Sections in this issue outline (in order)|
1 What they said. 2 The issue at a glance. 3 Background. 4 Internet information links. 5 and 6 Arguments for / against. 7 Further implications on this issue. 8 Newspaper items used in the compilation of the outline.
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Outline 2001 / 19: Should euthanasia and doctor-assisted suicide be legally available?
What they said ...
'They want autonomy at this time, to be allowed to die at home with the comfort and support of their families ...'
Dr Peter Goodwin, an American pro-euthanasia activist who helped to have a doctor-assisted suicide bill accepted in Oregon
'[It is important that those with] terminal illnesses are also made aware of the many cases in which initially suicidal patients have gone on to cherish their final months with family and friends'
Herald Sun editorial of January 8, 2001, advising caution before accepting the desirability of euthanasia or doctor-assisted suicide
The issue at a glance
A number of recent events have served to keep the euthanasia debate before the public eye.
In January, 2001, a Western Australian doctor was facing murder charges over the hospice death of a 48-year-old cancer patient and Australian euthanasia activist Dr Nitschke was required to answer police questions about the apparent suicide of a 72-year-old cancer patient.
In April, 2001, the Dutch Senate passed a law which decriminalised euthanasia and doctor-assisted suicide. Both acts would still remain offences, however, so long as they were performed in accord with certain guidelines doctors would not be liable to prosecution. This regularised the situation that has existed under common law in The Netherlands for over a decade.
The Dutch legislation has led to calls for similar laws in other jurisdictions, including Australia. Private members' bills on voluntary euthanasia have recently been presented in South Australia, New South Wales and Western Australia.
Meanwhile, Dr Philip Nitschke continues to run 'advice' clinics in a number of Australian states in which he outlines what people's options are in the event of terminal and incapacitating illness. This apparently includes supplying people with information on how to kill themselves.
Dr Nitschke has also proposed setting up a 'suicide ship' outside any nation's territorial waters and therefore outside any national jurisdiction, where people could be assisted to kill themselves.
Clarification of terms
Euthanasia, commonly referred to as 'mercy killing', is generally understood to mean deliberately ending the life of a suffering, terminally ill person. However, in the legislation recently passed in the Netherlands, euthanasia and doctor assisted suicide are available to people who are not suffering a terminal or life-threatening condition.
Passive and active euthanasia.
1. Passive euthanasia refers to the failure to take an action that may prolong a patient's life.
A possible example of passive euthanasia is the withdrawal from a patient of food and sometimes water. This is what is sometimes done in the case of grossly deformed newborn babies who have no long-term life expectancy.
A similar procedure is what is sometimes referred to as 'terminal sedation', where a patient suffering a fatal condition is sedated and food and sometimes water are withheld.
Passive euthanasia is not often the focus of public debate and is not what advocates of euthanasia legalisation are seeking.
2. Active euthanasia means that steps are taken to bring about the patient's immediate death. The most commonly discussed example of this form of euthanasia is the deliberate administering of a lethal injection by a physician.
Voluntary and involuntary euthanasia.
3. Voluntary euthanasia indicates that the person euthanised has requested his or her own death.
4. Involuntary euthanasia occurs when another person, either the treating physician or a family member, decides that the patient is to be euthanised, without the expressed consent of the patient.
Throughout this debate the emphasis is on voluntary euthanasia, however, critics of euthanasia have noted the 1990-91 Remmelink report and the subsequent 1995-96 report have indicated that in the Netherlands there is a significant incidence of involuntary euthanasia.
In the euthanasia debate as a whole, the cases of babies, young children, the mentally deficit and those incapacitated and perhaps unconscious as a result of illness are particularly problematic.
Euthanasia and doctor-assisted suicide
5. Euthanasia occurs when a physician or some other person acts to deliberately bring about the death of another, usually terminally ill person. For euthanasia to have occurred, the doctor would have to have administered the fatal substance or have otherwise been the direct cause of death.
6. Where the patient self-administers a lethal substance supplied by a doctor and that doctor possibly oversees this act this is referred to as doctor-assisted suicide or medically assisted suicide.
