Euthanasia in Tasmania - Assisted suicide in Tasmania - Dying with Dignity in Tasmania

Ray Groom
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Written article
Ray Groom

Aged care - protecting the vulnerable

Hon. Ray Groom

Former Premier of Tasmania and Chairman of Southern Cross Care

 

 

Key Reasons why Euthanasia should never be legalised:
  • Every individual has intrinsic worth and value regardless of age or physical or mental condition;
  • State approved physician assisted suicide would change attitudes to the value of life generally.
  • It might encourage young people to believe that life is not worth living.
  • At present, the aged care environment is enhanced when the medical profession respects the already existing right of people not to have their dying unreasonably prolonged and to be able to reject futile and overly burdensome treatment.
  • At present, the aged care environment is enhanced when appropriate palliative care is provided to alleviate physical and emotional distress.
  • Parliament should examine how to further advance palliative care; to improve its quality and availability, as previously recommended by the 1997 Inquiry into euthanasia.
  • Legalising euthanasia will create an atmosphere of fear, uncertainty and mistrust; it will cause elderly residents to question their worth and the worth of others.
  • The cheerful positive atmosphere of aged care would be seriously undermined.
  • It is the fundamental duty of governments to protect the safety and security of the community – legalising euthanasia is contrary to this duty.
  • Members of Parliament should decide what is in the best interests of the community – not depend on popular opinion which has not been refined through full consideration and debate of the issues.
  • People might be influenced by others to adopt euthanasia, particularly those suffering depression, in effect it may not be a free choice.

 

 

 

 

 

29 July 2009

 

Mr Charles Casimaty
Secretary
Joint Standing Committee on Community Development
Parliament House
HOBART TAS 7000

 

1. INTRODUCTION
Southern Cross Care (Tas) Inc is a leading Tasmanian aged care provider. We are a not-for-profit charitable body. We currently provide care, accommodation and support for more than 1,500 Tasmanians. Our organisation operates seven residential aged care facilities (formerly referred to as "nursing homes") and nine retirement villages in the south, north and north-west of the State. We also provide community care services for people residing in their own homes. Southern Cross Care (Tas) Inc employs approximately 850 people. We are also assisted by many volunteers. The whole purpose of our existence is to provide loving and professional care and support to older citizens of Tasmania regardless of their culture, colour, religious belief or social status.

 

Our organisation believes in the intrinsic equal worth of each individual and values each person's life regardless of age or physical or mental condition. Those beliefs are at the very heart of the work that we do. Our staff members constantly marvel at the way our residents, even when very old and frail and often suffering serious illness, can still find enjoyment and satisfaction in life. Our desire is to maximise that enjoyment and satisfaction and to provide a positive and supportive environment for our residents.

As pointed out in a 1997 submission on the same subject, we recognise that this environment is further enhanced when doctors and other health care professionals respect the right of people not to have their dying unreasonably prolonged and the individual's right to reject treatment they regard as futile or overly burdensome, and when appropriate palliative care management is provided to alleviate physical and emotional distress.

 

We strongly believe that this proposed legislation is unnecessary and dangerous. We consider that it would create an atmosphere of fear, uncertainty and mistrust and cause some of our elderly residents to question the worth of their own lives and perhaps the worth of the lives of others. This would be the inevitable result of assisted euthanasia occurring in one of our facilities. Such an occurrence could not remain confidential in an aged care facility. The cheerful and positive atmosphere we seek to create in our facilities would then be seriously undermined.

 

Having considered this issue carefully and seriously, we conclude that we could not countenance assisted deaths occurring in any of our facilities as proposed in this legislation.

We appreciate that those who propose this fundamental change to the law are well-meaning. Clearly there are individual cases in which euthanasia can be seen by some to be the solution. However, very sad and difficult individual cases should not cause a change to the law which would pose dangers to other individuals including the weak and vulnerable in our community.

