The Right to Die

It’s unsettling to learn that one in five Australians spend their final hours of life in moderate to severe pain despite the best efforts of palliative care. For many patients, their suffering precedes their death by weeks or even months, and is not fully relieved by medical intervention. A patient’s dignity, comfort and quality of life may continue to deteriorate until their very last breath, whenever that may be.

2017-07-09 Right to Die Featured Photo

In Australia, we currently have no laws enabling individuals who are terminally ill or suffering from intolerable and untreatable pain or suffering to be assisted by medical professionals in ending their life. However, the Victorian Government has announced that it will introduce a bill to legalise physician-assisted dying (PAD) in the second half of 2017, reigniting public interest in this contentious topic.

The vast majority of Australians indicate that they are in favour of introducing assisted dying legislation, reflecting a progressive shift in our culture around death and dying. While the western medical model has long centred around prolonging life, we are increasingly concerned with the quality of one’s life as opposed to its length as the defining feature.

PAD refers to a doctor providing a patient with the means to end his or her own life. This is different from euthanasia, which involves a doctor personally administering the lethal dose of medication at the patient’s request.

Both are illegal in Australia, while administration of increasing doses of morphine remains an acceptable option for relieving pain – though this cannot be executed with the intent of ending the patient’s life. It’s worth noting that morphine does not relieve all pain and suffering, hence this measure is largely inadequate for many patients.

The autonomy of terminally ill patients wishing to alleviate their suffering is thus restricted to very few options. Firstly, they can complete an Advanced Care Directive (ACD), outlining their wishes regarding future care. ACDs enable patients to determine what they do and don’t want to happen at the end of their life, including the option of not-for-resuscitation orders, should they be unable to contribute to future decision-making or give informed consent.

In the meantime, they can refuse medical treatments or even resort to refusal of nutrition and fluids if they wish to hasten their disease process – I use the word ‘hasten’ loosely here: dying of thirst and starvation is by no means a quick or painless process.

Whilst these options may appear to give patients a certain level of control over their end of life care, they do very little, if anything, to alleviate their suffering. This raises significant ethical questions regarding the morality of a healthcare system in which starvation, dehydration and prolonged suffering are legal, but being able to end one’s life safely and painlessly on one’s own terms with medical assistance is not.

It’s not difficult to see how the current lack of options places enormous strain on patients, their families and their doctors during what is already an incredibly difficult time. Grief and sadness will inevitably accompany death, but suffering should not be exacerbated by the very system responsible for caring for those facing it.

Much of the criticism of PAD consists of faith-based ideology and misinformation. The sanctity of human life remains a centre point for arguments against all forms of assisted dying. However, willingness to honour human life can certainly be applied to both sides of this debate, and it’s difficult to see any moral justification for the prolonged suffering of human beings at the end of their lives.

Persistent arguments against PAD include the potential for coercion of the elderly, concern that the final decision may rest in the hands of relatives with ulterior motives, or that suicidal patients may exaggerate their suffering so as to be assisted in dying. Not least of all is the concern that if we make it legal to assist some patients’ deaths, where will we possibly draw the line – the famous ‘slippery slope’ argument. These arguments instil doubt in the minds of law-makers and the general public, further delaying the process of legalisation.

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It cannot be emphasised enough that any legislation enabling patients, with the help of doctors, to end their lives would be highly safeguarded. Only a competent adult would be able to request assistance in ending their life, and of course the eligibility criteria would be carefully considered. All alternative options would first be discussed with the patient, and each case would need to be agreed upon by multiple doctors and aligned with the coroner’s office.

Assisted dying laws now exist across a number of European countries, as well as Canada and some US states. Importantly, there is no evidence of widespread abuse of these practices in places where they are legalised, and only a small fraction of eligible patients actually utilise them. Eligibility criteria ranges from a “terminally ill” diagnosis such as metastatic cancer, to “unbearable and untreatable suffering” which may include a broader range of diseases such as dementia and psychiatric disorders.

In Australia as in other countries, we place enormous trust in doctors to act in the best interests of their patients. We need to acknowledge when patients’ best interests can no longer be met by conventional medical treatment, and indeed when further intervention would only cause more suffering.

Every patient deserves the right to assistance when their suffering becomes unbearable and untreatable, and the reality for some patients is that their suffering will only be relieved by death.

Progressive legislation surrounding PAD in Australia is long overdue, as so too is the relief for the countless patients who continue to suffer painful drawn-out deaths.

The views and opinions expressed in this article are those of the author and do not necessarily represent those of the Doctus Project.