Medically assisted suicide is what Dr Kevorkian in the United States performs. Dr Kervorkian frequently assists people end their lives via carbon monoxide poisoning.
In the Netherlands, where neither active euthanasia nor medically assisted suicide are liable to attract a criminal penalty, patients who commit medically assisted suicide appear to be given enough tablets to fatally overdose and are then left to self-administer, normally in their own homes. The Oregon Death with Dignity Act allows doctor assisted suicide, but not active euthanasia.
Within Australia the four people who died under the Northern Territory's Rights of the Terminally Ill Act self-administered a lethal injection using a computer-operated device developed by Dr Philip Nitschke.
Medically assisted suicide appears very closely related to active euthanasia, in that the doctor sets up circumstances where a lethal dose can be given to a patient, however the final act of administering the lethal substance is performed by the patient, not by the doctor.
The Northern Territory 's Rights of the Terminally Ill Act 1995 allowed for both active euthanasia and medically assisted suicide.
Laws that have allowed or still allow euthanasia and medically assisted suicide
1. The Netherlands - Termination of Life on Request and Assisted Suicide (Review
Procedures) Act 2001
In the Netherlands euthanasia and assisted suicide continue to be criminal offences, but doctors will not be liable to prosecution in certain circumstances.
Direct euthanasia (termination of life on request) and assistance with suicide will not be treated as criminal offences if carried out by a physician following agreed 'due care' criteria.
These 'due care' criteria require that the doctor
* believes that the patient's request is voluntary and well-considered;
* believes that the patient's suffering is lasting and unbearable;
* has informed the patient about the situation he is in and about his prospects;
* has consulted at least one other, independent physician who has seen the
patient and has given his written opinion on the requirements of due care
* notifies the authorities that he has either performed an act of euthanasia or has assisted with a suicide
In The Netherlands euthanasia or assisted suicide may be carried out where a person is not suffering an incurable, terminal condition. A person can request euthanasia or assisted suicide to escape 'unbearable' physical or psychological suffering.
2. The United States - The Oregon Death with Dignity Act 1997
Only one American jurisdiction currently allows doctor-assisted suicide - the state of Oregon. Oregon allows a doctor to prescribe medication for a patient over 18 so that patient may end his or her life.
Such an action is legal where the following conditions have been adhered to.
The attending physician shall:
(A) Determine whether a patient has a terminal disease, is capable, and has made the request voluntarily;
(B) Inform the patient of
* his or her medical diagnosis;
* his or her prognosis;
* the potential risks associated with taking the medication to be prescribed;
* the probable result of taking the medication to be prescribed;
* the feasible alternatives, including, but not limited to, comfort care, hospice care and pain control.
(C) Refer the patient to a consulting physician for medical confirmation of the diagnosis, and for determination that the patient is capable and acting voluntarily;
(D) Refer the patient for counselling ;
(E) Request that the patient notify next of kin;
(F) Inform the patient that he or she has an opportunity to rescind the request at any time and in any manner, and offer the patient an opportunity to rescind at the end of the 15 day waiting period;
(G) Verify, immediately prior to writing the prescription for medication under this Act, that the patient is making an informed decision;
(H) Fulfil the medical record documentation requirements;
(I) Ensure that all appropriate steps are carried out in accordance with this Act prior to writing a prescription for medication to enable a qualified patient to end his or her life in a humane and dignified manner
3. The Northern Territory Rights of the Terminally Ill Act 1995
This Act allowed active euthanasia or physician assisted suicide in the following manner, with the following safeguards:
* The patient had to have made a request to die;
* The patient had to be at least 18 and suffering from an illness that would result in death;
* A first doctor must have diagnosed the terminal illness and have been willing to help with the death;
* A second doctor, specialising in the patient's illness, must have confirmed the diagnosis and prognosis;
* A psychiatrist must have confirmed that the patient was not suffering a treatable clinical depression;
* Seven days must have passed after the patient formally indicated the wish to die;
* The patient must have completed and signed a certificate of request, signed by the second doctor;
* The patient must have shared the same language as the second doctor, or an interpreter must have signed the request;
* Forty-eight hours after the request had been signed, the patient could die.
