A euthanasia retrospective "safe legalized euthanasia is a myth"

The name Brian Pollard is well known to Australians involved in the anti-euthanasia movement just as it is in palliative care circles.  Dr Brian Pollard founded the first full time Australian Palliative Care Service and Concord Hospital in Sydney. Over the intervening years Dr Pollard has been a vocal critic of euthanasia, providing evidence before parliamentary committees and critical analyses of bills over a very long period. Many, including myself, have benefited from Brian's observations and clarity on this subject. He is now retired and considered by this writer and others as a heroic model for our continuing work.
I recently came across a radio interview that Brian gave to Radio National in 2004. Nearly a decade ago and only a few short years after both Belgium and the Netherlands took their first steps off the moral cliff, his observations have been confirmed time and time again. The following retrospective look at Brian's thoughts as an educative tribute.

On the findings of the parliamentary enquiries:

When the difficulties in making euthanasia law have been thoroughly examined, as they were by five large government-sponsored committees of inquiry in recent years in the United Kingdom, the United States, Canada and Australia, the conclusion they all reached and published independently must be given serious consideration. Each of them found that it would not be possible to make a safe euthanasia law, because the so-called safeguards can't be guaranteed to work in practice. They would neither protect others of the sick who didn't want their lives taken, nor assure the community that there had been probity in every instance. Most dangerously, many of the resultant abuses would be difficult, if not impossible, to detect. On such a contentious issue, it is surprising that three of those reports were unanimous, though their committees all included some members who approved of euthanasia. In one instance, 80% of the committee favoured euthanasia at the outset, though their final vote was 100% against legalisation, after considering the evidence.

On the fallacy of 'safeguards':

Requiring more than one doctor to be involved would provide no protection, unless their competence in terminal care was certainly established, since several doctors who don't know best practice in the circumstances are no better than one.

Requiring a psychiatric consultation is already known to have failed to protect depressed patients in the Northern Territory, when euthanasia was legal there.

It is virtually impossible to be sure that patients are not being coerced by others.

A requirement for the doctor to provide suitable information to patients could never, of itself, ensure that that information may not be partial, biased or incorrect.
The times allowed for patients to reflect on their decision are sometimes shorter than those required for purchasers of commercial goods.

Allowing the doctor to be the chief actor, the sole survivor and the only author of the report to the coroner is not a safeguard, but rather an invitation for abuse. A requirement to notify the coroner, who will keep public records, will be insufficient if the doctor is not also required to keep, and make available, adequate private records before, during and after the event.

Reflecting on comments by pro-euthanasia advocate Kep Enderby (on an earlier program) that the overturning of the Rights of the Terminally Ill Act in the Northern Territory was a travesty, Pollard shows what a failure that law was in protecting vulnerable people and in providing adequate safeguards:

He (Enderby) made no mention of a published review of that law in action which revealed that Dr Nitschke had had no experience with dying patients prior to the Act, palliative care facilities in the Northern Territory were underdeveloped, one patient who received euthanasia didn't meet the requirements of the Act, a difference of opinion between doctors over the medical future of one of the patients was resolved at last by the opinion of a doctor with no expertise in terminal care of that illness, in one case relevant psychiatric evidence had been withheld, and finally, patients with treatable depression were not protected by the guidelines specifically included to deal with that problem.

When Mr Enderby also said the overturn of the Northern Territory Act 'implanted Church dogma into Australia's constitutional arrangements', he implied that opposition to euthanasia rests solely on religious grounds. That view is partisan and factually incorrect. None of the previously listed inquiries relied on any religious argument whatever in finding against legalisation.

Pollard dismissed as illogical the argument that a 'right-to-die' could actually exist while also expounding on the logical limits of autonomy:

The contemporary case for voluntary euthanasia is based chiefly on two propositions: that it is an expression of a person's right to die and that it is an expression of individual autonomy.

A right to die, understood as a right to request another to take one's life and for that person to agree, is not found in any code of ethics, morals or law, or in any document of human rights. That is, no such right presently exists. Before it can be accepted as a right, especially as a fundamental human right, as it is sometimes called, it must be effectively argued. But it is not being argued currently by those who want euthanasia, they simply assert it in the hope that others will agree.
At the same time, those same people totally ignore the genuine right of every person to the integrity of their life, as set out in the 1984 United Nations Universal Declaration of Human Rights, to which Australia is a signatory. In it, this right is described as being equal, inherent, inviolable, inalienable and should be protected by law. A putative right to die, understood as a right to be killed, and the genuine right of every person to their life could not logically coexist.

There are no objective criteria available to enable anyone to put a value on another's life. So, if a doctor agreed to take a patient's life on request because he thought it had lost sufficient value, this could only be because he shared the patient's values, even though, in the same circumstances, most other doctors would not agree. In that case, that doctor's decision would be both arbitrary and subjective, and could never justify a change in the objective requirements of criminal law.

If a patient's autonomy were held to be simply a sincere statement of personal preference, then 'I want to kill you' would have the same force as 'I want you to kill me'. If one's autonomous wish was meant to oblige others to respond, then all its consequences would also need to be closely examined, including its wider effects on the rights of others and the common good. Euthanasia law would create a momentous change in the criminal law for which there is no precedent, and would indicate official approval for the concept of a life not worth living. What might that mean for others whose lives were also devalued? One group evidently at risk would be the disabled.

Pollard said a great deal more. You can read the transcript of the full interview HERE.
In closing, this criticism of the pro-euthanasia movement and its tenuous grasp on reality:

Though the currently proposed safeguards in draft euthanasia laws are known to be weak and ineffective, euthanasia supporters still complain they're too intrusive in what they see as a private matter between a patient and a doctor. In fact, much more intrusive safeguards would be needed, if society was really serious about eliminating the possibility that a patient's life might be taken wrongfully, especially in the presence of treatable mental abnormality. Yet, no request for hastened death can be fully understood without exploring the psychological background against which it is made. That is a difficult task, beyond the competence of many, if not most, doctors. Treatable clinical depression is a common cause of some seriously ill patients wanting to have their lives ended; a world expert on mental illness, visiting Australia in July 2000, claimed that 90% to 95% of suicides are associated with major psychiatric illness, while general practitioners commonly fail to diagnose depression in these patients. Even psychiatrists can have difficulty with this diagnosis unless they have been specially trained. In truth, this is a major area of medico-legal difficulty, for which no acceptable solution may ever be found.The most serious abuse of voluntary euthanasia is the taking of life without the patient's knowledge or consent, called non-voluntary euthanasia. Most people understandably find it hard to credit that doctors would ever do that, but since published evidence shows that this practice occurs commonly in the Netherlands, the United States and Australia, how is it to be explained? The explanation is simple and alarming. Since the rationale for voluntary euthanasia is that it provides a benefit to the one who asks, to some doctors it can then appear discriminatory or unjust to withhold that benefit from others who seem to suffer as much or more, but who can't ask. For such doctors, this progression seems logical, and is alarming because appearing logical, it will never be preventable.

Thank you Dr Pollard.