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I’m pleased to see that the apparent suicide death of the hideously disfigured and terminally ill Chantal Sebire seems to have reopened the debate about euthanasia in Europe. Pity the same isn’t true here in Australia. Apparently her pain couldn’t be reduced even with morphine. It would almost universally be regarded as cruel to keep a dog alive in those circumstances, so why do we continue to pander to the religiously cruel minority in such situations?
One aspect I hadn’t appreciated was the extent of reasonably humane euthanasia laws in Europe. Active euthanasia is now legal in Holland and Belgium, assisted suicide in Switzerland and an active euthanasia law is pending in Luxembourg. In the US the state of Oregon has allowed active voluntary euthanasia since 1999.
I wonder what political factors allowed laws to be passed in those jurisdictions where in most places pragmatic inertia prevails? Euthanasia consistently enjoys strong support in public opinion polls in most countries, but politicians are almost universally reluctant to enact laws. Fairly clearly that’s because it isn’t a vote-changing issue except for the religiously-motivated minority opponents. While most people support euthanasia they don’t feel all that passionate about it unless they or a close family member is facing or has faced a slow, painful and/or demeaning end.
Such were the circumstances that led to the Northern Territory’s pioneering euthanasia law, until it was itself euthanased in one of the numerous despicable acts of the Howard government. Marshall Perron, the Territory’s longest serving Chief Minister and the archetypal political “hard man”, experienced both his mother’s death and that of a close political colleague in Don Dale at close quarters, and as a result developed an ethically-driven determination to use the authority of his office to ram through euthanasia legislation despite misgivings by quite a few colleagues.
I imagine it will take somewhat analogous circumstances for an Australian State government to acquire the intestinal fortitude to stand up to the religious minority and enact a humane law which provides adequate safeguards but allows terminally ill people to elect to end their own suffering and to enlist a doctor to assist them. In the meantime, should the worst ever occur I’ll certainly be topping myself well before I get to a stage like poor Chantal Sebire and at a time when I can still do it myself without giving family members the dreadful choice of risking manslaughter charges or allowing me to continue suffering pain and indignity.
All well and good, KP, and I wholeheartedly agree with your sentiments. However, just how does one manage to bring into this country the requisite barbiturates to do the job? You certainly can’t buy them over the counter and no medico who values his licence to practice, let alone his freedom, wants to be even remotely connected with one’s demise. Even being sprung ‘importing’ the drugs is a punishable offence, although I dare say, as I read recently, those who are dying & wish to do so by their own hand in their own time, really don’t consider that a threat.
“It would almost universally be regarded as cruel to keep a dog alive in those circumstances, ”
Ken, I’m generally sympathetic to your view. But this particular rhetorical gambit often loses me. Isn’t the point that humans are NOT dogs? I’d hate to see a human euthanased every time we thought their situation approximated the type of situaton where we’d euthanase a pet. Or is that just me?
Anthony, nobody, bot NOBODY, is euthanased involuntarily, nor ever would be under the NT and other Bills. When dogs gain the conscious ability to sign a consent form, that’s when the rhetorical statement becomes invalid.
I think Holland introduced euthenasia laws as far back as the 1980s, and as you mentioned there are laws in Belgium, Switzerland, and “death with dignity” laws in Oregon, one of the more secular American states.
Its interesting that none of our the state governments have taken even exploratory steps, I’m not sure the backlash from religious voters would be that significant. Indeed it could be a handy strategic move in NSW, stirring up the fundies in the Liberal Right, in so doing functioning as a weapon of mass distraction to take the emphasis away from a pretty tumultous last twelve months for the government – putting the focus on the hyperbole of an opposition at war with its own small l liberal constituency (the voters want a Greiner, not the incompetent lot the Clarke clique will try to push forward.)
You’d have to feel sorry for O’Farrell if a Machiavellian Labor back-room boy got this idea to float. Yes that is awfully cynical, but I do think such laws do have merit, but they’ll probably only be introduced by a “crazy brave” leader, which in an era where the electorate tends to go for “white bread” safety, doesn’t offer much hope.
Also on the same day Chantal Sebire committed suicide, the Belgian writer Hugo Claus (who was suffering from Alzheimers) choose to end his life via voluntary euthanasia.
http://www.bostonherald.com/news/obituaries/general/view.bg?articleid=1082031&srvc=rss
“Isnt the point that humans are NOT dogs? Id hate to see a human euthanased every time we thought their situation approximated the type of situaton where wed euthanase a pet.”