A federal Act of Parliament overturned the Northern Territory Rights of the Terminally Ill Act 1995 in 1997. Four people died under the provisions of the Act before it was overturned.
Current legal situation in Australia
Within Australia, the law and accepted practice mean that a form of treatment may be withheld from a patient because it is viewed as unduly onerous and ultimately futile. Where the intention is assumed to be to reduce suffering, rather than to hasten death, such an action is not usually considered euthanasia and is not outside the law.
Similarly, a drug administered or supplied to a patient to relieve pain may have the incidental side effect of hastening the patient's death, but if the physician's primary purpose is to control pain, rather than end the patient's life, then the act is legal and is not regarded as euthanasia.
(There are those who claim that rather than hastening death, pain-relieving medication may extend a patient's life by relieving stress, promoting sleep and enabling the patient to move about.)
Most Australian states and territories have legislative or common law provisions dealing with the rights of the terminally ill, however, these laws allow a physician only to supply pain relief or to refrain from taking extraordinary measures to prolong life.
It is not legal to deliberately end a patient's life or to supply patients with the means to end their lives. Though suicide is not an offence, it is currently an offence in all Australian states and territories to assist someone commit suicide.
The South Australian Natural Death Act, 1983, allowed persons of sound mind aged 18 years or more to complete a 'notice of direction' indicating that if they became terminally ill, they did not wish their lives extended by extraordinary means.
The South Australian Palliative Care Bill, introduced in November, 1995, makes euthanasia illegal. However, it allows terminally ill people to determine their level of medical treatment and whether they want life-sustaining treatment.
In Victoria, the 1990 Medical Treatment Act does not recognise the 'right to die' nor has it altered the law prohibiting aiding and abetting suicide or homicide.
However, the Victorian Medical Treatment Act does allow a patient to refuse certain treatments and provides for representation should a patient have become incompetent.
The right to refuse certain treatments does not include the right to refuse ordinary care, such as the provision of food and water.
In the Australian Capital Territory, the Medical Treatments Act, 1994, gives patients the right to refuse treatment, allows life support to be switched off, and guarantees access to pain relief, even if it can cause death.
In Western Australia, under common law, a person has the right to refuse medical treatment.
In New South Wales, doctors are allowed to turn off life-support on the basis of clinical judgement and in consultation with the patient's family.
Queensland has no laws that require a person to accept medical treatment, nor any laws that say a person can refuse treatment.
In June, 1996, the Queensland Law Reform Commission released a report examining the concept of a 'living will' which allows a person, while in sound mind to indicate their treatment preferences should they be incapacitated by a terminal illness and unable to indicate their wishes.
In Tasmania, a doctor cannot actively assist a patient to commit suicide, but a patient has the right to refuse treatment. Tasmania has circulated 'dying with dignity' guidelines.
Internet information links
There is an enormous amount of information on euthanasia available on the Internet. The following set of sources is offered as a guide only. It gives some of the major sites arguing either for or against euthanasia, gives the provisions of three laws that have allowed euthanasia and/or doctor assisted suicide, gives some comment on these laws and supplies a number of less well-known sites where discussion of the issue is presented.
The Ontario Consultants on Religious Tolerance has set up a useful site that has a sub section dealing with euthanasia.
The group's writers provide background information on a wide range of ethical issues, attempting to present and discuss a range of views on each.
Their treatment of euthanasia and physician assisted suicide can be found at http://www.religioustolerance.org/euthanas.htm
This supplies a useful set of definitions and much background information on euthanasia as it occurs or has occurred in the United States and other nations, including Australia.
Though the site is generally impartial, please note that when it considers the 'Ethical Questions Raised by Euthanasia' it appears to have a pro-euthanasia bias.
The United States magazine, Atlantic Monthly, has an Internet site, The Atlantic Online. On March 27, 1997, the magazine published an article titled, 'Whose right to die?' by an American oncologist, Ezekiel Emanuel. Ezekiel Emanuel is an associate professor at Harvard Medical School.
