Since the 1987 case of R v. Johnstone in which a sixty-two year old man electrocuted his mentally ill wife at her request, euthanasia has become the subject of ongoing public, medical and political debate in South Australia. The term euthanasia originates from the Greek word “euthanatos”, meaning good death, and voluntary euthanasia refers to the practice of bringing about a quick and peaceful death under medical supervision “at the request of and in the interests of a patient”. Voluntary euthanasia is currently considered to be murder under the South Australian Criminal Law Consolidation Act 1935 [s.11]. Several attempts have been made to legalise the practice; the latest of these being the introduction of The Consent to Medical Treatment and Palliative Care (Voluntary Euthanasia) Amendment Bill 2010 into Parliament in September 2010. Voluntary euthanasia was however legalised for a short time in the Northern Territory and is currently allowed under prescribed circumstances in Oregon, Washington, Switzerland, The Netherlands, Belgium and Luxembourg. There are many reasons why voluntary euthanasia should be introduced into South Australia, which predominantly centre around three principles; respect for personal autonomy, compassion for those experiencing suffering without relief, and respect for the dignity and quality of life for the patient. As well as discussing these arguments, this essay will consider the objections to voluntary euthanasia and seek to argue that there is both legal justification and a moral obligation to legalise the practice of voluntary euthanasia in South Australia.
Arguments in favour of Voluntary Euthanasia
Voluntary euthanasia allows patients to choose when and under what circumstances they will end their lives, showing respect for personal autonomy. Pro-euthanasia supporters argue that neither the state nor society has the right to insist that an individual who no longer wishes to go on living must do so. While suicide is legal, patients may be unable to bring about their death due to incapacitation or may be fearful that any assistance provided by their family and friends will result in prosecution, as assisting a suicide remains an offence. Furthermore the methods available for suicide often involve mutilation of the body, pain and severe discomfort. In contrast, voluntary euthanasia provides a means by which a person can die pain free, peacefully and in the care of their loved ones.
Voluntary euthanasia is also supported on the grounds of relieving unbearable and unmanageable suffering. On the 22nd May, 2002, 69 year-old Nancy Crick ended her life by drinking a 100mL solution of the drug, Nembutal, while 21 witnesses consisting of family, friends and voluntary euthanasia supporters watched on. In 1999, Nancy had been diagnosed with bowel cancer and after undergoing 3 operations which managed to remove the cancer, she was left with several adhesions leaving her in pain and with a poor quality of life. While Nancy reviewed her situation and delayed her decision to end her life to see whether palliative care eased her pain and suffering, she found that it did not help her to her satisfaction. Palliative care in many cases can remove pain and suffering from terminally ill patients but palliative care experts agree that 5-7% of patients are not able to have their suffering adequately relieved. Voluntary euthanasia allows patients such as Nancy to end their life in a quick and pain free way, preventing them from suffering for substantial periods of time. In such cases, death is inevitable and voluntary euthanasia seeks only to hasten this process and relieve the associated pain.
The term ‘dignity in dying’ is used by many societies advocating voluntary euthanasia and describes the need for patients to maintain their dignity and quality of life prior to death. Many patients, particularly those suffering from degenerative diseases, experience significant diminishment of their dignity in the end stages of their life. They may lose all control of their bodily functions or be completely reliant on others for the most basic tasks and in such circumstances, voluntary euthanasia can provide means by which these people can end their life peacefully while they are in control and aware of what is happening.
It is also argued that euthanasia, despite its current legal position, occurs commonly without regulation and without any guarantee that it is voluntary. Evidence of this argument was found in 2001, when Douglas et al published their survey of 683 Australian general surgeons which reported that 36.2% had “given drugs in doses greater than was necessary to relieve symptoms with the intention of hastening death”, 20.4% had “given drugs with the intention of hastening death, but without the explicit request of the patient” and 4.2% had “acceded to requests for voluntary euthanasia”. This is further supported by the results of a survey conducted by Neil et al in 2007 of 854 Victorian doctors which found that “of doctors who have experienced requests from patients to hasten death, 35% of doctors have administered drugs with the intention of hastening death.”As euthanasia already occurs regularly, it is better to have it legalised where it would be subject to a strict regulatory environment.
