The current law
Practices that are deliberately intended to cause the death of a patient in Western Australia are illegal. The options currently provided to chronic and/or terminally ill patients are limited, but lawful, and for the most part, good.
Life Ministries believes that every Western Australian should receive competent and compassionate medical assistance throughout the end stages of their life. The solemn duty of health care professionals is to “heal, care for, nurture and preserve all human life, [and] not to intentionally cause premature death”.1
We support the World Medical Association (WMA) and its national members, including the Australian Medical Association, in their long-standing opposition to physician assisted suicide and euthanasia, even at the request of the patient or close relatives, calling it “unethical”.2
We agree with the WMA statement on physician assisted suicide, that it too “is unethical and must be condemned by the medical profession”, and that any doctor who assists in ending the life of a patient “acts unethically.”3
The WMA, in its Resolution on Euthanasia, states:
The World Medical Association reaffirms its strong belief that euthanasia is in conflict with basic ethical principles of medical practice, and strongly encourages all national medical associations and physicians to refrain from participating in euthanasia, even if national law allows it or decriminalizes it under certain conditions”4 (emphasis mine).
We support the WMA’s Declarations on Euthanasia and Assisted Suicide, as well as its resolutions.
Care for the dying
It is our understanding that the vast majority of health professionals in this state offer a high standard of care for the dying and that citizens in this state have little to worry about if current practices continue to be employed.
When patients are confronted with their approaching death, understandably worried, and have questions relating to their treatment, the majority of Western Australian physicians offer reassuring and comforting advice. Dr Lachlan Dunjey, the founder of Medicine with Morality is a Western Australian GP with over 50 years’ practice. In addition to caring for many dying patients over the past five decades he has run seminars on Death and Dying. He claims that it has been his privilege to care for these people through the natural process of dying. When one or two patients alluded to physician assisted suicide in the early stages of their treatment, he alleviated their concerns by promising that he would look after them and not allow them to die in pain.
We support the AMA’s statement that:
Patient requests for euthanasia or physician-assisted suicide should be fully explored by the medical practitioner in order to determine the basis for such a request. Such requests may be associated with conditions such as a depressive or other mental disorder, dementia, reduced decision-making capacity, and/or poorly controlled clinical symptoms such as pain. Understanding and addressing the reasons for such a request will allow the medical practitioner to adjust the patient’s clinical management accordingly or seek specialist assistance.5
We support the recommendation given in a submission to the recent Inquiry of the Victorian Parliament into End of Life Choices by Palliative Care Victoria:
[T]he level of sedation used should be the lowest necessary to provide adequate relief of suffering: “The doses of medications should be increased or reduced gradually to a level at which suffering is palliated with a minimum suppression of the consciousness levels and undesirable effects, with documentation of the reason for changes and response to such manoeuvres.” Further-more, they assert, “Only under exceptional circumstances is deep and continuous sedation required from initiation of palliative sedation therapy.6
Dr Dunjey has said that none of his patients, including those with cancer, has died in pain. When he has had difficulty dealing adequately with pain, he has sought help from Silver Chain hospice staff which has been helpful and always resulted in relief. It is his view that “refractory pain” implies that medical professionals have not done well enough. Furthermore, he argues that proper pain management, not only effectively controls pain, but contrary to popular belief, in some instances may actually extend life.
Writing on the topic of terminal illness and pain management Dr David van Gend reasoned:
I would not use the argument against euthanasia that “palliative care can ease all suffering”. We cannot ease all suffering in dying any more than we can ease all suffering in childbirth, even though we have made enormous progress.” He concluded, “Rejection of euthanasia is not dependent on perfecting palliative care for all patients.7
Life Ministries praises the compassionate care extended to dying patients by caring doctors and physicians of the Palliative Care Service in the state of Western Australia.
However, we note with concern that some terminally ill patients who are receiving medication to alleviate pain, are deprived of hydration. It is our view that depriving water to a dying patient that is clearly distressed is cruel and not consistent with good palliative care.