The article opposes the legislation of voluntary euthanasia and physician-assisted suicide. It does so from a moderate and well-considered position. It examines four popular misconceptions about euthanasia and explains from a public policy position what some of the dangers associated with legalised euthanasia are. Its author is not absolutely opposed to either euthanasia or doctor-assisted suicide but believes they should not be sanctioned by law. The article can be found at http://www.theatlantic.com/issues/97mar/emanuel/emanuel.htm
Stanford University's encyclopaedia of philosophy has a section of its site given over to the issue of euthanasia and physician-assisted suicide. This treatment favours the legalisation of both. It presents its arguments in a moderate and well-supported manner.
The entry gives background information on euthanasia, suggests a number of preconditions which should apply, presents 'a moral case for voluntary euthanasia' and argues against six criticisms commonly made of euthanasia.
This material can be found at http://plato.stanford.edu/entries/euthanasia-voluntary/#AMo
The American College of Physicians and the American Society of Internal Medicine have an Internet site that reproduces the articles printed in their journals.
In April 1998 it published an article titled 'The Debate over Physician-Assisted Suicide: Empirical Data and Convergent Views'
The article was written by Timothy E. Quill, MD; Diane E. Meier, MD; Susan D. Block, MD; and J. Andrew Billings, MD
It looks for shared aims between the medical profession as a whole and those promoting physician-assisted suicide. This is an interesting and unusual article that ultimately argues that the euthanasia debate is a diversion from the real issue, which is, to provide universal, high quality palliative care.
The article can be found at http://www.acponline.org/journals/annals/01apr98/pasdebat.htm
The Voluntary Euthanasia Society of Scotland (VESS) provides a very large, but well organised, set of reading materials on the topic of euthanasia. Most of the readings supplied actively support making euthanasia readily available.
The site includes information on the history of euthanasia and euthanasia issues from around the world. It has a special section dealing with the situation in The Netherlands.
A directory linking to this wide range of pro-euthanasia treatments can be found at http://www.euthanasia.org/contents.html
The Hemlock Society is one of the most significant pro-euthanasia pressure groups in the United States. The Society's home page can be found at http://www.hemlock.org/default.asp
The Society's background information page contains a wide range of articles including considerations of the limitations of hospices and a number of defences of doctor-assisted suicide.
This material can be found at http://www.hemlock.org/background.htm
One of the best starting points for finding material and links opposed to euthanasia is a page maintained by the International Anti-Euthanasia Task Force.
The site gives regularly updated news reports on euthanasia issues from around the world. It has special sections dealing with the situation in The Netherlands and Oregon. It also looks specifically at the issue of withholding food and fluids.
A directory linking to these and other material presented from an anti-euthanasia perspective can be found at http://www.iaetf.org/index.htm
Another useful anti-euthanasia site is the United States' Euthanasia.com. This site is also very easy to navigate and contains a wide range of information, including definitions, articles written from a legal and a medical perspective and articles outlining the situation re euthanasia in various jurisdictions in the United States and elsewhere.
The site's directory can be found at http://www.euthanasia.com/index.html
The Dutch Justice Department has a site looking at the recent changes in euthanasia law in The Netherlands.
A fact sheet issued in December 2000 can be found at http://www.minjust.nl:8080/a_beleid/fact/suicide.htm
The site includes the text of the Dutch Euthanasia Bill that has recently become law and current figures on the incidence of euthanasia in The Netherlands. Both of these documents are in pdf format and require Adobe Acrobat Reader to be read or downloaded.
A BBC report titled 'Dutch MPs legalise mercy killings' can be found at http://news.bbc.co.uk/hi/english/world/europe/newsid_1044000/1044289.stm
Though a news report, the article does not appear neutral and is essentially supportive of the Dutch legislation.
A later BBC report titled 'Opposition to Dutch euthanasia' gives a brief account of some of the objections to the new legislation.
The article can be found at http://news.bbc.co.uk/hi/english/world/europe/newsid_1045000/1045939.stm
The full text of the Oregon Death with Dignity Act can be found at http://www.rights.org/deathnet/ergo_orlaw.html
The full text of the Northern Territories Rights of the Terminally Ill Act can be found on the Northern Territory's Attorney-General's Department site at http://notes.nt.gov.au/dcm/legislat/legislat.nsf/d989974724db65b1482561cf0017cbd2/4d6231fd5c4f4e396925657000094754?OpenDocument
The Australian Commonwealth Parliament's Law and Public Administration group provided a summary of arguments against the Northern Territory's Rights of the Terminally Ill Act when its overturn was being debated in Federal Parliament in 1996-97.