Objections to Voluntary Euthanasia
There are many objections to the introduction of voluntary euthanasia, some of which are founded on religious morals and others which concern the extent to which safeguards are able to prevent misuse. One such objection is whether a patient actually wants to die, with many expressing concern that families will put pressure on individuals or that the elderly will choose to die in order to avoid being a burden. While it is not possible to look inside the minds and thoughts of individuals, there are strict safeguards which exist under The Consent to Medical Treatment and Palliative Care (Voluntary Euthanasia) Amendment Bill 2010, that require two doctors to examine the patient making the request with one being a specialist in the condition that is suffered by the person, and the patient to undergo psychiatric assessment if either doctor believes the patient is not in the right state of mind or is behaving under undue influence. These safeguards ensure that patients are given adequate opportunity to express the true extent of their desire to end their life. Furthermore, the unfortunate reality is that euthanasia already exists within the profession and therefore exacerbated by the lack of legalised voluntary euthanasia. Legalising voluntary euthanasia would bring acts of euthanasia into a monitored and regulated environment where it can be effectively minimised and discouraged.
Many also raise concerns that people will choose to utilise voluntary euthanasia for diseases which cures may be found for after their death, or even that people will restrict their efforts to find cures and advances in palliative care as a result of legalised voluntary euthanasia. The idea that a cure may be found after the patient’s death is unlikely given that most treatments take years to be developed, tested and become available, during which time these patients would experience immense pain and suffering. Ultimately, it is up to the patient to weigh up the possibility of a cure becoming available against the pain and suffering they are experiencing and make an informed choice with the aid of their doctor as to whether it is worth waiting for a cure. Similarly, the argument suggesting that less effort would be devoted to finding cures and improving palliative care is unlikely given that palliative care is still widely used and supported in countries where voluntary euthanasia is available. In fact, it might even have the effect of increasing the drive to find and work towards a cure in order to reduce the occasion for voluntary euthanasia.
It is also widely held that those of religious persuasions do not support the shortening of life under any circumstances. This is essentially a moral judgement for the individual and should not be applied to others who do not hold that religious or moral belief from accessing voluntary euthanasia. To quote the Hon. Sandra Knack MLC, “Some Christians believe that it is wrong to access right-to-die legislation but it is a belief system. They have their right to their belief; others have their right to their beliefs. To deny the right to access voluntary euthanasia under the guise of religious authority is to deny freedom of religious expression in our society”. Furthermore, it has in fact shown that in response to the 2002 Morgan Poll in South Australia in June 2002, 81% respondents nominating as Anglicans, 69% of Catholics and 74% of those identifying with the Uniting Church agreed with the statement that ‘a hopelessly ill patient, experiencing unrelievable suffering with absolutely no chance of recovering should be allowed to be given a lethal dose by their doctor.’ While public opinion polls have their weaknesses, there is no denying that there is evidence of widespread support for voluntary euthanasia in South Australia.
While there are a number of objections to the legalisation of voluntary euthanasia it remains a valid and reasonable practice which people should be able to utilise where they deem it morally appropriate and justified. Evidence has shown that euthanasia is already a regular practice, which with legalisation, would be more effectively supervised and controlled. Personal autonomy and freedom of choice are imperative within any democratic society and as such South Australia should support any means by which a person’s liberty can be secured, provided that it is not at the expense of others freedoms. Those who object for moral or religious reasons to voluntary euthanasia are entitled to their opinions, however they are not entitled to insist via legislation that everyone else hold those same morals. Voluntary euthanasia is a personal choice for the individual and therefore if a person is experiencing unrelieveable and unmanageable suffering which cannot be placated by palliative care, and wishes to die with dignity and in the presence of loved ones, the state must recognise and validate this choice.