The Herald Sun ran an article today by a Chris Fotinopoulos under the heading: We all have a right to a dignified End. This article earlier appeared on the ABC's The Drum under the title: Dignity in Dying shouldn't be just for the rich. 

The original title best reflects the nature of the article and also my response.

'Let them have death!'

The miss-attributed, but often quoted "Qu'ils mangent de la brioche" or 'Let them eat cake' has always been a potent phrase commenting on class distinction. Attributed falsely after Rousseau's reference as having been said by Marie Antoinette it echoed the belief that the elites (in this case, the French Aristocracy at the time of Louis XVI) were out of touch with the lives of the starving French peasantry. The sentiment is alive and well.

Chris Fotinopoulos on the pages of the Herald Sun (We all have a right to a dignified end, July 16) provides us with a window into the mind of modern elites arguing as he does that lack of social status and wealth is a barrier to access to euthanasia and assisted suicide. Fotinopoulos self-identifies as such an elite and attempts to posit himself as a champion of social justice and equity as one of the 'privileged few' who can 'die on their own terms'.

This misses the point in so many critical ways; first of which is that history shows, rightly or wrongly, that social change is most effective and lasting when driven from the bottom up - not the top down.

But Folinopoulos ignores totally the contingent reality that there is no level playing field; that those of us who, unlike him, could not afford his 'I'm-okay-thank-you-very-much' solution to this supposed dilemma may very well have other social equity barriers that would make his universal access model simply dangerous.

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Access to quality palliative care is a prime example. While Australians can be justly proud of the advances made in the last decade and more in the provision of the very best in care, still not all Australians experience the same access. Are we to deal with this inequality by state-sanctioned-death or by striving to meet the real need?

We're building a world-leading Disability Insurance Scheme which is a great step towards equity and self-management for people living with disability; but we're not there yet. Even here, the NDIS by itself will not immediately remove the experience of many who feel devalued and mistreated by individuals within medical and other systems who subtly or otherwise question the value of life with a disability.

And what about those who, for whatever reason, don't have the where-with-all to negotiate on their own behalf; those who are vulnerable to paternalistic influence? Whether by depression or other psychological issues or by way of the effect of chronic illness or age-related infirmity or even by the notion of being a burden, there are significant dangers lurking in the suggestion that equality of access to euthanasia or suicide is a simple matter.

Would it be 'fairer, sensible and indeed safer' to allow doctors to prescribe and /or administer lethal substances? Maybe we can talk more when other more pressing social equity realities have been addressed. In the meantime, those who can afford to circumvent the law will continue to do so in a variety of ways, no doubt. For the rest of us, we should remain thankful that the law that Folinopoulos so easily dismisses, remains as a protection for us all - including the vulnerable and socially disenfranchised.

Paul Russell is director of HOPE: preventing euthanasia & assisted suicide and is Vice Chair of the Euthanasia Prevention Coalition International.