Instead, it is our view that dying patients should be offered “ice chips, a popsicle, or sips of water.”8
We believe that the process of dying should never be characterised as “undignified.” Natural death usually involves loss of appetite, fatigue, increased sleep, physical weakness, confusion, disorientation, social withdrawal, laboured breathing, loss of bodily control and so forth. This progressive decline is to be expected and nurses and doctors know how to deal compassionately with it. This is not an “undignified” death, any more than a woman giving birth to a child is undignified, or a person forced to wear a colostomy bag is undignified, or a quadriplegic requiring someone to look after his/her bodily needs is undignified. On the contrary, caring for the terminally ill through the final stages of their lives demonstrates our society’s care, compassion, commitment and respect for the dying. It is our view that deliberately killing a human being with a lethal injection, or by any other means—is truly undignified.
Previous Bills
Life Ministries has no specific information concerning the proposed legislation in this state, other than it is evident that the WA government is contemplating the introduction of legislation that it hopes will legalise voluntary euthanasia in Western Australia.
However, we note that the Western Australian Legislative Council dealt with a Private Member’s Bill to introduce voluntary euthanasia in the latter part of 2010. At that time the Legislative Council dealt with the matter in great detail (Andrew Lansdown and I sat in the gallery through much of the debate) and ultimately the Voluntary Euthanasia Bill 2010 was soundly defeated by a margin of 24 votes to 11.
The Bill was defeated in part because of imprecise definitions of “pain, suffering or debilitation”, “terminal illness” and “reasonable medical judgment.” The Bill would have permitted a person to be euthanised if it was concluded that the illness they were suffering from would result in death, not within days or weeks—but within two years! Doctors cannot accurately predict if a patient will die in two weeks much less two years. Imprecise terms and extra-ordinarily long time-frames make for very bad legislation.
But, perhaps more importantly, the Bill was defeated in my opinion for two very important reasons: Firstly, there was a palpable feeling in the Legislative Council that shifting away from palliative care for the dying to killing them on request was a step too far, and secondly; many Members were convinced that there were no legislative measures that could limit the creep of euthanasia from terminal to non-terminal patients, and from voluntary euthanasia to non-voluntary euthanasia. We believe that no matter how proscriptive a new Bill, if introduced, may be, these two problems cannot be overcome. It is never right to kill patients, even at their request, and adequate safeguards, no matter how stringent, will inevitably be ignored or eroded with the passage of time.
Indeed, this inevitable creep would be better described as a gallop in several countries that legalised voluntary euthanasia with supposedly stringent guidelines to protect against abuse.
Belgium
Belgium’s legislation legalised euthanasia in 2002 for patients with “constant and unbearable physical or mental suffering that cannot be alleviated”.9
In the lead up to the legalisation of euthanasia in Belgium, the euthanasia of children was debated but rejected. Yet, just 12 years later, in 2014, Belgium’s euthanasia legislation was amended to permit lethal injections for terminally ill children of any age.10 In September of that year the first child was killed by euthanasia.
The number of euthanasia deaths in Belgium has risen exponentially. In 2002, the year that euthanasia was legalised, 24 people were euthanised. In 2015, only 13 years later, the annual total rose to 2,022, an increase of over 840 per cent! Belgium provides a sombre example of lawmakers giving hand-on-heart assurances that turn out to be deceptive and worthless.
Now, lawmakers in Belgium are proposing to “perform euthanasia on patients who are unable to express their will”, and to “oblige doctors [to] refer patients to other doctors [when] they do not wish to perform euthanasia.”11
So much for voluntary euthanasia—for either patients or doctors!
Netherlands
Euthanasia is regulated in the Netherlands by the “Termination of Life on Request and Assisted Suicide (Review Procedures) Act”, which became law in 2002. At that time doctors and lawyers in the Netherlands set strict guidelines that granted doctors the right to assist only terminally ill patients who wished to die.
“According to the Dutch government’s own data, doctors in The Netherlands put to death several hundred patients a year without any explicit request, even where the patient is competent to give or withhold consent.”12
Dutch doctors explained to the UK House of Lords: “We agonised over the first cases of euthanasia all day, but the second case was much easier and the third was a piece of cake.”13
According to Dr David van Gend, “… the public should have no illusions about the corruptibility of doctors if they are given authority to take life.” 14
It is now suggested in the Netherlands that euthanasia should be available to people who are simply “tired of life.”15 Legislators are proposing the “Completed Life Bill”16 that would allow anybody aged 75 or older to be euthanised even if they are healthy. Life Ministries believes that once a state sanctions the killing of its citizens, it will be virtually impossible to contain it.
