Euthanasia has been illegal in Australia since the federal government overturned short-lived Northern Territory laws in 1996. Despite it being a crime to assist in euthanasia, prosecutions have been rare. Four decades’ worth of opinion polls have shown that a majority of Australians appear to support the legal option of aid-in-dying for those suffering intolerably and without relief near the end of life. Although a significant number of countries and US states have legalised euthanasia and assisted suicide in recent years, Australian federal and state governments have continued to debate the political, legal and ethical implications of legalised voluntary euthanasia.
An elderly woman's hands, in Poole, Dorset.
But now, Victorians suffering with an advanced and incurable illness, disease or medical condition would be able to seek a medically assisted death from 2019, under a model to be considered by the Victorian Parliament.
An expert panel chaired by former AMA president Professor Brian Owler has outlined how a Victorian assisted dying scheme would work. Politicians will be granted a conscience vote on the matter later this year. If the law is passed, it would not become operational for another 18 months.
Dr Nirdosh Gogna, a radiation oncologist from Brisbane thinks it might be the only dignified solution to some of the terminally ill patient’s problems. According to Dr Gogna, although medical treatments and palliative care have come a long way in giving terminally ill patients the most comfortable life in their final days, yet, it has not become advanced enough to take away the pain and misery for all patients. In some cases, the pain and suffering is so severe that even the best treatment or management plans fail. These patients, according to him, do not have a good quality of life to live and sometimes the patients themselves wish for their sufferings to come to an end. In such circumstances, voluntary euthanasia can be the best and dignified option for patients to end the cycle of pain.
“Due to modern treatments, the life of a chronically ill patient can be extended, however, sometimes a situation arises where no treatment works and the patient suffers intolerable mental and physical pain. In such situations, voluntary euthanasia comes into question.”
But, all is not as straight forward as it seems. There are major ethical, medical and religious issues to consider before any decision is made around voluntary euthanasia. It’s an ongoing debate between those who champion the ‘right to life’ as opposed to those who assert the ‘right to choose’ when and how to die? Can palliative care always provide adequate pain relief? If legalised, could voluntary euthanasia be the ‘slippery slope’ that leads to involuntary or non-voluntary euthanasia? Is voluntary euthanasia dignity in dying, assisted suicide, or homicide?
Two elderly hands holding onto one hand of a younger adult.
According to Dr Gogna, these decisions are not made lightly in the countries where voluntary euthanasia is legal. While considering euthanasia, apart from the patient’s doctor, an independent physician makes an assessment of the patient’s condition; the patient himself makes a request for voluntary euthanasia multiple times and is given time to reconsider his decision; there is also a mental assessment done on the patient to see whether he is mentally competent to make an informed decision etc.
“The decision is not taken lightly. Palliative care is highly advanced in many countries now and it’s only when all other options are exhausted that a terminally ill patient has the option to request for voluntary euthanasia in countries where it is legal. Even then, there is a proper process to go through to get approval.”
Even though the ‘right to life’ advocates argue that no human has the right to take away life and life and death should be left to the natural course, Dr Gogna argues that only a patient knows how he feels trapped in a body that only gives pain and suffering. He mentioned that even the Hippocratic Oath that doctors take to uphold specific ethical standards also says that a physician must never harm a patient and must never encourage them to end their own life. However, in some circumstances, the actions of the doctors indirectly lead to a patient’s death e.g., increasing the dose of morphine to elevate pain.
Close-up of man going to overdose drugs
After an ongoing debate in Australia regarding euthanasia, The Voluntary Assisted Dying Ministerial Advisory Panel (the Panel) was given the responsibility of developing a safe and compassionate voluntary assisted dying framework for Victoria.
Here’s a look at the main points outlined in the model that has been proposed for the Victoria.
- Only people over the age of 18, who live in Victoria and are an Australian citizen or permanent resident would be eligible.
- Only patients will be able to initiate the request - To qualify, a person must be of "sound decision-making capacity" and the condition they are suffering from must be expected to cause death within 12 months and be "causing suffering that cannot be relieved in a manner that is tolerable to the person". Dementia patients will not qualify.