 

2. EUTHANASIA IN AUSTRALIA AND ELSEWHERE
At present there are no statutory or common law rules in Australia which make euthanasia legal. Previously there was legislation in the Northern Territory which applied for a short period of time but which was overridden by Commonwealth legislation applying to all of the Australian Territories.

 

If the Tasmanian Parliament passed this legislation it would be the only legislation of its kind in Australia. If that eventuated, there is no doubt that it would encourage people from other parts of Australia to establish residence in Tasmania solely for the purpose of their assisted death. This has been the experience in Europe, where some people travel to the Netherlands, Belgium or Switzerland for that very purpose.

 

There are very few countries in the world where euthanasia has been legalised. Similar proposals for legal reform have been rejected in a number of other countries in recent times, including the United Kingdom, a number of States in the United States of America, Canada and recently in Victoria.

 

A bill was defeated in the House of Lords in May 2006 and a euthanasia related bill was defeated in July 2009. In 2007 an assisted suicide measure was defeated in California and bills were defeated also in Hawaii and Vermont. In Canada, a bill was defeated on 30 October 2005. The Upper House of the Victorian Parliament defeated the Medical Treatment (physician Assisted Dying) Bill on 10 September 2008.

 

3. DANGEROUS PUBLIC POILICY
In our 1997 submission to the Community Development Committee of the Tasmanian Parliament, a strong point was made that voluntary euthanasia was dangerous public policy. We trust a copy of that submission is available to the Committee. lf not, then we can arrange for a copy to be provided.

 

One of the fundamental duties of the Government and indeed the Parliament is to protect the safety and security of the community. This is the primary duty of Government. It is pointless providing, for example, good standards of health education and housing and well-built roads and bridges if action is not taken to reduce any existing danger to the community - this is the purpose, for example, of our road laws and sanctions against criminal conduct.

 

Legislation to permit legal voluntary euthanasia is contrary to this primary duty of Government. If the legislation is passed, vulnerable people within the community will be placed at risk. Experience in the Netherlands has shown that guidelines laid down in that country before euthanasia is performed are often not strictly followed and are not properly enforced.

 

An illustration of the leniency of the system in the Netherlands can be seen in the 2001 prosecution of Dutch GP Dr Wilfred van Oijen. The evidence in that case shows that Dr van Oijen administered a lethal injection to his 84 year old comatose patient at the urging of her family even though the patient had made no request for euthanasia.

 

Dr van Oijen was convicted of murder but the Court declined to impose any punishment except a suspended fine for falsely reporting the patient's death as natural. The doctor had failed to obtain a second medical opinion. The Court considered the doctor's conduct to be "an error of judgement". Dr van Oijen faced a medical disciplinary board but received only a warning and was able to continue to practice medicine.

 

Another good example of failure to protect the vulnerable when a euthanasia law is passed can be found in the following example from Belgium. A doctor admitted to ending the life of his 87 year old patient who had dementia. Dr Marc Cosyns published an article describing how he ended his patient's life because he wanted to encourage the extension of the euthanasia law to patients suffering from dementia (Belgian Medical Magazine "Huisarts" 9 February 2006). A proposal to extend euthanasia to dementia sufferers has been introduced into the Belgian Senate and the Chamber of Representatives.

 

We wish to refer to a speech made in the House of Lords in the United Kingdom earlier this month on 7 July 2009 by Baroness Campbell of Surbiton when debating proposed euthanasia related legislation. Baroness Campbell is herself severely disabled. She referred to a gathering of 100 disabled people with terminal conditions who opposed an earlier euthanasia Bill. She said in her speech as follows:

 

"We were there for a very simple reason: because we feared for our lives and the lives of hundreds of other disabled people if the Bill were to become law. Our belief was that if the State were to sanction any person to assist another in the ending of that person's life, it would switch the mindset of doctors and those who would help us in this country to thinking that that is what we really want- the very people who need every encouragement to live and not to succumb to society's prevalent view that our situation is so tragic, so burdensome, so insufferable that surely we must want to die. It takes an extraordinary will to rise above such views, and many do not, especially when those views are held by our loved ones. That is when it is the hardest. "

