Andrew Denton's controversial argument for assisted dying explained
- WYZA Life
(Photo: Wheeler Centre/Kelly Black)
Andrew Denton recently presented his case for an assisted dying law that would spare many Australians from unnecessary suffering. You can now read his Di Gribble Argument 2015 speech in full here – outlining his months of research and careful reasoning.
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Andrew Denton is widely recognised as one of Australian media's genuinely creative forces. He delivered the Di Gribble Argument in November 2015. This broadcaster and interviewer laid out his case for the legalisation of voluntary assisted dying in Australia.
The result of eight months of research, and hundreds of hours speaking with 'nurses, doctors, politicians, lawyers, academics, priests, surgeons, palliative care specialists, and activists on both sides of the debate', Denton has put forward a model for a law which would allow patients to self-administer medication in situations of unbearable and untreatable suffering. Read the full transcript of his argument here.
Who am I to be talking to you about a subject as complex as assisted dying? I have no medical qualifications – just two Logie nominations – so what would I know? It’s true, I have no expertise. . . other than the expertise many of us share: I saw someone I love die badly. My dad, Kit, used to joke that he wanted to go by walking into the shallow end of an Olympic-sized pool filled with single malt whisky, and just keep walking. Sadly, that never happened. Watching him die remains the most profoundly shocking experience of my life.
"People cling to life more fiercely than you could ever imagine. Remember that, because it’s important. People do not want to die."
He was 67, and though clearly dying of heart failure, and obviously in great pain, dad was assisted to die in the only way that Australia’s law then (and now) would allow: he was given ever-increasing doses of sedatives to settle the pain. But morphine never did settle the pain. The images of those final three days will never be erased. That was 18 years ago.
In the years since, whenever I’ve talked about it, I’ve been struck by how many respond with similar stories about people they love dying slowly, in pain – and, seemingly, beyond medical help. Every time I hear it, I think, 'Surely we can do better than this?'
Then, a couple of years ago, I read an article by Tasmanian writer Margaretta Pos, describing the final days of her father, Hugo, who lived in the Netherlands. People cling to life more fiercely than you could ever imagine. Remember that, because it’s important. People do not want to die.
Hugo, dying of cancer, had been granted the right to euthanasia under Netherlands law. His last week was spent farewelling friends. His last night was with family, and Mozart, and with nothing left unsaid. He died peacefully and on his own terms. That article set me thinking: why can’t we have a law for assisted dying in Australia? What’s stopping it? So, eight months ago, I set off to try and answer those questions. In that time, I’ve spent hundreds of hours talking with nurses, doctors, politicians, lawyers, academics, priests, surgeons, palliative care specialists and activists on both sides of the debate, both here and overseas. Above all, I’ve spent time with those who embody the need for this law in Australia: the dying and their families.
Along the way, I’ve discovered two immutable truths. One: dying is complicated. And two: people cling to life more fiercely than you could ever imagine. Remember that, because it’s important. People do not want to die.
The man behind shows such as The Chaser, The Gruen Transfer and Enough Rope, and now a euthanasia advocate, Andrew Denton, puts forward a model for legislation (Photo: Wheeler Centre/Kelly Black)
My starting point was an anti-euthanasia convention in Adelaide, featuring speakers from around the world. Here I heard, in detail, warnings about what was happening in places where laws to help people die already exist: of babies and children being killed; the vulnerable being made expendable; people being euthanased without their consent. Of doctor-patient trust destroyed and palliative care services degraded.
"All we have is doctors doing what they believe is best, depending on their moral view of the universe."
Belgium, Netherlands and Oregon, I was told, were societies weakened at their moral core; a slippery slope where the number of people seeking to die was sharply on the rise, and the reasons for their legalised deaths ever-expanding.
At its heart lay two key accusations: that the safeguards don’t work; and that the elderly and disabled were threatened. I took careful note of it all, then took off overseas to see if their warnings held true.
What I found was almost the exact opposite of what I’d been told: long-running systems, based on years of open research and debate, with multiple safeguards, and overwhelming acknowledgement that they work, from across the spectrum – the public, medical bodies, and political parties of every hue. Their greatest safeguards? That only a competent adult can ask for help to die; and that they are voluntary.
As one doctor put it to me: You are under no obligation whatsoever to do this. That is the essence of the law. It does not give a right to a patient; it protects the doctors. It is something that can be asked. It is something that can be given, but it is not something that can be demanded.