The Research Note was titled 'The Sanctity of Life: Summary Arguments Opposing Euthanasia'
These arguments can be found on the Parliament House site at
The Research Note giving arguments in favour of euthanasia was titled 'Choice, Quality of Life and Self-Control: Summary Arguments in Support of Euthanasia'
These arguments can be found at http://wopared.aph.gov.au/library/pubs/rn/1996-97/97rn12.htm
The Victorian Voluntary Euthanasia site has the text of a speech given by the former Northern Territory's Chief Minister, Marshall Perron, justifying the Northern Territory's Rights of the Terminally Ill Act.
The speech was given at the eleventh International Conference of the World Right to Die Societies held in Melbourne on 17 October 1996.
The speech can be found at http://home.vicnet.net.au/~vesv/marshallOct96.htm
The Federal Euthanasia Bill that overturned the Northern Territory's Rights of the Terminally Ill Act was a private member's bill introduced by Kevin Andrews. Kevin Andrew's second reading speech criticising the operation of the Northern Territory Act and opposing euthanasia can be found at http://members.ozemail.com.au/~burkets/andrews.htm
Arguments against the legalisation of euthanasia and doctor-assisted suicide
1. Legalised euthanasia diminishes respect for life and leads to abuses
Margaret Tighe of Right to Life Victoria has made this point. Mrs Tighe has stated, 'If doctors are allowed to kill patients it will eventually become easier, cheaper and quicker to kill people rather than to strive to help them to live even as they are dying. In addition to that there will be pressure on people who are elderly.'
According to this line of argument, legalising euthanasia may undermine respect for life so that economic and administrative considerations will be given more weight.
There is fear that a diminished regard for life will impact heavily on vulnerable people who are less able to represent their own interests. Thus opponents of euthanasia argue that increasingly the elderly and the infirm, if not the immediately terminal, will be euthanised.
There is also concern expressed that where a person is comatose or otherwise incompetent there will be an increasing tendency to have that person euthanised without his or her expressed consent.
Two separate reviews of the practice of euthanasia in The Netherlands have indicated that a significant percentage of people have been euthanised without their consent.
Critics of legalised euthanasia have also criticised the support recently given by the Dutch Health Minister for a suicide pill for very old people.
This has been claimed to be an example of the 'slippery slope' principle in operation. The slippery slope principle refers to the likelihood that once a certain change is made in law or public values then more and more problematic changes will follow.
This point has been made by the Dutch Christian Democrats, who have commented, 'It's only a couple of days since the euthanasia law was voted in, and already the minister wants to go a step further.'
2. Palliative care is available for the terminally ill
David Kissane, the University of Melbourne's director of palliative care, has estimated that between 60 and 80 per cent of the population who require it receive palliative care. It has been noted that since 1998, after the Federal Government overturned the Northern Territory's euthanasia legislation, federal funding for palliative care has been increased.
It has been claimed that for many people palliative care can relieve much of the physical pain associated with terminal illness.
It has further been suggested that if euthanasia were legally available many people might decide to end their lives before they had discovered that palliative care could give them some acceptable quality of life.
The Herald Sun in an editorial published on January 8, 2001, stated, that it was important that those with 'terminal illnesses are also made aware of the many cases in which initially suicidal patients have gone on to cherish their final months with family and friends'.
It has been suggested that the terminally ill might make the decision to end their lives while in a depressed state and before they were aware of the full range of treatment options, including palliative care.
It has also been argued that were euthanasia and doctor assisted suicide to be legalised governments' financial support for palliative care might be reduced as the need for it would appear less.
3. Those who wish to reject medical care can do so
Opponents of legalised euthanasia argue that under current Victorian legislation patients are able to refuse burdensome treatment. It is claimed that such legislation already serves to prevent patients' lives being extended by treatment that has no curative purpose.
As part of an education campaign designed to ensure that patients' right to refuse treatment is respected Palliative Care Victoria has sent to every Victorian GP a leaflet outlining the right of terminally ill patients to refuse medical treatment.