This comment seems to assume that I’m advocating involuntary euthanasia, which is of course what happens to dogs. I’m not. Chantal Sebire wanted to die but the State refused to allow her to be helped so she had to do it herself, and die in pain and loneliness. I don’t think that’s OK at all. Or is that just me?
Everyone:
The really big issue in the euthanasia debate is the limits of euthanasia..
When does “voluntary” cease to be voluntary? Given Australia’s ongoing love affair with the bureaucratic abuse of power – of course, the clients/welfare-recipients/ applicants/patients/victims are always given a “choice”: Hobson’s choice!! – there is very good reason to be both suspicious and very sceptical about the choices on offer, even those with the noblest of stated purposes. Is the aim to relieve unbearable untreatable pain or to save money and to release resources for more “deserving” clients/applicants/etc,? If it sounds to you as though I am being nasty then you are wrong as can be.
I want a world where suffering is minimized but not a world like “Logan’s Run” or “Brave New World” or “THX-1138”
I would be interested if anyone out there had any facts/stats on the effect of the overturn of the NT Rights of the Terminally Ill (ROTI) Act.
That Act, iirc required that there be medical and psych assessments be done on any applicant to ensure that a) they were terminally ill, and b) not suffering from depression. ie the intent of the Act was to ensure that there were no mistakes in diagnosis, and someone with depression would be screened out and treated.
Following the overturning of the ROTI Act, there is of course no such screening, and given that depression is one of the major causes of suicide, I wonder whether the overturning of the Act actually had the effect that the overturners wished.
There is a possibility that in fact, the overturning of the NT ROTI Act may have actually increased suicide amongst those who should not have resorted to it, while ensuring that those who were terminally ill should suffer far longer than they otherwise would. Not to mention that people who do suicide normally leave gruesome results for some poor police person or paramedic to face.
I wonder also (speculation alert here) if the rationale of the overturning of the NT ROTI Act was a concern about euthenasia, or just a cynical vote grabbing stunt – not caring for the dignity of the dying, nor for those left to deal with the gruesome leftovers.
I shall go in my own way if I can physically arrange it – near one of the various Parliament Houses.
But the numerical facts would be good.
I think the reason many people don’t care that much or at least don’t do anything about the laws is that they figure (incorrectly in some cases) that if something like that happens to them, then they can kill themselves easily and there is nothing the law can really do to stop them. Thus whilst there are laws, I imagine the perception is they make little difference and are not worth the bother campaigning for.
Graham (6) I don’t believe euthanasia of the type legalised by the NT government was in any way, shape or form, a ‘Hobson’s Choice’. Nor was the NT considered to be any form of ‘Brave New World’. The Perron legislation was among the most stringent in the world at the time. In the final analysis though, euthanasia or self-termination is within the will of the individual. Bureaucracies have no place in deciding whether the will of the individual is valid. As KP stated, and I totally agree, when my time comes, I’m not afraid to make the decision to end my existence in a manner of my choosing. I do not expect that those nearest or suitably qualified ought to be demonised for assisting.
Niall [9]:
Not critical at all of the efforts of Marshall Perrin nor of the N.T.laws – as laws went, they were very good.
What should alarm us is the Australian propensity to go for manifestly unjust bureaucratic solutions to problems that can be readily solved by involving the object of attention in the decision-making process. I really do mean the object of attention – they quickly cease to be a person with feelings, preferences and rights [despite all the ballyhoo about “protecting clients rights”] when subjected to that sort of process.
For example: Just look at all the pressure, by families, to tip grannies out of their very valuable bits of real estate and into nursing homes, any nursing homes, anywhere. That many of these same grannies were perfectly capable of living out their lives in their old homes if they had a bit of home assistance [ daily short visits by relatives would be nice too]. Assessment teams are not to blame – they are always short staffed and overwhelmed by unfair workloads. Errors of judgement do occur – and greedy families move hell-and-high-water to make sure such errors do occur. e.g.:There are plenty of regulations to prevent greedy relatives from looting granny’s bank account once she goes into a nursing home and her old home is sold off; none at all to prevent a “lucky” purchaser [such as a grandson’s partner] of granny’s old home making a squillion.
In the social environment we have here in Australia, not even the finest laws in the universe will prevent the intentional killing of those who have no unshakable and reasoned desire to have their lives ended. Add financial incentives for either families or governments to get rid of them – and they’re as dead as a dodos.
A person with a powerful need to consider euthanasia would be much safer in another country with far less perfect laws but with strong social compulsions against euthanasia-for-profit.
