Four South Australian MPs have taken the unusual step of co-signing a letter today to all their colleagues concerning The Hon Bob Such's Ending Life with Dignity Bill.
This is effectively a summary of objections made by various organisations (including HOPE) to the parliament in recent days in respect to this bill. It provides a reflection upon the framework of the bill, in particular; and the problems with euthanasia legislation in general.
Congratulations to these courageous MPs for re-establishing the debate on it's proper footing!
Subject: Ending Life with Dignity Bill 2013
Ending Life with Dignity Bill 2013
Please find below a short summary of serious concerns that have arisen from the above bill. We have also attached a further more detailed letter which responds to the points made by Dr Such in his letter to members dated 21 February 2013.
We firmly believe that the bill should be opposed because;
1. The Australian Medical Association (SA) Inc. strongly opposes this bill (and the Consentto Medical Treatment and Palliative Care (Withdrawal of Nutrition and Hydration) Amendment Bill 2013), stating,
“The AMA(SA) strongly opposes both Bills, considering them to be fundamentally and irretrievably flawed.”
The complete AMA(SA) letter dated 1 March 2013 is attached.
2. The Law Society of SA has stated in a 12 page letter dated 1 March 2013 that more than 30 major changes to the bill are needed, in addition to some minor changes. The required changes generally concern the procedures and so-called protections in the bill. A copy of the letter is attached and should be read by anyone considering supporting this Bill.
3. Only one doctor must certify that the patient has a terminal illness. That doctor could, and most likely would be, a strong advocate for euthanasia.
4. There is no requirement whatsoever that any doctor involved has any past involvement with the patient, or even any knowledge of the past history of the patient.
5. Patients suffering from depression, even major depression, still qualify for euthanasia. The expert opinion of a psychiatrist is not required.
6. There is no requirement whatsoever to notify a terminally ill patient’s relatives of intended euthanasia.
7. Persons as young as 18 years old (including those suffering from depression) can be put to death just 48 hours after the issue of the certificate of confirmation.
8. The law already allows patients to refuse ongoing treatment or life support, such that death results.
9. If euthanasia is legalised, the elderly will be vulnerable to feelings that they are a burden.The simple availability of euthanasia will itself place pressure on the elderly and vulnerable. Elderly people can be easily influenced, and may feel unwanted, even when this is not the case.
10. A poll referred to in ‘the Australian’ in October 2010 indicated that of those aged 65 to 74, only 18% approved of euthanasia. Euthanasia is an issue most relevant to this group.
11. The doctor who finally kills the patient need only be a general practitioner. The very real possibility of an error in diagnosis is always present, especially without a requirement for a second medical opinion.
12. Only a very small minority of countries in the world have legalised euthanasia.
13. The bill requires that the cause of death be falsely stated in official documents as the underlying disease, even though this was not the cause of death. This will distort official statistics.
14. The bill requires insurance companies to pay on a death claim, even though death is by choice through euthanasia. The insurer would not be told of the true cause of death. This illustrates the fact that there can be financial advantages for the patient and family to consider in deciding upon euthanasia.
We hope you will take these important matters into consideration as the debate on the bill continues.
Leesa Vlahos MP,
Hon. Dennis Hood MLC,
Martin Hamilton-Smith MP,
Hon. Tom Kenyon MP.
Ending Life with Dignity Bill 2013
I write this detailed letter in response to the letter of Dr Bob Such dated 21 February 2013, which has been circulated. I provide a response to the various points that he raises. I ask that you consider the issues carefully.
The Bill does not have adequate safeguards.
Subjective requirements and early availability of euthanasia I received a draft of this bill from Dr Such with a letter dated 9 January 2013. The draft included the following definition, which is consistent with the definition contained in the Consent to Medical Treatment and Palliative Care Act 1995; “ ‘terminal phase’ of a terminal illness means the phase of the illness reached when there is no real prospect of recovery or remission of symptoms (on either a permanent or temporary basis);”
This definition has been deleted from the bill put forward in the Lower House. Rather than requiring the terminal phase of a terminal illness before euthanasia can be applied, the requirement under the bill is that a person is terminally ill. The bill defines a person as “terminally ill” if the person has a terminal illness and the illness is causing unbearable suffering which cannot be alleviated to a degree that the person finds acceptable.
Importantly, the wording means that there is self-assessment, both as to whether there is unbearable suffering, and whether the suffering can be alleviated to a degree the person finds acceptable. There cannot be an objective standard as to whether suffering is unbearable. Only a patient can decide that. The provision expressly provides that the person must determine for himself or herself whether they find any alleviation acceptable. There can be no safeguards to prevent very wide claims to entitlement where the tests are subjective. Presumably ‘pain’ includes psychological pain with no organic basis.
Many diseases satisfy the definition of ‘terminal illness’. Persons with multiple sclerosis have a life expectancy of 5 to 10 years lower than that of the unaffected population. Thus this disease is a terminal illness, notwithstanding the fact that an affected person may have many years of life remaining.
Witnessing by 2 doctors – no certification of statutory requirements The 2 witnessing doctors are required to provide certain advice to the person. If they suspect that the person is of unsound mind or is under duress, inducement or undue influence, they must take certain steps. What they are not required to do is to independently certify as to whether there is in fact a terminal illness or whether such illness could be causing unbearable pain. Neither the provisions of the bill, nor the terms of the certificate require them to do this.
It is only the doctor who performs the euthanasia that must certify that the patient is terminally ill.
