I DO NOT necessarily condone the high-profile activism of euthanasia campaigner Dr Philip Nitschke,1
but a sensible debate about whether a euthanasia right should exist is overdue.
Euthanasia opponents present the possibility of depression during the final decision-making process as their
chief concern. Even with depression, is that enough reason to deprive an individual of a right to not want to
suffer?
The implication of an affirmative answer is that otherwise we are likely to remove the testamentary capacity from all depressed people. Clearly no one in their right mind is contemplating that.
While as doctors we have the responsibility to help depressed patients, there is a higher level of responsibility we bear, and that is to respect the wishes of the patient who refuses treatment.
This is consistent with the AMA code of ethics, although the AMA has not clearly stated its view unambiguously apropos euthanasia.
On the other hand, there are always situations where doctors can help dying patients achieve their wishes without coming into conflict with existing laws. This is by way of “slow euthanasia”. The American Academy of Hospice and Palliative Medicine cites three scenarios for this.
The first is refusal by patients, of life-prolonging treatment (not an option beyond a certain stage if adequate preparation and planning has not been put into motion well before the testamentary capacity is lost). Remember we do not go out of our way to force on dying patients treatments that may prolong their suffering.
The second is voluntary refusal of food and fluids, which may result in slow dying over days. Again, we agree that as patients they have this right and as doctors we are bound to respect their autonomy until the end of their lives. This is especially so if we believe they still have testamentary capacity. Here we are not talking about
provision of palliation for any associated suffering.
The third option is the use of “palliative sedation, even to unconsciousness”. This is a process of titrated medication, controlled by the doctor, not the patient, which again may occur over some days.
This is usually associated with withdrawal of fluids and is a process that leads to death, albeit slowly. The slow titration approach to palliative sedation is not based on legal concerns — doctors providing medication with the intention of relieving pain and suffering, which foreseeably hastens death, have no legal problem.
The AMA code of ethics supports this approach.4 Admittedly, while this is practised by some, albeit quietly, on a regular basis with no involvement of medical oards, problems arise when either the practitioner or family members involve the media or law enforcement agencies.
Given claims that 85% of the Australian population
agrees with some freedom of euthanasia, it seems it is only the power of a few politicians hindering a decision between patients and doctors. Given an enlightened society such as ours where virtually everything appears to be open for review, this fundamental human right should be enshrined in law ASAP.
Dr Tony Marshal is a GP From Frankston, Vic
Medical Observer; Dr Tony Marshal; 31/03/2015
References:
- http://www.australiandoctor.com.au/news/latest-news/no-indemnity-cover-for-nitschke
- https://www.mja.com.au/insight/2014/30/rodney-syme-dying-autonomy
- http://aahpm.org/positions/pad
- https://ama.com.au/position-statement/ama-code-ethics-2004-editorially-revised-2006
- http://www.abc.net.au/news/2012-11-16/survey-shows-australian-support-for-legalised-euthanasia/4376524