The director of Palliative Care Victoria, Margaret Box, has stated, 'It's about empowering people and giving them a right of refusal of certain treatments like chemotherapy - not to terminate their lives.'
Supporters of Victoria's Medical Treatment Act, which gives patients the right to refuse certain treatments, claim that one of the Act's objectives is to reduce the burden suffered by the terminally ill. Opponents of euthanasia argue that such legislation reduces the supposed need for euthanasia.
4. Those who wish to will suicide
The Herald Sun in an editorial published on January 8, 2001, stated, 'No Government can ever hope to control such an intensely private and emotional issue.'
The editorial was referring to those who attend Dr Philip Nitschke's clinics giving advice to the terminally ill on the options available to them. The editorial suggests that whatever the legal situation there will always be those who decide to take their own lives in the face of terminal and incapacitating illness.
Critics of euthanasia legislation maintain that it is unnecessary as suicide is not illegal and those who wish to end their own lives in these circumstances will do so.
There are also some who argue that whatever the state of the law, there will be doctors who will perform euthanasia or assist suicides where they believe this is necessary.
Critics of legalised euthanasia and doctor-assisted suicide are concerned about the normalising effect of such legislation, which, they fear might convert acts that are currently seen as extreme into accepted practice.
5. Euthanasia undermines the nature of the doctor-patient relationship
It has been noted by critics of legalised euthanasia that the Australian Medical Association does not support euthanasia.
It has been argued that legalised euthanasia would fundamentally change the nature of the relationship between doctor and patient. Currently one of the principal tenets of this relationship is that a doctor 'will do no harm'. Critics of euthanasia argue that if it were to become legally acceptable for a doctor to assist in the taking of a patient's life this could undermine the trust between doctor and patient and shift the current emphasis of medical treatment from one of cure, where the condition was deemed curable, and patient support and pain management, where it was not.
It has also been argued that assisting in the termination of a patient's life could be extremely stressful for doctors. Pro-euthanasia activist Dr Philip Nitschke has acknowledged this point. Referring to staying with a terminally ill woman, while she initially refused food and drink and later took an overdose of palliative drugs, Dr Nitschke stated, 'It was difficult, it was emotional, it was gruelling ...'
Dr Nitschke has stated that he does not regret the actions he has taken in supporting those seeking to end their lives but admits that such actions are emotionally draining. Some critics of euthanasia have argued that for many doctors being legally placed under pressure to assist someone in the ending of their lives would be very traumatic.
Arguments in favour of the legalisation of euthanasia and doctor-assisted suicide
1. The individual concerned should make the choice
The central argument in support of euthanasia is that the decision as to when a terminally ill person should die can really only be made by that person.
This point has been made by Anna Sewards, in a letter published in The Age on February 5, 2001. Mrs Sewards describes the final distressing stages of her husband's life when he told his doctor that resources would be better used for the living 'than the living dead'.
Mrs Sewards has written 'when the chips are down, no one has the right to question another's belief or decision'.
A similar point has been made by Dr Peter Goodwin, who helped to have a doctor-assisted suicide bill accepted in Oregon, a state in the United States.
Dr Goodwin has stated, 'They want autonomy at this time, to be allowed to die at home with the comfort and support of their families ...'
Supporters of euthanasia argue that it is fundamentally a matter of personal choice. They claim that no one else, especially no authority such as an organised religion or a government, should be able to control the manner and timing of an individual's death.
2. Palliative care can be inadequate and is not always available
Supporters of euthanasia argue that palliative care does not remove the need for legislation allowing euthanasia. One of the complaints made about palliative is that it is not available to all who need it. Current figures suggest that between 20 and 40 per cent of terminally ill Australian who require palliative care do not receive. The situation is apparently worse in the United States where there is no universal health cover and people need to be privately insured to guarantee treatment.
It is further argued that for a certain percentage of people palliative care will either not be effective or will not be effective for the whole course of their terminal illness. According to this line of argument, even among people for whom palliative care has generally been effective there may come a time when this ceases to be the case and when they wish to end their lives.
