Opinion: No place for euthanasia

How can we assert a ‘right to die’ if it means that […] people will be at risk of losing their right to live? writes anti-euthanasia campaigner, Paul Russell

Above: Paul Russell, writer and founder of HOPE (see below).

I have followed with great interest the discussions on euthanasia in the pages of the Australian Ageing Agenda website and I congratulate the editors for engaging in this most contentious of subjects.

Australian-born Professor of Law, Medicine and Ethics at McGill University in Canada, Margaret Somerville, suggests that we need to re-engage in what she calls ‘death talk’; a healthy conversation about our last moments. It is true that our modern societies have ‘sanitized’ death to a great degree. People die less and less in their own homes in familiar surroundings and with their loved ones than ever before. No matter how caring the hospital, hospice or aged care facility we all know that there’s something a little impersonal about the experience.

We also know that we’re living longer and more likely to die from a chronic illness than our forebears and that our ageing population creates pressures on the health system generally and in services for the aging in particular. In that context it is understandable that people should be concerned for their welfare when nearing life’s end. But euthanasia is not a reasonable solution.

It is not a reasonable solution because it is bad public policy to include euthanasia as an ‘alternative’ to good care and pain management. If we have a problem, it’s really more that many doctors lack the skills, knowledge and training about palliative care services or where to go to access such care.

I have a friend who has worked 40 years in a really top quality palliative care and hospice environment. She told me once that in all her years and in all the different and difficult situations her patients have experienced she had never once heard anyone call out for euthanasia. Observing her work I must say I’m really not surprised. Why? Because good palliative care is not only about pain management; it’s also very much focussed on empowering the patient and including their loved ones every step of the way. It is, in fact, the fear of loss of autonomy and power that rates far more highly, by a factor of more than four-to-one, than does the fear of unmanaged pain.

If we include euthanasia as an ‘option’ in critical care we’re making the patient the problem and not the condition. Once we begin to cross that line, does anyone really believe that the ‘cheaper, quicker option’ won’t begin to take precedence over good palliative care?

We should also consider the problem of elder abuse. As far back as 1994 a study in NSW found that something like 5% of people over the age of 65 were subjected to some form of elder abuse. Elder abuse has been called the epidemic of the century and is known to cost more than $2.6 billion in the US alone each year as the elderly are swindled out of their savings. Elder abuse can also be physical, emotional and even sexual and it’s not hard to imagine that, if euthanasia were an option, that vulnerable aged people might be swindled out of existence as well.

Readers will remember the famous case of Dr. Harold Shipman who, by his own admission, killed 600 elderly, vulnerable people in the UK by his own hand. With euthanasia we risk giving the protection of the law to this kind of behaviour. We must remember: Doctors are human too and suffer from all of the same kinds of urges and errors that we all might experience.

Ultimately it is the duty that we owe to the vulnerable in our community that, I believe is the strongest argument against euthanasia. Those who cannot speak for themselves; the frail aged, the disabled and the weak deserve our protection. How can we assert a ‘right to die’ if it means that these people will be at risk of losing their right to live? A recent survey in the UK said that 70% of people living with disabilities feared the advent of euthanasia and assisted suicide and more than 50% felt that their social standing would diminish. When people like Baroness Warnock can stand in front of an audience of disabled people, as she did in Belfast a few years ago, and tell them that they had a ‘duty to die’, then we know that the possibility of such abuses is all too real.

Living in a society places demands on all of us. Our freedoms are rightly limited by the fact that we cannot diminish the freedoms and rights of others at the same time. It’s a dynamic balance that must be respected lest society descend into chaos and anarchy. Euthanasia, the ‘right to die’ as it is often called, is one of those issues where we would be putting others at risk. We need to think about our children and grandchildren and those at risk and the society we leave for them and decide against crossing this line.

Paul Russell is a writer and founder of HOPE: Preventing Euthanasia & Assisted Suicide.
Paul will be speaking at the Euthanasia Prevention Coalition’s international conference in Vancouver in June.

Tags: aged-care, ageing, assisted-death, baroness-warnock, dementia, disabled, duty-to-die, elder-abuse, end-of-life-planning, ethics, euthanasia, euthanasia-prevention-coalition, harold-shipman, hope, law, margaret-somerville-, mcgill-university, medicine, pain-management, palliative care,

12 thoughts on “Opinion: No place for euthanasia

  1. It is necessary to address the real issues (and first we all have to agree on what they are).

    One of them is whether excellent palliative care is sufficient. Some say it is, others (including those who have experienced it) do not. Surely if those experiencing the best palliative care (and those providing it) still feel it is not enough, then they are in the best position to give an opinion – and they do. Should we disregard their opinion?

    We need to weigh up the risks and benefits properly.

