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

Medical viewpoints
Viewpoints from eminent Tasmanians...
Medical viewpoints

Tasmanian doctors and specialists refute the claim that euthanasia is already occurring and clear up misconceptions around patient choice, pain management and dying

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Q and A
with Dr Nicholas Cooling

Dr Nicholas Cooling, a senior lecturer in Medical Practice and a General Practitioner, discusses the impact of euthanasia and assisted suicide on the education of medical professionals; the doctor / patient relationship; and the ethical framework for medical practice

Written article
Cooling

Dr Nicholas Cooling

Senior Lecturer in Medical Practice, UTAS and General Practitioner

 

 

Secretary
Joint Standing Committee on Community Development,
Parliament House,
Hobart 7000
committees@parliament.tas.gov.au

 

27th July 2009

 

Submission to the Inquiry into the Dying with Dignity Bill 2009


The Dying with Dignity Bill 2009 was introduced in the House of Assembly on 26 May 2009 as a Private Members Bill and deals with the matter of voluntary euthanasia. The Bill provides for terminally ill patients who are experiencing intolerable pain and suffering to request the assistance of a doctor to end their lives.

 

This is a short submission based on my personal views and does not necessarily represent the institutions I am employed by.

 

It is of great concern that the Dying with Dignity Bill has been introduced into the Tasmanian Parliament. It has implications for the medical profession particularly the specialty of palliative care, for the vulnerable in the community whether frail, sick or elderly and for the value placed on the life of all persons.


Here are the reasons I am strongly opposed to legislation enabling voluntary euthanasia in Tasmania.


Have things changed?
Since the last Inquiry into similar legislation by the Parliamentary Community Development Committee in 1998 what has changed? There may have been a slight change in public opinion favouring euthanasia. However, since then, there are improved methods of palliation of pain and other distressing symptoms, more palliative care services, better understanding and care for emotional, spiritual and existential distress.


Why bring in euthanasia now when generations have refused this avenue. We have, in 2009, a greater capacity to alleviate pain and suffering than ever. (Abbott 2009)


The undermining of what it means to be a doctor.
This proposed bill would permit doctors, with specific guidelines, to kill patients on their request. Doctors are trained to preserve life or improve quality of life. They take the Hippocratic Oath which includes the words:

To practice and prescribe to the best of my ability for the good of my patients, and to try to avoid harming them.


I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan.

They are not trained to deliberately kill patients. The heart of being a doctor is to cure sometimes but to always show compassion and healing especially in times of suffering. The tools to assist with suffering include words, gestures, medication, procedures and mere presence. They have never included, in Tasmania, the ability to deliberately kill.


The Bill gives no indication on how the doctor should kill a patient if they request it.
Section 8 (2) of the proposed Bill states: In assisting a sufferer under this Act a medical practitioner must be guided by appropriate medical standards and such guidelines, if any, as are prescribed, and must consider the appropriate pharmaceutical information about any substance reasonably available for use In the circumstances.


While such guidelines on how to kill a patient are available in certain clandestine web sites they are not freely available nor taught in medical schools. There are no medical standards on the deliberate killing of patients .To develop such would be degrading to the profession and unethical .The situation on the medical management of those with terminal illnesses is currently working well although it is always going to be imperfect. There will never be a situation where we can alleviate all pain or suffering-physical or emotional. Many doctors and patients have private discussions where patients are made aware that medications such as morphine will be given in doses sufficient to relive most pain and distressing symptoms. Occasionally doses required to achieve a satisfactory palliation of symptoms can hasten death - but the intention is to relieve suffering not deliberately kill. The moral distinction is enormous.


Suffering
What is more significant for our patients, particularly those at the end of their life, is the suffering that comes from loss of meaning and purpose. The suffering is profound but is not hopeless. We physicians can address it by being present for our patients, by giving weight to their experience, and by becoming the kind of doctors we always wanted to be. (Chen 2007).


