By Debra Vermeer
More than 30 of Australia and New Zealand’s top palliative care practitioners have joined forces to oppose the introduction of euthanasia and physician assisted suicide, describing the practice as “unnecessary and unsafe”.
A letter, authored by Professor Douglas Bridge and co-signed by 32 other palliative care specialists and medical professionals was published in this week’s edition of the Medical Journal of Australia’s MJA InSight.
It was a response to an opinion piece recently published in the MJA by Palliative Care Specialist, Professor Emeritus Ian Maddocks, who asked whether it was time to consider an integration of palliative care, euthanasia, and physician assisted suicide (EPAS).
“As palliative care practitioners, we know this supposed common ground is both a contradiction in terms and contrary to sound medical practice,” the letter from the 33 practitioners says.
“Supporting people when they are dying is utterly different to intentionally causing them to die. What Professor Maddocks calls ‘a single effective intervention’ is in fact an act of killing.”
The intervention comes as the Victorian Parliament prepares to consider a bill for assisted suicide later this year. Similar legislation has also been flagged in New South Wales, Tasmania and Western Australia.
“The term ‘voluntary assisted dying’ conceals the true nature of what is proposed in the bill before the Victorian parliament,” the practitioners’ letter says.
“The patient’s dying is not assisted; rather, a doctor is required to kill the patient or to help the patient commit suicide. The word ‘voluntary’ attempts to emphasise the patient’s autonomy. Ironically, EPAS legislation weakens patient autonomy by devaluing the final stages of life.
“Further, overseas experience has shown that supposed safeguards within these laws do not effectively guard the autonomy of those most vulnerable to the extension of these laws.”
The doctors also take issue with the sanitising of language in the public debate on EPAS, noting the use of euphemisms such as ‘voluntary assisted dying’ and ‘go gentle’.
“However, the inconvenient truth remains that at the heart of EPAS, the action of the doctor is to end a patient’s life or assist patients to kill themselves,” the letter says. “This has profound ramifications for all health professionals. ‘Do not kill’ has been a core ethical principle of every civilisation and the practice of medicine; we violate it at society’s peril.”
The signatories, who include palliative care practitioners from both city, regional and bush hospitals, and palliative care facilities in Australia and New Zealand, say that quality health care manages the cause of a patient’s distress, rather than ending life.
“In our experience, requests to terminate life prematurely are uncommon and often a cry for help. Such requests rarely spring from uncontrolled pain, but rather from despair, a sense of loss of control, or fear of being a burden on others,” the letter says.
“Evidence shows that a person’s desire for hastened death changes over time and reduces when care is good. It is illogical and immoral to even consider euthanasia legislation before ensuring there is universal access to palliative care.”
They conclude by saying that irrespective of whether EPAS is legalised in Australia or New Zealand, it has no part in the ethical and professional practice of palliative medicine.
The letter, first published by MJA Insight, and a list of signatories can be found here.