Quotes from the Senate Legal and Constitutional Legislation Committee Report, Australia 1997

The slippery slope

“If we allowed the thin edge of the wedge with abortion – the beginning of life, why should we think we won’t do the same thing with the matter of euthanasia – the end of life? Once we have opened the door even by a crack, there are no longer effective safeguards against that subtle and almost silent encroachment of humanly initiated death – whether in the womb or the aged folks’ home.” (Page 70)

The issue of individual rights and choice

“The individual rights and autonomy argument is at first glance persuasive. However, even if one supports the principle of euthanasia the question needs to be asked: “Can we sufficiently codify the circumstances in which we would allow euthanasia?” We are of the view that it is impossible.

Individuals have the unfettered right to forego medical treatment. Suicide is not a crime, although we as a community spend millions of dollars each year trying to counsel and dissuade the suicidal.

The Rights of the Terminally Ill Act 1995 does not so much change the law for the patient as it changes the law for the third party (the doctor). What is currently illegal for the doctor will become legal. This has the potential to fundamentally alter the doctor/patient relationship. Ultimately a new right is given to doctors to terminate the lives of those who are suicidal and terminally ill. To describe this as providing a ‘right to die’ defies logic.

The potential for ‘guilt feelings’ for being a burden or too costly by those of our community who are in difficult circumstances, vis a vis their health, may become such that they perceive a subtle duty on them to exercise the euthanasia option. The choice may well become a perceived duty.

This is especially so when considered in the context of comments by those such as former Governor General, Hon Bill Hayden’s comments that “…. there is a point when the succeeding generations deserve to be disencumbered – to coin a clumsy word – of some unproductive burdens.” (Page 126)

Dying with dignity

“The emotive description in support of euthanasia is unfortunate. The dignity or otherwise of a death is not to be determined by the physical circumstances or degree of pain in which the patient finds themselves.

With very few exceptions, pro-euthanasia submissions that dealt with the term ‘dignity’ described particular physical circumstances and described living or dying in such circumstances as necessarily involving a loss of dignity. These circumstances regularly included loss of continence and mobility.

This approach, in referring to various physical circumstances, consistently dealt with circumstances where the person had taken on certain disabilities and described such circumstances as involving a loss of dignity.

A disturbing equation is thus drawn between having ‘dignity’ and being ‘without disability’. The term has been used as though there is a loss of dignity if somebody who was previously without disability takes on a disability in the course of a terminal illness.

Whilst it was concerned about the impact on people with disabilities who have highlighted this issue it needs to be noted that the impact is even broader. Any notion that those who choose the path of natural death or those who choose to live with disabilities are in some way taking the less dignified path should be abhorrent to any caring society.

Unfortunately the attitude from certain quarters that dying with dignity demands that life ends before such circumstances begin carries a message which only serves to devalue those who live in such circumstances.” (Page 126)

Doctors’ objections

“Also noteworthy was the overwhelming objection by doctors to euthanasia. As those at the ‘coalface’ they would be only too aware of the misdiagnosis and other errors that can be made.” (Page 128)

Anecdotal Evidence

“In the course of the inquiry, and in the course of the debate in the community, much as been made of anecdotal evidence of individuals dying in harsh circumstances. Such extraordinary circumstances warrant the most compassionate response for the person themselves and for the carers and family involved. Regardless of whether or not euthanasia might be the appropriate response in such circumstances, the task before the Committee, and in turn before the Senate, is to determine how a change in the law so as to allow such a response, stands up as a matter of public policy. Whilst many a moving and compassionate submission was presented detailing individual circumstances, we are of the view that: “No question as serious as euthanasia should be settled on individual cases. A general principal must be found which transcends particular cases.

As with capital punishment, one principle which could be universally applied is that human life should be valued to the extent which puts it beyond the state.” “(Page 127)

On the place of a moral standpoint

“The view that Australia is a pluralist society with diverging values within its citizenry is no justification to uproot a foundation stone of our notions of civilisation and the value we place on human life.” (Page 128)

On different concepts and important distinctions

“We join with the long established view that there are strong intuitive moral and clinical distinctions between stopping futile treatment and giving a lethal injection. To try to equate the two is disingenuous. As is the blurring of the concepts of not prolonging the life of, and killing, a patient.

