Euthanasia – time for a broad ethical response

Sound familiar?

A DECISION will be taken within weeks on whether to switch off the “futile” life support for the woman left for dead in the boot of her car in Melbourne earlier this year.

Melbourne Magistrates Court heard today that Maria Korp would die in two weeks if medical intervention were removed. The magistrate hearing the case, Paul Smith, said Mrs Korp was “unlikely to recover” given the medical evidence before the court.

Mrs Korp is in a persistent vegetative state, a condition similar to that of Terri Schiavo, the Florida woman who died last month after a tumultuous debate in the US over the morals of switching off life support for coma patients.

It seems the hospital is consulting Mrs Korp’s immediate family excluding her husband, who is charged with her attempted murder. I assume another family member has obtained an adult guardianship order permitting them to give directions in relation to life support in place of the husband as next-of-kin. This distinguishes the case from that of Terri Schiavo (whose husband, incidentally, was never accused of attempting to murder her, despite some odious and unfounded smears by some of the more ethically-challenged parts of the American Religious Right and their Republican panderers).

But otherwise there are quite a few parallels. I wonder whether Australia will deal with this situation more maturely than the Americans managed. It wouldn’t be difficult. I reckon it’s time for State governments, starting with Victoria, to revisit the question of comprehensive euthanasia legislation. That could at least mean that future Maria Korps or Terri Schiavos could be given a quick, painless and completely open lethal injection instead of being left to die slowly, or given a sly overdose that “accidentally” kills under the morally dubious “double effect” doctrine with which the AMA apparently feels entirely comfortable.

The Northern Territory’s Rights of the Terminally Ill Act wasn’t a perfect model by any means, but it would certainly be a good place to start. This could be another subject for Nicholas Gruen’s list, where co-operative legislative effort by the States could productively outflank the Howard government and bring some certainty, dignity and firm ethical principle to a morally fraught area.

Of course, the conventional answer is that any legislative action in such an area is “courageous” in a Sir Humphrey Appleby sense i.e. one where any sort of positive action can only lose the votes of committed opponents, without necessarily gaining any from the general community. However, I’m not convinced this is necessarily the case with euthanasia laws:

A survey conducted by Newspoll in 1995-JUL found 81% of Australian adults support voluntary euthanasia. This is an increase over an earlier result of 79% in 1994-JUL. A poll by the Roy Morgan Research Centre in 1995-JUN showed similar results: 78% in favor. This is an increase from 66% in 1986. A separate poll showed that 60% of doctors and 78% of nurses in Victoria favored voluntary euthanasia. An additional poll was taken among 6500 Christian congregations, representing 19 denominations. They found that 40% agreed with assisted suicide for terminally ill persons; 30% opposed; 30% uncertain. Among older church attendees, support was higher (50% among those 60 and older).

These are very positive results, and there’s no reason to think support for euthanasia laws has dropped since 1995. This suggests that a well-drafted, well-researched uniform state law on voluntary euthanasia (along with clear rules for safe third party and/or court approval in “persistent vegetative” situations) would be likely to command strong public support.

PS – One reason why the family might well be reluctant to countenance active euthanasia measures in the Korp case is that it would almost certainly preclude murder charges (as opposed to attempted murder) against her husband. That creates a layer of ethical dilemma absent from the Schiavo case. Is it possible to be sure that Mrs Korp doesn’t feel pain or distress during the two weeks it will apparently take her to die if life support is turned off? If not, can inflicting avoidable pain on her be justified if it allows her alleged killer to be charged to the full extent his actions warrant?

PPS – Here’s a link to an excellent discussion on voluntary euthanasia at Stanford Encyclopedia of Philosophy site

About Ken Parish

Ken Parish is a legal academic, with research areas in public law (constitutional and administrative law), civil procedure and teaching & learning theory and practice. He has been a legal academic for almost 20 years. Before that he ran a legal practice in Darwin for 15 years and was a Member of the NT Legislative Assembly for almost 4 years in the early 1990s.
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Robert
2022 years ago

Ken, a WA family has been calling for a fresh euthanasia debate for the last several weeks. The son is terminally ill, but not in a persistent vegitative state:

http://www.news.com.au/story/print/0,10119,12664138,00.html

Mark Bahnisch
2022 years ago
tim
tim
2022 years ago

One important point of distinction: Schiavo wasn’t on life support.