"Assisted dying is happening in Australia, only we don’t really know how much. Or whether it’s being done well, or for the right reasons, or with the consent of patients"
I discovered that there are key differences between the laws in Europe and the US – both of which, I believe, have relevance to us. In Oregon, the law is limited only to those with a terminal illness and a prognosis, agreed by two doctors, independently of each other, that they have six months or less to live. If they meet the requirements, a doctor will supply them with life-ending medication which they can then choose to take – but which only they can administer – when they’re ready. It is known as voluntary assisted dying, and the fact that only the patient can end their own life is number one of many safeguards. The number of Oregonians who use these laws is tiny – less than half of 1% of all people who die.
As the former president of the Oregon Medical Association, Leigh Dolin, put it: Oregon’s law has been a dramatic success. We have an experiment that works. Anyone that tells you otherwise is giving you a crock of shit. Unlike Oregon, doctors in Belgium and the Netherlands end their patients lives by injection – and the entry point for eligibility is unbearable and untreatable suffering. The patient has to convince two independent doctors of this and, between them, they have to agree that no alternative treatment is available. It is not the illness that determines whether or not a request for euthanasia is granted, but the suffering.
"The absence of a law here means we have no guidelines, no reporting mechanisms and no system of review."
This is an acknowledgement that unbearable suffering doesn’t just come in packages marked ‘cancer’ and ‘heart failure’. It can come in such things as MS, motor neurone disease, profound stroke, chronic unrelenting arthritis or multiple, irreversible disorders often seen in the elderly.
It also acknowledges that sometimes, terrible, untreatable illnesses can strike children, even babies – and there are special provisions in their laws to treat such rare cases. The fact that only the patient can end their own life is number one of many safeguards.
I discovered that there is debate within the medical community about some of the more difficult cases such as dementia and psychiatric illnesses. But it is debate in the true sense – an ongoing conversation between medical professionals about how best to treat the many different examples of suffering that come before them.
To me, this was proof of a healthy system, not one out of control. I found nothing ‘slippery’ or underhanded about what they were doing. The systems in Belgium and the Netherlands are based on full and transparent disclosure – where every case is reported and reviewed by peer committees, aligned with the coroner’s office, and with the power to report doctors to state prosecutors for any breaches.
These are the only countries in the world where end of life care has been so thoroughly studied; where both the strengths and weaknesses in the system are there for all to see. They do not pretend that their systems are perfect or impervious to abuse, because they know that no system can be.
But they do know – and are proud of the fact – that the likelihood of unethical practices has been vastly reduced by the openness of what they do, and the controls they have put in place.
As with Oregon, the greatest proof I found that these laws work was in the numbers. A huge percentage of people support them, but only a tiny fraction use them. In Belgium, it’s less than 2% of all deaths. In the Netherlands, less than 4%. I also found zero evidence within the system of the elderly and disabled being abused.
To double check, I went outside the system and asked those whose only interest is advocacy for the elderly and the disabled – representatives of their peak bodies in Belgium, the Netherlands and Oregon – if they had any concerns. The response could not have been clearer. Not one of these organisations reported any abuse of their members or any threat of abuse under these laws.
"Today, in Australia, a doctor can assist a patient to die with no witnesses, no second opinions, no cooling-off periods or whatever."
I put to them every single warning I had been given, and they were emphatic in their rejection of them. And they went further – explaining that the laws gave their members reassurance that, should the worst befall them, they had the choice of asking for help.
I heard only two complaints. One from Illya Soffer, who represents 250 disability groups in the Netherlands, and who told me some members found the laws so strict they were hard to access. The other came from Bob Joondeph, executive director Disability Rights Oregon, who said: Since the law has been passed we have not received a complaint from anyone, other than a complaint from a person who was paralysed and concerned that the law discriminated against them.
It was hard to avoid the conclusion that using the disabled and the elderly as the spearhead of a campaign against assisted dying is politics at its most brutal.
"There’s another ‘but’ about palliative care in Australia: 57% of it is provided by the Catholic Church."
Having seen the care and thought that surrounded end of life medicine overseas, I wondered how Australia, with no law for assisted dying, compared. The first thing I discovered is that, even without a law, doctors here have been assisting people to die for years. Not only did I get this anecdotally from most of the doctors I spoke to – surveys down the years confirm it.