Dying is a natural process and all people have a right to refuse treatment. But that is not euthanasia. Nor is the administration of substances intended to alleviate pain and discomfort which may have the ‘double effect’ of hastening death. The ‘intention’ is the key factor.

Physician assisted suicide or euthanasia has one purpose – to kill the patient. Those who blur these concepts seek to establish that legalised euthanasia is only a small step for legislature to take. It needs to be recognised that the step taken by the Northern Territory is this: to move from a situation where no citizen may intentionally take the life of another citizen, to a regime where certain citizens are given a full legal sanction and Parliamentary endorsement to intentionally take the lives of certain other citizens. This by any objective analysis represents a major shift.” (Page 128)

Call for increased funding for palliative care

“The Senate Committee was not charged to investigate the availability of palliative care in Australia, however this and the quality of palliative care became one of the issues of the Committee’s inquiry.

It was noted that palliative care in Australia is under pressure. The Palliative Care program is under review, and is not funded as mainstream. Its funding was cut by 10% in last year’s budget and there is no evidence of a commitment by the Commonwealth to the Palliative Care Program.”

Comments arising from the Senate Inquiry:

“The development of palliative care services across Australia is now at a critical stage. For palliative care services to mature and be funded as a mainstream health service a number of milestones are yet to be achieved. In this difficult time the Commonwealth has reduced its funding of palliative care for 1996-97 by 10%, in the name of administrative efficiency. The Australian Association of Hospice and Palliative Care (AAHPC) sees no evidence to suggest that the federal government is deliberately and specifically reducing funds for the care of dying people, nevertheless the end result is the same: less money for dying people.”

One of the senators on the Senate Committee made the following comment:
“Suffering patients cannot make real choices about their medical treatment unless good quality palliative care services are available throughout Australia. Regardless of whether active voluntary euthanasia is legalised, both Federal and State governments have a clear obligation to ensure more resources are devoted to research, training and service provision in the palliative care area.” (Page 173)

In his statement, Professor Peter Baume said “….but palliative care, even the best palliative care, leaves about 5% of people unrelieved. The figure may be a bit more or a bit less than 5%, but that 5% still remains a problem which we must address. For the other 95% of people, palliative care is very effective and it is developing. That 5% figure might shrink, but it exists at the present time….”

Palliative care experts indicate that no studies have been undertaken to show that there is a ‘percentage’ who cannot be assisted totally by palliative care. It was noted by a representative of AAHPC “There is an implication very often in this discussion that x%, 2,3,5 or whatever, has not relief of any sort.. that palliative care is either pass or fail; you either get total relief or you get no relief at all.” It was explained that ‘the group of people who do not get complete relief of their symptoms in fact do receive a proportionate degree of relief.’

Members of the Committee sought clarification of how palliative care can assist that small percentage of patients whose suffering is acute.

It was commented by a representative of the Aust & NZ Society of Palliative Medicine: “I think we have to focus on a small proportion and realise that, although we may not get the pain for the people in that group under total control, my experience is that we get it under such good control that they can live with it.

There are many other problems that come up at that time. Let us suppose we have the hypothetical patient who really does have such severe pain. I think we have to talk to them about whether they want to go on with this or whether they would like some more sedation. We have to talk to them about those sorts of things, and usually the patient will tell you what it is that they want.”

When asked what he would do for those patients who indicated that they have just ‘had enough’ the professor replied: “I have not had that experience, but if they did I would be talking to them about their mental state. I would be talking to them about family issues. I would be exploring the reasons why they had come to that conclusion, because often there are reasons that need to be sorted out … Often people who are in that circumstance have it explored by a sympathetic team and that may actually be a doctor or it might be an art therapist because a person just cannot tell you how bad it is, they need to paint it for you – or a music therapist.”

Another representative responded that: “Palliative care is more than just morphine .. Morphine plays a smaller and smaller part in palliative care science. There are other medications, other drugs; there are other ways of dealing with pain in particular. Pain is not the biggest issue in the dying. I think it is more a spiritual, a grief, an emotional thing. Often when people have pain which is out of control it is compounded by their other suffering, which can be addressed in other ways.” (Page 173)