Mark Bahnisch
2022 years ago

Tim’s hairsplitting, I think. Terri Schiavo’s life could only be sustained by medical intervention. Surely by definition that’s “life support”.

Ken Parish
Ken Parish
2022 years ago

Moreover, I’m not sure to what extent Mrs Korp is on life support either. If it’s correct that she’s likely to take 2 weeks to die if it’s turned off (as the stories I read suggested), then it seems unlikely she’s on a respirator etc (unless it’s purely precautionary). She may well also just be on a feeding tube.

saint
2022 years ago

Food and water is medical intervention?

No I’m with Tim on this. I actually think drawing even slight parallels with Schiavo and somehow making the leap to voluntary euthanasia (what’s voluntary about this case?) is a bit naughty too.

Not to mention the article’s use of loaded words like ‘futile’.

From what I understand, some European countries have become masters of ‘futile treatments’ now even taking the decisions away from families and leaving them with doctors.

saint
2022 years ago

Just read your comment Ken. The article also says she’s in a coma. The info is still sketchy.
In fact, I wonder given what we havewitnessed with Schiavo, Crick etc if it is dangerous to discuss specific cases in the public sphere or use them as examples in such debates as it may unfairly pressure those who currently care for them makers. And we are talking people’s lives here.

Dave Ricardo
Dave Ricardo
2022 years ago

I can no longer wait for Currency Lad to put in his two cents worth, so I’ll do it for him

God … sin … culture of life* … Church … sin … sin … sin … sin … (sorry about that. I got on a roll and couldn’t stop) … where was I? Oh yes … God … Pope’s funeral (do you think any condom makers will sponsor the telecast?) …. culture of life ** …. let’s see, what would Bartholomew (“call me Bob”) Santamaria have said? I know I’ve got the videos of his Sunday morning broadcasts on Channel 9 here somewhere …

* death penalty for sinners excepted

** pregnant women whose life will be endangered by carrying their foetus to term excepted

Mindy
Mindy
2022 years ago

Yesterday’s media reports said Maria was on a feeding tube only and breathing on her own. However, her long term prognosis is that she will remain in a vegetative state as long as the feeding tube remains, although the judge in her husband’s case has delayed the trial for 6 weeks, in case she dies in that time (of her own accord) and the charge can be upgraded to murder.

I think that voluntary euthanasia should be available to those that want it. In a case like Terri or Maria its much more difficult because they can’t say. Are their families in a better position to know? I know for myself and my husband that we have discussed the issue and would rather a quick needle than years of going insane inside our own heads, if indeed we had any mind left. But if you asked our parents would they say the same thing on our behalf? If (God forbid) I had to make the same decision for my son what would I do? I don’t know. We do need some form of release for those able to choose. Probably the best thing to do is clearly state in your will what your wishes are re: being in a vegetative state. At least that way your voice can still be heard.

Mark Bahnisch
2022 years ago

I shouldn’t have responded to Tim. He may achieve his probable aim of derailing this thread into another Schiavo discussion.

But saint, a feeding tube is medical intervention.

John Morhall
John Morhall
2022 years ago

If I can’t shuffle off of this mortal coil myself then I hope that someone will extend the courtesy to assist me. I recognise that it’s easy to make the choice when the implementation is not imminent. An effective Bill on voluntary euthanasia would be a start, but does not deal with the Schiavo cases as has been pointed out, but it would be a start. Ultimately, given the NT experience it would have to be something that the Feds embraces, and I fear, given the current composition of the Federal Parliament that this will be a long time in coming. If the States do take some form of ultimate collective action there would always be the risk of them invoking s122 as previously.

Taking these sorts of decisions out of the hands of the families and putting in the hands of detached professionals is an easy cop out for those of us who are not involved. It still does not address the broad ethical problems and the difficulties that those who do believe in an after life face not wishing to to cause others to embrace it prematurely. For me, death with dignity beats the heck out of the alternative. Put me down as a non vegetarian.

