Fix services; address inequality; eradicate ableism - then maybe we can talk!

By Paul Russell:

There's a truth that those of us pushing against euthanasia and assisted suicide know well; that the more people understand the issue, the more concerns they find, the less they are convinced that we should go down that path.

Sure, it is not always the case but, time and time again I have seen the truth of it in action.

A colleague sent me a copy of an article published in the latest edition of the Medical Journal of Australia (behind paywall) that reminded me of this point and also how crucial it is that people get beyond their limited understanding of how euthanasia works to some of the detail.

This isn't one of those 'passionate advocate completely changes mind' stories. Briony Murphy, a PhD student at Monash University studying 'Suicides and Homicides among nursing home residents' admits in the close of her article that she is now a 'fencesitter' on the issue of euthanasia. But that's not where she started.

What we discover in her article is that her PhD work led her from believing that she was pro-euthanasia in the beginning, to voicing concern "that vulnerable older people may continue to slip through the cracks between voluntary euthanasia laws for the terminally or chronically ill and lack of services and support for older adults with serious emotional and mental health needs."

How often do we hear this kind of observation? Lack of service for all sorts of needs. Disability support, mental health, aged care, suicide prevention, social support, palliative care - all issues that greatly impact upon life choices and life outcomes and matters that, when the need is not being met, actually reduce people's choices and may, as Murphy observes, see people fall through the euthanasia cracks.

It is a simple matter of equity and fairness that every Australian should enjoy the same standard of services and care no matter where they live. It would add tragedy to injustice if euthanasia were ever to be come law while such problems still exist.

As part of her research, Murphy listened to Andrew Denton's podcast series. She notes that Denton began each podcast with the disclaimer that it is not about suicide. He's dead wrong about that just as he was wrong to tell Emma Alberici on the ABC 7:30 Report that euthanasia was not killing. Murphy observes:

"However, in my experience, separating the question of suicide among older adults from the euthanasia debate has proven to be substantially more difficult."

"Do older adults not deserve the same help and prevention initiatives as anyone contemplating suicide? Would we say to a 35-year-old man suffering from depression after going through a divorce: "we get it...go ahead"? No, we would make sure that he receives all the possible support and treatment."

Should everyone get suicide prevention if they need it? Or is there a category of persons - the aged in Murphy's case and those with a disability or illness, more generally - who get suicide-enabling? People to whom we would implicity suggest, by virtue of the existence of a euthanasia regime: "we get it...go ahead".

Murphy also notes problems with elder suicide and 'how often and easily these can be overshadowed by the euthanasia debate'. It is never simple:

"...are we talking about the 80-year-old man who has been suffering depression for years...where some days he is lucid and others he is not? Would he be considered capable of making an informed decision about voluntary euthanasia? If not, would he get the support and treatment he needs or would he end up killing himself anyway?"

That's a huge question and one that cannot be ignored. But it is not answered by euthanasia or assisted suicide; something that Suicide Prevention advocate, Jeff Kennett and Victorian Coroner, John Olle simply don't get.

It was Olle, who presented statistics to the recent Victorian Inquiry on the 50 or so suicides per year in their category of people 'with 'irreversible decline', so terminal disease; death was foreseeable; incurable, chronic disease but death not imminent; permanent physical incapacity and pain. But the cohort did not include mental ill health or feared imminent decline.' In answer to a question on this data, Olle concluded that, "They are determined. The only assistance that could be offered is to meet their wishes, not to prolong their life."

In otherwords, Olle's answer to these tragic suicides is to offer them the alternative of suicide. The fact that, in most of these suicides, in data later disclosed to the committee, the people would not have qualified under the limited euthanasia regime suggested by that same committee, has largely escaped scrutiny. So much for all the caring!

Kennett's is a different story. A brilliant advocate for suicide prevention, he nonetheless, supports euthanasia and assisted suicide. To his great credit, he did intervene and join me and others in reporting Nitschke to the medical board a while back, which serves for mine to make his support for a legal regime all the more difficult to fathom.

In a recent opinion piece in the Herald Sun, he echoes Olle's call for suicide provision so as to avoid suicide - hardly suicide prevention! He also writes passionately about suicide prevention in general terms but, for mine, loses out badly by claiming that assisted suicide is a different issue.

Just saying it is so doesn't make it so.

Briony Murphy concludes that she is not saying that, 'we should not have a system in place to allow for voluntary euthanasia in particular cases.' She adds: 'I am saying that we need to carefully consider how we go about allowing euthanasia because we cannot afford to get it wrong. We cannot, in good conscience, establish voluntary euthanasia laws before first looking at our aged care and mental health systems.'

We will always 'get it wrong' for many reasons. For one thing, the law is a very blunt instrument and simply cannot cover all the possibilities nor provide protection for everyone in every circumstance. Murphy, while remaining a 'fencesitter' has provided the debate with a great point of reflection.

At the very least, these matters of inequity, ableism and access should be addressed first. Then maybe come back and talk about making people dead.