Friday, April 1, 2011

'Unproductive burdens' still have a right to live

Australian, Dr. David van Gend has written an interesting article about euthanasia that was published today in the in Australia. I don't like the title - 'Unproductive burdens' still have a right to live because viewing a person based on their productivity is a utilitarian attitude that demeans the nature of the human person. But I assume by the article that van Gend agrees with my statement.

The fact is that when euthanasia is debated, the elephant in the room is the question of economics and "quality of life". Who determines the quality of life of others?

It is also interesting that the debate concerning the legalization of euthanasia in Australia is very similar to the debate elsewhere. What is important is that legalizing euthanasia will result in some vulnerable people being killed without consent and it will extend new avenues for elder abuse and the abuse of people with disabilities.

The article is republished in full:

'Unproductive Burdens' still have a right to live
"Doctors who treated the law with contempt when euthanasia was illegal would be even more comfortable and relaxed about abusing the practice once it was socially approved."

There was a moment during the last national debate on euthanasia that deserves to be revisited by a new generation of legislators, a moment that crystalised fears that the so-called right to die would come to be felt by the frailest among us more as a "duty to die".

It was 1995 and our then governor-general, Bill Hayden, was addressing the College of Physicians during debate on the Northern Territory's euthanasia laws. The scene was significant, since the dual concern with euthanasia is the corruption of the relationship between the state and its most vulnerable citizens, and between doctors and their most vulnerable patients.

Our head of state urged doctors to support euthanasia not only as a right, but also as a positive duty towards society. He reflected on past cultures where the elderly would take their lives when their usefulness had passed, and declared of our own culture:
"There is a point when the succeeding generations deserve to be disencumbered of some unproductive burdens."

The next day a retired state governor, Mark Oliphant, publicly supported Hayden's astonishing message to "unproductive burdens" that they should do the right thing by society. This is the callousing of social attitudes, the insidious pressure on the frail and demoralised, that we could expect within a culture of mercy-killing.

A year earlier in Britain, a House of Lords select committee on medical ethics completed the most thorough enquiry into euthanasia ever undertaken, and concluded in stark contrast to Hayden:
"The message which society sends to vulnerable and disadvantaged people should not, however obliquely, encourage them to seek death, but should assure them of our care and support in life."
This committee began with a majority in favour of euthanasia, but ended by rejecting it as unsafe and corrupting public policy:
"It would be next to impossible to ensure that every act of euthanasia was truly voluntary. We are concerned that vulnerable people - the elderly, lonely, sick or distressed - would feel pressure, whether real or imagined, to seek early death."
Doctors have no illusions about the pressures that can be felt by vulnerable people.

One patient of mine, a woman with disabilities and minimal self-confidence, received a cruel letter from a close relative effectively telling her she should be dead, and demanding certain arrangements in her will. She then developed cancer.

Consider such family dynamics in a setting of legalised euthanasia, and ask what the "right to die" would mean to a cancer patient so isolated and intimidated.

And the public should have no illusions about the corruptibility of doctors if they are given authority to take life.

According to the Dutch government's own data, doctors in The Netherlands put to death several hundred patients a year without any explicit request, even where the patient is competent to give or withhold consent.

The Dutch officially legalised voluntary euthanasia in 2002 and some claimed that bringing euthanasia "out into the open" in this way would reduce such abuses. Not at all. The Netherlands' 2007 report on euthanasia states that the rate of patients killed "without explicit request" since legalisation in 2002 is "not significantly different from those in previous years".

And why would we expect a reduction?

Doctors who treated the law with contempt when euthanasia was illegal would be even more comfortable and relaxed about abusing the practice once it was socially approved.

Professors of psychiatry in Brisbane, Frank Varghese and Brian Kelly, warned of the impossibility of protecting patients from "the doctor's unconscious and indeed sometimes conscious wishes for the patient to die" once doctors run the state machinery of mercy-killing.

Even the assertion by euthanasia advocates that psychiatric assessment will protect patients by detecting any depression that might be marring the patient's judgment is shown to be a sham, on the available evidence from the US State of Oregon and the Northern Territory.

In Oregon, for instance, of the 49 patients who died by physician-assisted suicide in 2007 not a single patient was referred for psychiatric assessment prior to taking their lethal drug. In the NT during the period of legal euthanasia (July 1996 to March 1997) there were four deaths, all presided over by euthanasia advocate Philip Nitschke.

