Monday, 29 October 2012

Public debate hotting up in NSW

In recent days the media in New South Wales has been awash with a renewed discussion on euthanasia & assisted suicide prompted, it seems, by the news that Greens Upper House MP, Cate Faerhmann will introduce a private member’s bill sometime soon.

In NSW private members can list an intention to table a bill which would then await an opportunity to be raised to the notice paper for debate.

Two of the pro-euthanasia commentators seem to be bent on bludgeoning opposition.
One commentator used a number of pejoratives: ‘hysterical opposition’, ‘vigilante religious fundamentalist nurses’, ‘bullying religious fundamentalists’ – you get the picture.

Another (called the NSW Premier and the Australian Prime Minister, ‘supremely arrogant’ for expressing their opposition to euthanasia & assisted suicide. He also called Prime Minister Gillard, ‘wilfully ignorant’ in respect to what he sees as happening in jurisdictions where euthanasia is legal.

The Sydney Morning Herald report quoted both the Premier and the Prime Minister:
Mr O'Farrell has described himself as ''strongly opposed'' to euthanasia, while last year Ms Gillard said she was concerned it would ''open the door to exploitation and perhaps callousness towards people in the end stage of life''. Ms Gillard added there were no appropriate safeguards to protect vulnerable people from using euthanasia as an ''out''.

While Mr O’Farrell gave no indication of why he is opposed, the Prime Minister’s comments echo a number of parliamentary reports on the subject, including the House of Lords and the Inquiry by the Tasmanian Parliament in 1998.  How deeply have each of these leaders thought about the issue? We can’t really tell; but we cannot attribute ignorance to either of them based solely on these comments.

So called ‘Catholic lobbyists’ also came in for some attention for the use of ‘emotive terms’, so-called. Railing against such phrases as, ‘legal killing’, ‘suicide’, ‘death by doctor’ and ‘lethal injection’, Dr. David Leaf added, ‘I’m not anti-Catholic, but I’m anti- (BS).’ I think we can accept that Dr. Leaf is not anti-Catholic but it still leaves me to question: why mention the Catholic Church at all? Perhaps because of the contrary statements by Fr. Frank Brennan in the article.

But these terms are accurate; and if we’re to debate legislation with such grave consequences (death) then terms that describe the actions that the legislation seeks to allow or to describe a bill in terms of what it would allow is hardly ‘BS’. Sure, such phrases might be emotive for some – but at least they have a descriptive character that is accurate; very much unlike terms such as ‘dignity in dying’ or ‘end-of-life-assistance’ which could describe a range of actions and circumstances from the benign to the sinister. (anyway, one doesn't need to die by euthanasia to have a dignified death)

In his comments, Dr. Robert Marr makes the point that the membership of his pro-euthanasia medical group would not actually want to ‘be responsible for the death of a patient wanting to die.’

He went on to describe what is essentially assisted suicide and not euthanasia:
'But doctors wouldn't be administering the drug, because that responsibility could instead lie with the patient who would self-administer the dose, which is what happens in countries where it is legalised,''.
This is similar to the Oregon and Washington situation, but self-administering and the absence of the doctor at the time of death has its own inherent problems.

So, the group is called Doctors for Voluntary Euthanasia Choice; but they’re advocating for assisted suicide – and they would still be responsible, albeit without the act of administration of the lethal substance. This reality cannot be avoided. They would still be making a judgement (choice) about the quality of life of such persons and they would still be prescribing the lethal dose.

Dr. Leaf argued that where euthanasia and/or assisted suicide was legally practiced that ‘numerous independent audits’ have shown them to be safe. He further argued that, ‘In Oregon in the US, those choosing euthanasia are white, well off and well educated, and that is the same in Belgium and Holland.’

Firstly, euthanasia is not practiced in Oregon; rather assisted suicide. The reference to ‘white, well off and well educated’ is in fact correct. Dr. Leaf seems to be suggesting, as have others more directly, by reference to this fact that it somehow proves that vulnerable people are not over represented in the statistics (as was the concern of the Prime Minister mentioned above).

There are two possible conclusions arising from such an observation: Firstly, that those in the cohort mentioned are ipso facto never vulnerable; and, secondly, that vulnerable people are largely (if not exclusively) non-white, poor and poorly educated. As I've commented before, anyone can be vulnerable; for example, people with a diagnosis of cancer are 12.6 times more likely to commit suicide and people with depression are 4.1 times more likely to request euthanasia. This is hardly surprising.

Contrary to Dr. Leaf’s assertions, there are studies pointing to concerns about the practice of euthanasia and assisted suicide in places like the Netherlands, Belgium and Oregon. But even if we were to concede that there is evidence supporting both the pro and the con side of this debate, we cannot simply adjudicate the case based on some sort of balancing act – weighing the scales, so to speak.

No, when there is a recognisable risk of abuse and where such a risk relates to life and death we cannot behave in such an arbitrary fashion – we must decide to protect the lives of all citizens equally. So said the summary statement of the 1998 Tasmanian Parliamentary inquiry in this regard, adding that this is the ‘obligation of the state’.

And even if we were to set limits upon who would qualify for euthanasia or assisted suicide and to include so-called ‘strict safeguards’, as the British House of Lords Committee on Medical Ethics concluded, it is impossible to set secure limits:
“…to create an exception to the general prohibition of intentional killing would inevitably open the way to its further erosion whether by design, by inadvertence, or by the human tendency to test the limits of any regulation.”
I have met a number of advocates for a limited access to euthanasia and/or assisted suicide and I don’t doubt that people like Dr. Marr and Cate Faerhmann MLC are genuine in what they believe and want to achieve. But other Australian groups and advocates have different objectives; they set their agenda limits differently. Most seem to want the ‘limits’ set more broadly. It would be na├»ve to expect that any group with a broader agenda would simply ‘pack up and go home’ if their particular goals had only been partly achieved.

The reality is that once we pass legislation – even if it expressly reserves access to euthanasia & assisted suicide to a limited few, we will have made an acknowledgement in law that euthanasia & assisted suicide is a quasi-human right which, by that very action of law, includes everyone.

Find that hard to accept? Please consider: If Cate Faerhmann’s bill were to pass into law and then, at some later date, another bill appeared looking to expand the limitations on who might qualify (backed up by the inevitable ‘hard case’ stories in the media); would we then be debating the merits or otherwise of euthanasia & assisted suicide? No, we will have already conceded that in the earlier bill.

Once we accept euthanasia & assisted suicide for some, we’re excepting it for all. No such law can adequately protect vulnerable people. Yes, we should be compassionate to those who are suffering, but we cannot let such compassion drive a law that would, ultimately, treat some citizens unequally; knowingly putting some at risk of their lives.

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