4th June 1997
Dr Rob Pollnitz

My background is a medical one, graduating here in Adelaide 30 years ago, doing more training in England and Canada, and then returning to specialist practice here in Adelaide 22 years ago. Being involved in advising when life-sustaining treatment had become so useless or burdensome that they should be withdrawn led me to an interest in the misinformation about euthanasia.

Euthanasia can be defined as the intended killing of a patient either by a deliberate act (as with giving a lethal dose) or by the deliberate omission of ordinary care (as with not offering milk feeds to a newborn baby who has a disability). This issue has nothing to do with stopping unwanted treatments, or turning off machines, or providing patients with the most effective forms of pain relief even where that may possibly mean that the person dies earlier than expected. In euthanasia, the key is that death is the intended outcome. Essentially the euthanasia debate is about giving lethal injections.

Those who favour euthanasia present it as a simple issue of personal freedom of choice — it's my life, and I should have the right to end it when I choose. But euthanasia and suicide are different. By always involving a second person, euthanasia is about how we as a community respond to someone who is suicidal.

Under the Anne Levy bill now in the Upper House of our SA Parliament, a newly diagnosed diabetic aged 18 who found the idea of daily insulin injections "intolerable" would be eligible for euthanasia. Given that Australia has one of the highest youth suicide rates in the world, I believe that a law that allows persons of 18 and over to seek death is sending the wrong message to society. Surely there is nothing compassionate about telling people who feel worthless that they are right.

It is worth noting that of all the groups representing people with disabilities, and senior citizens, and health care workers, there are none with a pro-euthanasia position... Perhaps the notion that personal freedom of choice is the highest moral value might work in a perfect world — one where fully informed people calmly weighed all the issues carefully to reach a balanced decision.

But the world I work in is far from perfect. In particular, I do not trust most lawyers and most politicians. I do not believe that it is possible to make a safe law to allow some doctors to kill some patients some of the time. In 1984 in Holland the Supreme Court decided that voluntary euthanasia would not be punished, provided certain conditions were observed. No supervision of the guidelines was provided. Slowly lethal doses for the sick and aged became a part of medical practice. When 8 years later Dr John Keown of Britain examined the Dutch system, he found that over 50% of the acts done or omissions made with the intention of causing death were taken without the consent of the patient. Over half of these decisions for death were not voluntary. The doctors had come to believe that they knew when patients had reached their use-by date.

More recently a Dutch court found a Dr Chabot was justified in giving a lethal dose to a physically well woman of 50 who was depressed and feeling suicidal after the deaths of two of her children and the breakup of her marriage. In Holland, grief and emotional distress will now qualify you for a lethal dose.

The Northern Territory law to permit euthanasia which came into effect in June 96 and was overturned in March 97 was pushed through the one-house NT Assembly in one 16-hour sitting, essentially by the efforts of, one charismatic leader, Marshall Perron. Mr Perron has since admitted that when he drafted his law he had never heard of palliative care. He claims that he introduced his law to relieve pain and suffering. If that is so, I wonder why the NT has no cancer specialist, no palliative care specialist, and no hospice.

Like lawyers and politicians, doctors are human and are equally liable to make mistakes. Despite all our modem tests even a careful doctor can make a wrong diagnosis, and we can label an illness terminal when it is not, and we are hopeless at predicting when patients are going to die. Patients do make unexpected recoveries - but not when they have been euthanased.

For over 2000 years the role of we doctors has been to cure when we can, to give relief when we cannot cure, to seek to comfort always, and not to kill. The majority of doctors do not wish their caring role to be changed to include the status of executioner. My specialist colleagues who work in the palliative care assure me that their 1997 ability to relieve pain and other distressing symptoms makes euthanasia unnecessary. Those doctors who are interested in providing lethal injections (such as Jack Kevorkian and Philip Nitschke) appear to have peculiar emotional needs of their own that are met by the blend of power and intimacy in a death-dealing relationship.

A new concern is the rise of the health care manager, whose concern is with dollars expended rather than with quality of care. To quote the Head of the New York State Task Force on Life and the Law, "it is extraordinarily dangerous to legalize assisted suicide as we rush headlong to a system of managed care. It is far easier to assist patients in killing themselves than it is to care for them at life's end. "Governments and health care funds do have a cost saving mentality, and a one-off $30 lethal injection is much cheaper than providing good health care. It is no accident that Holland spends less on palliative care than any other European community nation.

To finish: No law that allows some doctors to kill some patients some of the time can have secure safeguards. The Anne Levy bill allows verbal requests for euthanasia, and after the act the chief witness will be dead. No one is ignoring the issue of euthanasia. Parliaments around the world are considering it and are rejecting it, essentially on the basis of one principle: the people who will be most at risk are the most vulnerable — the disabled, the sick and the aged — and a law that fails to protect the weak will always be a bad law.

