Nick Goiran: Elephant in the euthanasia room

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Irritable Bowel Syndrome could be grounds for euthanasia under legal loopholes
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Politicians tell people what they want to hear. In contrast, parliamentarians consider what is in the best interests of the people they represent.

As the euphemistically named Voluntary Assisted Dying Bill 2019 makes its way through the WA Parliament, a number of politicians have pointed to polling suggesting levels of voter support at about 88 per cent. Meanwhile, an increasing number of parliamentarians are expressing concern about the dangers within the legislation.

It is difficult to identify another area of public policy that has more significant ramifications than a law that seeks to exempt some citizens from the prohibition against homicide. In this context, it is trite for politicians to justify supporting the Bill on the basis of majority public support. Those politicians have gravely misapprehended their role and duty as lawmakers.

The fact that a majority of voters support the concept of euthanasia is merely the first threshold question. It ought never to be the determiner. Whilst majority electoral support elevates this policy from a mere idea to a debateable matter, a number of questions must then be considered by responsible lawmakers.

The first question that ought to be asked is whether it is possible to construct a safe regime for euthanasia and assisted suicide. As we have the benefit of the lived experience in a small number of jurisdictions it is incumbent on anyone answering the first question in the affirmative to identify the international or domestic model that forms the basis for their answer.

My answer to the first question is documented in my 248 page minority report The safe approach to End of Life Choices: License to Care not Licence to Kill.

In that August 2018 report, I set out why the Parliament should rule out introducing such a regime based on the experience in the Netherlands, Belgium, Switzerland, Canada and Oregon. Indeed Australians need to look no further than the fatal experiment in the Northern Territory to see how ineffective “safeguards” are in practice.

Once a parliamentarian studies the lived experience of those jurisdictions it is no wonder that they repeatedly reject such proposals. Only last year we saw our Federal Senate vote against allowing our Territories from legislating in this area.

This was hot on the heels of Finland, Guernsey and Portugal also rejecting these schemes. Indeed the previous year saw some 26 of the states in America do likewise. So, why are parliamentarians so frequently unaligned with public opinion polls on this issue?

The reason is that it is far easier to answer an overly simplistic polling question with a one-word answer for yourself than it is to safely legislate to allow doctors to kill their patients.

Euthanasia can, and does, go horribly wrong. People have taken the poison prescribed by their doctors and have woken days later, only to pass away weeks after that from their underlying condition.

SJOG Health Care Group CEO Dr Shane Kelly said while the organisation will not support voluntary assisted dying and euthanasia it will respond to the needs and requests of patients in a “sensitive and non-judgemental manner”. Photo: Gnangarra/Wikimedia Commons, CC BY 2.5 AU
SJOG Health Care Group CEO Dr Shane Kelly said while the organisation will not support voluntary assisted dying and euthanasia it will respond to the needs and requests of patients in a “sensitive and non-judgemental manner”. Photo: Gnangarra/Wikimedia Commons, CC BY 2.5 AU

People have undergone euthanasia only for it to be discovered in post-mortem examination that they were not suffering from the medical condition for which they were euthanised.

Even in Australia, while euthanasia was legal under the Rights of the Terminally Ill Act 1995 (NT), people were euthanised whose mental and physical suffering was inadequately addressed by their physician prior to their death.

As the only parliamentarian to have attended every meeting and every hearing in the 12 month inquiry by the WA Joint Select Committee on End of Life Choices, I can attest that the evidence confirmed that it is inherently complex to determine the influences which drive an individual diagnosed with a terminal illness to seek to end their life, including the influence of mental health comorbidities.

In fact, diagnosing demoralisation is as important as diagnosing depression and other conditions when seeking to alleviate and manage psychological suffering.

The stakes can hardly get any higher than if we are to give an individual responsibility to distinguish between euthanasia requests that are a mis-expression of an underlying unresolved need, and those that reflect a personal philosophy of choice, despite optimal care.

It does not take a parliamentarian long to comprehend that medical error in diagnosis and prognosis are grave risks to patients presented by any assisted suicide regime.

However, the fatal flaw that is not as readily identified is that of an individual being “steered” to requesting assisted suicide. “Steering” is the elephant in the room.

Countertransference and undue influence from a medical practitioner are dangerous risks in any euthanasia regime. Undue influence is, of course, not limited to practitioners and is actually more prevalent amongst family members. Indeed, elder abuse is a real and burgeoning problem in Western Australia.

Sadly the capacity of medical practitioners to identify elder abuse in their patients is incredibly variable in Western Australia. The presence of undue influence can be difficult to identify and is easily missed.

Politicians consistently ignore that steering is the elephant in the euthanasia room. In contrast, parliamentarians acknowledge the grave reality that an assisted suicide regime that involves a medical practitioner being licenced to end the life of their patient is only as safe as the practitioner is competent.

Hence parliamentarians generally around the world routinely reject that radical policy option which guarantees casualties in favour of the authentically safe approach of facilitating access to expertly practised specialist palliative care.

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