40 years of general practice exposed me to many end-of-life decisions. One I particularly remember is a patient who was dying at home; he had terminal cancer which was untreatable at that time. With the help of one of the marvellous palliative care units existing in Brisbane (as is common, this one was run by a religious organisation) I was caring for him at home and his family rallied around. His pain became more and more difficult to control and he needed larger doses of morphia as time went on. He reached the stage that his drugs were making him very dopey and depressing his breathing. He was distressed by his condition and craved sleep. I discussed the situation with him openly and, separately, discussed his management with his family. He was distressed mentally after months of discomfort and incapacity and wished for sleep. I suggested he could have a sedative which would relieve his distress, but might reduce the time he had alive. The patient and family were in favour and I, somewhat diffidently, approached the palliative care organisation, knowing that it had a lot of religious input (from the Mater).
To my surprise, the organisation put up no objection and had the equipment and expertise to provide him with what was necessary. He became peaceful and died about a week later. This was possibly more quickly than he would have lasted if he had not had sedation. The drug saved the patient from distress and his family from having dreadful memories of their relative’s death.
My conscience was clear. I do not consider that I had killed him. I fulfilled my obligation to relieve suffering. I had the motive of reducing suffering.
So what do you call the whole episode? Did I commit euthanasia? I say I did not, as my motive was to relieve his suffering and I did not give him one massive dose of drugs which would kill him immediately. Most euthanasia advocates say I did, as I prescribed a treatment that caused his death. This difference in the definition of the word “euthanasia” is the reason I do not like to use the word, unless the speaker first defines exactly what she means by the word. This ambiguity of definition is the reason I was pleased to read that Andrews had used the phrase “physician assisted suicide”. This is more specific than “euthanasia” as “euthanasia” in Australia means that a doctor or relative has killed a dying patient because the patient was suffering, while “physician assisted suicide” means that the patient had decided to commit suicide and that the doctor helped her.
The Andrews Bill has the necessary safeguards. It is confined to adults, with the patient having to express the solemn wish to die on two separate occasions, to two different sets of witnesses. The patient is dying, with a short length of life to live. The patient performs the suicide, with the help of the doctor.
Today, I will try to outline what I see as the advantages and disadvantages of the Bill. I will not tell anyone what to think about it, but just tell you what I think are the pros and cons.
The first advantage I hope for is that there will be more resources given to Palliative Care units and less resistance from patients and their relatives to referral for Palliative Care. Even though I worried that I had ended the patient’s life – the patient I discussed earlier – than if he had not had the drug, the figures show that patients referred to a Palliative Care Unit live longer than similar patients not referred. Yet, in this very church, after Mass last year, one social worker told me that she still needs to battle to get dying patients into Palliative Care units, either as inpatients or as outpatients. The treating doctors often resist this! And many patients and relatives, not understanding what palliative care is, also resist the idea.
The next advantage is that this will reassure dying patients that dying in severe pain or discomfort is virtually a thing of the past. Of course, this management is available through Palliative Care Units, now, but ignorance and lack of resources can prevent this. We really do not need legislation for this except to clarify the legal position and to reassure doctors and patients.
The disadvantages are that doctors and relatives are like the rest of humanity – largely decent and kind, but with some rotten apples. When speaking of the terrible things a small proportion of doctors do, consider that the legislation in England years ago to allow heroin addicts to get their supplies legally on a doctor’s prescription made millionaires out of a small group of venal doctors. It soon became known among teenagers where you could go to get legal supplies of heroin from a doctor who would sign the form, testifying falsely that he knew you to be a drug addict etc etc.
If you doubt that relatives will use the law to subtly persuade grandma to ask for suicide, consider that 40% of Australians in aged care homes are not visited by any friend or relative from one year’s end to the next. Remember the lengths that some people go to try to get part of an inheritance.
There are many loose ends to what I have said. I am following Peter Kennedy in giving you information and everyone must make up their own minds. I hope we all have discussions about the issue and even that SMX would have a formal discussion after Mass one Sunday. I have three bits of advice for each person present today.
- Take the hours of time and the effort to get and sign an ADVANCED HEALTH DIRECTIVE and discuss it with your doctor and your relatives.
- Try to see a Palliative Care Unit soon after you get a diagnosis of a disease that might be fatal. Support any moves to get better funding for the units. It is a well-known fact among doctors that those doctors and staff who work in these units are the nicest people practising medicine.
- Discuss the fact that you will die with your descendants, especially your grandchildren. Tell your grandchildren that they must not be too upset, as it is necessary for old people to die to make way for the youngsters.
If the legislation is passed by all the governments around Australia, there would be some advantages and some risks. I judge that some dying people will use it, even if they are have the best medical care, including good palliative care. You can count that as a positive. On the other hand, I am certain that some older people will be persuaded by relatives to ask their doctor to use the mechanisms of the Act. Some of these people could have lived longer and would have been prepared to do so if they had not been persuaded to ask for physician assisted suicide. I consider that this will result in a less caring society. You consider the advantages and disadvantages of the Bill and decide whether the good done by physician assisted suicide outweighs the risks.