Dying with dignity

Dying with dignity image

Recently, the South Australian Parliament debated and rejected the Death with Dignity Bill, which proposed to legalise euthanasia. It was the 15th time a euthanasia bill had been rejected by the house. The bill’s proposer predicts that this is not the end of the debate, referring to the overwhelming public support for “the right to choose and have a dignified death”. With Andrew Denton regularly advertising his desire for legal euthanasia with evangelistic fervour, I agree that we have not seen the end of the debate. But I still hope for a more honest one.

Sadly, Denton’s enthusiasm has its origins in a personal tragedy – the difficult passing of his father. It is true that some people still suffer at the end of life. Many Australians who lobby most strongly for a change in the law have witnessed such a death. While services such as palliative care can do much to relieve the distress dying people experience, many still do not have access to it. We must do better.

But in the public discussion of suffering at the end of life, we are hearing stories that muddy the waters of the euthanasia debate. Definitions are confused. Medications are misunderstood. It is possible that in reality public support for euthanasia is not as high as assumed, because many members of the public are not familiar with what normally happens in end of life care, or clear about what would change if we legalised euthanasia. Which is understandable in a country where most people die in hospitals, away from everyday life.

Euthanasia laws aim to allow the killing terminally of ill persons by their doctor if they are experiencing suffering. A lethal injection. The intention is to relieve the suffering by killing the patient.

I find it difficult to read some of the stories that have been collected by Denton’s group, ironically called ‘Go Gentle Australia’. Such terrible suffering, sometimes so easily avoidable. There are stories of patients receiving treatment that they obviously do not want because they do not realise they have the right to say ‘no more’. But you can refuse treatment without legalising euthanasia. This is because sometimes treatments at the end of life which are aimed at prolonging life either stop working – they become futile – or the burden of side-effects such as nausea and vomiting can rule out any benefits by way of extra time. In such a situation, the treatment may not be prolonging life so much as prolonging the process of dying. Stopping such treatment is an ethical and legal choice in Australia. No mentally competent person has to undergo treatment they don’t want, even if it means shortening of their life.

It is not euthanasia because the aim is not to kill the person, but to allow the underlying disease to run its course.

Similarly, some people suffer at the thought of being kept alive by machines long after their quality of life is gone. But you can let your loved ones know this is not your wish, and such treatments can also be stopped legally and ethically without a change in the law. Once again it is not euthanasia. It’s not flicking the switch that kills the patient, it’s the underlying disease that does so. That’s why they were on life support in the first place.

Sometimes at the end of life the distressing nature of someone’s symptoms may require the giving of large doses of analgesics such as morphine to manage pain, or sedatives to relieve symptoms such as breathlessness. This is not euthanasia because the aim is not to kill the patient, but to relieve the distress. Some people call this process ‘slow euthanasia’ because of an urban myth that morphine shortens the life of the patient. They argue that if you practice that sort of euthanasia, which they call ‘passive euthanasia’, why can’t we have the other sort of euthanasia with the lethal injection, which they call ‘active euthanasia’ to make it quick? But it’s all based on a lie – that morphine shortens the life of the patient. In fact, there is much research showing that this is not true. Morphine in therapeutic doses does not shorten life. Therefore this argument for euthanasia is invalid. Any argument in support of euthanasia needs to look elsewhere to justify the change. And it would be a change. Doctors are taught to be protectors of life, not executioners.

But I don’t think this debate is really about pain and physical distress at all. If it were, we would not have started discussing euthanasia at a time when we have more medical cures than ever before. I think it is about a society that has lost touch with existential concerns, and when facing death its citizens find they do not have answers to the big questions that arise. Questions about meaning and purpose and what lies beyond this world. While Christians can understand why we may learn through suffering, such beliefs are not widespread. In a society that has forgotten the meaning of suffering, there is understandably a lack of willingness to endure it. Personally I can understand why you would want to check out of this life if you thought this was all there was and you were suffering. It’s not that I don’t sympathise. I do. I don’t oppose euthanasia because I don’t care.

My main objection to euthanasia is that, in the countries where it is practised, abuses occur and some people –around 1,000 in 2010 alone in Holland- are given euthanasia without their knowledge or consent. It is dangerous to think that some lives are not worth living. To forget that we are all made in the image of God and therefore to be treated with respect regardless of physical condition. It upsets healthcare providers when their patients are distressed. Don’t tempt them. You can’t rely on the rules. It is not possible to write a law that can’t be abused. That’s why euthanasia bills keep getting defeated in parliament. Because, even though we ache for those who are suffering and desire to die, we feel responsible to protect the vulnerable who would be at risk of dying under the legislation if it were to pass. Surely the worth of a society lies in how it treats those who can’t care for themselves.

And that is one of my greatest frustrations. This debate is uneven. We hear about the people who wish to die, but what about those who wish to live? The frail and vulnerable who cannot go on Q & A and talk about their experiences of coercion and being made to feel a burden? Elder abuse is on the rise.

The prospect of inheritance brings out the worst in some people. Are we really so naïve about the consequences of changing the law?

As Christians we know that that we live in a fallen world where suffering is inevitable. That there is a better world to come. That it is wrong to kill the innocent, even when they ask us to. This is a challenge for the church – to support those who suffer whenever we can, to help them learn from the suffering saviour, because you can only peacefully let your life go when you understand its meaning.

Dr Megan Best is a bioethicist and palliative care doctor who works for HammondCare. She serves on the Social Issues Committee of the Diocese of Sydney.

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