- In 1997, national research into the decisions doctors make while caring for dying patients found that euthanasia, including physician-assisted suicide, accounted for nearly 2% of all Australian deaths;
- A survey of Victorian doctors in 2007 showed that, of those who had experienced requests from patients to hasten death, 35% had administered drugs with the intention of doing so; and
- A national survey of general surgeons in 2001 revealed that more than 20% had hastened death by giving more medication than was necessary – without the consent of the patient.
All we have is doctors doing what they believe is best, depending on their moral view of the universe.
By the way, you’re probably wondering what that phrase ‘without the consent of the patient’ means. I did too, especially when it was put to me by the opponents that this was happening all the time overseas – the clear inference being that it was murder.
What I came to understand, however, was that, in almost all of these cases, patients can’t give consent because they’re in the last days of their life and in a coma; that often, consent comes from the family. And that even then, when doctors give life-ending medication, they generally do so not to intentionally kill the patient – but to relieve their pain.
"All Catholic care is openly guided by an idea from the 13th Century: Saint Thomas Aquinas’ Doctrine Of Double Effect. It exists today as the central tenet of palliative care – ‘we will neither hasten nor prolong death’"
These kind of difficult decisions are faced by doctors in palliative care every day. Death is complicated. So assisted dying is happening in Australia, only we don’t really know how much. Or whether it’s being done well, or for the right reasons, or with the consent of patients – as they do overseas – because the absence of a law here means we have no guidelines, no reporting mechanisms and no system of review.
All we have is doctors doing what they believe is best, depending on their moral view of the universe. As Marshall Perron, the former NT Chief Minister, put it to me: If you want to have a conspiracy with your doctor to put down Grandma and inherit the estate, this is the country for you – because today, in Australia, a doctor can assist a patient to die with no witnesses, no second opinions, no cooling-off periods or whatever.
Still, you may be thinking, ‘but if doctors are already helping people to die, what’s the problem? Why do we need a law?’ Let me answer that question with another. When you don’t have a law, who does it affect? I’ve conservatively identified 4 different groups.
The first is doctors themselves. No law for assisted dying means no protection from prosecution; means a natural hesitation to help those who they might otherwise wish to.
The second is patients in palliative care. Australia is blessed with one of the great palliative care systems in the world. We should be proud of it. But – there is always a but – Palliative Care Australia itself acknowledges that ‘it cannot relieve all pain and suffering, even with optimal care’.
"I can hardly believe that we live in a country where it is ethically acceptable for a patient to choose a slow, painful death by dehydration and starvation, but ethically unacceptable for them to choose a death that is quick and painless."
As a past President of the Australian Medical Association (AMA), Dr Brendan Nelson, put it, there is ‘. . .a small group of patients for whom no amount of medical treatment is going to relieve their suffering’. How small? The latest figures from Wollongong University’s Health Services Unit, which collects data from 106 Palliative Care units across Australia, show that one fifth of those in the last 24 hour of life died in moderate to severe pain despite the best efforts of palliative care.
To people that work in the system, this is not news. I spent many hours talking with Ray Godbold, a palliative care nurse, who told me: I’ve been there when lots of people have had terrible deaths that – no matter what palliative care people say, the last 24 to 48 hours of somebody’s life can be completely unexpected – if we all sat down and people were honest, a lot of them would come out and say: ‘Look, that was a shocking death. We should have done something else to help.’
And there’s another ‘but’ about palliative care in Australia: 57% of it is provided by the Catholic Church. Now, lest you think I’m about to diss the church, let me tell you that one of the highlights of this year was spending a week with the staff of Sacred Heart Hospice at St Vincent’s Hospital in Sydney.
They gave me full access and I was there at all hours, including at 3am one morning, sharing nurse Fran Damon’s delicious homemade muffins. I could not have been more impressed by the compassion and professionalism I found there.
"What seems to be a common thread through the family is this absolute sense of respect for someone they love [and] this absolute sense of helplessness."
But I also discovered there is a limit to that. Because when it comes to helping people at the end of life, all Catholic care is openly guided by an idea from the 13th Century: Saint Thomas Aquinas’ Doctrine Of Double Effect. It exists today as the central tenet of palliative care – ‘we will neither hasten nor prolong death’ – and what it means in practice is that whatever you do to relieve the person’s suffering, you must never intentionally hasten their death.