 

The Baroness later added:

" ... not a single organisation of or for terminally ill people or older people support this assisted dying legislation. That includes organisations that advocate on behalf of people with motor neurone disease and multiple sclerosis - two disabling conditions that are often referred to when describing who would benefit most from the legislation. "

(House of Lords. 7 July 2009 : Column 613)

 

4. PUBLIC OPINION
We notice that the proponent of the Bill has made a point that opinion polls indicate public support for voluntary euthanasia. It is well known that you can achieve any result you want to achieve from an opinion poll by posing the question in the most suitable form.  Opinion polls are so often used to push causes and it is interesting to note that the, body which seeks the opinion poll usually obtains the result they want.

 

We suggest that if an individual person who may have said yes in an opinion poll was present when there was a full and proper debate on the issue of euthanasia, it is quite likely that he or she may change their mind In the United States an opinion poll was taken showing some 80% support for euthanasia but those results were in marked contrast to a later referendum where people were subjected to a range of views over a period of time before formally voting. The end result was that the referendum showed that some 55% of voters were opposed to the suggested euthanasia legislation.

 

In any event, Members of Parliament are elected to be representatives of the people. We live in a representative democracy. It is for the Members of Parliament to finally decide what they believe to be in the best interests of the community. Lf the wider community decided every issue, then there would be some interesting results. Perhaps there would be no taxation to fund all the essential services of Government. We doubt that the end result would be as beneficial to the community as good representative government where Members of Parliament think carefully about the issue at hand and decide what is best for the wider community.

 

An interesting example is capital punishment.  When public attitudes are polled following a heinous crime, the poll usually shows that a clear majority of people are in favour of capital punishment. Yet through representative government, no Australian State currently permits capital punishment.

 

5. THIN END OF THE WEDGE
This point has to some degree been dealt with in 3 above. There is no doubt that State approved, physician assisted euthanasia would lead to a marked change in attitude. If it is determined that a person can freely choose that his or her life is not worth living and so end it with the help of medical practitioners, then the attitude to the value of life will for ever be changed.

 

We appreciate that under the proposed legislation it would not be simply a matter of choice for the individual. There are other pre-conditions which must be present before an assisted death can occur. However, experience elsewhere has shown that in practice pre-conditions can be ignored. As a society we must continue to value life. There are, for example, young people who may be depressed or have other mental or physical disabilities. We do not want to do anything to encourage young people to believe that it is not worth going on and, because of the attitude evident in this legislation, decide that an acceptable option is to end their lives. But as Baroness Campbell pointed out in her recent speech, a change in mindset can have unintended results.

 

6. "MENTALLY COMPETENT"
A key provision in the Bill is that the individual concerned must be mentally competent to sign a certificate of request.  It is interesting that the definition of mentally competent in clause 3 of the Bill states that the person must '"understand the general nature of the illness or condition" and is able to "weigh the pros and cons" of certain matters.  This is rather uncertain language for such a vital element within the Bill.

 

We would be most concerned that a person might be influenced by others to agree to sign the necessary certificate so that it is not a genuine free choice or that the person might be quite depressed at the time and because of that depression, decides to take the step. Depressed people can recover from that illness. There is ample evidence that people who have contemplated suicide, or even attempted it, have later recovered to lead normal and very useful lives.

 

7. 1998 COMMITTEE REPORT
The Community Development Committee, then differently constituted, did examine a similar Bill during the course of 1997 and 1998 and after an exhaustive enquiry made the following principal finding:

 

"5.29 The Committee found that the legislation of voluntary euthanasia would pose a serious threat to the more vulnerable members of society and the obligation of the State to protect all its members equally outweighs the individual's freedom to choose voluntary euthanasia."

 

We are concerned that the proponent of the present proposed legislation opposed the Committee examining his proposal in detail. One would have thought that as this is literally a life and death matter, an adequate opportunity to consult with members of the community was appropriate and that sufficient time should be provided for such consultation. We are grateful to the Government and the Opposition for agreeing to a proper examination by the Committee of this proposal.

