Are anti-euthanasia advocates the less compassionate ones for not wanting to relieve people suffering unbearable pain? A 12 August Notre Dame forum sought to restore some logic and clarity to the euthanasia debate. Anthony Barich reports
Euthanasia strikes at the heart of basic clinical care, changes the whole dynamic of the relationship between doctor and patient and is actually the least compassionate response to suffering.
Yet this is a notion that is simply not heard, or simply scoffed at, and thus the public debate over euthanasia in WA has been conducted with no quality control: misconceptions, errors and blatant deception are published as fact and gain force by virtue simply of being published at all.
But euthanasia is too important an issue to be hijacked by emotivism or mere intuition; it must be informed and consistent, radical, logical and intelligent from start to finish.
When a patient sees a doctor, certain unwritten rules are in place. The proposed euthanasia law will fundamentally alter these norms, from the doctor considering what treatment works to “benefit the life in question” which currently underpins medicine in Australia, to “relief from the life in question” – though this is expressed by euthanasia lobbyists in compassionate terms.
These are the assessments given at a 12 August Euthanasia and Palliative Care forum hosted by the University of Notre Dame Australia’s Centre for Faith, Ethics and Society, given by a medical law expert, a senior WA physician and a bioethicist.
The forum drew over 200 people, from nursing and law students from other universities to pro-euthanasia advocates.
“The question isn’t ‘is the relief of suffering a good thing’. The question is ‘at what point is it recognised that there is a dimension of human life in which there are some things that can’t be done to relieve whatever residual amount there is’,” said Barrister Peter Quinlan from Francis Burt Chambers who has a particular interest in medical law having acted for the Medical Board of WA, hospitals and health professionals.
The forum addressed a fundamental flaw in the euthanasia advocates’ thinking that pain must be relieved at all costs, without looking beyond this to the inescapable fact that suffering will continue unabated even if the Bill is enacted and that suffering is, at times, an unavoidable part of life.
“Unless the Voluntary Euthanasia Bill 2009 and its proponents can stare straight into the abyss and accept the premise that no human life has an intrinsic value (and allow everyone the ‘right to die’), it is unavoidable that the law, if enacted, will have enshrined a policy of “ranking” the value of human lives,” he said.
Euthanasia advocates respond to this, he said, with the “often hostile and offended objection that I must have missed something in the argument, because proponents of euthanasia – being the compassionate ones in the debate – could not possibly be accused of denying the intrinsic value of human life”.
The conflict between the moral intuition and logic is pragmatically sidestepped by euthanasia advocates, by saying that “all this philosophising is unnecessary, and ‘can’t we just get on with the business of relieving suffering’,” he said.
A view that suffering can be eliminated is ultimately utopian, and all utopias tend to end in disaster, he said, precisely because they misunderstand the human condition.
Quoting John Gray, Professor of European Thought at the London School of Economics – who is “certainly no theist” – he said: “Disasters of this magnitude do not come about as a result of ignorance, error or disinformation … They are consequences of a type of thinking that has lost any sense of reality”.
“Ultimately, we can only do what we have always done (before the option of euthanasia occurred to us), that is: be with them,” Mr Quinlan said.
“It causes us pain to be in the presence of our loved ones and the pain they are experiencing.
“The Romans have given us a word for that too. We get it by combining the Latin for the word ‘with’ (cum) and for the word ‘suffer’ (passus): ‘to suffer with’.”
Dr David Watson, Clinical Dean at St John of God Hospital in Subiaco, WA who set up the hospital’s medical unit, helped establish the Medical Oncology Department at Royal Perth Hospitla and started the first Physician Training Scheme in WA, noted that the pain felt by people with malignant disease is the focus of the euthanasia lobby.
But this is deceptive, he said, as European experience suggests that there will be other people affected by the Bill other than those with terminal malignancy.
In 1992 – nine years before Holland legalised mercy killings and assisted suicide, enabling doctors to end the lives of patients with unbearable, terminal illness – it was already clear that children with severe defects were being put to death in Europe, Dr Watson said.
While there are now guidelines covering that, the frail aged and those with dementia are potentially, “once the chains have been taken off” the safeguards, get caught up in being considered worthy of euthanasia, he said. This situation is not helped when, around the world, the management of pain is poorly done despite the fact that there are now over a dozen opioid drugs compared to just morphine and pethadine, he said. Neither is the medical industry managing the side effects of these drugs.