Psychiatrist and palliative care specialist David Kissane reviewed Nitschke's cases and made this assessment of the so-called "safeguard" of compulsory psychiatric assessment:
"Nitschke reported that all patients saw this step as a hurdle to be overcome. Alarmingly, these patients went untreated by a system preoccupied with meeting the requirements of the act's schedules rather than delivering competent medical care to depressed patients."
More than once I have urged Nitschke to study palliative medicine, to broaden his awareness of what can be done for people with advanced disease. When we look after such patients well, thoughts of euthanasia often fade. Then, in the words of one hospice patient who had asked me for euthanasia only the day before, but was now pain-free, "It's a different world, doc."

However, I would not use the argument against euthanasia that "palliative care can ease all suffering". We cannot ease all suffering in dying any more than we can ease all suffering in childbirth, even though we have made enormous progress.

Rejection of euthanasia is not dependent on perfecting palliative care for all patients.

Its rejection is on the grounds of injustice to the weak, as Kevin Andrews made clear on presenting his Euthanasia Laws Bill 1996, which overturned the NT's legislation:
"The people who are most at risk are the most vulnerable, and a law which fails to protect vulnerable people will always be a bad law."
We must reject euthanasia both as a corruption of the doctor-patient relationship and as an insidious oppression of society's "unproductive burdens".

And parliament must reject the Greens' trivialisation of such a momentous issue, their proposal that five politicians on Norfolk Island or nine in the ACT assembly should have authority to transform national culture on a matter of life and death.


KiAnnaFleur said...

It's interesting that those politicians in Australia bring up the old practices of primitive cultures. I was aware of the practice among the indigenous people of the North American Arctic Circle (Eskimos and Innuit), but that was at a time when it was a matter of life and death for others in the group. As a grandmother, I would give my life for my grandchild to survive a winter of little food. I would *not* take food from my grandchild, and that was a real choice for people of that place once upon a time. But they're not like that today, and they struggle with suicides that are a remnant of the attitude that one should not burden the group. In old days, they mourned those who sacrificed themselves, but it was with gratitude to the dead. Today, they mourn those who convince themselves that they are burdens, but it is with anger and frustration that people, especially young people, are taking their lives for no need and no good to the group. They no longer face starvation winters, so as far as they are concerned, there is no reason for suicide. The politicians who *exploit* ancient customs for their own antisocial ends are reprehensible. I don't doubt that if I showed that quote to an Eskimo in Alaska, the Eskimo would be furious at such an insult.

Unknown said...

With all of the discussions as of late regarding depopulation, economic crises, possible food shortages, U.S. Republicans' plans for cuts to Social Security and other social programs to help the elderly and the disabled, scarcity of help available worldwide for the like, attitudes of disdain towards us 'sponges' broadly popularized seemingly daily...Why would a depressive who's run the gamut on treatments and still faces a desire for sleep, a deep sense that they've overstayed their visit, be viewed as wrong--or much less their doctor be viewed as corrupt-- for causing a completion in the process of being for one...and creating an increased availability of resources for a fellow human who has a true possibility of thriving?? There are people who've been so sad and broken, disenchanted, lost and confused as to how to assimilate since even their toddler years forced by 'civilized and moral' folk to continue taking in air. Being born of a Catholic mother, being neglected and severely abused, and labeled autistic, and being despised by one's siblings wholeheartedly just for existing... I can assure you that guilt can, indeed, make a person continue to breath...but others forcing their views on someone who just wants to stop feeling so much pain--who just wants to stop the awareness that they are not even really capable of being of much use or appreciation to the general populace and are for lack of a better phrase "just taking up space"--who are "We" to force any will on them? I applaud the Dutch. I would gladly step down to ensure a place at the proverbial table for a little one who is wanted and who will thrive. It is a very PERSONAL decision, and I hope there is a method developed that protects those seeking the procedure from those against it...and protects those who still have SOME hope within themselves from being manipulated or forced into the process like we as a society put an end to unwanted animals. A retroactive abortion granted those who really should've never been, would be a comfort and would provide validation to a person who just cannot reconcile why they came to be here through no action on their soul's part. There is no single recipe for all...not all appreciate every flavor. Under-water a lilley, and it will shrivel and die; OVER-water a cactus for a spell, and it will...shrivel and die. Euthanization would at least reduce traumatic discoveries of successful suicides by family and/or friends, as well as unsuccessful suicides possible effects beyond outside discovery, possibly creating a further burden on the failed and/or family/society by way of effected physical disability via botched suicide. No single recipe, no solitary fix. Dylan Thomas cannot speak for everyone...and not only because he's deceased.