Ken Parish
Ken Parish
2022 years ago

John

The federal government could certainly invoke s122 to stop the territories from legislating for voluntary euthanasia. In fact they’ve alread done so. But I can’t see any head of federal power that would permit the Commonwealth to prevent a co-operative uniform regime of voluntary euthanasia laws in the States.

And those who’ve pointed out that the Schiavo/Korp situation isn’t voluntary euthanasia are obviously correct. What I’m suggesting is that we should take a comprehensive look at end of life issues and devise a set of laws that deals compassionately with all such situations (voluntary and vegetative) and provides the most stringent safeguards to ensure that voluntary euthanasia can only occur when there’s a fatal condition and no hope and it truly is voluntary, and that authanasia in cases of persistent vegetative conditions can also occur only when there is genuinely no hope of any sort of recovery of consciousness, when next of kin agree and when (as far as possible) it represents what would have been the person’s wishes had they still been conscious, thinking beings.

Mark Bahnisch
2022 years ago

Anyone in Queensland wishing to make submissions on a review of issues to do with sustaining life can do so here:

http://www.law.qut.edu.au/research/lifesustain/

tim
tim
2022 years ago

You’ll find that the linked story has been updated to delete references to Schiavo. The two cases are essentially dissimilar; Korp requires assistance to breathe and eat, while Schiavo was merely being fed.

Mark, a feeding tube may be a “medical intervention” in that it is supplied in a hospital by medical staff, but its role is simple: to feed. The altogether more complex machinery required by Korp much better fits the term “life support”.

Mark Bahnisch
2022 years ago

Yes, Tim, but in the absence of the feeding tube, she dies. Therefore it’s life support through medical intervention.

John Morhall
John Morhall
2022 years ago

Ken I take the point re s122, but believe that the legislation would need to be Australia wide, based on the same, universal set of values and conditions, as the issue is bigger than one State. If the Feds blocked NT and ACT legislation that would mean those who may wish euthanasia within the Territories having to travel elesewhere, at a time when it would be inappropriate to do so from every aspect.

I just see the issues as still being generally divisive amongst broad sections of the community to the extent that it will be hard to reach a meaningful consenseus on an ethical and practical basis within a suitable legal framework. The issues are probably well understood within this forum, although even here there will be diversities of opinion.

Getting the complex issues out to the punters in a way that they can make viable choices, or understand the implications of the choices being made for them is where it is hard IMO. That being said, I believe that the right to personally choose for myself, or to have others choose on my behalf in what ever circumstances they believe may be in my best interests is vital. Perhaps a voluntary scheme ascribing to a broad set of principles would be a start, rather like donating your body bits when you no longer need them. It would not overcome the legal and ethical hurdles, but might provide a push for broader consideration.

Robert Merkel
2022 years ago

One thing that I don’t really understand about all this is why the AMA, which I presume represents the majority of doctors on the topic, remains so resolutely opposed to voluntary euthanasia. Like Ken, to me the difference between euthanasia and and current standard medical practice is wafer-thin; but doctors beg to differ.

So what’s the deal?

Ken Parish
Ken Parish
2022 years ago

John

In the NT at least, the euthanasia law was not divisive in any meaningful sense. We certainly had a small but extremely vocal and well-resourced lobby group against the legislation, but it had overwhelming general community support and bipartisan (albeit conscience-based) political support. I’m sure the same would be true if similar laws were enacted in the States. The 80% community support figure reflected support both before the legislation was enacted and on an ongoing basis thereafter. The Howard government’s intervention represented an overbearing elitist response from an external force; in no sense was it responsive to the sentiment of Territorians themselves.

Robert

I could’t agree more. Why do religious people (and the AMA) apparently feel so comfortable about doctors killing people with few if any real safeguards under the fiction of “double effect”, yet oppose a principled, transparent regime that would allow people with fatal or vegetative conditions, and their families, to make their own decisions with appropriate medical advice and assistance?

James Farrell
James Farrell
2022 years ago

A great post, Ken. I can’t for the life of me see why the distinction between medical treatment and feeding is important in the case of someone in a permanent vegetative state. It may make all the difference in current law, but morally it doesn’t make any. If someone has no conscious thought and never will have, they are better off completely dead. There is an obvious need for legislation to permit euthansia in these cases.

