Euthanasia Issues...
Physician Assisted Suicide: Personal Right or Medical Wrong
A Society with Planned Death
Should we have the ‘right to die?’ If so, should that right belong just to the terminally ill, or to everyone - to the young and healthy as much as to the old and sick? Is access to physician-assisted suicide a simple matter of personal choice, or does it raise deeper social concerns which potentially could harm us all? Would legalising physician-assisted suicide be compassionate, or would it cause more misery and abuse than it would cure?
Why do some people want to die?
The most common reasons for seeking death are untreated pain, untreated depression, and a sense of abandonment by family, friends, and health care workers. But is death an appropriate treatment for any of these problems? Let’s examine each in turn.
* Untreated Pain:
Most experts agree that people no longer have to die in pain, nor in a drug-induced stupor. Modern pain control allows virtually everyone to die in comfort, with a clear mind. But many doctors in Australia have not yet been trained in modern pain control techniques. Some people are still dying in pain. If doctors are given the power to put people to death, many patients will die unnecessarily people wanted to continue living been properly trained. It seems more compassionate to teach doctors modern care skills than to kill the victims of outdated methods.
* Untreated Depression
Many psychiatric experts tells us that curable depression in the terminally ill is generally neither diagnosed nor treated; this suggests that if doctors are given the power to assist in suicide, more people will die from untreated (curable) depression than from their underlying illness. Killing to relieve pain or depression smacks more of malpractice than mercy.
* Abandonment:
What greater abandonment can medicine offer a person at a time of intense vulnerability than doctor assisted death?
* Financial concerns:
Time was, doctors were paid for providing too much treatment; now, many doctors are paid more, the less care they provide. Death will always be cheaper than any form of curative treatment or symptom relief. And some families will no doubt remind their loved one how much their care costs. Governments may discover significant cost savings offered by physician-assisted suicide. Similarly, ‘quality of life’ assessment based on bias against minorities or the disabled could produce the ultimate in discrimination.
What about the individual right to choose?
But, you might say, these are all social concerns. What about the poor, suffering individual whose life is at stake? Doesn’t he or she have a choice? Perhaps, but how often would such a person choose death if he or she knew all the facts about available options? Usually, advice comes from the attending physician. Many attending physicians haven’t been trained to treat pain or depression. They may have a financial conflict of interest, or bias against the patient. Can such doctors provide accurate , complete information? Or will they unconsciously slant their advice towards death? Is a choice made on faulty information in any sense a free one?
Even if the choice to be killed were fully informed and free, would it be wise public policy to make it legal? Hard cases make bad law. Under our system of government, virtually all rights are constrained by social considerations. The right to free speech is almost absolute, but no one is free to shout "Fire!" in a crowded theatre, because others are likely to be injured.
So it is with physician-assisted suicide the number of victims of abuse will be many times larger than the number of legitimate "beneficiaries"
The Slippery Slope: Two Case Studies
The Dutch have been officially tolerating direct euthanasia and physician-assisted suicide since 1973, under carefully-considered safeguards. Nonetheless, according to their own government , almost 5% of deaths in 1990 resulted from involuntary euthanasia . Another 6% died when their care was stopped without their agreement.
It is ironic to realise that the Dutch euthanasia system was set-up - in the name of patient’s rights - to ensure patient control over end of life decisions. But the government’s own statistics show that doctors decide when death should come for one patient out of ten. More than half the doctors do not consider themselves bound by society’s safeguards.
German doctors accepted the ‘medicalization of death’ in the 1920’s, well before Hitler came to power. They justified physician-assisted death on the grounds of compassion for the hard cases, with iron-clad promises that the ‘right to die’ would remain strictly voluntary. They were wrong. Doctors were 'compassionately' killing disabled World War I veterans and the mentally ill long before the Nazis conceived of the Holocaust.
This is not to predict Nazi-style death camps in Australia if physician-assisted suicide were legalised. But we must not forget how dangerous it is to accept the idea that some people would be better off if their doctor killed them. Increasingly today there are disputes about the cost of health care with not enough health care money to go around and with a shortage of hospital beds. To legalise physician-assisted suicide is to risk opening a Pandora’s box which we will never be able to close.
The Alternative
We have a better choice - Hospice (a system of dignified, holistic terminal care which was developed in Britain). Many observers consider that Hospice has made the "right to die" debate irrelevant in Britain, by making available to every one the sort of care which gives people the desire to go on living. In Australia, there are some excellent hospices and palliative care services but not nearly enough of them and so far, none in the Northern Territory.
In Holland where euthanasia is widely practised, there is a real lack of hospices and palliative care services.
Hospice care is cheaper than hospital care and allows most people to die naturally at home with their families, in comfort and true human dignity. If there is a ‘right to die’, it surely is the right to die naturally and in comfort - as happens under good Hospice care - not to be ‘put to sleep’ like a pet. Patients only request assisted suicide when they fail to receive the support and care they need. We must not accept the false claims of euthanasia advocates who say that killing a person is compassionate and dignified. Let’s make hospice available to all, not physician assisted death. Our humanity is at stake.
RIGHT TO LIFE AUSTRALIA
P.O. Box 70
EAST BRUNSWICK VIC 3057
Ph. (03) 9387 7098
Robin Bernhoft, M.D., F.A.C.S. Author and Consulting Physician