Dr Graham McLennan, Director of the National Association of Christian Leaders, reports that the NACL made the following submission to the Senate Committee investigating Senator Bob Brown’s proposed Bill to legalise euthanasia in the Northern Territory. The submission was written by Dr Peter James Saunders, BHB, MBChB, FRACS. Dr Saunders outlined the following reasons for NACL’s opposition to Senator Brown’s Bill:
1. Voluntary euthanasia is unnecessary because alternative treatments exist. It is widely believed that there are only two options open to patients with terminal illness: either they die slowly in unrelieved suffering or they receive euthanasia. In fact there is a middle way, that of creative and compassionate caring. Meticulous research in palliative medicine has in recent years shown that virtually all unpleasant symptoms experienced in the process of terminal illness can be either relieved or substantially alleviated by techniques already available. This has had its practical expression in the hospice movement, which has enabled patients’ symptoms to be managed either at home or in the context of a caring in-patient facility. This is not to deny that there are many patients presently dying in homes and hospitals who are not benefiting from these advances. There are indeed many having sub-optimal care. This is usually because facilities do not exist in the immediate area or because local medical practitioners lack the training and skill necessary to manage terminally ill patients properly. The solution to this is to make appropriate and effective care and training more widely available, not to give doctors the easy option of euthanasia. A law enabling euthanasia will undermine individual and corporate incentives for creative caring.
2. Requests for voluntary euthanasia are rarely free and voluntary. A patient with an illness is vulnerable. He lacks the knowledge and skills to alleviate his own symptoms and may well be suffering from fear about the future and about the effect his illness is having on others. It is very difficult for him to be entirely objective about his own situation. Those who regularly manage terminally ill patients recognise that they often suffer from depression or a false sense of worthlessness which may affect their judgement. Their decision making may equally be affected by confusion, dementia, or troublesome symptoms which could be relieved with appropriate treatment. Patients who on admission say “Let me die” are usually after effective symptom relief most grateful that their request was not acceded to. Terminally ill patients also adapt to a level of disability that they would not have previously anticipated they could live with. They come to value what little quality of life they have left.
3. Voluntary euthanasia denies patients the final stage of growth. During the time of a terminal illness is when people have a unique opportunity to reflect on the way they have lived their lives, to make amends for wrongs done, to provide for the future security of loved ones, and to prepare mentally and spiritually for their own death. Not all make full use of this opportunity, but those involved in hospice work often observe a mending of family relationships and rediscovery of mutual love and responsibility that may not have been evident for years.
4. Voluntary euthanasia undermines medical research. One of the major driving forces behind the exceptional medical advances made this century has been the desire to develop treatments for previously fatal illnesses, and the eagerness to alleviate hitherto unmanageable symptoms. Medical research is essential if medicine is to advance further. When the focus changes from curing the condition to killing the individual with the condition this whole process is threatened.
5. Hard cases make bad laws. Legalisation of euthanasia is usually championed by those who have witnessed a loved one die in unpleasant circumstances, often without the benefits of optimal palliative care. If care is aimed at achieving “the best possible quality of life for patients and their families” by focusing on a patient’s physical, psychosocial and spiritual suffering, requests for euthanasia are extremely uncommon. The answer is not to change the law, but rather to improve our standards of care.
6. Autonomy is important but never absolute.Autonomy is important. We all value the opportunity of living in a free society, but also recognise that personal autonomy has its limits. Rights need protection, but must be balanced against responsibilities and restrictions if we are to be truly free.
7. Voluntary euthanasia leads to euthanasia tourism. Once voluntary euthanasia is legalised in a single country or state, people from neighbouring constituencies will take advantage of it.
8. Voluntary euthanasia changes the public conscience. The law is a very powerful educator for the public. When a practice becomes legally accepted and widely practised in society, people cease to have strong feelings about it.
9. Voluntary euthanasia violates historically accepted codes of medical ethics. Traditional medical ethical codes have never sanctioned euthanasia, even on request for compassionate motives. The Hippocratic Oath states: “I will give no deadly medicine to anyone if asked, nor suggest such counsel”.
10. It gives too much power to doctors. Calls for voluntary euthanasia have been encouraged either by the failure of doctors to provide adequate symptom control, or by their insistence on providing inappropriate and meddlesome interventions which neither lengthen life nor improve its quality. This has understandably provoked a distrust of doctors by patients who feel that they are being neglected or exploited. Doctors are human and subject to temptation. Voluntary euthanasia gives the medical practitioner power which can be too easily abused and a level of responsibility he should not rightly be entitled to have.
11. It leads inevitably to involuntary euthanasia. When voluntary euthanasia has been previously accepted and legalised, it has led inevitably to involuntary euthanasia, regardless of the intentions of the legislators.
12. The British House of Lords recommended no change to the law on euthanasia after an extensive inquiry. The House of Lords set up a Select Committee on Medical Ethics to look seriously into this issue in 1993. The committee, in its final report in February 1994, despite being earlier undecided on the issue unanimously ruled that there should be no change in the law.