Added to this, end of life research in palliative care is “very difficult”, he said, as the patients are so frail. Related to this is the issue of medical records, which he said are “dreadful and hard to understand”, and are rarely read by doctors and nurses, as proven by a survey he did several years ago at SJOGH.
“Technology is not used in medical records to further our clinical care, let alone our research,” he said.
The only advance in medical record keeping over the past 30 years in his hospital has been the building of bigger rooms to store them in, he said.
“These are the imperatives of clinical care that each of us face every day. We (as doctors) must attend all the needs of individual patients; and while we can’t attend all their needs, we’re responsible for seeing that it’s done.
“We must provide the best care that resources can allow.”
These basic elements of clinical care – even the use of records for research in end of life care – is endangered by the euthanasia Bill before WA Parliament, he said.
The key of clinical care, he said, is to work as a team – knowing the patients’ history is key to treating them.
Therefore, “we have to seriously question the wisdom of allowing doctors the opportunity of doing things in their professional lives that are not open to anyone else – and that is killing people,” Dr Watson said.
Under the Bill, the doctors’ actions in this regard is not open to the Medical Board – the registration body that governs them – to enquire, it’s not open to the courts, and Dr Watson sees this as a fundamental problem, as is removing constraints against the way they work, “because we do have to be bound by constraints – there’s no question about them”.
Mr Quinlan noted three main conditions that must be met for a request for euthanasia under the Bill:
1. A medically-diagnosed illness or condition, the normal progress of which will cause death in two years;
2. Pain, suffering or debilitation that is experienced as a result of the progress of that illness or condition; and
3. The absence of a state of clinical depression or anxiety.
Even within these there are inconsistencies, he said.
“On what grounds is euthanasia to be made available to a person suffering pain as a result of an illness that will result in their death within two years but not made available to a person whose death will not result for five years?” Mr Quinlan asked.
Another self-defeating question raised by the Bill, he said, is: “Why should the right to die be denied to a person who will never die of their illness or medical condition? Or a person who has no illness at all but is simply bored with life, no longer has any friends or family or has achieved all that they wish to achieve in this life?”
These criteria show that the Bill denies the premise that humans are not simply the sum total of their usefulness, and will show that Parliament agrees that “it is right, and proper, and reasonable, to regard non-existence as preferable to this human life”, while saying to others, “No, this life still has value. It is worth living, regardless of whether you, the person living that life, agrees”.
In dealing with the treatment needs of patients entering the final stages of their lives, the law currently in no way seeks to assess the “value” of their lives compared to other patients, Mr Quinlan said.
It also refuses to make such judgments even where the treatment of the patient may have the effect of hastening their death (see breakout on Church teaching on this matter).
Bioethicist clarifies Church teaching on what is and isn’t euthanasia
Rev Dr Joseph Parkinson, STL PhD
LJ Goody Bioethics Centre
– The Catholic Church does not object to withholding futile or burdensome treatment, even when that treatment is required to sustain life, if the patient so chooses. This is the patient’s legal and moral right. If the patient subsequently dies, that death would be the result of their choice not to treat their underlying illness. Death is foreseen but it is not caused by the patient’s or doctor’s action. The cause of death is the illness.
The withdrawal or withholding of unreasonable or overly burdensome treatment is not euthanasia. It is common sense in medical practice.
– The Church supports the use of any and all means necessary to ease severe pain, even if in some extreme cases that treatment also shortens the life of the patient. This has always been accepted as legitimate medical practice. It is intended solely to bring the patient comfort. Death is foreseen but not intended. This is not euthanasia either.
– In both of these cases the Church makes the legitimate and vital distinction between withdrawing unreasonable treatment to allow a person to die naturally, and setting out to kill the person deliberately. The former is acceptable, the latter is not. The first treats with great respect the person in all dimensions of his or her humanity, including respecting the fact of mortality. This is good, ethical medical practice. The latter deliberately causes death. This is unethical in anyone’s language, and will always be so.
– The fundamental stance of the Christian community is for the good of both the individual and the social, corporate whole. For that reason we would counter current moves toward euthanasia with a strong and consistent call for the extension of palliative care and other medical and social services which can and, where they are available, do in fact meet the needs of even the most desperate.
– So if a life-sustaining treatment is withdrawn as futile or too burdensome, the patient must still be provided with all necessary palliative care and medication, and kept comfortable while nature takes its course.