In any other significant proposal that governments consider the proper application of the precautionary principle would demand that the known risks are effectively addressed and a high standard of proof is required. It would have been far better for 'community debate' had The Age broached the discussion about safeguards in a less-dismissive fashion; because we're not talking about proposals the likes of which governments' deal with all the time. Nor is this something that any later government could easily undo and compensate.
 
The real question then, is not as the editor suggests about creating community debate for the sake of 'wider understanding and acceptance', which itself implies that there are merits in change, but about whether or not it is appropriate to accept a level of risk, given that any level of risk is the consideration of a human life.
 
That there are risks is not denied by any rational person - certainly not The Age as evidenced in the above quote.
 
The predictable procession of personal stories supporting change in the law continues. With respect to the genuine plight of the sick people concerned, their arguments for law change are a parroting of the pro-euthanasia mantra with only the slightest of variations. If they were school essays any teacher would question whether these were 'original works'.

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Dr Syme earlier reflected Steve Guest's choice as being between suicide by Nembutal and being sedated and starved to death in a hospice. Mr Short likewise reduces palliative care to simply 'dying at the end of a morphine drip in a drugged state'. Ian Wood provided yet another example of this kind of reductionist thinking in a recent letter to the Bendigo Advertiser:

"Yes - the truly vulnerable are those who are dying yet still have to endure futile and unnecessary treatment.

"Yes - palliative care can be excellent but it does not help all. 

"The last resort is "terminal sedation" where the dying person is put into a coma until they die of starvation or dehydration."

No-one is mandated to undergo, futile or unnecessary treatment and no-one need die of starvation or dehydration. This is little more than scaremongering. Certainly, sedation - either temporary or at the very end of life - is in the tool box to relieve intractable pain; but in the very last days of life, nutrition and hydration may not only be uncomfortable for the patient, but also not appropriate and possibly futile. A model of good care would see the person die comfortably of their condition and not by starvation or thirst.
 
Mr Short creates some images of his own pending death:
 

"I would like my last life scene to be one of great beauty and warmth - and perhaps even of inspiration for those around me and for me."

"It is wrong that I cannot choose to pass away with my wife's and sons' arms around me and a kiss on the head. As it stands, my prolonged death would probably be well-managed – I have a great medical team around me. But days or weeks in bed on debilitating doses of drugs, with me having no control, is not the way I will die."

We will all, at some time, consider the possible circumstances of our passing and, like Mr Short, imagine a serene and wholesome scene surrounded by family and friends; perhaps even at home. But to suggest that these aren't available to us through good palliative care is not only to do a disservice to the medical discipline, it is also, in some ways, re-enforcing and amplifying people's natural fears and concerns in an irrational way. To 'pass away with my wife's and sons' arms around me and a kiss on the head', while not guaranteed, is entirely achievable with good care.
 
That said both Mr Guest and seemingly Mr Short have made a choice not to seek or continue with such care until their natural demise. Fair enough. But to effectively plead, therefore, that the state should simply accommodate their wishes is a non sequitur. It does not follow. They seek state approval for an act that society actively shuns: suicide. They seek also to implicate the state and at least one other (the doctor) in their demise.
 
 
This obfuscation of a private act with mostly private consequences (suicide) with an act involving third parties with public consequences (legal physician assisted suicide) suits the pro-euthanasia argument if, indeed, it is also not entirely the cause of it. There is a clear, bright light between the two that must remain if we are to provide protection for citizens on an equal and just basis. The hard cases, as ever, while poignant and compelling, remain the stuff of bad law.
 

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