 

It seems to us that the earlier Committee examination should be taken into account and carefully considered when examining the current Bill. In a democratic society such as ours, this type of consultative process is most valuable and is greatly appreciated by an organisation like ours which is so fundamentally involved on a day to day basis in the matters addressed by the Bill.

 

8. PROBLEMS WITH THE DYING WITH DIGNITY BILL 2009
[not re-produced in this online version]

 

9. PALLIATIVE CARE
We urge the Committee to examine the issue of palliative care and how palliative care might be further advanced in Tasmania, particularly in regional and remote parts of our State. We note that Professor Ray Lowenthal made the following comments on the state of palliative care in Tasmania when giving evidence before the last Inquiry:

 

"The Tasmania model follows that generally regarded as desirable in that it integrates home care, hospital consultation and in-patient care in a hospice setting, where appropriate for each individual patient. The nursing and medical staff who operate Tasmania's Palliative Care Services have been widely praised for their ability to deliver effective palliative care in a wide variety of settings in both urban and rural areas of the state. However more funding is desperately needed to fill gaps in the provision of 24-hour cover, and to provide education for general practitioners, other medical practitioners and general nursing staff."

 

The theme of palliative care practices was also noted in the submission from Dr Craig Hassed, Department of Community Medicine, Monash University:

 

"Training for medical students and doctors in the area of palliative care is terribly deficient. For example, in the medical course at Monash University there are just nine hours of formal palliative care teaching spanning the six years. Doctors, even those in teaching hospitals let alone GP's, are often unaware of what treatments are available. "

 

Southern Cross Care (Tas) Inc strongly supports the following recommendations of the Community Development Committee Report No. 6 handed down on 2 June 1998:

 

5.34 The Committee strongly recommends universal access to palliative care for all patients who require it.

 

5.35 The Committee recommends that greater resources be made available to assist in improving the efficacy of palliative care. Such resources should include technical/medical and the ancillary services that focus on relieving the emotional distress of terminally ill patients.

 

5.36 The Committee recommends that specialist palliative care services be equitably distributed throughout the state.

 

5.37 Greater resources should be made available for education of medical practitioners in undergraduate and postgraduate settings. Education of general practitioners, patients and the general public is also necessary to ensure that the benefits of currently available palliative care services are understood and accessed.

 

We believe that in 2009 a great deal more is required to be done in Tasmania to improve the quality and availability of palliative care.

 

10. CONCLUSION
Southern Cross Care (Tas) Inc strongly opposes this proposed legislation. We consider it to be bad public policy as it would lessen the safety and security of the Tasmanian community, especially for its more vulnerable members. We believe its implementation would seriously undermine the positive and cheerful atmosphere we seek to establish in our aged care facilities and would cause mistrust and suspicion. Even for those who may support euthanasia, it is a most unsatisfactory piece of legislation.

 

We therefore urge the Committee to oppose this legislation.

 

This submission is made with the support of the Board of Southern Cross Care (Tas) Inc.

 

RAY GROOM

 

Chairman
Southern Cross Care (Tas) Inc

 

 

 

Biography
Bios
Hon. Ray Groom

 

Ray Groom is a lawyer, former Australian sportsman and politician who served as Premier of Tasmania from 1992 to 1996.  During his political career, Ray served as a Federal and State minister for a total of 13 years. 


Ray is actively involved in community affairs and has been a chairman/director of several community organisations since retiring from politics.  

 

He is currently Chairman of Southern Cross Care Tasmania, an organisation which has provided aged care residential and support services in Tasmania for thirty-four years and is recognised as the leading provider of such services in Tasmania.


In the Australia Day Honours of 2010, Ray was appointed an Officer (AO) of the Order of Australia.

 

Viewpoints

Viewpoints on euthanasia and assisted suicide from eminent Tasmanians