Only the patient can initiate a request for assisted dying, and the person must be assessed by two doctors, one which must be an expert in the person's particular illness.
One doctor must also have at least five years post-fellowship experience and all will have to complete specialist training to be involved in the requests.
The system is proposed to work in the following way:
- Firstly, the patient makes a request to their medical practitioner, who will make an assessment
- Another practitioner makes an independent assessment
- The patient then makes a written declaration of an enduring request. This is to be witnessed by two people, one must not be a family member or anyone who may be a beneficiary from the person's death
- Finally, the patient makes a third and final request to their medical practitioner. In most cases there will be a minimum of 10 days between first and last request before the medication is dispensed.
The doctor must ensure the person is properly informed of the:
- Diagnosis and prognosis
- Treatment options
- Palliative care options
- Expected outcome of taking the lethal dose
- Possible risks of the lethal dose
The doctor must also inform the patient "they are under no obligation to continue with their request for voluntary assisted dying, and that they may withdraw their request at any time".
3.The drug will be self-administered after being dispensed from a compounding chemist - The panel has recommended the lethal medication be kept in special locked boxes, with medication to be returned to a doctor in the case of a patient being too incapacitated to take it.
In cases of people who are unable to administer the drug, such as motor-neurone disease patients, a doctor would administer the lethal dose.
4. New offence to be created to guard against abuse - One of the concerns was that the system could be open to abuse. The panel has moved to assuage these concerns by recommending new criminal offences for anyone who induces someone to request or self-administer assisted death.
A new charge will also be created for people administering a lethal dose to a person who does not have decision-making capacity.
Doctors will be able to conscientiously object to any aspect of the process.
View the entire proposal here:
So are there any options currently available to patients in Australia that can assist them with their exit strategies?
Molina Asthana, Principal Solicitor with the Victorian Government Solicitor’s Board, says that currently the patients have two options that can lawfully assist them with their exit strategies. Suicide, which was earlier unlawful in Australia, has been rendered lawful under Section 60 of Crimes Act.
Generic picture of a statue of Themis, the Greek God of Justice, outside the Supreme Court in Brisbane. (AAP Image/Dave Hunt) NO ARCHIVING
Second can be the refusal of medical treatment by a patient who is competent, including artificial nutritional hydration under the Medical Treatment Act 1988.
“In terms of active voluntary euthanasia, which is physician assisted suicide, in this case, at a patient’s request a medical intervention occurs resulting in the patient’s death. This is unlawful, though it may be lawful if the intention of the medical intervention is to relieve pain, even though the physician knows that the patient is likely to die.”
For anyone seeking help, please contact the following numbers:
Men's Line Australia - 1300 78 99 78
Beyond Blue - 1300 22 46 36
Lifeline Australia - 13 11 14
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Last night saw the screening of a documentary filmed by the Australian Special Broadcasting Service (SBS) and made by their highly regarded European Correspondent, Brett Mason. It looked at the Belgian euthanasia regime through the lens of personal stories.As the documentary unfolds we hear clearly from Mason, a voice of concern. To his credit, both in the documentary and in his blog story, he doesn't put his own views nor conclusions. Clearly, however, the reality of euthanasia is very different from his initial conceptual thoughts as evidenced in these comments from the blog:
"I was taken aback - not for the first time in recent weeks - by just how mundane and unremarkable euthanasia is to those who perform it."
"I'm unable to bury a burning sense of anguish in the pit of my stomach. While I fully accept and respect that this decision was the patient's and the patient's alone, over these last nine months I've been filming in Belgium questions have repeatedly been asked about how this nation's euthanasia laws are safeguarded."
Reflection during the program came in the testimonies of Belgian, Tom Mortier, whose mother was euthanased without his knowledge and Dutch Professor, Theo Boer, who had formerly been a member of one of the Dutch euthanasia review committees. Both had formerly supported their countries laws. It would be wrong to suggest that Professor Boer is now totally opposed, but Tom Mortier most certainly is so. Both raised concerns that the Belgian and Dutch laws had moved far beyond any initial sense and remit as being only for terminally ill people and only at the end of life when all else had failed.
