Intention the key to care of dying

Jeremy Stuparich* replies to Peter Baume, whose survey and article were published in The Canberra Times last week.

The controversy over the survey on euthanasia has done little to enhance the debate about the nature of euthanasia, nor the ethical issues associated with euthanasia.

Euthanasia is intentionally ending the life of a person, by action or omission.

Ethical treatment of terminally ill people does not involve sustaining the life of these people at any cost. It is perfectly acceptable – and legal – for a patient to refuse treatment which has no therapeutic effect or which is burdensome disproportionate to benefit. It is also true that a doctor is not obliged to prescribe or to maintain such treatment.

The intention behind a decision made to treat, or not to treat a patient, is the important thing. Ceasing useless treatment for a person who has no prospect of recovery is just accepting reality. The intention is not to kill. The direction of treatment can then be changed to concentrate on making the patient comfortable in his or her last days.

Polls are often quoted by euthanasia activists in support of euthanasia. However, opinion polls have significant limitations. While they can discover, or can even be framed to create public opinion, they do not measure the strength of opinion. Neither do they measure the respondent’s level of knowledge of the subject, the importance of the issue to the respondent, nor the commitment behind the opinion. A poll may even oblige a respondent to form an opinion on the spot rather than give a negative answer such as “I don’t know”.

Public confusion on this issue is illustrated by the fact that many people answering polls would think that ethical withdrawal of treatment, which might involve turning off a life support machine, is euthanasia.

If so many people supposedly support euthanasia, why wasn’t this demonstrated in the submissions, received by the ACT Legislative Assembly’s Select Committee on Euthanasia, which overwhelmingly rejected euthanasia?

In the case of the survey recently published by Professor Peter Baume, it was announced that 28% of doctors in NSW and the ACT had practiced euthanasia. However, only 63% of those doctors asked to reply to the survey had actually answered. That means less than 18% of those doctors asked had claimed to have ‘taken steps to hasten death’. But need hastening death be euthanasia? A doctor may have given perfectly ethical treatment to relieve pain which, as a side effect, may have shortened the patient’s life. However, the doctor’s intention was to relieve pain, not to kill.

Professor Baume is patron of the Voluntary Euthanasia Society of NSW, and with issues such as euthanasia, surveys are conducted to prove a point. Professor Baume was keen to claim that a large number of doctors end their patient’s lives because this is one of his arguments for changing the homicide laws.

Not surprisingly, Baume did not ask whether doctors who claimed to have ended their patient’s lives had done so with the patient’s permission.

A Flinders University study of South Australian doctors found that approximately half of the doctors who said that they had ended their patient’s lives also said they had done so without the request of the patient or the patient’s family.

Euthanasia proponents often quote the Netherlands as a model to demonstrate the success of offering voluntary euthanasia. However, the Dutch Government’s own Remmelink Report, issued just a few years ago, demonstrated that over half the cases of euthanasia in that country were involuntary. The patient had not requested to die, but the doctor knew better.

If a small number of doctors are prepared to act this recklessly, there is no reason to believe extending the law to allow voluntary euthanasia would slow them down. It would, more likely, encourage them.

The logical approach to helping terminally ill patients is to address their problems, whether it be pain or loneliness or some other condition, rather than eliminating the patient. Good medical care attacks the patient’s condition, not the patient.

Palliative care is treatment of patients to make sure that they are comfortable so that they can enjoy whatever precious time they have left to live. It is a recognition that even if nothing can be done to cure the patient, there is alway something that can be done to help the patient.

In its submission to the Select Committee on Euthanasia, the AIDS Action Council wrote, quite correctly, that “given our current understanding of palliative care and pain relief, the experience of severe pain in any patient must be seen as a failure by the health care team. Adequate pain relief should never be subject to economies or the convenience of an institution.”

Canberra is fortunate to have an excellent palliative care service. Once we have a hospice and a palliative care specialist, we will be very well off. Last year a position was advertised and an applicant chosen to be the ACT’s palliative care specialist. Unfortunately the position was scrapped before the applicant was appointed and the money was spent elsewhere.

However pain is not the only concern of the terminally ill. Terminal illness involves fear of the unknown for many patients. To address a patient’s anxieties about dying, it is often enough to fully inform and involve patients in decision making on their future treatment. It is the unknown and the unfamiliar which many patients find frightening.

The patient needs to know that she or he is supported by both health workers and family. Even the slightest suggestion of euthanasia from anyone in this group would mean the collapse of the patient’s support structure. How much trust could a patient invest in someone who suggests to them, while they are in a vulnerable state of dependence, that perhaps they shouldn’t be alive at all?

Having euthanasia will not ensure that patients are cared for and that there is adequate provision of palliative care for all. On the contrary, it is more likely to result in just the opposite situation.

Euthanasia is an indication of a failure of care.

* Jeremy Stuparich is president of the ACT Right to Life Association.