How doctors deal with suffering patients differs substantially. Many doctors handle this challenge well using both medical treatments, heartfelt compassion and comforting words. Those doctors are rarely if ever asked to end a patient’s life. Doctors with lesser experience, training or compassion might more readily turn to a lethal injection or pill given the legislative option and patient request ultimately doing them more harm. The mandate outlined in the proposed legislation, that a patient is made aware of and offered appropriate palliative cafe does not prevent this advice being given in a cursory manner nor without a bias which could influence the patients decision.


What most dying patients want is a skilled, compassionate doctor who is sensitive to their physical, mental and spiritual needs and who is willing to journey with them as they leave the world.


The slippery slope
The introduction of legal euthanasia with lethal injections perpetrated by doctors will bring in its complications and problems. It is likely to degrade the ethics of the medical profession. It will put pressure on the disabled and marginalised to give up their lives if they are deemed to be suffering. It will make the ending of life all too easy. With the strengthening of the economic rationalist position there is likely to be pressures on the frail aged and disabled to terminate their lives in preference for expensive complex drawn out treatments.


Given the logic of euthanasia - that induced death is an acceptable response to human suffering - there is little prospect that "mercy" killing would remain restricted to people with terminal illness. There are, after all, myriad forms of human suffering, many more acute or protracted than that associated with terminal illness. So if killing ever became accepted as an answer to the difficulties associated with dying, there is little doubt it would quickly become a "remedy" for other forms of distress as well. (Smith,W 2001)


This is borne out by the experience of the Netherlands, where doctors have been permitted to lethally inject patients since 1973, and where the pretext that euthanasia would be limited to terminal cases was long ago abandoned. Indeed, the Netherlands has reached the point where euthanasia isn't even limited to patients who are physically ill. (Smith, 2001)


Will this help Tasmania?
When the Dying with Dignity legislation was temporarily enacted in the NT (Rights of the Terminally Ill Act into law in 1996) it divided the community. The NT was much maligned over the legislation. Does Tasmania want to be the first state this legislation is enacted for the long term. It would be an embarrassment and shame for many Tasmanians. It would isolate Tasmania as the only state in Australia to have such legislation. We would join Oregon, Switzerland, Belgium and the Netherlands and the worlds attentions would be focussed on Tasmania- for the wrong reasons.


Put more funding into the care of the dying
Where our energies should go is the training of doctors to provide better care of the dying and for better services for those who care for the dying including families.


A prominent concern from patients contemplating their death is that they will suffer intolerably. Most people hope for a peaceful gentle death. Fear that this will not occur drives some people to want the option of euthanasia to be readily available. If adequate palliative care, highly trained doctors, nurses and community members were available and people were adequately informed about death and the management of unpleasant symptoms, then there would not be the impassioned cry for euthanasia.


As the last Inquiry in 1998 concluded: there is an ongoing need to increase the resources for the palliation of symptoms when people are in the process of dying.
This need continues today and is the best alternative to euthanasia.


References
Abbott, T (2009) lntelligence Squared Debate-Euthanasia Feb 3 ABC Fora tv http://www.youtube.com/watch?v=NpCj4F4aFlw
Chen P (2008) Final Exam: A Surgeons reflection on Mortality. Souvenir Press. London.
Smith W (2001) The Age, Wednesday August 22,2001

 

Yours sincerely,

 

 

Dr Nicholas Cooling
Medical Educator
Senior Lecturer, University of Tasmania
General Practitioner

 

 

 

 

 

Biography
Author bios
Dr Nicholas Cooling


Dr Nick Cooling is a general practitioner of 20 years with special interests in intellectual disabilities, allergies and men's health.

 

He has been a medical educator for both undergraduates and postgraduates for 15 yrs with expertise in clinical reasoning, support of challenging learners and assessment.

 

He is currently the Director of Electives and Internationalisation and Senior Lecturer in Medical Practice at the University of Tasmania.

 

 

 

Viewpoints

Viewpoints on euthanasia and assisted suicide from eminent Tasmanians