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

Medical viewpoints
Viewpoints from eminent Tasmanians...
Medicall viewpoints

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

Video interview
Q and A
with Prof. Ray Lowenthal

Prof. Ray Lowenthal, a Clinical Professor in the School of Medicine with over 30 years experience in assisting patients in their final stages of life, clears up misconceptions around uncontrolled pain and the use of morphine and considers whether safeguards would be sufficient to protect the vulnerable

Written article
Ray Lowenthal

An unnecessary and dangerous law

Prof. Ray Lowenthal

Clinical Professor, School of Medicine and Member of the Menzies Research Institute

reminds the Committee of its duty to protect the weak...

 

 

Key Reasons why Euthanasia should never be legalised:
  • It is unnecessary to legalise voluntary euthanasia. Physical symptoms, especially pain can be well controlled in virtually all dying patients.
  • Once immediate symptoms are controlled, each day is a precious gift for the dying person.
  • It would poison the atmosphere between doctors and their dying or seriously ill patients.
  • It would threaten the frail and disabled.
  • It would open the door to unscrupulous relatives and misguided doctors. Weakened patients are vulnerable to coercion.
  • Law makers and medical practitioners share a common goal of protecting the weak and vulnerable.
  • It would send a message to dying patients that their lives are of no value.
  • Almost uniformly all legislative inquiries into the legalisation of euthanasia have reported against the legislation.
  • Most medical associations are against legalising euthanasia.
  • Doctors are not trained to kill – it legalises murder or manslaughter by doctors.
  • Not all medical practitioners could be trusted to end lives in a wise manner.

 

 

 

SUBMISSION TO THE JOINT STANDING COMMITTEE ON
COMMUNITY DEVELOPMENT INQUIRY INTO THE
DYING WITH DIGNITY BILL 2009


PROFESSOR RAY LOWENTHAL AO


I write in my capacity as a medical practitioner for over 40 years, and a medical oncologist (specialist in cancer medicine) for over 30 years. My training was at the University of Sydney, and since graduation I have worked in NSW (3 years), England (7 years) and most of the remainder of the time, since 1975, in Tasmania. In addition it has been my good fortune to be able to have had several periods of sabbatical leave of 3 to 6 months each, to gain experience in other medical systems; on these occasions I have worked in the USA, Germany, France and Israel. Thus I have had the opportunity to observe medical practice in a number of countries and jurisdictions. I am or have been a member of a number of national and international medical organisations, and I have been actively involved in clinical and laboratory cancer research with over 130 papers published in the peer-reviewed scientific literature. My career highlights have included periods as president of the Cancer Council Australia (2001-2004) and as president of the Tasmanian branch of the Australian Medical Association (1996-98). Just recently I have stepped down as Director of Medical Oncology at the Royal Hobart Hospital after nearly 20 years, but I am continuing as a full-time staff specialist and remain active in research.


During my career it has been my privilege to have been involved in the care of several thousand cancer patients. My involvement takes in the early stages of investigation and diagnosis, the middle stages of short- and long-term treatment, and the later stages of survivorship or palliative care. Some of the patients have been cured and a large number have had their disease and its symptoms controlled for a period, but in the end many have died of their disease, that being the nature of cancer.


From this large personal experience, from a wide reading of the literature, and from actively having been involved in the euthanasia debate, it is my strong opinion that the introduction of legislation to legalise active voluntary euthanasia or physician assisted suicide would be not only wrong but dangerous. It would be wrong firstly because it is unnecessary - despite public fears and despite media misrepresentation physical symptoms, especially pain, can be well controlled in virtually all dying patients these days. (This is not to deny that many dying patients may suffer mental or 'existential' pain.) It would be dangerous because it would poison the atmosphere between doctors and their dying or seriously ill patients, it would threaten the frail and the disabled, and it would open the door to abuse by unscrupulous relatives and misguided doctors. Legalisation of euthanasia would be a temptation to economic rationalists to reduce costs by shortening patients' lives and would send a message to dying patients that their lives were seen by the community as of no value.


In my long experience virtually no dying patient has requested that their death be hastened, once their immediate physical symptoms were controlled. (It's notable that in the Northern Territory experience of 1996-97, no patient sought euthanasia on the grounds of uncontrolled pain.) On the other hand, relatives have from time to time (albeit rarely) taken me aside and, whispered 'Can't you do something?' One can easily see that in many cases the relatives would not be disinterested observers. To end a patient's life to appease the suffering of a relative, or for the relative's benefit, clearly would be unethical. No matter what safeguards ere in place, a weakened patient would be vulnerable to coercion. In these circumstances a selfless critically ill person might well be persuaded to agree to have her life terminated to end the apparent suffering of loved ones.


In writing this I acknowledge that the Dying with Dignity 2009 bill now before the Tasmanian Parliament includes a number of safeguards, and it is clear that its authors are conscious of the dangers inherent in similar legislation considered elsewhere. None the less, no legislation can properly guard against risk of abuse. I am especially conscious of elderly women who may wish to have their lives ended to ease the perceived suffering of their relatives. Further, it must be acknowledged that not all medical practitioners could be trusted to use the power to kill their patients in a wise manner, if that is possible at all.


Indeed, the more one considers the issue, the more potential pitfalls to safe legislation become apparent. That this is so can be seen from the numerous legislative enquiries that have been held on the subject in recent decades. Almost uniformly these enquiries have reported against such legislation, even though when first constituted the members of such enquiries have mostly approached the issue favourably. Apart from the previous enquiry held by the Parliament of Tasmania (1997), there have been notable enquiries by the South Australian Parliament and the House of Lords, the latter being a particularly detailed investigation. Furthermore, almost all large medical associations regard active euthanasia or assisted suicide as unethical; they include the World Medical Association, the American Medical Association, the British Medical Association and the Australian Medical Association (AMA).