    Lisel O’Dwyer

  2. It is necessary to address the real issues (and first we all have to agree on what they are).

    One of them is whether excellent palliative care is sufficient. Some say it is, others (including those who have experienced it) do not. Surely if those experiencing the best palliative care (and those providing it) still feel it is not enough, then they are in the best position to give an opinion – and they do. Should we disregard their opinion?

    We need to weigh up the risks and benefits properly.

    Lisel O’Dwyer

  3. I agree totally on one point, Lisel: that it is a matter of risks and benefits. Can we really put people’s lives at risk to provide a benefit for others?

  4. Great words Paul,

    One only has to look at Holland and hear what elderly people visiting that country feel.
    Euthanasia cannot be legalised and no parliament has or should have the right to legislate an act that deliberately when enacted leads to the death of its constituents.

    God bless you Paul

    Tony Zegenhagen

  5. I agree completely with Paul Russell’s linkage of calls for euthanasia to the under-resourcing by governments and organisational managers of palliative care; and also to the lack of training and dubious proficiency of some clinicians relied upon to provide effective palliation for those in pain of all types.
    Increasingly strident calls for legalised euthanasia from a relatively small number of activists highlight many issues and concerns that health professionals have had for some years. At the forefront of these dilemmas are registered nurses in the aged care sector who are in daily contact with people who are in pain, suffering chronic diseases and others who are simply sick of living. Over the past few years the participation level of registered nurses in aged care homes has been systematically reduced leaving most of the direct care to care workers. The increasing scarcity of professional nurses in aged care facilities means that care staff oversight is also becoming less and less effective. The result is that pain and misery are less likely to be identified and managed effectively by people with kind hearts but no nursing or medical skills. Underlying this situation is the low priority given to older people in our community and to aged care as an essentially service to the public.
    As Paul rightly points out, if we as a society sanction homicide for those with certain chronic illnesses and lack of access to effective palliative care, will we find ourselves in a position where others with the same conditions and lack of access will have to mount an argument for the right to remain alive in a situation that has warranted euthanasia or assisted ‘suicide’ for others?
    What safeguards will be in place to prevent this sanctioned homicide from being applied to a range of people whose long lives have become a burden to others?
    Will the introduction of legally sanctioned killing be an excuse for system failures that do not effectively relieve pain and suffering, or identify and treat depression, or manage dysfunctional relationships that lead to despair?
    Any suggestion that euthanasia (or whatever weasel words are used to describe it) be included as part of a health system, is completely ludicrous. As a nurse with over 45 years’ experience I have a clear idea about the business I am in – and it does not include killing people who have conditions that are expensive to treat or difficult to manage well. If our legislators sanction the killing of such people then it will be both bad policy and ethically indefensible. Whatever the outcome, such killing must not be considered as part of ‘health care’ and not involve nurses, doctors and others who have spent their adult lives learning how to promote health, heal the sick and comfort the dying. And certainly NOT be given Medicare funding.
    Making euthanasia an option under the ‘healthcare’ banner would compromise the trust that people have in the health system and health professionals to act in their best interests and to do nothing that would cause harm.
    Tracey McDonald

  6. Hi Paul! I should state first that I love grappling with difficult ethical questions and thinking about the factors involved and the reasons why people use certain logic etc and the use of language to support (or betray) views.

    To address your question – we already do put peoples lives at risk to provide benefits to others in many other realms, (eg soldiers’ and police’ lives are at risk in their line of duty to protect or defend civilians, vaccination has adverse effects on a tiny proportion of recipients,etc). In these cases,the risks and benefits have been identified and which way the balance tips is clear (to the majority anyway, including policy makers). (Of course, some may still argue that the risks of vaccination outweigh the benefits).

    This does not mean “well it’s OK in X situation, so it is OK in Y situation”, but it does mean that in X situation the relative risks and benefits have been clearly identified and weighed against each other. In some circumstances (and granted, not others), yes, we can indeed “put people’s lives at risk to benefit others”, so I don’t think that is the question we should be asking in regard to euthanasia. It is quite easily refuted, so if you want to hold your position, you need to refine the rhetoric. In the case of euthanasia, it seems to me that the risks have not been identified clearly enough. In turn, there could be (and is!) a range of reasons for that.

    In this instance (euthanasia), it seems to me it is not a matter of asking “can we put lives at risk to provide a benefit to others?” It is a matter of identifying the relative risk and benefit. We don’t really know what the real risk is in quantitative terms(apart from looking at the experience of the Netherlands – and interpretation of that situation also varies according to one’s view). We don’t know what the real benefit is either, in quantitative terms. We can try simulating it statistically, using both extremes and see how it looks. This is then open to the argument that the issue is not about numbers but about ethics. Personally I don’t think you can separate the two. Just look at the old ethical dilemma of “Would you kill someone if it means thousands are saved?” If someone answers “yes”, then at what point do they say no – when it is dozens, a few that can be saved? People they know? What if was a baby vs ten adults? What if it was an adult vs 5 babies? What if it was Hitler? Should they ever say no?