The documentary then follows two people contemplating euthanasia. Neither, it should be said, are terminally ill. From the SBS online profiles:
"Peter Ketelslegers is a 33-year-old father of two boys, Alex and Thomas, and suffers from a rare condition called cluster headaches.
The intense headaches can last up to three hours, several times a day. He's tried many different treatments, but nothing has worked.
He used to run a farm with 300 cattle near Brussels alongside his wife Conny, but now the animals are gone as he's no longer able to work.
The headaches won't kill him, but there's no known cause or cure. He tells Dateline that the suffering is now so unbearable that he wants to be euthanised."
"Simona de Moor is a physically healthy 85-year-old. She lives in a care home in Antwerp, but is still active and on no medication.
However, she's been unable to accept the death of her daughter Vivian from a heart attack three months earlier, and sees no reason to go on."
Peter Ketelslegers' situation is intensely difficult and will draw appropriately compassionate thoughts and sentiments from every viewer without doubt. As the documentary went to air, according to the end credits, he is scheduled for an operation in October. We will all wish him well.
Simona de Moor suicides after being handed a lethal potion by well-known euthanasia doctor, Marc Van Hoey. Strictly speaking, an act of assisted suicide, Mason's voice over makes it perfectly clear, as any thinking viewer will realise, that de Moor's trigger for her desire for death is the recent death of her favourite daughter from a heart attack only a few short months earlier. She is grieving. We are told that she has another daughter who is estranged. As was the case with Tom Mortier's mother, it was not deemed necessary that de Moor try to re-establish her relationship with this daughter and, like Tom's situation, that daughter will only have learned about her mother's death afterwards.
At this, I found myself raging inside. During a time of grieving it is never sound practice to make life-changing let alone life-ending decisions. Where is the simple, natural and normal thought to provide comfort, support and encouragement for this dear lady through the grieving process? Gone! Evaporated on the altar of autonomy and the Belgian love affair with personal choice.
Indeed, that is precisely how van Hoey puts it. After taking part in more than a hundred euthanasia deaths it would seem that this obviously caring doctor has perhaps become cold to other less drastic and more truly compassionate alternatives. A truly shocking counsel of despair: doctors as little more than dispensing machines for people's darkest choices.
Peter Ketelslegers' situation is tragic in the here-and-now. During the telecast last night I had contact from two people who wanted to provide help for this man and his family; including one who had found successful relief from the very same ailment. As with all these matters, things are never as black-and-white as they might seem and there is always hope.
As Ketelslegers' story unfolds, we see the poignant interaction with his wife and his two children. His wife Conny, understandably seems wearied by Peter's difficulties. He talks about being a burden on them. She is clearly loving and dedicated to Peter and the family. She tells Mason:
"At some point you would be enormously selfish to keep your husband with you when he knows that he's in so much pain, so I stand behind him."
Mason: "You'll let him have his wish?"
Conny: "Yeah. With pain in my heart, but yeah."
How incredibly difficult. There's no sense of anything other than standing with Peter as she clearly has done so well and for a long time. But for Conny, there are no apparent choices.
A tweet came to me from a genuine inquirer: "if you had power to decline his request, what would you say to him (Peter). How would you justify he should continue to suffer?" A very good question and one I think that everyone who opposes euthanasia and assisted suicide needs to grapple with.
We cannot stand firm in opposing any changes in the law without doing whatever we can to pressure those in power to provide better care. As Mason and others observed, 'unbearable suffering' is entirely subjective; but that should not stop nor hamper progress nor the drive, from a compassionate disposition, to do everything possible to ease such distress.
But black-letter-law can never adequately describe nor restrict such laws to a particular cohort nor to a particular understanding about for whom the law is intended and under what circumstances. Nor can it ever account adequately for the necessary protections for vulnerable persons. Currently, absent euthanasia laws, Simona de Moor would hopefully had her real issues of grief addressed. She was indisputably vulnerable.
Congratulations to Brett Mason and SBS for this fine work.
View the documentary HERE
Read Brett Mason's blog HERE
View ancillary footage and information HERE