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Thank you for the invitation to address you today on the subject of euthanasia.
When I was a medical student 40 years ago the topic was, with abortion, frequently debated. Little has really changed in that time, although legislative changes in the Netherlands of 2 February 1993 which guaranteed doctors immunity from prosecution if they followed certain guidelines, and the proposed introduction of a private members bill in the Northern Territory have revived debate.
It is a debate that has been around since the time of Hippocrates.
In my address I will cover 3 aspects - the argument for, the argument against and my own position.
Before proceeding, I would like to outline my qualifications. I graduated in medicine in 1956, trained in surgery and became the first Queensland Cancer Fund clinical research fellow in melanoma in 1963. 30 years ago, melanoma was regarded as a death sentence.
Over the next 30 years my professional life has been dominated by work with patients with cancer - melanoma, bowel and breast cancer and I was a visiting surgeon to the largest hospital in Australia concerned with death and dying, Mt Olivet, run by the Sisters of Charity in Brisbane.
More recently, I spent 2 months with Care Australia in Rwanda and have looked after my own mother who died of cancer.
I have had a lot of experience with death and dying.
Before outlining the cases for and against I want to give you an opinion I have reached after considerable thought.
It is that there is no place for a lawyer or psychiatrist at the deathbed.
Lets examine the case for voluntary euthanasia, but first I want to define the terms.
Euthanasia - the word is derived from the Greek - euthos (easy) and thanos (dying).
Voluntary Euthanasia - defined as a quick peaceful death with medical assistance, in the interests of the patient and at the request of the patient.
The Voluntary Euthanasia Society " views it as an expression of care, an act of humanity, in no way incompatible with sound medical practice".
Non-Voluntary Euthanasia
Active - Euthanasia at the request of a relative.
Passive - Withholding treatment at patient request.
Arguments for euthanasia have been advanced by many groups around the world. The first voluntary euthanasia society was formed in Britain more than 50 years ago and there is now a World Federation of Right-To-Die Societies.
In Australia various groups are linked through the Federation of Australian Voluntary Euthanasia Societies (FAVES) although voluntary euthanasia is primarily a matter for state legislation.
The arguments for euthanasia are based on 3 principles:
1) Compassion for the suffering. Compassion should not be denied to those who seek merciful release from a life which has become a meaningless burden and for whom there is no prospect for remission or cure.
2) Concern for the quality of life. Life embraces self awareness, the ability to communicate with others, and to be conscious of and respond meaningfully to our surroundings. When such attributes are gone, never to return, live is devoid of quality.
3) Respect for self determination. It is axiomatic in a free democratic society that individuals have a right to make their own decisions on matters that are primarily their own concern.
Based on these principles, other arguments are advanced. A principle one is the need to take into account the fact that modern technology now often allows life to be sustained in babies with gross congenital malformations and at the other end of the spectrum people with severe head injuries, or with strokes and irreversible brain damage.
The arguments against can also be encapsulated in 3 principles.
1) The responsibility of society. Society as a whole has a responsibility to care for the disabled, the sick and the old in the evening of their life and not make them feel unwanted.
2) Limits on personal autonomy. Limits already exist eg. driving on the wrong side of the road, wearing seat belts, etc. The autonomy of the doctor needs to be respected in that a doctor should not be coerced into any act complicit with euthanasia.
The vulnerable also need to be protected from those wishing to hasten their death against their own wishes.
3) A peaceful death can be achieved by the use of adequate doses of medication and if necessary admission to a hospice or hospital. People may die peacefully at home with adequate palliative care.
A Select Committee of the British House of Lords was established in January 1993 and reported in May 1994. It rejected euthanasia and the report stated:
"There is insufficient reason to weaken society's prohibition of intentional killing which is the cornerstone of the law and social relationships - it protects each one of us impartially, embodying the belief we are all equal."
On 11 August 1994 I attended a seminar in Canberra organised by the AMA. There were speakers representing the Voluntary Euthanasia Society as well as intensivists, nurses, hospice workers and general practitioners.
Three major points came out of this discussion.
Living wills ie. statements that resuscitation should not be attempted if required were not a deterrent to intensivists. Dr Malcolm Fisher of Royal North Shore Hospital said he disregarded them as he had never had an ungrateful surviving patient !