It has also been argued that palliative care is designed to relieve pain and there are people for whom distress is psychological and therefore not addressed by palliative care medications.
Dr Philip Nitschke has made this point. Dr Nitschke has claimed that some patients have 'existential problems' and that for these patients suffering comes from 'lying there waiting for death'.
3. Legalised euthanasia should reduce the chance of abuses
Some supporters of legalised euthanasia argue that in the current situation euthanasia is occurring, but as the act is illegal it is not being properly monitored. Those who put this case argue that such a situation creates opportunities for abuse.
Melbourne urologist, Dr Rodney Syme, has stated, 'the problem is that it is occurring under the carpet ... without any control.'
Supporters of euthanasia and doctor assisted suicide note the reporting requirements that are part of the Dutch, Oregon and Northern Territory legislation.
All three pieces of legislation also require that the treating doctor be convinced of the patient's informed consent before either euthanasia and/or medically assisted suicide could proceed.
Both the Oregon and the Northern Territory legislation also allowed cooling off periods to ensure that the patient had an opportunity to reconsider.
Supporters also note that all three pieces of legislation contain provisions that the patient must have a second confirming doctor's opinion before either euthanasia and/or doctor assisted suicide could proceed.
It has been suggested that these various safeguards and the reporting requirements mean that legalisation would make doctors less likely to act inappropriately.
There are also those who argue that because euthanasia is not securely and legally available, some people end their lives before they would wish to do so, because they want to act while they are still able to act independently.
Dr Philip Nitschke has paraphrased this position as 'Better to do it while you're well and able rather than leave it until you become sick and unable.'
It is also argued that some people attempt unsuccessfully to end their lives and leave themselves in a worse physical situation than they were in prior to their attempt.
Supporters of euthanasia and doctor-assisted suicide argue that these botched suicides and premature deaths would not occur if the law allowed doctors to help the terminally ill to die.
4. Some terminally ill people require assistance to end their lives
It has been claimed that not all terminally ill people are able to end their lives without medical assistance. It has been noted that one of the features of terminal illness is decreased autonomy as those suffering terminal illness rely increasingly on medical support. Such people, it has been argued, may not be in a position to take their own lives.
An elderly woman with breast cancer, the second person to have her life ended under Oregon's doctor assisted suicide legislation, stated, 'I can't even walk. I have trouble breathing. I'm just looking at the four walls.'
Supporters of legalised euthanasia argue that such a person may not have sufficient physical autonomy to end her life and may need medical assistance in order to do so.
It has also been argued that many people may not have the knowledge needed to successfully end their lives and so would need medical assistance.
As the law currently stands in most countries of the world it is illegal for doctors to assist their patients kill themselves.
5. Doctors could not be compelled to assist patients to end their lives
It has been argued that no law could compel a doctor to take an action to which he or she objected. In The Netherlands, where euthanasia with limited likelihood of prosecution has been practised for nearly twenty years, there are apparently still some 12 per cent of doctors who have indicated that they would not be prepared to either assist a patient suicide or kill them at their request.
Relatedly, it has been argued that patients who would be uncomfortable being treated by a doctor who was willing to perform euthanasia could go to one who did not support the practice.
This is certainly an issue that will persist in the field of public debate. In Australia there is apparently a clear majority of people who support legalised euthanasia and doctor-assisted suicide.
Critics of both practices argue that such apparent popular support may be based on poorly framed survey questions or on the public's limited knowledge of what is really involved. However valid these criticisms may be, this popular support for law reform may ultimately translate into political action. Currently legislatures worldwide appear to be exerting a restraining or dampening influence on perceived popular will. Perhaps this is because there is not yet sufficiently determined support for legalised euthanasia. Despite the survey results, it is not clear how significant an issue this really is in the public mind.
The current momentum for law reform appears to be coming from lobby groups such the Hemlock Society in the United States and activists such as Australian Philip Nitschke, who are skilled at keeping the issue before the public eye. Instances where dying individuals, such as Diane Pretty in the United Kingdom, challenge current law and demand to be allowed to end their lives also serve to re-invigorate the issue in the public mind.