Boudewijn Chabot, a psychiatrist subspecialising in the assessment and treatment of elderly people and prominent euthanasia supporter, recently said that things are “getting out of hand.” He continued, “[L]ook at the rapid increase … The financial gutting of the healthcare sector has particularly harmed the quality of life of these types of patients. It’s logical to conclude that euthanasia is going to skyrocket.”17
In the Netherlands, euthanasia is now legal for minors over 12 years old.18
It should be noted that while death by euthanasia is often portrayed as a means of ensuring a calm, peaceful death, this is frequently not the case. A study from the Netherlands found that up to one-quarter of people who die by assisted suicide experience complications or problems including vomiting, gasping, psychosis, seizures, muscle spasms and awakening from induced coma.19
Life Ministries believes each of the points above illustrate the desensitising effect of euthanasia on the government, physicians and the general population.
Oregon
Oregon’s Death with Dignity Act was enacted in October 1997. It allows “terminally-ill” Oregonians to end their lives through self-administration of lethal medications prescribed by a physician.
Advocates of Oregon’s legislation claim that it has strict safeguards which allow lethal “medication” to be prescribed only to people with an incurable and irreversible illness that will result in their death within six months. They claim that Oregon’s Death with Dignity Act is working well, with no evidence of abuse or creep.
But there is a significant problem with the legislation. Under Oregon’s Act, a person can be classed as being “incurably” sick even when the disease can be treated! With treatment, these people would not be classed as “terminally ill”, but “chronically ill.”
Thus, all diseases which, without treatment, would be expected to result in death within six months are considered under the Oregon Act to be incurable and therefore qualify for assisted death. This is a corruption of the common understanding of “incurable,” which usually means an untreatable condition. Consequently, a far larger number of patients qualify for medically assisted death than “just the extreme cases for which the law was originally said to apply.”20
Add to this that only two thirds of people in Oregon who were prescribed “medication” to end their lives, actually took the tablets.21 What happens to the tablets that were not ingested? Do they remain in a cabinet or in a drawer, perhaps for a depressed spouse to take instead?
Although death by euthanasia and/or assisted suicide usually occurs quickly, data from Oregon, USA, reveals that death can take over four days to occur after ingesting the prescribed “medicine”.22
Furthermore, consider that there is a clear correlation between state-sanctioned assisted suicide and suicide itself. The practice of assisted suicide has contributed significantly to the overall suicide rate. After 20 years of exposure to assisted suicide in Oregon, “the suicide rate is now 41% higher than the national average.”23
Canada
“Creep” cannot adequately describe what is taking place in Canada, which legalised euthanasia for terminally ill patients in June 2016, less than two years ago. Racing at full speed ahead, just last month (February 2018) “The Superior Court of Justice Division Court of Ontario ruled … that if doctors are unwilling to perform legal actions, they should find another job.”24
With chilling logic Justice Herman J. Wilton-Seigel of the Superior Court of Justice Division Court of Ontario wrote on behalf of the panel: “Those who enjoy the benefits of a licence to practise a regulated profession must expect to be subject to regulatory requirements that focus on the public interest, rather than the interest of the professionals themselves.”25
We should be clear about what Justice Wilton-Seigel is advocating: “Those who enjoy the benefits of a licence to practise a regulated profession [i.e., medical practitioners] must expect to be subject to [i.e., forced to comply with] regulatory requirements [i.e., euthanasia] that focus on the public interest [i.e., killing patients on request], rather than the interest [i.e., freedom of conscience and belief] of the professionals themselves.”
So, while Canadian doctors who object to participating in euthanasia cannot be forced to perform it (at least for the time being), the Canadian government is determined to compel them to refer their patients to other doctors who will.
This is outrageous! Doctors, who could have been charged in Canada with killing patients by euthanasia less than two years ago, are now being forced to refer patients for killing by euthanasia! This is an unconscionable act against freedom of religion and conscience.
