The only place it leads

In anticipation of the review into the operations of Victoria’s euthanasia and assisted suicide legislation, The Age has unsurprisingly joined the bandwagon asking for its remit to be extended.

In an opinion piece this week, ironically the same week we celebrate Mothers’ Day, former deputy editor Michael Bachelard advocates for euthanasia and assisted suicide to be available for the leading cause of death for women over 75: dementia.

Bachelard uses an unpublished anecdote written by the late Dr Rodney Syme about a woman in the late stages of dementia who Syme described as being in a “catastrophic vegetative state” to suggest the Victorian inquiry should consider finding a way to allow dementia sufferers to make a request for euthanasia while they are still able to provide informed consent, and then have the request carried out even if they later lose the ability to provide that consent.

Bachelard writes:

“Nobody pretends it will be easy to assess how to gain informed consent from dementia sufferers, or how then to enact their wishes. But the review should canvass the issue – as other countries such as Canada are doing. In my view we must work to find a way to give relief to dementia sufferers from the fear and pain they ultimately will be unable to express.”

Bachelard mentions Canada, but one wonders whether he has also considered what this change has done in The Netherlands.

Recall the case of the 74-year-old woman who was suffering from Alzheimer’s disease. She had provided an advance directive that said she wanted euthanasia “when I myself think the time is ripe.”  Every time the subject was raised, however, she responded:“Not now though, it’s not that bad yet.” 

Her doctor decided that she knew better: the doctor put a sedative in the patient’s coffee because she knew the patient would not have taken the euthanasia drugs if asked. When the patient resisted the injection, the doctor summoned the patient’s family and they held her down while the lethal drug was injected.

How did the Dutch authorities respond?

Instead of punishing the doctor, the authorities amended the position on euthanasia for dementia patients to “allow doctors to consider euthanasia for patients with advanced dementia who have a written dementia request but can no longer make their wishes plain.”

“Doctors”, the regional euthanasia authority said, “can best judge whether a dementia patient is ‘suffering unbearably’ - one of the six legal requirements for euthanasia - and do not have to ask the patient in such cases.”

They went further to say that “it is not necessary for the doctor to agree with the patient the time or manner in which euthanasia will be given… because such a patient will not understand the subject.”

Doctors deciding what they believe is best for patients, even if that includes death, is the only way that allowing euthanasia for dementia patients unfolds. Those - like Bachelard - who think otherwise might need to read a little wider than the unpublished memoirs of euthanasia advocates.