11 November 2011
Calls for euthanasia and physician-assisted suicide to be legalised are the result of an increasingly individualistic society and an unwillingness to take a holistic approach to death and dying. A public issues forum at St John’s in the City in September canvassed views around the issue of legalising euthanasia in a sometimes heated debate.
At times needing to raise her voice above heckling from pro-euthanasia supporters, palliative care specialist Dr Anne MacLennan told the September 29 meeting physical pain was not usually behind requests for euthanasia. It was often more to do with suffering, defined as a state of severe distress associated with events that threaten a person’s integrity.
People may also be experiencing guilt at being a burden on family, a loss of social role, psychological or spiritual distress and loss of body image.
Dr MacLennan said quality of life was also an important factor. ‘People with profound disability may rate their quality of life as higher than physically fit but demoralized individuals.
‘It has been said that people would rather be dead than unloved. Some endure great pain with little complaint because they feel loved.
‘As [Austrian neurologist and psychiatrist Viktor] Frankl said it is suffering without meaning that is intolerable.’
She agreed with a palliative care specialist in Auckland who said that ‘When people tell him they don’t want to live they usually mean they don’t want to live like this’.
Killing the victim does not address the underlying problem. Society as a whole must look at what is needed to minimize suffering and maximize those conditions deemed by society to constitute a good death. ‘Palliative care is not the answer either but it is part of the solution.’
Dying is a very special time of life, she said. ‘I have come across so many precious moments before or at death that would not have happened had life ended prematurely.’
Nathaniel Centre director John Kleinsman welcomed the debate on the issue. He said even though the issue is most commonly presented as freedom of personal choice, it could not be about personal choice.
In the current society, he said, the sick, disabled and elderly are currently feeling marginalized. With legalized euthanasia, ‘the right to die will all too quickly become the duty to die’.
Research suggests the numbers willing to die at the hands of another are small but their views are being forced on the whole society.
He said the question is about ‘protection of the vulnerable, about the common good.’
‘We live in a society increasingly inclined to question the right of the vulnerable to live. We cannot create a right to die when it means that others are going to lose their right to live.’
Reverend John Murray, a former minister at St Andrews on the Terrace and now a spokesperson for the Voluntary Euthanasia Society said the present law was a form of torture.
‘Dying is not a single thing. We are born into a family, we die in a family, we hope. I look forward to dying with dignity with the family around me. Assistance to die in this way is not a crime, we say. ‘At best it is a family event, it is not a crime scene.’
‘Is not medically assisted dying the fulfilment and not the contradiction of palliative care?’ he asked palliative care specialist Anne MacLennan.
She said she had been asked more often by family members about euthanasia than by patients. ‘Several times I’ve been accused, “You wouldn’t treat a dog like this”. It’s really uncomfortable to be in the firing line and it would be tempting if legal to squirt in a lethal dose just to get rid of the relatives.’
Other presentations came from Don Mathieson QC who said a law in favour of euthanasia must contain safeguards against abuses but these were bound to be ineffective. He said everyone agreed that the administration of the lethal dose must be truly voluntary. The patient must give full and informed consent.
‘But the requirement of consent bristles with legal and practical difficulties … a patient in the final stages of illness may be incapable of giving a genuinely free and rational consent … their mental condition may fluctuate. After an apparently clear request [to be helped to die] the patient may vacillate.’
He cited an attempt at a law in the Northern Territory in 1995 which was aborted by the federal parliament because, he said, it was impossible to maintain safeguards in the law.
He talked about a ‘slippery slope’ which formed when suffering and/or distress were lumped in with pain and cited a widely reported case in the Netherlands where a healthy woman in her 50s who was devoted to her sons, one of whom was murdered and the other killed in a road crash, was euthanized because she felt she couldn’t live without them.
In the 30 years since euthanasia has been legal in the Netherlands, society has moved from accepting euthanasia for the terminally ill to the chronically ill. He said there had been a recent shift to euthanasia for a person who ‘is simply over the age of 70 and tired of living’.
Nurses’ Union CEO Geoff Annals said nurses were often involved in questions about whether to implement CPR or initiate renal dialysis, or whether to withdraw nutrition and hydration. The law doesn’t require these decisions to engage the consent of the patient.
He said nurses often faced questions from patients or relatives about how to hasten death. He said a recent Australian survey of 1,000 critical care nurses revealed that 17 percent had received requests to end life. Other surveys find similar results from 15 to 30 percent.
Society should consider questions about voluntary euthanasia within the spectrum of questions about life and end-of-life care.
‘Many say these questions are fully for the person concerned … Nurses have no special authority in answering these questions; nor do doctors, lawyers, priests or ethicists.
‘These questions are for all of us and that’s what makes this discussion so important.’
Image: Nathaniel Centre director John Kleinsman