Everyone here restricts discussion on euthanasia to the legal, medical, religious and moral aspects …. yet nobody wants to talk about the social and financial aspects. Okay, What’s the market value of the corpses and how fast can production be increased?
Graham, could you be a bit more specific about exactly who you think will go about killing off old people, and how you think the term ‘voluntary’ could/will be got around? You talk as if you thought legalised euthanasia was a sort of opening-the-floodgates scenario and that anyone who could legally get away with killing off old people would do so without delay. Is your view of human nature really that grim?
Mind you, given the naked hatred and contempt I’ve seen expressed by many for the Boomer generation, to which I belong now that they’ve changed the definition of it and thrown the original one (DOB 1946-1950, I believe) down the oubliette, I fully expect some disaffected Gen X sausage to give the orders to bump us off en masse as soon as a chance presents itself, but your comments seem to rest on an assumption that the homicidal impulse is built in to human nature at large. Is that really what you think?
Wilful and Graham, I know – or assume – that you’re not advocating involuntary eithanasia. That was precisely my point: in such circumstances any throw away rhetorical reference to how we treat sick pets seems beside the point and not really advancing your argument. Just sayin, that’s all.
Graham, I’m afraid you’ve lost me entirely. Perhaps it’s because I’m not aware of any family all too ready to tip ‘Granny’ out of her home and into a nursing home. From familial experience, I can assure you I would not advocate such actions. One might as well drive her to the tip and chuck her in the green waste pile. Nursing homes have far less benefit.
I advocate individual rights and freedoms on the subject of right-to-die. We all have our individual dignity and ought to be allowed to maintain it throughout life, right up until the very end. When my essence leaves this vail, it will be with ultimate dignity, without pain and at a time of my choosing. I wish the very same for everyone who desires it.
Sorry, back at 12, that should have lead off with ‘Wilful and Kenneth’ or ‘Wilful and Ken’ or whatever. Didn’t mean to drag you into it Graham
Niall [13] …. and Pavlov’s Cat [11] :
Yea verily!
My opinion comes from many years working in health …. and I think I’ve seen just about the full range of responses to infirmity and age – from giving a slanderously false and misleading history so as to get the stupid old bitch out of that lovely house right through to displaying genuine love and concern..
Many of the aged and the infirmed would be better off in institutional care than in the old homes; that’s not the issue. Annoyance and sloughing off responsibility are common enough and, though not nice, are unlikely to cause grave harm – so they should not cause fear about what would happen if widespread euthanasia were introduced. Introduced, that is, without a hard dispassionate look at the hefty social and financial incentives to get rid of inconvenient and/or expensive oldies and infirmed.
Australia is a lovely country but it does have some very nasty aspects – and the attitudes and the actions [not the flowery words] of some families and most governments towards the aged and the infirmed do have to be recognized, no matter how uncomfortable and confronting that recognition may be.
Trying to introduce voluntary euthanasia in Australia without considering the social and financial aspects would be a disaster – no matter how near perfect the law may be.
A few comments:
1. I appreciate this is an issue that some people feel strongly about, but I suggest it would be beneficial to drop the religion bashing line of rhetoric. I find it offensive to suggest that the only people opposed to such laws are a “religiously cruel minority”. I also don’t think the only reason laws have not been passed is because it “isnt a vote-changing issue except for the religiously-motivated minority opponents.” I think one of the reasons why Parliaments have stayed away from this issue is that it is exceedingly difficult to legislate for (which I think is the point Graham is making), even though most people recognise the current situation is well short of ideal. Sugggesting that everyone who might be uneasy about such a law is just some sort of narrow-minded religious bigot who thinks people should suffer is not a good way to win their support.
2. I’m not trying to derail the thread by turning it into one on Philip Nitschke, but I think it has to be said that as a leading advocate for such laws, he does not give me great confidence that whatever legal boundaries are put in place will be strictly followed.
3. From memory – I’m sure Ken will correct me if I’m wrong – some of those who expressed strong concern about the NT laws when they were passed were Aboriginal people. That’s not a reason in itself not to have such a law, but it it’s not a factor which should be ignored either.
4. I don’t mean to sound pedantic, but while it wouldn’t have happened without the support of John Howard, I think it is more accurate to say that it was the federal Parliament, rather than the Howard government, which overturned the NT law. It was a conscience vote on a Private Members Bill, and people from Labor, Liberal (including Cabinet Ministers), National and Democrats voted both for and against the Bill.