And the problem there is that for many people who are dying, their suffering will only end with their death, because the pain is beyond treatment.
I think we are largely ignorant about what could happen to us when we are dying and in palliative care. Are there patients in palliative care who make rational and persistent requests for a hastened death? Yes, and Palliative Care Australia acknowledges as much. But under their philosophy of ‘neither hastening nor prolonging death’, they are requests that will never be met.
"They know this person is screaming for help, but no-one is going to answer the call, not in this society. So they have to die alone."
The most they will do for you, if you’re that person begging for help, is what’s called terminal sedation – where they slowly put you into an induced coma until you die.
Why should a competent adult, who is dying and who asks to die quickly, be told they have to die slowly instead? It’s a question I put to several people at Sacred Heart. Always it was followed by a pause, then the answer, ‘euthanasia is not part of quality care’.
So what’s it like to be on the other side of that line? Spencer Ratcliff’s partner, Deb, was literally clawing the walls in pain in palliative care. Spencer, a journalist who had reported from war zones told me: ‘I’ve never see pain like it.’ He asked the nurse, ‘How can you sit and watch her in such pain and tell me she can't have more morphine?’ ‘Because the doctor says I can’t’. The night palliative care team told him the same. ‘We’re not allowed to do any more.’ To whose benefit was Deb kept alive for a few more days of pain? Not hers.
I think we are largely ignorant about what could happen to us when we are dying and in palliative care. We believe that it will all be taken care of but, for some of us, it won’t.
Of all the things I learnt over the last eight months, the most shocking was this: there is one circumstance in which Palliative Care Australia will accept a patient’s right to hasten their own death – which is to refuse treatment, including food and water, until they die.
"Two people over the age of 80 are taking their lives in Australia every week."
Seared into my brain is the conversation I had with Professor Richard Chye, the head of palliative care at St Vincent’s – a gifted physician and teacher who, when I asked how long it can take for a patient to die this way, told me it could take weeks – weeks which were psychologically painful for both the person dying and their family watching on.
Are you thinking what I’m thinking? This is outrageous. I can hardly believe that we live in a country where it is ethically acceptable for a patient to choose a slow, painful death by dehydration and starvation, but ethically unacceptable for them to choose a death that is quick and painless. In what way is that alright?
This is in such stark contrast to what I found overseas, particularly in Belgium, where Arsène Mullie, the former head of palliative care for Flanders, talked about euthanasia as an ‘act of love’ towards his patient.
‘When someone is suffering,’ he asked, ‘how can I ask them to suffer more?’ There is a third group of people affected by the absence of a law for assisted dying in Australia: those who are suffering painful deaths but who don’t wish to die in hospital. These are the people I’ve spent the most time with over the last eight months.
One of them was palliative care nurse Ray Godbold. ‘Velvet Ray’, as he was nicknamed in the Territory for his gentle way with the dying, had gastro-oesophageal cancer. He was 59. In a hidey-hole somewhere in his home, he kept the illegal drug Nembutal – his guarantee of a painless death when the living became too painful. It gave him great peace of mind knowing that he could spare himself, and especially his family, the worst of his dying.
But because he could seek no legal help, Ray had to face the awful arithmetic of death alone. Should he take the Nembutal and die prematurely before the cancer would make it too late for him to swallow? Or should he hold on, hold on, hold on, for dear life, even if it risked the death the death he didn’t want?
"My initial intention here was to argue that assisted dying should be allowed to happen in Australia."
Over four months, I watched as Ray wasted to skin and bone. But still he held on. Death is complicated and people do not want to die. When the end came – despite all Ray’s knowledge – it came with a wildness that no one could have predicted.
In his dying hours, deeply agitated and in pain, Ray finally called out, 'Get it. Get the Nembutal.' But it was too late. The arithmetic of death had beaten him. Ella Godbold told me how the shock of watching her father die like that will never leave her.
His family want to know why we can’t have a law where someone in Ray’s condition, clearly unable to swallow, could have been injected instead? A law where someone could have been there to help?
You may know that the Victorian Parliament is currently holding an inquiry into end of life choices. But what you may not know is that, when he appeared before it a few weeks ago, Coroner John Olle choked up three times as he gave evidence of a distinct group within our society who are taking their own lives in a premeditated way.
They make up the fourth group I have identified as being affected by a lack of a law in Australia: the rational elderly.