To make matters worse, Canadian hospices are now being bullied into hosting euthanasia. Demands are being made that the palliative hospice movement, “founded on a promise to never deliberately hasten death should now provide a death-hastening service.”26
These rulings show how quickly tolerance vanishes after euthanasia has been legalised. Life Ministries believes these few examples of many that could be cited lead to the conclusion that the reassurances from euthanasia advocates regarding protections are worthless. Indeed they are worse than worthless, they are false, misleading and dangerous.
Victoria
The vote to legalise voluntary euthanasia in Victoria was carried on a vote of 22/18 on 29 November 2017.
Leading up to the passage of the Bill former Prime Minister Paul Keating urged Labor MPs to reject the Bill, calling it “bald utopianism”.
In an opinion piece he wrote:
The justifications offered by the bill’s advocates – that the legal conditions are stringent or that the regime being authorised will be conservative – miss the point entirely. What matters is the core intention of the law. What matters is the ethical threshold being crossed. What matters is that under Victorian law there will be people whose lives we honour and those we believe are better off dead.
He warned:
The culture of dying, despite certain and intense resistance, will gradually permeate into our medical, health, social and institutional arrangements. … It is fatuous to assert that patients will not feel under pressure once this bill becomes law to nominate themselves for termination.27
Contrast the words of a former Prime Minister with the words of a former Governor-General who aspired to be Prime Minister. At the precise time when this state is looking into elder abuse, it is timely to think of comment made by Bill Hayden in 1995 to the College of Physicians during the debate on the Northern Territory’s euthanasia laws. Hayden urged doctors to support euthanasia as a right and a duty. He said, “There is a point when the succeeding generations deserve to be disencumbered of some unproductive burdens” —what a cruel statement targeted at frail elderly people who our society should value. The next day, retired State Governor Mark Oliphant supported Hayden’s statement that “unproductive burdens” should do the right thing by society!28
The comments of Bill Hayden and Mark Oliphant should disabuse some Members of Parliament of the belief that weak, frail and demoralised elderly people will not be pressured to succumb to euthanasia. Life Ministries is deeply concerned that if legislation on assisted dying is introduced and passed it will have a callousing effect on Western Australian society, that will be particularly focused on the weak and elderly.
Maintaining the status quo
If the status quo is maintained, which is what the Life Ministries is advocating, no legislative changes need to be made, indeed the Parliament does not need to waste its time or taxpayers’ money dealing with a highly divisive issue, and therefore the Parliament can deal with other matters of importance to all citizens in this state.
If, however, legislation on euthanasia is introduced, and subsequently passed, a great deal of legislation will have to be altered. Advocates of euthanasia argue that it is an entirely private matter for the patient to decide, but this is far from the truth. Andrew Lansdown writes:
It is more than personal if it requires governments to revise laws to allow certain types of homicide and suicide. It is more than personal if it requires doctors to assist in the killing. It is more than personal if it desensitises medical staff to the preciousness of human life. … It is more than personal if it creates an atmosphere in which other weak or unwanted people feel pressured to choose to die.
The current laws in this state prohibit voluntary and non-voluntary euthanasia. This is why, for example, when Dr Alida Lancee, admitted in the The West Australian that she deliberately euthanised a patient upon her request, the police opened an investigation into her actions.29
Life Ministries supports the status quo under which physicians who administer medications with the intention of alleviating suffering, but not with the intention of causing death, have never been prosecuted even when their patient died. However, the Coalition supports the prosecution of physicians who would intentionally end the lives of their patients.
Palliative Care
Life Ministries encourages the government to continue to help support excellent palliative care for the dying, especially as the population is ageing. Much of the demand for voluntary euthanasia will dissipate if the citizens of this state can be convinced that they will be provided with excellent palliative care when required. Wouldn’t it be wonderful if Western Australia became known for having the highest standard of palliative care in the world?
Conclusion
As our readers would know, the Western Australian Labor Government is considering the legalisation of euthanasia. Life Ministries, as well as many other Christian and family-based organisations, opposes the legalisation of either physician assisted suicide or euthanasia in any form, and instead supports the retention of the current laws, which provide a high level of protection to the elderly, weak and vulnerable.