Voluntary euthansia, i.e. medically assisted suicide, is surely a completely different issue, and one that actually needs to be debated. I have no problem with it when a disease is incurable (although not necessarily terminal) and causes intlorable pain. But I can see why some people are afraid it might be abused, and it’s a real challenge to design a foolproof system to ensure the choice is always voluntary and final.

Ken Parish
Ken Parish
2022 years ago

James

I think the NT voluntary euthanasia law went fairly close to being an adequate system to ensure that the choice was purely voluntary, and that it could only be made in the case of fatal conditions (it didn’t allow for authanasia for chronic but non-fatal conditions). The only major addition I would have wanted was to have the patient’s wish to die and fatalness of condition certified by two designated/government authorised medical practioners + psychiatrist, rather than just any two doctors + psychiatrist.

You’re right that euthanasia in the case of persistent/irreversible vegetative conditions raises a range of different and extra issues than voluntary euthanasia, but I still think both voluntary euthanasia (where fatal illness exists) and third party authorised euthanasia (court or next-of-kin or both)vegetative conditions can and should be dealt with in an overall carefully drafted law.

Such a law would also provide for people to be able to make legally binding directions against taking extraordinary measures to prolong life (a law which does in fact exist in the NT but not in most other states, where doctors and next-of-kin may or may not honour a person’s clearly expressed wish not to be kept on life support in a Schiavo/Korp situation).

saint
2022 years ago

“I could’t agree more. Why do religious people (and the AMA) apparently feel so comfortable about doctors killing people with few if any real safeguards under the fiction of “double effect”, ”

Ken – I think its wrong to say “religious people” are so comfortable – many are not, some are, or don’t care to think about it. And the same goes for “non-religous people”.

Many of us here have been through these decisions know that there are complex and often subtle even if sometimes uninintentional pressures placed on both doctors and families in these situations…with many a hint and suggestion, voiced or unvoiced…which influence the dynamics of decision making. When it comes to medicos etc. there are also questions of power. Some people look to medicos, lawyers or other experts as some sort of demi-gods and often defer to their judgment as people who ‘know better’…or are afraid to ask the blunt questions.

Brian Bahnisch
Brian Bahnisch
2022 years ago

Mark and Tim, the Qld issues paper, Rethinking Life-Sustaining Measures, in the glossary says that artificial nutrition and hydration “is regarded as a form of medical treatment and is usually a life-sustaining measure.”

This is probably because the tube itself is medically inserted, has to be medically monitored, and I understand the ‘food’ mix/quantity has to be monitored also. I say ‘food’ because it is not just pureed soup but a special mix.

I understand the term commonly used in Australia is ‘post coma unresponsiveness’ rather than ‘persistent vegetative state’ which would be a sub-category. I heard that on the radio, so I’m not totally sure. Essentially I think it means that when you can’t communicate your wishes then some-one has to decide for you. It may not mean your condition is hopeless. I’ve bought my Advance Health Directive form from the newsagent, but it is rather long and I’m allergic to forms so I haven’t really studied it yet.

The term ‘futile treatment’ seems to be in common usage, so it makes the glossary of the Qld paper which says it doesn’t have a settled meaning. “However,” they say, “a common formulation sometimes adopted in this area of the law is that treatment is futile when it is no longer providing a benefit to the patient, or the burdens of providing the treatment outweigh the benefits.” It’s meant to be a technical term rather than a loaded term.

The Qld paper can be downloaded from:

http://www.law.qut.edu.au/research/lifesustain/issues.jsp

You need at least a version 6.0 acrobat reader, it seems. If you go to http://www.adobe.com you’ll only be offered version 7.0 for which you need Windows 2000. If you have Window98 like me the routine is to google version 6.0 and follow the trail from there.

btw, the Pope said a few years ago that feeding tubes were to be regarded an ‘ordinary’ form of treatment.

James Farrell
James Farrell
2022 years ago

‘…a law which does in fact exist in the NT but not in most other states.’

Does Kevin Andrews about this?