'They know this person is screaming for help, but no-one is going to answer the call, not in this society. So they have to die alone.’
The stories he related were scarifying. The 75-year-old man with prostate cancer and a poor prognosis who shot himself with a nail gun. The 93-year-old woman with crippling arthritis who smuggled a razor blade into her aged-care facility and bled to death. An 85-year-old woman who did the same with an assortment of knives and scissors.
"If compassionate and loving care towards patients and families is what palliative care is all about, then assisted dying is part of that. It is time the profession dealt with it."
Coroner Olle went out of his way to stress that these were people without a history of mental illness, faced with the slow, ‘irreversible decline’ of chronic disease. Speaking of those left behind, he said: What seems to be a common thread through the family is this absolute sense of respect for someone they love [and] this absolute sense of helplessness.
They know this person is screaming for help, but no-one is going to answer the call, not in this society. So they have to die alone.
Coroner Olle estimates the number of elderly Victorians dying in this way at one a week. I contacted the National Coronial Inquiry Service to see if they could give me a sense of the national picture. Their estimate: that two people over the age of 80 are taking their lives in Australia every week. The most common method used? Hanging.
My initial intention here was to argue that assisted dying should be allowed to happen in Australia. But it’s already happening, which begs the question: as we already do it, shouldn’t we regulate it so that we know that it’s being done by the right people, in the right way – and for the right reasons?
So what should that law look like? We are fortunate. There is now enough knowledge and experience overseas for us to draw on to create a law that we know will work.
"Doctors do not control life and death. They help us tend to life and death."
Better, the opportunity is there for us to take the best of different approaches from other countries.
I’m no lawyer – Logies remember? – but here are my suggestions:
- As in Oregon, voluntary assisted dying – where you are given the medication, but only you can administer it. The only exception being if, like Ray, you are physically incapable – then, a doctor can give you an injection;
- As in Belgium and the Netherlands, the entry point is unbearable and untreatable suffering;
- To make a request, you must be a competent adult and you must do so both orally and in writing. A second written and oral request is required a minimum of 30 days after the first;
- Two doctors, independent of each other and one a specialist, have to agree with your request, and have to discuss all alternatives with you. These discussions must be taken in the absence of family to identify any hint of coercion;
- If either doctor has concerns about mental health, a third (psychiatric) specialist is to be involved;
- Both doctors must notify the coroner and submit written reports to – and make themselves available for questions from – a permanent committee of review;
- An opt-out clause for all doctors and nurses who do not wish to participate.
What’s the law for if it’s not to deal with hard things? That’s it. Beyond the safeguards written into this law, there are four unwritten ones which, I would argue, are perhaps even more important:
- As I discovered overseas, doctors are conservative and have a natural reluctance to help people die. In the Netherlands, two-thirds of requests for euthanasia are declined. In Belgium, one quarter.
- Peer oversight. Opponents of these laws within the medical system will be watching their colleagues like hawks for any breach of the rules, just as they do overseas – though, significantly, with not a single prosecution brought in either Belgium, the Netherlands or Oregon since these laws began.
- The foundation of this law is that it is entirely voluntary. Under it, you – and only you – can request this. Your illness and suffering has to be manifest and beyond medical help and you have to convince two doctors of this. Even then, it is entirely your decision whether or not to take it. One of the things I found (that I really didn’t expect to find) is that in Oregon, 30% of people who are prescribed the medication ultimately don’t take it. Turns out the peace of mind of knowing it was there was palliation in itself. And. . .
- As Oregon doctor Peter Regan put it when he was asked why such a tiny number of people used their law: ‘I cannot imagine why they would expect an avalanche anywhere. It just turns out that people don’t want to die!’
It’s been put to me we should not do this because it’s such a small number of people affected, and that hard cases don’t make good laws. I disagree. What’s the law for if it’s not to deal with hard things?
"It is not time that we had a law for assisted dying in Australia: it is well past time."
Does anyone here think that what I’ve been describing is acceptable simply because it’s not easy to find a solution? Can I guarantee that my law will never be breached by an unscrupulous individual? Of course not.
Every law is open to the possibility of human weakness. But imagine if we had applied that same standard of perfection to building hospitals. What if there’s golden staph? What if someone dies on the operating table? They would never have been built.
