Right: Dr Rodney Syme, who announced that, a decade ago, he had supplied a drug to a dying cancer patient who wished to end his life, was interviewed by police. No charges have been laid, but the sase is still being investigated.
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Arguments in favour of the legalisatation of voluntary euthanasia
1. Euthanasia should be available, at the request of those enduring terminal illness
Those who support euthanasia typically do so when it has been freely chosen by a person suffering, or anticipating, significant distress as the result of a terminal illness. More than 75 percent of Australians typically answer yes to the following Morgan Gallop poll question, If a hopelessly ill patient, experiencing unrelievable suffering, with absolutely no chance of recovering, asks for a lethal dose, should a doctor be allowed to give a lethal dose or not ?
Those who believe that euthanasia should be available under these circumstances generally argue that the individual has the right to assistance to end his or her life prematurely when enduring a fatal disease that is causing him or her physical or psychological distress. Supporters of this position see it as the individual exerting control over the circumstances of his or her life and the manner of its ending. They argue that the choice primarily affects the suffering individual and that ending a persons life at his or her request under these circumstances advantages the individual and does not harm others.
Supporters claim that euthanasia or assisted suicide should not be seen as murder on the part of the physician, because the patient is already facing imminent death. It is also argued that the act is not murder because it follows the wishes of the patient.
The question is often argued in terms of human rights, with supporters of voluntary euthanasia claiming that any sane, informed human being should be able to choose physician assisted suicide in the face of incurable, distress-inducing, terminal illness. Euthanasia advocate Philip Nitschke argues that a right to life carries with it a right to surrender that life.
In 2011 Dr David Benatar, of the Philosophy Department of the University of Cape Town, stated, To be forced to continue living a life that one deems intolerable when there are doctors who are willing either to end ones life or to assist one in ending ones own life, is an unspeakable violation of an individuals freedom to liveand to dieas he or she sees fit.
2. Safeguards can ensure that only appropriate candidates are euthanised
It has been claimed that any legislation allowing for euthanasia or physician assisted suicide would be surrounded with sufficient safeguards to ensure that the law would not be abused.
A BBC ethics guide available in 2014 discussing the regulation of euthanasia made the following stipulations. For safeguards to be meaningful and effective, they have to involve investigations of the patient's psyche, his family dynamics and the financial implications of his death, along with more obvious things such as the patient's medical condition and the likely course of the disease.
In order to ensure that requests are properly considered, by the patient, the family and the authorities, regulations need to build in a time-period for reconsideration.
Proper regulation must also make sure that a patient was receiving good palliative care before a request for euthanasia is considered.
The Northern Territorys Rights of the Terminally Ill Act 1995 attempted to put safeguards in place that would ensure that euthanasia was not abused. These safeguards included
that the patient has attained the age of 18 years; that a first medical practitioner is satisfied, on reasonable grounds, that the patient is suffering from an illness that will result in the death of the patient and that there is no medical measure acceptable to the patient that can reasonably be undertaken in the hope of effecting a cure; and that any medical treatment reasonably available to the patient is confined to the relief of pain, suffering and/or distress. A second medical practitioner must confirm these judgements. The patient must not be suffering from a treatable clinical depression in respect of the illness and the illness must be causing the patient severe pain or suffering.
The patient must be fully informed of the nature of his or her illness, the prognosis and available treatment options. The patient must be of sound mind and the decision to end his or her life must have been made freely, voluntarily and after due consideration.
The US state of Oregon is sometimes put forward as a jurisdiction with a rigorous set of safeguards surrounding the use of euthanasia. Oregon legalised physician-assisted suicide in 1998. During the first three years, only around two people a month used this to end their lives. This was partly because of the severe conditions that had to be satisfied before a request for euthanasia could be granted. These conditions state: the patient must be resident in Oregon; the patient must be aged over 18; the patient must make two oral and one written request for euthanasia; there must be at least 15 days between the first and the last request; the patient must be terminally ill with a life expectancy of less than 6 months; this prognosis must be confirmed by a second consultant physician; both doctors must confirm that the patient is capable of making this decision; both doctors must confirm that the patient does not have medical condition that impairs their judgement; the patient must self-administer the lethal medication.
About 30% of patients who started the process died before it was completed. 19 patients in the period who were given access to lethal medication decided not to use it. One survey showed that 45% of patients who were given good palliative care changed their mind about euthanasia.
Not all supporters of euthanasia favour a regime as strict as Oregons, but that jurisdictions safeguards are used as an example of the manner in which abuses can be prevented.
3. Any expanded categories for euthanasia would be cautiously implemented and legally determined
Supporters of euthanasia being made legally available in Australia argue that any expansion of the practice would only occur if it were legally sanctioned.
Australias legislatures have been very cautious in their implementation of euthanasia. Despite many private members bills seeking to make euthanasia legal having been tabled in different states, such legislation has only been passed in the Northern Territory and then was overturned by federal legislation. Supporters of law reform note that this caution is likely to persist and that if euthanasia were made legal any extension of its use would be implemented with equal care.
