DOE: Letter to SA Parliament re Medical Defences Bill

Dear,

We the undersigned medical professionals wish to make known our strong opposition to euthanasia and assisted suicide becoming available by law in South Australia.

We regard the most recent bill, the Criminal Law Consolidation (Medical Defences – End of Life Arrangements) Amendment Bill 2011, as particularly dangerous because, if passed, it would place vulnerable patients at even more risk than from previous bills.

We note that the conditions that must be proven so as to constitute a defence for euthanizing or assisting the suicide of a patient are so easily met that the result will be broad access to euthanasia and assisted suicide in the community.  This will take place without scrutiny and with no second opinion, psychiatric assessment or consultation with a palliative care specialist. There is also no provision for monitoring or reporting.

With regard to Section 13 subsection 1 (b); who is to decide that the situation is irreversible?  If it is to be a medical decision, differences of opinion are likely.  The reality is that we are often wrong.

If it is to be sufficient that an individual says “this is intolerable” then we must recognise that situations change and responses change.

The greatest abuse arising from permitting euthanasia and assisted suicide would be the taking of lives of any who did not wish to be killed.  That this could happen is illustrated by two points:-

1.  Abuse of the aged is widespread in the community

The Advertiser 12/5/09 quotes the Aged Rights Advocacy Service stating that about 1 in 20 people over the age of 65 is physically, emotionally, financially or sexually abused, usually by their children: financial and psychological being the most common.

Also in The Advertiser 3/9/09, Council on the Aging Executive Director, Ian Yates, is quoted as saying “abuse of the elderly is much more widespread in the community than people think”.

Hence it is not difficult to see that subtle or unsubtle pressure could be exerted on the frail elderly by relatives or friends.  A doctor from St. Christopher’s Hospice in the United Kingdom makes a cogent point when he says “I am very concerned about those patients who feel themselves to be a burden though they want to live.  There may not even be any external pressure but they feel a pressure”.

This Bill, if passed, would lead to great danger to the most vulnerable in our society.  These people may not want to die but feel so pressured that they request death.  It is particularly worrisome that the current bill would permit a medical professional to defend themselves from prosecution by arguing that their patient had merely implied they wanted assisted suicide.

2.  Impossibility of providing adequate safeguards

We want to make it clear that the ultimate “choice” to die by euthanasia would never be the prerogative of the patient.  No matter how much it might be said that people want to “choose”, the decision would ultimately rest with the requesting and specialist practitioners – not the patient.

The Key’s Bill provides no protection for patients who feel that life has become intolerable, even though that belief may be fuelled by depression, anxiety or other mental health issues.  Requests for euthanasia or assisted suicide often cease when patients receive proper care.  However, this Bill undermines the delivery of such care by providing a less demanding alternative.

We note the well-recognised findings that in The Netherlands and Belgium patients who have not requested euthanasia have nevertheless received it.  This Bill, by providing a defence for euthanasia and assisted suicide under circumstances where the only witness is the medical professional, leaves open the possibility for the same to occur.

In support of our view recommending against permission for voluntary euthanasia or assisted suicide are the findings of five parliamentary inquiries who found that the risks to others who did not wish to die could not be eliminated.

•  Report of the Select Committee of the British House of Lords 1994

•  New York State Task Force on Life and Law 1994

•  Of Life and Death: report of the Senate of Canada 1995

•  Report of the Community Development Committee of the Parliament of Tasmania 1998

•  Report of the Social Development Committee of the Parliament of South Australia 1996

•  Report of the Holyrood Committee of the Scottish Parliament November 2010

The reports of the first two of these committees were unanimous even though they both included members who initially approved of euthanasia.

In the Tasmanian Inquiry, four of the five MP members personally supported euthanasia, but after lengthy deliberations, the final report unanimously recommended against legalising voluntary euthanasia because it had found that “it would not be possible to frame legislation with sufficient safeguards” to protect others with a reduced quality of life who did not wish to die.

Palliative Care

This is one of the great advances in modern medicine.  It is becoming much more available, not just in hospices or specialised units in major hospitals and is now part of the curriculum of the medical under-graduate course.

But more needs to be done.  In particular, the advocacy for good basic palliative care for the elderly needs to expand more strongly to our general public and to the staff of our aged care institutions.  Older persons are dying miserably in hospitals and nursing homes in this State, still being given treatments they do not want nor need and struggling on with discomfort when they would be happy to cease such treatment.

The answer is not to kill them as this legislation would permit, but to bring them effective comfort through compassionate and skilled palliative care, letting them die in peace.

Palliative Care relieves suffering in most patients.  In a very small minority pain cannot be completely relieved without sedation.  But this fact should not outweigh the overall good of society from not exposing its weaker members to the evident risk of non-voluntary killing.

We sincerely request that you reject any attempt to enact euthanasia or assisted suicide legislation in South Australia and in particular do not create a medical defence those carrying it out.

Yours sincerely,

Dr Daniel Thomas MBBS, B Med Sci (Hons), FRACP, FRCPA
Haematology Consultant, Cancer Specialist

Mr Robert Britten-Jones, AO MB BS FRACS FRCS(Eng&Edin)
Emeritus Consultant Surgeon at the Royal Adelaide Hospital

Signed on behalf of the full list of signatories (below):

Co-signatories:  (listed on original)

  Letter to SA Parliament re Medical Defences Bill