Q&A style debate with Dr. Nitschke

On the 17th of May I was invited by the Sydney University Union to speak at a 'Q & A style' debate on the issue of euthanasia & assisted suicide. With me on the 'no' side was Dr. Andrew Pesce, President of the  who spoke exceptionally well about why the AMA does not support euthanasia & assisted suicide.

Australian Medical Association

On the 'yes' side were Dr. Nitschke and NSW Greens MLC, Cate Faehrman.

Following is my text:

The famous British novelist, GK Chesterton once said: Don't ever take a fence down until you know the reason it was put up.

We have laws prohibiting assisting in a suicide and we have laws prohibiting euthanasia.  If you like: fences.

We're not talking here about rates, roads and rubbish nor are we talking about social equity programs or economic stimulus.  No, we're talking about killing people.

So, in terms of this discussion, Chesterton's assertion has significantly more gravitas than for virtually any other public policy debate.  It's about killing.

Legalizing assisted suicide and euthanasia is simply a bad idea.

If assisting in suicide were legal, we would be creating the opportunity for the perfect crime.  Already elder abuse is being recognised as the Crime of the 21st Century.  Elder Abuse is usually perpetrated by a family member or someone who has gained the trust of an elderly person.  It is very often for financial gain and according to a 2009 report causes financial losses of $2.6 billion a year in the US alone.  Reports in Australia echo similar concerns.

As far back as 1992 a NSW report suggested that 5% of people over the age of 65 were victims of some form of elder abuse.  We're talking financial, psychological, emotional, social, physical and sexual abuse and abuse through neglect.

Victims often do not report abuse for fear of retaliation or because the perpetrator is a family member.  It is a hidden epidemic.

Legal Assisted Suicide would give perpetrators another path of abuse, and one that is legally protected.  Pressure the victim to change the will and there's no one else around to witness the killing.  As I said, the perfect crime.  No witnesses to contradict the assumption of a willing suicide.  In Oregon where assisted suicide is legal, the authorities don't even ask the question whether consent was evidenced.

Let's not pull down this fence.

Assisted Suicide would have a negative effect on health policy.  In Oregon, in separate cases, Barbara Wagner and Randy Stroup both applied to the Oregon State Health Plan (Medicaid) for payment for the treatments for their illnesses.  Both requests were denied.  Medicaid did, however, kindly offer to pay for their suicides.

"It was horrible," Wagner told ABCNews.com.  "I got a letter in the mail that basically said if you want to take the pills, we will help you get that from the doctor and we will stand there and watch you die.  But we won't give you the medication to live."

This is policy madness where the state assists directly in the suicide.  Neither Wagner nor Stroup had any choice over the decision; the state was steering them towards their suicide.

The fence is there for good reason.

Vulnerable Dutch people are known to carry cards in their wallets or handbags with the message to the effect that, should they be taken to hospital, they did not want to be euthanized.  In the debate on the Andrew's Bill which overturned the Northern Territory's Rights of the Terminally Ill Act, we heard testimony from NT aboriginal people that they were reluctant to go to health services for fear of being euthanized.

What kind of society would it be where people lived with such fear?

Just last week a new poll released in the UK showed that 70% of disabled people felt that changing the law on assisted suicide would result in 'pressure being placed on disabled people to end their lives prematurely'.  More than half also said that such a law would be 'detrimental to the way that disabled people are viewed by society as a whole'.

Again I ask: What kind of society would it be where our laws and policy caused people to live with such fear?

Let's not pull down this fence.

Let's turn to euthanasia legislation.  In South Australia the parliament is debating the Criminal Law Consolidation (Medical Defences—End of Life Arrangements) Amendment Bill 2011.  This bill is a euthanasia free for all.  It creates a defence for a doctor if someone brings a complaint against them.  I say IF deliberately because there is nothing in this bill that requires the doctor to tick any boxes or jump through any hoops or seek formal consent before killing the patient.  No witnesses required; no testing for depression; the condition doesn't need to be terminal and above all, the doctor has immunity from prosecution by the simple assertion that he or she thought it all 'reasonable' and the bill actually directs the court to see it that way.  It's a protect-the-doctor bill with no protection at all for the patient.  Family and friends can complain all they want that their dead friend or relative didn't want to be euthanized.  All the doctor has to assert is that the deceased asked to be killed and that he saw the request as a 'reasonable' response to the circumstances.

In a case that could be described as 'elder abuse meets the medical profession', Dr. Harold Shipman was convicted in 2000 in the UK of killing 15 elderly patients then falsifying their death certificates.  Motivated by 'power over life and death' it is said that he actually may have killed up to 600 people this way.  He was only discovered when he falsified a victim's will mistakenly signing his own name.

Why would we want to provide additional protection for the Harold Shipman's of this world?

And you know, you'll hear from proponents of euthanasia that their bill is a better bill than that and includes so-called 'safeguards' against abuse.  Yet Dutch figures show that consent was not obtained in something like 17% of reported euthanasia cases.  In Belgium it's around 32%.  Failing to gain consent, except in emergency, is itself a serious abuse.  Abuse of the law and abuse of patients is ever a real possibility.

In 1998 a Committee of the Tasmanian Parliament reviewed the question of euthanasia in an extensive inquiry.  At the outset all but one of the committee members was known to favour euthanasia; at the end, the opposition was all but unanimous.  Two points from their report:

7.  The Committee found that the codification of voluntary euthanasia legislation could not adequately provide the necessary safeguards against abuse.

(Note: this was not a reference to a particular bill, but to euthanasia bills in general)

10.  The Committee found that the legalisation of voluntary euthanasia would pose a serious threat to the more vulnerable members of society and that the obligation of the state to protect all its members equally outweighs the individual's freedom to choose voluntary euthanasia.

Don't pull down the fence!

And then there's this comment from SA Greens MP, Mark Parnell in his summing up speech before the defeat of his 2009 euthanasia bill:

"One of the dilemmas that we have got is that we want safeguards, but we do not simply want to put obstacles in the way of people so that they cannot ever use it.  We have got to get the balance right."

I invite you to think about what the 'right balance' might look like.  Enough 'safeguards' to satisfy people's concerns but clearly not enough so that no-one will be at risk because, in his own words, that would mean that no-one would ever be able to use the bill.  For the bill to work, there are inherent, unavoidable risks.  This is incredibly callous: he knows that there'll be abuses.

Perhaps he doesn't believe that he'll ever be in the position himself; it's easier to talk like that when it's theoretical.

But it's deeply personal for me.  I have a 10 year old son with a disability and my wife's brother lived all his life with a significant intellectual disability.  I don't want to see Joseph or people like Mark put at risk.  When you think about it, the unknown path of life that all of us take and that of our families and friends might mean that this becomes deeply personal for each one of us in some way.

Legalizing assisted suicide and euthanasia is a bad idea.  As the Tasmanian report says the state has the obligation to protect all its members equally and to protect them from abuse — and that's why this fence still stands and why it should remain.

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