In some ways the euthanasia debate has aspects in common with the abortion debate where legislatures for many years maintained what they saw as a moral stand in the face of challenges from well-organised pro-abortion lobby groups. It seems likely, however, that abortion law reform was a more significant issue for the majority of women, who regularly faced the prospect of unwanted pregnancies, than euthanasia law reform is for a majority of people. Each of us dies only once.
A number of factors, however, may serve to increase the importance of euthanasia law reform for a majority of people. One of these is the ageing populations of many Western countries. As baby boomers face late middle age and approaching old age the issue of euthanasia is likely to become of greater concern to them. This age group is a large voting bloc in all Western democracies and also makes up the majority of those actually exercising power as elected representatives. As this age group watches its parents decline into extreme old age and begins to contemplate its own ultimate degeneration and death, support for euthanasia may grow stronger among legislators.
Typically support for euthanasia is strongest among young people and least strong among the aged and the disabled, who presumably fear that it may be inflicted upon them without their consent. For the middle aged, approaching old age may make euthanasia seem desirable but not yet a threat.
We are reaching a point in Western democracies where an alliance of young and middle-aged voters and politicians may succeed in introducing and passing euthanasia legislation. The strong influence of Christian churches in the United States may block that development there; however, there is no similar block in Australia where the general influence of the churches appears to be less strong and on the decline. It is worth noting, however, that the influence of politicians' religious convictions is an important factor in Australia.
This is clearly an issue that warrants vigorous public debate as euthanasia may well be legalised within our lifetimes. Whatever one's personal position on the question, if legalised, euthanasia will have implications for general medical provision for the aged and the terminally ill. It is an issue ultimately likely to affect us all.
5/1/01 page 6 news item, 'Healthy, and learning to kill themselves'
12/1/01 page 4 news item, 'Siblings, doctor face new cancer death trial'
16/1/01 page 8 news item by David Reardon, 'Clinic ruling fires euthanasia debate'
24/1/01 page 6 news item by Stephen Cauchi, 'Nitschke agrees to cooperate'
27/1/01 page 5 (News Extra section) analysis by Farah Farougue, 'The house call that lasted two weeks'
4/2/01 page 11 news item by Zenon Pasieczny, 'Tiptoeing the fine line on euthanasia'
5/2/01 page 14 letter from Anna Sewards, 'Euthanasia: you can only decide for yourself'
22/2/01 page 10 news item by Brett Foley, 'Appeal to rethink euthanasia'
4/3/01 page 5 news item by Paul Osborne, 'Judges the "last stop" on matters of ethics'
2/4/01 page 8 news item by Rada Rouse, 'US study finds few take final medicine'
8/4/01 page 13 news item by Steve Dow, 'Doctors to challenge death law'
12/4/01 page 2 news item by Brett Foley and Kerry Taylor, 'Death law may attract travellers'
12/4/01 page 17 analysis by Brett Foley, 'Hard days for Dr Nitschke'
12/4/01 page 17 overview of law euthanasia law in the Northern Territory, the Netherlands and Oregon, 'Three states that took the plunge'
12/4/01 page 17 news item by Simon Mann, 'Dutch courage or cruelty?'
12/4/01 page 17 analysis by Brian Doyle, 'Ageing baby boomers versus the Catholic Church'
24/1/01 page 3 news item by Sarah Stock, 'I'll co-operate in cancer death inquiry'
30/1/01 page 3 news item by Christopher Niesche, 'Nitschke to advise Kiwis on suicide'
12/4/01 page 10 news item by Tracy Sutherland, 'Dutch first with legal euthanasia'
12/4/01 page 10 news item by Alison Crosweller, 'Backers for ship of death'
12/4/01 page 10 timeline, 'The key events'
16/4/01 page 7 news item, 'Minister backs suicide pill for "very old" people'
2/7/01 page 5 news item by Richard Yallop, 'Patients have "right of refusal"'
2/7/01 page 5 news item by Richard Yallop, 'Easing the pain of the terminally ill'
The Herald Sun
8/1/01 page 18 editorial, 'Life lessons to learn'
9/4/01 page 9 news item by Sasha Baskett, 'Suicide ship to cruise globe'
12/4/01 page 17 cartoon by Mark Knight