Life and death decision would change the nation

Victoria’s Voluntary Assisted Dying Bill is about much more than individual choice or a patient’s rights. The state legalising killing, subject to particular conditions, is a public, society-wide issue. It concerns everyone, despite the fact Victorian Premier Daniel Andrews did not consult voters about such a grave matter when he sought office in 2014. If the controversial legislation, vigorously opposed by Deputy Premier James Merlino, passes both houses of the Victorian parliament, the state will cross the Rubicon, as Australian Medical Association president Michael Gannon says. Regardless of strict safeguards, experience overseas suggests the medium to long-term repercussions will extend far beyond what many supporters of the bill, acting in good faith, envisage. Victoria would become the first state to legalise euthanasia, after a previous scheme in the Northern Territory was overturned by the federal government 20 years ago. The issue is of national concern, given the prospect of suicide “migration” and likely demands for copycat legislation in other jurisdictions.

In the lead-up to the parliamentary debate, our coverage has reflected heartfelt opposing viewpoints. Long or short, dying is rarely painless and often traumatic, especially for those left behind who often endure the anguish of watching a loved one suffer, as well as coping with grief and loss. Victorian Health Minister Jill Hennessy’s recollections of the death of her mother, Joan, who was in constant pain and weighed just 36kg when she died in August after a 40-year battle with multiple sclerosis, has struck a powerful chord with many. As Dr Gannon says, “We need to do better with end-of-life care.” Pain relief and palliative care services in hospitals and at home are advancing apace. As more serious illnesses become curable and the population ages, geriatric and palliative care will be even more important specialties in improving quality of life.

Attitudes vary among doctors, but the AMA is among 107 national medical associations, out of 109, opposed to euthanasia. Such concern is understandable. Doctors know they will be expected to be involved if the law changes. For many, the prospect of killing, in any circumstance, is unconscionable. They also dread coercion from less-than-altruistic relatives. Dr Gannon told Inquirer on Saturday: “It is frankly commonplace for patients to tell doctors in the presence of their loved ones that they feel they are a burden on their families.”

Advocates of the Victorian bill point to safeguards, recommended by the government-appointed independent panel chaired by former AMA and neurosurgeon Brian Owler. The proposal would restrict euthanasia to terminally ill patients aged 18 and older, of sound mind, suffering an ­incurable illness likely to cause death within a year. It would be off-limits to patients with dementia or any disease impairing mental function. Two doctors would be required to verify all conditions were met. On paper, these appear strict.

Overseas experience, however, suggests such legislation generates expanding use and wider legal boundaries. As Paul Kelly wrote a year ago: “Its rate and practice quickly exceeds the small number of cases based on the original criteria of unacceptable pain.” In Belgium, under certain conditions, euthanasia is now available for patients who are not terminally ill but who suffer from dementia, psychiatric conditions and mood disorders. Sanctioned killings in Belgium have increased tenfold since 2003. In The Netherlands they rose from 2331 in 2008 to 6000 last year, accounting for one in 25 deaths. In 2012, the European Institute of Bioethics reported that while initially legalised under very strict conditions, euthanasia “has gradually become a very normal and even ordinary act to which patients are deemed to have a right”.

Some deny its existence, but the slippery slope is a fact. The Netherlands legalised euthanasia for terminally ill children over 12 in 2002. In 2014, amid strong opposition from pediatricians, Belgium removed all age restrictions. In Oregon in the US, requirements that patients seeking euthanasia undergo psychiatric evaluation is frequently overlooked. In 2010, the Canadian Medical Association Journal published a study of assisted suicides in Flanders between June and November 2007. Of 208 deaths studied, a third were the result of euthanasia “administered without an explicit patient request”, mainly involving patients over 80. Faced with the possibility of such prospects, fewer Australians would back the legislation.

Based on the experience of her sister, who died of a terminal illness at 43, columnist Niki Savva recently posed pertinent, practical questions about the legislation’s impact. “Would there be, even subconsciously and because of the pressures on the system, a diminution of care for, or interest in, treating the seriously ill or disabled? And would the patients feel pressured to avoid care because of the burden they felt they had become?”

The bill contradicts the “do no harm” principle that has guided medical care for centuries. As Paul Keating noted, in an important contribution to the debate yesterday, there will be “people whose lives we honour and those we believe are better off dead”. Mr Keating said all the safeguards in the world could not change what he called the “core intention of the law”.

Australia’s suicide rate — 3027 deaths from 65,000 attempts in 2015 — is already too high. Enlarging the powers of the state to encourage more killings is not in Australians’ interests.