While the informed, the intelligent, the powerful and the eloquent can make out a strong case for the legalisation of euthanasia for their sakes, one must not overlook those who are not so well equipped to speak for themselves. Law-makers and the medical profession share a common goal of protecting the weak and vulnerable. If active voluntary euthanasia were legalised, the frail, the very elderly and the severely disabled would be at risk. While euthanasia often seems an attractive option to those who have no immediate need to consider it deeply, it is very rare for dying patients to request it. Indeed, once immediate symptoms are controlled, for dying patients every extra day is a precious gift, allowing goodbyes to be said and stories to be told.


The development of palliative care services has made a huge difference to dying in our community. In Tasmania in 2009 we are fortunate to have both specialised palliative care nurses and specialist palliative care physicians who can visit patients at home and provide ready advice by telephone. It is no coincidence that the previous Northern Territory euthanasia legislation was set up at a time the NT had no palliative care services whatever. The instigator of that legislation, Mr Marshall Perron, has even been quoted as admitting that when he introduced the legislation into the parliament he had never heard of palliative care.


So if control of pain is not the reason for such legislation what is? Autonomy is often given as the reason - rational, thinking adults should be free to choose the time and manner of their departing from this earth. However nowhere is this a recognised right. Indeed, the USA Supreme Court in one of its rare unanimous verdicts indicated there was no such right. Furthermore, any civilised society the cares for its citizens knows that the killing of one person by another, in whatever circumstances, is always of concern to the community; it is not a private matter.


Legalisation of active voluntary euthanasia would potentially poison the relationship between doctors and their seriously ill patients. Evidence of the way in which the practice of euthanasia can interfere with patients' confidence in their doctors was shown in the NT where Aborigines feared admission to hospital while the law was in place, thinking they would be the subject of involuntary euthanasia; and the Netherlands, where euthanasia is quasi-legal and where some hospital patients hang a sign over their bed stating "I am not for euthanasia". It's also of note that in jurisdictions where such legislation has been introduced in recent years, such as Oregon, it is used extremely infrequently: it has been estimated that less than 0.1 % of deaths (that is, less than 1 in 1000) in Oregon make use of the legislation. It's a recognised legal dictum that exceptional cases make bad law.


Evidence of the manner in which euthanasia laws no matter how well crafted can be abused can be shown by many examples. A recent study of the Swiss system has revealed that 20% of the British who made use of 'suicide tourism' and died in the Dignitas Clinic in Zurich were not suffering from a terminal illness at all. In the NT many of the patients who sought euthanasia were shown to be lonely and depressed, even though they may have been given the required certificate to indicate that their mental health was adequate. The Dutch system remains of especial concern, it being freely admitted that non-voluntary euthanasia (the killing of ill and demented patients by their doctors without the explicit request and permission of the patients) indeed takes place.


The whole training and practice of doctors are directed at comforting and caring for their patients, not killing them. Legalisation of active voluntary euthanasia would in fact legalise murder or manslaughter by physicians. It would be a grave error to so overturn the fundamental principles of our civilised society as to allow the killing of one person by another. And consider, can all doctors be trusted with this power?


The Previous Tasmanian Enquiry
From May, 1996 to May, 1998 it was my privilege to serve as President of the Tasmanian Branch of the AMA. During that time the Tasmanian Parliament held its enquiry into 'the need for euthanasia legislation in Tasmania'. I was responsible for coordinating the AMA's submission to that enquiry. As is well known the Committee of Enquiry did not recommend in favour of euthanasia legislation. Instead, it recommended increased resources for palliative care services to ensure their wide availability throughout the state; it recommended an education campaign to ensure the public were informed of their already existing rights to refuse treatment, and of the availability of palliative care services; and it recommended amendments to the Guardianship Act to allow for the appointment of persons to speak for patients when unable to do so. In my opinion such decisions represented a wise compromise between the differing points of view. We can be proud that excellent palliative care services are now widely available in Tasmania.


I urge the Committee to consider its duty to protect the weak and vulnerable in our society and to reject the notion of euthanasia legislation. It is not needed and would be dangerous law.


If the members of the Committee thought it would be helpful, I would be delighted to have the opportunity to respond to questions in person.


Ray Lowenthal, AO, MBBS, MD(Syd), FRCP, FRACP, FAChPM
31 July 2009

Biography
Author bios
Prof. Ray Lowenthal

Prof Ray Lowenthal graduated MBBS from the University of Sydney in 1965. Since 1975 he has been based in Hobart, Tasmania, where he has appointments as haematologist/oncologist at the Royal Hobart Hospital; Clinical Professor and Member of the Menzies Research Institute at the University of Tasmania; and Director of the Tasmanian Statewide Bone Marrow Transplantation Service.

 

He was the first chairman of the Australian Leukaemia Study Group (1982-84). From 2001 to 2004 he served as President of The Cancer Council of Australia. In 2005 he was the recipient of the Medical Oncology Group of Australia’s Cancer Achievement Award and for 2005-06 he was the Bob Pitney Travelling Fellow for the Haematology Society of Australia & New Zealand. The HSANZ made him a life member in 2008.

 

He has been author or co-author on over 130 peer-reviewed scientific papers as well as conference abstracts and book chapters and a book for the general public Cancer: What to do about it (1990). In the Australian Queen’s Birthday honours list for 2006 he was made an Officer of the Order of Australia (AO) “for service to medicine in the fields of oncology and palliative care”.

Viewpoints

Viewpoints on euthanasia and assisted suicide from eminent Tasmanians