Tuesday, May 31, 2011

No place for euthanasia

Paul Russell, the founder of HOPE in Australia, has written an article for the Australia Ageing Agenda website.

Russell, a speaker at the Third International Symposium on Euthanasia and Assisted Suicide, later this week, is suggesting that excellent palliative care not only renders the desire for legal euthanasia, unnecessary, but euthanasia is not an appropriate mix with palliative care.

Russell is correct. His article follows.

No place for euthanasia

I have followed with great interest the discussions on euthanasia in the pages of the Australian Ageing Agenda website and I congratulate the editors for engaging in this most contentious of subjects.

Australian-born Professor of Law, Medicine and Ethics at McGill University in Canada, Margaret Somerville, suggests that we need to re-engage in what she calls ‘death talk’; a healthy conversation about our last moments. It is true that our modern societies have ‘sanitized’ death to a great degree. People die less and less in their own homes in familiar surroundings and with their loved ones than ever before. No matter how caring the hospital, hospice or aged care facility we all know that there’s something a little impersonal about the experience.

We also know that we’re living longer and more likely to die from a chronic illness than our forebears and that our aging population creates pressures on the health system generally and in services for the aging in particular. In that context it is understandable that people should be concerned for their welfare when nearing life’s end. But euthanasia is not a reasonable solution.

It is not a reasonable solution because it is bad public policy to include euthanasia as an ‘alternative’ to good care and pain management. If we have a problem, it’s really more that many doctors lack the skills, knowledge and training about palliative care services or where to go to access such care.

I have a friend who has worked 40 years in a really top quality palliative care and hospice environment. She told me once that in all her years and in all the different and difficult situations her patients have experienced she had never once heard anyone call out for euthanasia. Observing her work I must say I’m really not surprised. Why? Because good palliative care is not only about pain management; it’s also very much focused on empowering the patient and including their loved ones every step of the way. It is, in fact, the fear of loss of autonomy and power that rates far more highly, by a factor of more than four-to-one, than does the fear of unmanaged pain.

If we include euthanasia as an ‘option’ in critical care we’re making the patient the problem and not the condition. Once we begin to cross that line, does anyone really believe that the ‘cheaper, quicker option’ won’t begin to take precedence over good palliative care?

We should also consider the problem of elder abuse. As far back as 1994 a study in NSW found that something like 5% of people over the age of 65 were subjected to some form of elder abuse. Elder abuse has been called the epidemic of the century and is known to cost more than $2.6 billion in the US alone each year as the elderly are swindled out of their savings. Elder abuse can also be physical, emotional and even sexual and it’s not hard to imagine that, if euthanasia were an option, that vulnerable aged people might be swindled out of existence as well.

Readers will remember the famous case of Dr. Harold Shipman who, by his own admission, killed 600 elderly, vulnerable people in the UK by his own hand. With euthanasia we risk giving the protection of the law to this kind of behaviour. We must remember: Doctors are human too and suffer from all of the same kinds of urges and errors that we all might experience.

Ultimately it is the duty that we owe to the vulnerable in our community that, I believe is the strongest argument against euthanasia. Those who cannot speak for themselves; the frail aged, the disabled and the weak deserve our protection. How can we assert a ‘right to die’ if it means that these people will be at risk of losing their right to live? A recent survey in the UK said that 70% of people living with disabilities feared the advent of euthanasia and assisted suicide and more than 50% felt that their social standing would diminish. When people like Baroness Warnock can stand in front of an audience of disabled people, as she did in Belfast a few years ago, and tell them that they had a ‘duty to die’, then we know that the possibility of such abuses is all too real.

Living in a society places demands on all of us. Our freedoms are rightly limited by the fact that we cannot diminish the freedoms and rights of others at the same time. It’s a dynamic balance that must be respected lest society descend into chaos and anarchy. Euthanasia, the ‘right to die’ as it is often called, is one of those issues where we would be putting others at risk. We need to think about our children and grandchildren and those at risk and the society we leave for them and decide against crossing this line.

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