No need for a licence to kill

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No law reform or Nembutal can promise to make everything nice at the end of life. Photo: Pixabay

Let’s work together on a just and compassionate society for the terminally ill

Recently I accompanied a priest-friend of mine as he was dying of cancer at the Sacred Heart Hospice in Sydney. He was only in his early 60s and when I celebrated his funeral it seemed to us onlookers to be too soon.

Frank approached his death with resignation, good humour, even generosity. He said his goodbyes and prepared to say his hellos beyond the grave.

Though helped by his personal faith, supportive family and priest-friends, it was clear to me that his last weeks would have been much harder were it not for contemporary palliative and pastoral care.

My experience with Frank underlined for me that no one should romanticise dying, whether they are campaigning for state-sanctioned medical killing in certain cases or, like me, think there’s a better way to go. Both sides must face the same brutal fact: that death, like life, is rarely free from all pain and grief.

There are some things for which there is no morally or practically available fix. No end of government inquiries, law reform, or Nembutal will make everything nice. We do our best to manage pain and relieve other suffering. But there remains some palliative deficit or existential suffering that calls for personal forbearance and support from others.

No one should pretend that’s easy. Palliative care professionals do their best and today their best is very good. Most pain can be anticipated and blocked even before it begins: we don’t have to wait until people are begging for relief. In really difficult cases patients might have to be rendered unconscious, and only woken for brief periods with their loved ones and carers.

Drugs, nutrition and hydration should be provided whilever they can achieve their proper goal or at least provide some comfort. But when these can no longer be absorbed or are no longer effective they are rightly withheld. For the dying the focus changes from extending life to keeping the patient as comfortable as possible for the time they have left. And in my experience that time can be very precious for all concerned.

No one need fear that giving high but appropriate doses of pain relief or withholding too-burdensome treatments is unethical or illegal: it is good practice, even if, like the rest of healthcare, it has its risks. Sure, it might in some cases mean the patient does not live as long as he/she would if we ‘tried everything’. But the palliative approach is warranted in such cases and failing to adopt it could well be more debilitating and life-shortening than using ‘heroic’ measures.

All this is well understood in the palliative care world. It does not require changes to law or practice. But it does require greater resourcing if palliative care is to be available to all who might benefit. And we need better education of the community, even perhaps of GPs, about end-of-life care.

What we don’t need is to give some people a ‘license to kill’. We shouldn’t be telling sick people by our laws that we think they would be better off dead or that we would be better off if they were dead. Paul Kelly and Angela Shanahan have reported the dangerous consequences already apparent in places like Belgium that have gone down that path (Australian Inquirer 1-2 & 8-9 October, 2016).

I need not rehearse those here. But as we become more aware of widespread elder abuse in our own community and of alarming rates of suicide amongst the vulnerable, we have more cause to be especially cautious about introducing the idea of killing the burdensome or ‘volunteering’ for an early death.

There have recently been attempts to silence Catholics and other believers on euthanasia and other debates. Andrew Denton has spoken darkly of “subterranean Catholic forces” and told politicians and professionals with faith to butt out. But we surely need a serious and respectful discussion where all sides are heard and reasonable disagreement, and perhaps even agreement, is possible.

I believe such civil discourse is still possible in our country. And not just possible, but crucial. For how we go forward on matters of life and love will go to the heart of the kind of community we will become.

Were we to accept that some old people can be killed, why not some others? And why restrict it to the old and sick? Why not younger people and those who aren’t terminally ill? How about people who are just sick of life? Or people who are unconscious or too young or disabled to consent? It’s not that I’m a nervous ‘slippery-sloper’ on this matter: I’m just following the evidence from overseas and the logic of the argument for giving some people a lethal dose.

Of course, even the most enthusiastic ‘Dr Death’ would not give euthanasia to all comers. They would still have to make value judgements about which requests were reasonable, which kinds of suffering ‘bearable’, which conditions truly ‘hopeless’. And that means that for all the talk of patient autonomy and civil regulation, we would in the end be asking our doctors to decide who should live and who should die.

That would be a huge change. Having undermined the principles that doctors never kill patients and that our state will not sanction killing the vulnerable, we will have changed both what doctors are and what our justice system is. Perhaps most worryingly, we will have changed how we relate to ‘unwanted’ people.

A just and compassionate society can surely find more respectful and loving ways of dealing with suffering at the end-of-life than killing the suffering person.

This article first appeared in The Australian on 15/16 October 2016.

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