I have learnt that the chief strategy of the opponents is to raise endless hypothetical scenarios about terrible things that could happen under these laws, as proof that they can never be safe.
But Canadian Justice Lynn Smith confronted this strategy in her landmark 2012 decision that has paved the way for assisted dying laws to be introduced in her country. She said: It is unethical to refuse to relieve the suffering of a patient who requests and requires such relief, simply in order to protect other hypothetical patients from hypothetical harm.
I assumed, when I set out eight months ago, that the main reason we don’t have a law in Australia is entirely due to our politicians and that, at some point, I would end up shirt-fronting Tony Abbott, just like he did Vladimir Putin. How things change.
Yes, our politicians have a lot to answer for. Since the NT Rights of the Terminally Ill Act was overturned by the Howard Government in 1997, none of the 27 attempts in different states to pass a new law for assisted dying have succeeded.
In fact, only one has got through second reading – which means it’s never even been seriously discussed, much less a workable law considered. That is shameful, and our politicians deserve to be called to account for it.
One politician who agrees is our former PM, Bob Hawke, who went on the record with me to say: I think it is absurd that. . . a person who is suffering terribly and is in an irremediable condition should be forced to continue to suffer. It doesn’t meet any requirements of morality or good sense. . . the time has come when we in Australia should be getting legislation on our books which makes euthanasia not illegal.
Mr Hawke also urged other prominent Australians who feel the same way to speak up as a prompt to politicians, state and federal. I thank the Honourable Member for Eyebrows, and I urge the same.
But I’ve discovered there is another roadblock stopping these laws, one that sits ahead of the politicians. Until it is removed, no law will ever pass here. That roadblock is our doctors.
One thing that Belgium, the Netherlands and Oregon have in common is that their laws came from the same place: an honest acknowledgement by the medical profession that doctors were already making decisions to end patients lives, and that maybe it was better to regulate this – so that patients were better protected from malpractice, and doctors from prosecution.
In each place, the medical profession played a key role in making these laws happen. In the Netherlands, the guidelines for their euthanasia laws came from the Royal Dutch Medical Society. In Belgium, the drive for regulation came from palliative care. In Oregon, after open debate, doctors chose to take a neutral position on the issue so the people could decide for themselves whether or not they wanted a law for assisted dying.
Similarly in Canada last year, when their Supreme Court voted unanimously to allow a law for assisted dying there.
'If compassionate and loving care towards patients and families is what palliative care is all about, then assisted dying is part of that. It is time the profession dealt with it.’
Surveys of Australian doctors down the years show that support for assisted dying runs at over 50%. But the official position of the AMA and Palliative Care Australia has always been against any such practice.
I have been struck, as I have spoken to doctors across the spectrum in Australia, at how little most seem to know about what these laws mean for their colleagues overseas. They might be surprised to learn, for instance, that, as a direct result of these laws, doctor-patient relationships have improved in all three places.
Compare this with a survey of more than 15,000 doctors done this year by the Royal Australasian College of Physicians (RACP), which found that 80% of doctors don't know what their patients’ wishes are nearing the end of their life, and do not routinely talk about treatment options with them. Do you find that disturbing? I do.
Andrew Denton says he believes that anti-euthanasia arguments are based on 'conflation, distortion, and misrepresentation of facts'
But I think the problem may be deeper than just a lack of awareness. I have been getting the strong sense that this is a conversation the leadership of our medical bodies wants to shut down. Three examples:
- Over the last eight months, as I have spoken with doctors and medical bodies across the world, only one group has declined to be interviewed: the AMA. When I asked if they would answer written questions – about whether or not they’d consulted with their colleagues overseas to see how their laws work; or if they supported independent research to identify exactly what end of life medical decisions Australian doctors are making; or when had they last polled their membership on attitudes towards assisted dying – the answer was, again, ‘no’.
- The RACP, having earlier this year invited Melbourne urologist Dr Rodney Syme – a deeply knowledgeable campaigner for assisted dying – to address them about palliative care, then disinvited him two weeks before he was due to speak, citing ‘unnamed complainants’.
- This was the one that really got my antenna up – the submission to Victoria’s Parliamentary Inquiry Into End Of Life Choices by Palliative Care Victoria. Described as an ‘in-depth consideration of the issue’, based on ‘discussions with international colleagues, and reference to available evidence’, an examination of the footnotes – in which most of the key sources turn out to be some of the world’s most committed anti-euthanasia campaigners – tells you that it is anything but.
