Professors Rod MacLeod and Melanie Lovell from HammondCare's Greenwich Hospital discuss upcoming Australian legislation permitting assisted suicide and euthenasia.
Our thoughts on assisted suicide and euthanasia
In Victoria and NSW there is a legislative push for assisted suicide and euthanasia to be permitted. Here are eight thoughts regarding this topic:
1. Legislated safeguards cannot detect coercion behind closed doors
Safeguards cannot detect psychological pressure from family members and others with vested interests. This is particularly concerning for vulnerable groups such as older people, given more than one in ten older people experience psychological abuse in any given year.
2. Such a change would undermine the value that we as a community place on human life
By assisting people to end their life, our society would be sending the message that some lives are not worth living. Such a change in attitude could place pressure on vulnerable people including older people and those living with dementia and disability.
3. Legislated safeguards around mental health disorders and decision making capacity are severely limited
Safeguards to protect people with mental disorders and impaired decision making capacity require referral to a psychiatrist or other specialist. Where this requirement is optional, it is rarely used; where it is mandatory, significant concerns remain about the assessment of capacity and the presence of mental illness in people with a terminal illness.
4. Legislated safeguards have been diluted and removed in other jurisdictions
Physician-assisted suicide and euthanasia in the Netherlands and Belgium were initially intended only for people with terminal illnesses but includes people with psychiatric conditions, dementia, depression and old age. These practices were originally restricted to people aged 18 and over but can now be accessed by people under the age of 18.
5. People from vulnerable population groups are increasingly receiving assistance to end their lives where safeguards have been removed
In the Netherlands, 141 people living with dementia were euthanased in 2016 (compared with just 41 in 2012), including some people with advanced dementia. A further 244 people were euthanased due to a range of “ailments associated with old age” and 60 people were euthanased as a result of psychiatric disorders.
6. Such legislation could negatively impact the relationship between doctors and patients
If, as well as promoting quality of life, medical practitioners also began to assist with suicide and euthanasia, there is a valid and widely held concern that this would undermine the relationship of trust between other patients and their doctors. The Australian Medical Association (AMA) and the Australian and New Zealand Society of Palliative Medicine (ANZPSM) do not support physician-assisted suicide or euthanasia.
7. There is widespread evidence of a negative impact on doctors who take part in assisted suicide and euthanasia
In the Netherlands, many physicians have found performing euthanasia to be a “drastic and sometimes even traumatic event”. In other jurisdictions doctors who have participated in physician-assisted suicide and euthanasia have reported that this subsequently affected their ability to practice medicine.
8. Such a change has been linked to reductions in the use of palliative care
Allowing physician-assisted suicide and euthanasia without a requirement to engage with palliative care has led to a devaluing of these services. The utilisation rates of hospice and palliative care services in US states where physician-assisted suicide was legalised have reduced compared to other states where the practice remains illegal.
HammondCare supports greater investment in high quality palliative care that improves quality of life of people and families facing life-threatening illness by:
- Providing relief from pain and other distressing symptoms that result in suffering
- Affirming life and regarding dying as a normal process
- Seeking neither to hasten nor postpone death
- Integrating psychological and spiritual aspects of care
- Offering a support system to help people live as actively as possible until death
- Supporting the family to cope during the person’s illness and in their own bereavement
- Using a team approach to address the needs of patients and their families, including bereavement counselling, if indicated
- Enhancing quality of life