Depression – euthanasia may proceed regardless The two doctors are required to certify either that they have no reason to suppose that the person is suffering from treatable clinical depression, or, if the person does exhibit symptoms of depression, that they consider that treatment is unlikely to change the persons mind about the euthanasia request. It is easy to imagine that a person who claims to be in unbearable suffering to the point of seeking euthanasia may well appear to be suffering from depression. Indeed, suicide ideation is one of the symptoms of major depression. It would be extremely difficult for doctors to truly eliminate depression where a patient requests euthanasia. The alternative of forming an opinion that treatment for depression would be unlikely to influence the person’s decision to request euthanasia is fraught with difficulty. There is no requirement to actually treat any depression that is present, or to obtain the opinion of a psychiatrist.
If the patient requests euthanasia, the patient would presumably say that treatment for depression would not cause a change of mind. In considering the likely outcome of hypothetical treatment, the doctor would be free to form a range of opinions. His opinion would presumably be influenced by his personal views about euthanasia.
No requirement for long term treating doctor A person can change their treating doctor at any time. It follows that the requirement for a treating doctor to sign a certificate can be satisfied by any doctor who is appointed by the patient as their treating doctor. Presumably any person who seeks euthanasia will sign all paperwork necessary to achieve that outcome, including an appointment of a new treating doctor, if that makes matters simpler or more speedy. Doctors who support the concept of euthanasia will tend to be called upon to complete the certificates. There is certainly no requirement for a doctor who has been the treating doctor for any length of time to be involved.
Good palliative care is currently available and improving rapidly Wikipedia states, under the heading of ‘Palliative care’, “The focus on a patient’s quality of life has increased greatly during the past twenty years.” Emeritus Professor Ian Maddocks, Professor of Palliative Medicine, Flinders University, Palliative Care Consultant, founder of Daws House Hospice, who was named Senior Australian of the Year for 2013, said in November 2010 regarding a previous euthanasia bill, “The discussions regarding euthanasia that were begun in this parliament about 25 years ago, led not to legislation approving assisted dying for a few individuals with terminal illness, but to innovations in and support for palliative care which has been most salutary and effective in South Australia. But more needs to be done. In particular, the advocacy for good basic palliative care for the elderly needs to extend more strongly to our general public and to the staff of our aged care institutions. Old persons are still dying miserably in hospitals and nursing homes in this State, still being given treatments that they do not want nor need, struggling on with discomfort when they would be happy to stop. The answer is not to kill them, as this legislation might permit, but to bring them effective comfort through compassionate and skilled palliative care, letting them die in peace. And their families need to understand this, when they would, I believe, have more sympathy and support for care rather than a desperate hope for cure.”
Palliative care is a relatively new discipline, and is constantly improving. In virtually all circumstances, pain can be relieved through appropriate drugs. Problems with ongoing pain are more likely to be a result of well-meaning relatives insisting on every effort being made to cure the disease rather than of allowing the dying process to take its course in conjunction with palliative care.
The current Consent to Medical Treatment and Palliative Care Act already allows patients the right to refuse treatment and shorten their life Patients presently have the right to refuse medical treatment, even though this may result in their death. Indeed, where a patient is dying, and there is no prospect of a cure, it is often appropriate to refuse active treatment, although this is a decision for the patient on an individual basis.
The elderly and terminally ill people will be placed under pressure to choose voluntary euthanasia.
In a practical sense, this issue may arise in many instances. The decisions of elderly people are usually strongly influenced by the views of their children or other relatives. In fact, the influential factor is often those views as perceived by the elderly person, rather than views as actually held by children or relatives. If an elderly person with a terminal illness gains the impression that they are no longer valued, this would encourage a decision to undergo euthanasia. Such an impression may be incorrect, but possibly formed on the basis of diminishing visits by relatives, which may have occurred for other reasons.
The bill does not contain any provisions requiring relatives to be consulted, or even made aware, before euthanasia occurs. Death can occur after 48 hours from the examination on which the certificate of confirmation is given. In the case of a young adult, such as an 18 year old with a long term illness that is classed as terminal, parents need not be notified.
Claims of high level support for euthanasia are uncertain at best Polls are always influenced by the way the question is framed. If the question is framed as, “If a hopelessly ill patient, in great pain, with absolutely no chance of recovering, asks for a lethal dose, so as not to wake again, should the doctor be allowed to give the lethal dose?” respondents are inclined to say ‘yes’ for fear of appearing insensitive. If the word ‘suicide’ is included in the question, support for euthanasia is lower. Some respondents fail to distinguish between euthanasia and treatment withdrawal. Younger people, who fear old age and losing their faculties, are more in favour of euthanasia than elderly or terminally ill people. According to an opinion article in ‘the Australian’ on 2 October 2010, of those surveyed in the 65 to 74 age group, only 18% approved of euthanasia. It seems that those who have most at stake in this debate are the least in favour of euthanasia.
The AMA(SA) strongly opposes this bill
I attach a position statement received from the Australian Medical Association (South Australia) Inc. It states in reference to this bill and another bill, “The AMA (SA) strongly opposes both Bills, considering them to be fundamentally and irretrievably flawed.”
|Alex Schadenberg with Leesa Vlahos MP|
Possibility of errors – a person who is terminally ill may recover Of the three certifying doctors, only one (the one who completes the certificate of confirmation) must form a documented opinion that the person is terminally ill. There is no requirement that a patient be in the terminal phase of the illness. Indeed they may have years left to live. The two witnessing doctors need not give a certificate as to the nature or severity of the illness. The certifying doctors may be general practitioners. The possibility of an error in diagnosis is always present, particularly where only one doctor is required to certify that there is a terminal illness.
My final comments
I ask that you consider these matters carefully. Feel free to contact me or Martin, Dennis or Tom for any further information or discussion.
Leesa Vlahos MP