We remind the Western Australian Parliament of its own legislation in relation to Capital punishment in 1984. One of the main reasons for abolishing capital punishment was the belief that an innocent person could be executed by the state. Many argued that as capital punishment is an irreversible act that results in the ending of a human life, that it should be abolished if even one innocent person could potentially lose his/her life. This same reasoning could be applied to euthanasia. Is it possible that given time not one but hundreds or even thousands of innocent people could be euthanised in Western Australia without their consent? Every human life is immensely precious and it’s the government’s responsibility to protect the lives of its citizens. The current laws do this, and thus Life Ministries urges their retention.
References
- See, for example: World Medical Association Resolutions on Euthanasia, April 2013.
- https://www.wma.net/policies-post/wma-resolution-on-euthanasia/
- Ibid
- Ibid
- Australian Medical Association’s statement 10.6 contained within the Exposure draft of the Medical Services (Dying with Dignity Bill 2014 Submission 180 – Attachment 2
- Palliative Care Victoria, Submission to the Legal and Social Issues Committee: Inquiry into End of Life Choices (July 2015).
- https://www.theaustralian.com.au/national-affairs/opinion/unproductive-burdens-still-have-a-right-to-live/news-story/c40992e6470ab560a2437f006124b852?sv=d05d1a6fe8dd1b49a2fa25f103a165b0
- https://www.caring.com/articles/signs-of-death
- http://dailysignal.com/2016/11/03/euthanasia-deaths-hit-record-high-in-belgium-why-that-matters-for-the-us/
- Ibid
- Ibid
- https://www.theaustralian.com.au/national-affairs/opinion/unproductive-burdens-still-have-a-right-to-live/news-story/c40992e6470ab560a2437f006 124b852
- http://hansard.millbanksystems.com/lords/1998/may/06/euthanasia
- https://www.theaustralian.com.au/national-affairs/opinion/unproductive-burdens-still-have-a-right-to-live/news-story/c40992e6470ab560a2437f006124b852?sv=d05d1a6fe8dd1b49a2fa25f103a165b0
- http://dailysignal.com/2016/11/03/euthanasia-deaths-hit-record-high-in-belgium-why-that-matters-for-the-us/
- http://thefederalist.com/2017/06/30/netherlands-considers-euthanasia-healthy/
- https://www.lifesitenews.com/news/dutch-euthanasia-getting-so-out-of-hand-that-even-assisted-death-docs-want
- http://dailysignal.com/2016/11/03/euthanasia-deaths-hit-record-high-in-belgium-why-that-matters-for-the-us/
- JH Groenewoud et al, “Clinical problems with the performance of euthanasia and physician-assisted suicide in The Netherlands”, in The New England Journal of Medicine, 24 February 2000, 342 (8): 551-556.
- https://www.mercatornet.com/careful/view/the-watertight-oregon-model-for-assisted-suicide-is-a-leaky-boat/20969
- Charles Blanke, Michael LeBlanc and Dawn Hershman, “Characterising 18 years of the Death With Dignity Act in Oregon”, in JAMA Oncology 2017;3(10): 1403-1406.
- Charles Blanke, Michael LeBlanc and Dawn Hershman, “Characterising 18 years of the Death With Dignity Act in Oregon”, in JAMA Oncology 2017;3(10): 1403-1406.
- Lynne Terry, “Study: Oregon patients using physician-assisted suicide steadily increase”, Oregon Live 6 April 2017.
- http://alexschadenberg.blogspot.com.au/2018/02/canadian-court-tells-doctors-they-must.html
- https://www.mercatornet.com/careful/view/canadian-court-tells-doctors-they-must-refer-for-euthanasia/20975
- Ibid
- https://billmuehlenberg.com/2017/10/20/victorian-kill-bill-passes-lower-house/
- https://www.theaustralian.com.au/national-affairs/opinion/unproductive-burdens-still-have-a-right-to-live/news-story/c40992e6470ab560a2437f006124b852?sv=d05d1a6fe8dd1b49a2fa25f103a165b0
- https://thewest.com.au/news/australia/why-i-did-it-euthanasia-doctor-alida-lancee-speaks-out-after-police-probe-ng-ya-116421
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