This point was made in an article published in The Conversation on February 17, 2014. The authors, Ben White, Professor in the Faculty of Law at the Queensland University of Technology and a Director of the Australian Centre for Health Law Research and Lindy Willmott, Professor of Law at Queensland University of Technology and a Director of the Health Law Research Centre at the University, have stated, With the exception of a single act in the Northern Territory, parliaments have been persistent in their refusal to enact legislation that would legalise voluntary euthanasia and/or assisted suicide. Dozens of attempts have been made but only one (in the Northern Territory, and for a limited time) has succeeded.
The Professors concluded, This suggests that should assisted dying become lawful in Australia, a cautious and careful approach would be taken to arguments about widening criteria for who can access the scheme.
Further, any such decision-making would invariably be informed by the extensive empirical data that is routinely collected alongside such regimes (assuming such systems were also set up in Australia).
4. Palliative care is not effective for all enduring terminal illness
Supporters of euthanasia claim that palliative care is not always effective and that euthanasia has to be available for those whose distress cannot be relieved.
The South Australian Voluntary Euthanasia Society has stated, It is widely acknowledged, including by Palliative Care Australia and the Australian Medical Association, that even the best of palliative care cannot help all patients between 5-10% find their suffering so unbearable that they persistently request an assisted death.
In 2013 the Medical Journal of Australia published an opinion piece by three doctors representing the Doctors for Voluntary Euthanasia Choice. The doctors state, Dying may be associated with intolerable suffering and there may be a crescendo of suffering as death approaches. Some suffering will only be relieved by death. Some patients rationally and persistently request assistance to die. Palliative care does not relieve all the pain and suffering of dying patients.
Many of those who support euthanasia have had the experience of watching family members or friends die difficult deaths suffering symptoms that could not be adequately alleviated.
In a letter to The Age published on November 13, 2014, Nica Cordover wrote, My husband, Robert, advocated physician-assisted dying. He suffered bulbar-onset motor neuron disease and likened its symptoms to the tortures experienced at Guantanamo Bay: stress positions, sleep deprivation, waterboarding (choking), personal humiliations and, worst of all, the existential suffering of an indeterminate sentence. He faced a death of asphyxiation through choking or lung paralysis. Palliative care is excellent but cannot relieve all suffering of the terminally ill. The choice of the time to die belongs to the sufferer alone.
In another letter published in The Age, similar comments were made, however, the letter writer, whose name was withheld, declared that watching members of his family die without seeking euthanasia had made him the more convinced that he wants access to euthanasia for himself. The letter writer states, My brother has been bedridden since March dying of brain cancer. My mother has dementia and is fearful every moment as everyone is a stranger. My brother is grateful for any time he has; and my mother had always indicated she did not agree with euthanasia. That is their choice and I respect it. However, watching them both dying has made me determined that if I end up in an agonising, drawn-out death, I want my choice for when and how I die respected, too. It frightens me that I will have no choice and may experience 10 years of dying hell. Everyone tells you how palliative care is so good these days. Nobody mentions the distasteful real difficulties, like bleeding bowels, repeated explosive diarrhoea and having to be dosed up on Valium so you dont scream or abuse people. Opposers of euthanasia make dying sound so fun and cosy. I am discovering just how cosy it really isnt.
5. Legalising voluntary euthanasia would help ensure the practice was properly regulated
It has been claimed that if euthanasia were legalised then abuse which may occur while the practice is not legal could be guarded against.
Currently, in Britain, for example, approximately 130,000 people a year are placed on what is referred to as the Liverpool Care Pathway. This is a regime applied to the terminally ill which has what are deemed futile treatments ended in a bid to ease the patients dying. This can include the cessation of life-extending medications, food and water. It can also mean the administration of powerful pain-relieving medication which can have the further consequence of hastening death.
In 2012 the Marie Curie Palliative Care Institute Liverpool and the Royal College of Physicians examined a representative sample of 7,058 deaths which occurred between April and June last year, at 178 National Health Service (NHS) hospitals.
The national audit found that in 44 per cent of cases when conscious patients were placed on the pathway, there was no record that the decision had been discussed with them.
It also found that for 22 per cent of patients on the pathway, there was no evidence that comfort and safety had been maintained while medication was administered. Further, one in three families of the dying never received a leaflet they should have been given to explain the process.
Some critics of the above processes have used them to condemn euthanasia. However, defenders of euthanasia argue that what is being practised here is not regarded as euthanasia by the NHS. Rather, it is referred to as the withdrawal of burdensome treatment.
Euthanasia advocates argue that if Britain were to pass detailed, properly safeguarded voluntary euthanasia legislation then abuses such as those detailed above would not occur.
A similar point has been made in Australia by Dr David Swanton, director of Ethical Rights and the ACT chapter co-ordinator for Exit International. Dr Swanton has stated, If politicians dont like the direction [of] the voluntary euthanasia agenda &they should establish a voluntary euthanasia regulatory framework.
Legislation will provide sureties for society and reduce the risk of inappropriate access to information.