    These are the questions that trained ethicists and philosophers deal with, and while even they can’t agree, there is still the weight of conclusions based on professional training to consider. (Unfortunately this doesn’t always happen – eg the climate change issue and how the views of a minority tend to be given equal consideration.) Of course, this does not mean either that the majority is always right, but if it is a majority view based on well supported evidence or logic, then that is different from a majority of public opinion. If the two happen to coincide, that’s good.

    I like to think about these things even if it is something I agree with – I think it is a very useful thing to do. Sometimes doing so can lead a person to change their mind. That has certainly happened to me on more than one occasion!

    Maybe you have already done this, but then why ask the question “can we really put lives at risk to provide a benefit to others?”

    Anyway, just thinking out loud. (Or via the written word, to be precise!)

  7. What a lot of theoretical hoo-ha about VOLUNTARY euthanasia. What about my right to make a choice about how I want to die. In any case, its quite pointless to carry on about palliative care. Sure, it is wonderful for those who want it. Only problem is, there just isn’t any money for it in most countries, especially in Australia.

  8. The suggestion that voluntary euthanasia legislation will cause doctors to turn into serial killers like Dr Shipman is bizarre. It is even much bizarre to suggest that VE legislation would provide protection for such behaviour. The opposite is the case: it is much more likely that if the UK had a reporting and review system as the Netherlands has, as an important component of VE legislation, then Dr Shipman’s activities would have been picked up much earlier.

    Mr Russell seems to have an unusual and very poor view of doctors and makes claims based on that rather than on the basis of reputable evidence. In the NT 7.30 Report on the ABC on 1 April, he expressed the view that VE legislation “abandons … the aged, the vulnerable, the disabled and the voiceless to the whims of a doctor who may well be bent on seeing them die”. I’m amazed that the AMA is not coming out publicly to refute such unacceptable slurs against doctors.

  9. Those who do not wish to end up in nursing homes or palliative care, no matter how good their services are, do not have a say in a choice of ‘how they will die’ unless they take their own lives, often before they would die normally, to prevent being completely dependant on others. Compassionate doctors are already helping terminal patients avoid the last few days of life.
    Proper laws, already in place in some overseas contries, would protect physicians and give patients, who request this assistance to die, control over the end of their lives. 80% of adult Australians (Newspoll Feb2007) want this control.

  10. Mr Russell’s claims that his friend and palliative care practitioner has ‘had never once heard anyone call out for euthanasia’. Palliative Care Australia (PCA) in a March 1999 Mission Statement on palliative care states:

    1 ‘Palliative care practice does not include deliberate ending of life, even if this is requested by the patient.’ It then goes on to state:

    2 [PCA]’Acknowledges that while pain and other symptoms can be helped, complete relief is not always possible, even with optimal palliative care’, and

    3 ‘Recognises and respects the fact that some people rationally and consistently request deliberate ending of life.’

    It is pertinent to ask how point 1 can be reconciled with points 2 and 3. A minority of patients are destined to endure unrelievable suffering instead of having their own wishes respected and protected under a legal framework for end of life decision making: including the right to choose voluntary euthanasia as an option of last resort.

    This is unconscionable.

    Julia Anaf

  11. Same tired old fallacies about palliative care having all the answers. Even the National peak body, Palliative Care Australia publicly acknowledge that even with optimal PC, some still find suffering unbearable and seek to hasten their death.
    They should be permitted to do so by willing doctors. Anyone who disagrees can die any way they wish but they have no role in how I face my own demise.

  12. Well intended though this article might be, it still neglects to address the minority of individuals for whom palliative care is not the answer.

    It is always easy to promote an idea which embraces the needs of the many, whilst conveniently ignoring the needs of the few, and it is for those few that a more dignified, controlled exit from life is essential.

    Sure, palliative care is a solution for most of us, but if I wish another form of exit, and I am not harming anyone else by doing so – then why not? After all, dying is our last act, and often the culmination of many years of achievement and accumulated memories. Leaving this life should be something we control, and something which occurs in a way which completes the cycle in a dignified manner with as much choice as humanly possible.

    I have seen those on death row in palliative care, and it is not a pleasant sight, nor one which gives dignity to those who die in this manner. I would far prefer to die at a place and in a manner of my choosing, and if that is my wish then it should also be an option for me. Those who are happy to die in a palliative care institution would remain free to do so, and I would not seek to force my preferred options upon them. All I ask is that they should not force their preferences upon me.

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