5. Speaking of Private Members Bills, there is currently a short Senate inquiry into a Bill of Bob Brown’s, similar to one put up earlier by Lyn Allison, which seeks to overturn the federal law which overturned the NT law – that is, it would make the NT law operational again. Bob Brown’s Bill is not likely to be brought on for a vote for a while – I doubt Kevin Rudd would be keen to have the major Parliamentary debate that would be required for such a vote to occur – but people who want to contribute to public and political debate on the issue should put in a submission to the Senate inquiry. This link has details.
Andrew
Your reminder of the need for moderation (if only to avoid antagonising those whose support or at least non-opposition is necessary) is perhaps salutary. However it’s also insufficient. I don’t remember whether you were in Parliament when the NT legislation was voted down by the initiative headed by Kevin Andrews and his group. However, if you were then you would presumably remember that the NT law included quite extensive safeguards to ensure that only terminally ill people, and only those who freely and voluntarily consented while not in a state of clinical depression, undue influence or other state of mind which might affect their decision, could access state-approved euthanasia.
That said, I thought (and still think) that the law could have been improved. It relied on certification by (from memory) two doctors including a psychiatrist, but left it open as to who they could be. Thus it remained possible that somewhat fanatical if sincere doctors like Phil Nitschke might issue a certificate in a situation that didn’t strictly fit the statutory requirements but did fit his own moral criteria (e.g. a person whose life had become painful and intolerable but who was not in fact suffering a terminal illness, like Nancy Crick). No doubt one can mount a respectable argument for allowing euthanasia in such circumstances, but there’s much less chance of achieving a broad consensus on it. It opens up the situationm for fears about greedy relatives of the sort that Graham Bell has expressed on this thread.
Nevertheless, having endured the full gamut of the debate on euthanasia as a practising and academic lawyer with a deep interest in the question from several perspectives, the view I ended up forming is that the religious fanatics will never agree to a euthanasia law, and will never even mute their opposition, irrespective of how many safeguards are built into such a law. Their opposition is not susceptible to any form of compromise or rational persuasion. Hence my own view is that we need to find a way whereby the pro-euthanasia majority will be both sufficiently intellectually persuaded and sufficiently passionately committed to the principle to be prepared to override the religiously based objectors. Situations like that of Chantal Sebire provide opportunities that should be grasped. Thus I don’t shy away from emtoive expressions like religiously cruel minority, because they accurately express the situation and speak to the large majority whose emotional and rational support will be needed if a reform is ever to be taken forward.
For the record, Ken, do you yourself support legislation that enables assisted suicide in these circumstances? I would have thought that the basic logic is the same.
I also wonder what exactly a passionate euthanasia advocate has to do (or not do) in order to avoid being perceived as ‘fanatical’. In Nitscke’s case, did he do anything in particular that worried you, or do you just have a vague sense that he’s excessively enthusiastic about bumping people off?
Ken
I agree that people with deep moral opposition to the concept of voluntary euthanasia are very unlikely to support a law that seeks to legalise it (although I wouldn’t call all of these people fanatics). However, the point I was trying to make is that these are not the only people who are opposed to – or unconvinced about – euthanasia laws. Telling people who may be unconvinced that they are basically heartless or cruel, or that they are just cowardly people scared of offending religious fanatics, is not likely to make them more supportive.
BTW, I wasn’t in the Senate when the Andrews Bill was debated, although I did follow the debate closely, and have followed the issue relatively closely (although far from forensicly) since then.
James
I don’t have any fundamental moral objection to euthanasia for non-depressed adults who freely and voluntarily conclude on rational and credible grounds (as assessed by approved doctors) that their life has become hopeless and intolerable beyond reasonable prospect of improvement. Note the numerous qualifications. Unlike Niall, however, I don’t dismiss out of hand the “slippery slope” and “greedy relatives” scenarios of people like Graham Bell. They’re not common but they’re certainly real situations. Allowing for legal euthanasia beyond actual terminal illness allows greater scope for those sorts of fears to find fertile ground in public imagination. Thus my pragmatic position, and incidentally my reason for labelling Nitschke a “fanatic”, requires drawing the line (somewhat arbitrarily I accept) at and not beyond the point of terminal illness.
Some current Senate Committee Inquiries…
The federal Parliament is now on a seven week break, and doesnt sit again until May 13th, the day the Rudd government brings down its first Budget. In the case of the Senate, this will be just the eleventh sitting day for the year. However, there is…
Good comments Andrew.
BTW the bbc have an interesting page summarising basic for and against positions.
http://www.bbc.co.uk/religion/ethics/euthanasia/Like all ethical dilemmas its a difficult one.