No space was given to the views of palliative care doctors who actually work under these laws overseas. So blatant was their effort to paint a sinister picture of a ‘slippery slope’ that must never be allowed here, they failed to acknowledge undisputed evidence which shows that palliative care services in Belgium, Netherlands and Oregon have markedly improved since these laws were introduced.
They finished their submission with the strong recommendation that, should it be introduced, ‘assisted dying be strictly separated from all health care services. It is not health care treatment and should not be undertaken by health professionals’.
When I read this, I was saddened – and, to tell the truth, a little shocked. That they would put such an obviously one-sided document into a public inquiry told me a great deal about the conversation they are having with themselves – and about the conversation they don’t want us to have.
This seems to me to be the very opposite of what we would like to believe of our doctors – that they are the trusted ones we can turn to in our hour of need.
I’m sure Palliative Care Victoria give a wonderful service to their patients, within the limits of their philosophy, but they may want to ask themselves why the man acknowledged as the ‘father’ of palliative care in Australia, Professor Ian Maddocks, has this to say: If compassionate and loving care towards patients and families is what palliative care is all about, then assisted dying is part of that. It is time the profession dealt with it.
It is true that many doctors have strong moral objections to helping a patient die, and I totally support their right to hold that view. But there are many others who do – or who may – support assisted dying.
Their questions about what such laws mean deserve to be discussed openly and honestly. As do ours – their patients – who, for 20 years of polling, have said in vast numbers that we want these laws to happen.
Doctors do not control life and death. They help us tend to life and death. Few politicians are going to argue for assisted dying with the medical profession against them. The lesson from overseas is that nothing will change until opposition from doctors changes too. Doctors do not control life and death. They help us tend to life and death. As patients, we have a right to make decisions about the end of our lives, just as doctors have an equal right not to participate. One should never violate the other.
This is how it works overseas, and it works well. In Australia right now, only one of these rights is being respected. I started this journey by taking the claims of the opponents at face value, and have spent the last eight months seriously investigating them. One after the other, they proved to be distortions and claims that flew in the face of the facts. What I eventually came to realise is that they are not interested in facts.
Their purpose, wherever possible, is to run the whole issue of assisted dying off the road and into a ditch. Despite that, I don’t think compassion lies on just one side of this argument. I truly believe the opponents are genuine in their fears about coercion of the vulnerable. That when they use terms such as ‘abandoned’ and ‘lives being devalued’ to describe those seeking help to die, they do so from what they believe is a place of love.
But I also believe that, ironically, by blocking laws for assisted dying, they are making the lives of those they would protect even crueller. After all, who could be more vulnerable than those in unbearable suffering or in the last stages of a terminal disease?
Who could be more abandoned than those begging for help from whom opponents of these laws would turn away? Whose lives could be less valued than those desperately seeking a way to die that will not leave damage behind them, and who are told instead that ‘suicide is legal, why not just do that?’
And who could be more coerced than those facing no choice about how to end their lives – other than to do so violently and on their own? Assisted dying is not just an old person’s issue, any more than it is one simply for the chronically and terminally ill.
The scars of ugly deaths are livid in the lives of all of us left behind – who will never forget, can never forget, the terrible, lingering way in which someone close to us died; or the violent, lonely way in which others chose to take their own lives because they saw no other option.
Death is the last intimate thing we do. Like my dad, I wouldn’t mind ending by walking into the deep end of an Olympic-sized swimming pool filled with single malt whisky. Only I would like my pool to have Scarlett Johansson swimming in it in a bikini.
However I die – like most of you, I suspect, I hope it’s a death I can live with (if you know what I mean). Above all, I don’t want it to be a death that someone else determines for me.
A few weeks ago, as he signed into law California’s Voluntary Assisted Dying legislation – the fifth state in the US to do so – Governor Jerry Brown, a Catholic, said: In the end, I was left to reflect on what I would want in the face of my own death. I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill.
It is not time that we had a law for assisted dying in Australia: it is well past time.
I’m not talking about a right to die – as one Dutch doctor told me, ‘death is not a right, death is a fact at the end of life' – but instead, a right to ask for help if the suffering becomes unbearable and untreatable.
A right to have a choice about what happens to us at the end of our lives.
When someone is suffering. How can we ask them to suffer more?
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