Voluntary Euthanasia

South Australian Voluntary Euthanasia Society Inc. (SAVES)

    "If we so choose, the end of life need not be preceded by intolerable pain, or by senility and loss of bodily functions.
     Death with dignity is the right of every person who faces an incurable, painful or degrading future."

Sir Mark Oliphant. AC, KBE. FRS, FAA
Patron, SA Voluntary Euthanasia Society

It is not death we fear so much as
the manner of our dying

The one thing all forms of life have in common is the certainty of death. It is natural to hope that, when the time comes, we will die peacefully, certainly without prolonged suffering.

At present this hope is not realised by many people. Because of taboos, prejudice and the legal position in our society, we can be condemned to a long period of suffering and/or total dependence on others as a prelude to our inevitable death.

Voluntary euthanasia societies aim to change this position. They seek legislative changes to enable those suffering severe physical or mental distress with no reasonable hope of relief to have, if they so wish, access to a medically assisted or induced, quick, peaceful and dignified death.

Voluntary Euthanasia

It is now recognised as sound medical practice to withhold or withdraw life sustaining treatment that is medically futile or unduly burdensome. It is also recognised as sound medical practice to provide symptom relief to a terminally ill patient even though this may shorten life. The legality of both these practices needs to be clarified for the benefit of both patient and doctor.

The prescription, supply or administration of medication intended to bring about death is at present illegal, no matter how distressing or hopeless the patient's situation may be. SAVES believes the law should be changed so that these practices are no longer illegal in certain circumstances. They should be legally available options to any person who is incurably ill with no other prospect of relief from suffering which, from the point of view of that person, is intolerable.

Voluntary euthanasia, medical assistance or inducement to a quick and peaceful death at the request of the patient, in the interests of the patient and under prescribed safeguards, should be available as an option of last resort. The patient should have that choice.

SAVES takes the view that:

SAVES is concerned only with voluntary euthanasia — with securing for the individual, in appropriate circumstances, free choice from the full range of medical options to achieve a dignified death. "The doctor must also have free choice — to act according to conscience and professional medical judgement.

Public Opinion

The results of opinion polls in the UK, USA, Australia and other countries show widespread support for decriminalising voluntary euthanasia. One of the questions asked in the Australian Morgan Poll of 1994 was:

"If a person who is terminally ill, or injured with no chance of recovery, asks for a lethal dose so as not to wake again, or asks for some other help to die, should that person be helped to die or not ?"

Yes — helped to die 78%
No — not helped to die 13%
Can't say 9%

Support for the principle of voluntary euthanasia comes from a range of religious viewpoints. A breakdown of those answering "yes" showed Anglicans 84%, Roman Catholics 73%, Presbyterian 81% and Uniting Church 77%.

Medical Opinion

A survey of 2000 doctors in New South Wales and the ACT in 1993 by the University of NSW School of Community Medicine asked, "Do you think it is sometimes right for a doctor to take active steps to bring about the death of a patient ?"

59% of respondents said "yes".

When asked, "Do you think the law should be changed to allow doctors to take active steps to bring about a patient's death under some circumstances?"

58% of respondents said "yes".

Although it is apparent that there is support from many doctors, few medical professional associations here and overseas accept voluntary euthanasia as a legitimate measure in medical practice. SAVES is encouraging the medical profession to adopt a neutral position. Whether or not a doctor provides voluntary euthanasia in a given situation should be a matter of conscience and medical judgement.

The SAVES Program is to:

Encourage informed public discussion of voluntary euthanasia.

Encourage discussion within the medical profession aimed at examining the medical implications and feasibility of proposals for legislative change.

•Formulate specific proposals to decriminalise voluntary euthanasia and seek their introduction through Parliament.

Provide information to parliamentarians, governmental and political bodies, medical, legal and educational institutions, libraries, students and interested groups and individuals.

Provide speakers to church and community groups to increase awareness and understanding of voluntary euthanasia.

Promote the use of Advance Directives for Health Care.

Publish resource material on voluntary euthanasia and keep members informed of events in the voluntary euthanasia movement.

Promote public meetings and educational seminars at which ideas related to good dying can be exchanged and disseminated.

The Primary Aim of SAVES is:

To have the law in South Australia changed so that subject to appropriate safeguards it is no longer a criminal offence:

•    for a medical practitioner who has received a request from a patient for an assisted death to comply with this request provided medical assessment indicates that there is no reasonable prospect of remission and no treatment available which is acceptable to the patient;

•    for a medical practitioner to carry out the directions of patients previously expressed in properly attested form that, in the event of their becoming unable to give informed consent and medical assessment indicating that there is no reasonable prospect of remission, their life be brought to a peaceful and dignified end.

HOW YOU CAN HELP

You can help achieve the aims described in this pamphlet by becoming a member of SAVES even if you are unable to participate actively in the work of the Society. Your membership will increase the strength of our representations to have the law changed. You will be helping to obtain for yourself and loved ones, should the need arise, the right to choose a quick, peaceful death with legal access to medical help in bringing it about. You will be kept informed of progress through the SAVES Bulletin published quarterly.