ON a slight tangent, but still on the topic of mortality, it is a good reminder to complete an Advanced Health Directive (downloadable online) and also to think about sharing your useful bits when you are gone ;)
Sublime Cowgirl [22]:
What a good idea – or two!
One of the great joys in life is seeing donated-organ recipients restored to good health.
Ken Parish [20]:
Perhaps a little more common than is supposed.
Hands up any doctors, nurses, pharmacists, other health workers and clergy who have NOT been asked – on the quiet – if there was something to hurry things along.
No, not distressed relatives hoping that the unendurable suffering of their loved one will not drag on for much longer. That’s a normal humane reaction to a terrible situation; their motive in even saying something at all is ALWAYS for the comfort and peace of their loved one; that they have said something is, in itself, a measure of their anguish.
Hands down.
Now, hands up all those who have NOT been asked to hurry things along for the messy, the noisy, the incontinent, the confused, the bed-ridden and the like.
Hmmm. I see.
So back to my point. Do not imagine that the administrative, financial and social incentives to bump off the inconvenient can be ignored in any useful discussion of euthanasia in Australia.
Andrew [16] point 3
Just to note – aboriginal people in the NT are overrepresented in the incidence of suicide.
http://www.mja.com.au/public/issues/185_06_180906/mea10056_fm.html
I have always thought that the need to have psychiatric services and alcohol targetting programs was the real way to go for those concerned about suicide.
Unfortunately as I pointed out in my post previously there is no split up that I know of that can isolate the effect of the ROTI Act on the stats.
However, given that there were four assisted suicides over the period of the Act’s validity which amounts to approx 1.5 deaths per 100000, and the overall suicide rate seemed to be about 18 and rising, straining at a gnat and swallowing a camel seems to be an apt description.
The present situation is that we will not allow those with terminal illness and in pain to end their lives with dignity, but otoh (according to the report above) other suicides at far greater rates don’t get more than a ‘tut tut’.
(For example, there are plenty of broad programs to stop alcohol abuse, but how many ones targeted at individuals who have shown themselves to be at risk?)
Graham [23]:
It is worth recognising that there may be a range of reasons for other people to want us to begone – including our incontinence, confusion or sundry other messy issues. The ROTI Act in the NT recognised that these issues could be present and had in place processes to guard against them. While the Act was not in place long enough to be completely sure that the processes were sufficient, there was never any suggestion that the people who did take advantage of the Act did so because they were convinced by relatives or friends.
Andrew [16]:
Many Aboriginal people in the NT were very concerned about the ROTI law. Many Aboriginal people in the NT have strong religious beliefs. At the time there was a strong campaign telling people that the law would give doctors the right to kill them. The law was a worry for them and they found it hard to support. The law was passed though following the support of an MLA who had senior, traditional status representing an almost exclusively traditional Aboriginal electorate.
Surely the key to this issue is that it is about ‘voluntary’ euthanasia. It is therefore a matter of establishing a process that gives us all confidence that it is a voluntary decision. ROTI came close to that. It may even have been very good. It was knocked off not because it didn’t work but because it was considered to be morally wrong by some who held religious convictions, others who were politically gutless and some others who seemed to worry that it was all going too far.
On the subject of “tipping grannies out”, I know of two families who have split over the issue.
Many doctors are sympathetic to euthanasia and will “allow” it to happen. Many cancers are essentially untreatable, one GP said that the best pain killer and palliative is heroin, which is now illegal.
Heroin should not be illegal. I raised this for discussion at ALS a few weeks ago and Ken made reference to the discussion on Club Troppo at the time:-
http://alsblog.wordpress.com/2008/03/04/heroin/
However linking heroin relegalisation to euthanasia relegalisation would unnecessarily complicate both political debates.
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Rog [26]:
The aim in looking after the terminally ill is usually to keep the patient as comfortable and calm as possible and to allow them as much dignity and pleasure as possible. Sadly, the disease process itself does not always make that possible – as we saw in this tragic case of Chantel Sebire.
Have to wonder though, why there is such an insistence on analgesics [pain-killers] alone outside of palliative care units. Sedatives, muscle-relaxants, TV on to bloody awful soapies, visits by noisy great-grandkids and a whole lot of other things can help alleviate suffering.
One of the best medicines I saw prescribed for a terminally ill patient was “30 ~ 60 ml of the mixture [a damned good brandy] p.r.n. [as required]”. What? In breach of hospital regulations? They might get picked up for drunken driving? They might become alcoholics. Yeah, right. :-(