It is not possible to secure limits on euthanasia. The Report by the Dutch Attorney General showed that there were 1000 deaths in the Netherlands in 1990 from euthanasia without the patients request and only a handful were reported.
In Holland there is no coordinated hospice movement.
Why pick on doctors to kill patients ?
Doctors are programmed on leaving school and entering university training for 6 years (now usually 7) to preserve life. They spend 2 years in hospital training as a minimum before accepting sole responsibility for the care of another human being.
The advocates of euthanasia want such an individual to about face and terminate a life.
If we do go down the track of legalising euthanasia I think it is imperative that we take termination of life out of the hands of doctors.
We now have wedding celebrants - why not euthanasists ?
What about the survivors - the loved ones of those who die.
I have never seen any discussion about those who are left. Do they feel guilt if they have participated in planning the early death of a loved one ? What about the memory of devoted care for a loved one who has died surrounded by the comfort of a loving family ?
I quote from a letter I received recently:
"He died a very happy man with all his family, his brothers and sisters and my brothers and sisters around him. We would never have wanted to have been deprived of that lovely time together at palliative care."
The process of dying can be one of the most enriching periods of ones life.
At one extreme I speak of Tom Walsh. Tom was a single 45 year old train driver with no relatives. He was found to have bowel cancer secondaries in his liver.
He discussed his options with me - chemotherapy or not, continuing work, early retirement, etc. I asked him if he had any unrealised ambitions. He said his hobby was trains and he had always wanted to travel around Europe on trains.
I arranged a payout of his superannuation and Tom left for overseas with a 12 month Eurail pass. before he left he asked me when he would know he was approaching death. I advised him that he would lose weight and about a month before he would get jaundiced.
For the next 6 months I received postcards from all over Europe - the last had on it "Losing weight but feeling great."
Then he appeared on my doorstep - jaundiced and wasted. He explained that he wanted to be buried in Australia and he found out that it cost $12,000 to airfreight a dead body but only $1000 for a live one !
We had a further discussion and he went hot air ballooning that weekend prior to his admission to a hospice where he died a week later.
He told me his last 6 months were the best 6 months of his life !
At the other extreme I speak of Brian Templeton. A 48 year old architect friend, not a patient, developed secondary lung cancer which was incurable and he asked me to care for him.
I visited him at home until the time came when fluid developed in his lungs which needed draining. He was admitted to hospital, it was drained, but within a few days, it reaccumulated. I was called urgently to the hospital as he was screaming that he couldn't breath. His wife was at the bedside. I ordered a dose of morphia intravenously. The nun drawing up the drug paused and I spoke to her quietly - "Sister, if you have any moral dilemma I will give it myself."
She replied "Doctor, I wonder if it is enough."
He died peacefully within the hour.
One Sunday on Mothers Day, I was called to see an 89 year old widow who had vomited a large amount of blood from a stomach ulcer. I told her that if the bleeding continued the only way to stop it was by operating.
She said she felt she was too old and that before deciding I should speak to her daughter by phone. The daughter said her mother was declining and to let her die in peace. I explained that the decision could wait until the bleeding became life threatening. Within the hour it was. I explained the gravity of the position to the patient and again she asked me to ring her daughter. The daughter repeated her previous advice.
On returning to the patient another haemorrhage occurred. I explained the relative ease of the operation and the patient, perhaps a little sedated now, told me to do what I thought best.
I operated, easily removed the ulcer and she went home 5 days later.
I then remembered that I had forgotten to ring the patients GP. After I had apologised and explained the sequence, he told me the background. Mother and daughter were estranged, the daughter was in debt, mother had a large estate and after all - it was Mothers Day.
I am against euthanasia.
1) Doctors are not trained to kill;
2) There is no place for a lawyer or psychiatrist at the deathbed. It is impossible to enact legal safeguards to protect the vulnerable, support the dying, alleviate distress and ensure the loving memory of those bereaved;
3) Dying is the last great challenge for us all. We need all the support we can get.
I can but echo the words of the woman recognised as the founder of the modern hospice movement - Cecily Saunders.
"You matter because you are you, and we will enable you, not only to die with dignity, but to live until you die."
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