Nicholas Tonti-Filippini lives with a life-threatening chronic condition.
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| Nicholas Tonti-Filippini |
There are three ways in which euthanasia can become lawful: the parliament legislating to make an exception to the criminal law (the Oregon approach); the courts making lenient decisions that result in the public prosecutor deciding to accept medical guidelines for when no charges will be laid (the Netherlands approach); and changes to medical practice to permit fatal neglect – the ‘‘sedate and demand feed’’ approach that brings about a slow death by dehydration or starvation.
The recent decision by Rodney Syme to admit to having supplied the fatal dose that ended Steve Guest’s life indicates a shift from his pursuit of the first way in favour of the second. Presumably, the hope is that a police investigation will result in no charges being laid or, if they are laid, the courts will be reluctant to send an aged urologist to jail. Dr Syme is a far more wily advocate than Australia’s other ‘‘Dr Death’’, Philip Nitschke, who has found himself on the wrong end of the interest of the medical regulators.
Mr Guest’s decision to take his own life, with the help that Dr Syme now admits providing, was very public. He did his best to make his own unlawful manner of dying a euthanasia cause celebre. I engaged in discussion with Mr Guest during that time, and after his death I received a letter from his brothers that identified and implicated the medical assistance he received. At the time I sent copies of the letter to the Director of Public Prosecutions and to the police but received no acknowledgement from either. So I do not expect much to happen, now that Dr Syme has publicly admitted what was already known, that he was involved at the time and the likely provider of the fatal dose.
The Age’s recent reporting confuses the issue of supplying a fatal dose of barbiturate and the much more nuanced matter of prescribing pain relief that also shortens life. There is a world of difference between providing treatment of pain with foreseeable side effects that contribute to a shortening of life, and deciding to end someone’s life with an overdose of a sedative. In the former case, the modern-day issue would only be one of competence, because now there are alternative palliative care measures that avoid the need to give morphine at doses that suppress respiration. Drugs are given in combination and carefully titrated to ensure safety and effectiveness. Palliative care is more likely to lengthen life than to shorten it. People often live longer when their symptoms are relieved and they are well-supported.
Palliative care is also much more than just prescribing drugs. A multidisciplinary effort is involved, especially to deal with the effects of existential suffering. A person receiving palliative care is likely to have a community of carers available. Often that may involve trained volunteers, especially if they die at home with the support of a home hospice service. There are some brilliant initiatives, such as the biography project, in which trained volunteers record interviews with a person receiving palliative care and create a biography. It is a task that gives purpose and meaning and a great legacy for family and friends – the questions often revealing much about a life that was unknown to them.
Throughout the Steve Guest saga, my concern was that he was not receiving the care he could have received if palliative care professionals had been involved. It is a major concern that our Dr Deaths seem to be providing an alternative for chronically ill people that lacks the multidisciplinary support and the expertise needed to manage patient care well. The last person I would want to see at the end of my bed would be a lone Dr Death. I would much prefer to see a palliative care nurse and all that her competent presence implies fora team of expertise and support.
The euthanasia proposals are invariably discriminatory against chronically ill people like me. The proposals create a separate category of people, however we are described, whose lives are contingent upon our will to keep living. This is why most politicians have opposed specific legislation even while claiming to support euthanasia. The fact is that legalising the killing of a small category of people changes everything for us.
Living with a chronic illness means dependency upon a team of people who are actively engaged in supporting and sustaining us, and making life liveable. If euthanasia were lawful, my physician, and the nurses providing dialysis, would at least have to advise me of the option. That would utterly change the relationship. It would be like a football coach declaring that defeat is an option.
People with chronic illness struggle with depression. It is simply part of the advance of disease that loss of ability and increased symptoms are very challenging. Making the adjustment, at each stage of the way, needs all the support we can get. We do not need to have our legislators write us off. We do not need a law that would have family members and caregivers conscious of the other option, and the resultant feeling that we could relieve them of our burden.
What we need is better training of health care professionals in palliative care. No one should be tended by a doctor or nurse who thinks that an opiate or barbiturate is the only option. Competent care and the support of a multidisciplinary team should be a given, wherever a person lives. No one should be reliant on a Dr Death.
Nicholas Tonti-Filippini is associate dean of the John Paul II Institute for Marriage and Family, in East Melbourne.
The recent decision by Rodney Syme to admit to having supplied the fatal dose that ended Steve Guest’s life indicates a shift from his pursuit of the first way in favour of the second. Presumably, the hope is that a police investigation will result in no charges being laid or, if they are laid, the courts will be reluctant to send an aged urologist to jail. Dr Syme is a far more wily advocate than Australia’s other ‘‘Dr Death’’, Philip Nitschke, who has found himself on the wrong end of the interest of the medical regulators.
The Age’s recent reporting confuses the issue of supplying a fatal dose of barbiturate and the much more nuanced matter of prescribing pain relief that also shortens life. There is a world of difference between providing treatment of pain with foreseeable side effects that contribute to a shortening of life, and deciding to end someone’s life with an overdose of a sedative. In the former case, the modern-day issue would only be one of competence, because now there are alternative palliative care measures that avoid the need to give morphine at doses that suppress respiration. Drugs are given in combination and carefully titrated to ensure safety and effectiveness. Palliative care is more likely to lengthen life than to shorten it. People often live longer when their symptoms are relieved and they are well-supported.
Palliative care is also much more than just prescribing drugs. A multidisciplinary effort is involved, especially to deal with the effects of existential suffering. A person receiving palliative care is likely to have a community of carers available. Often that may involve trained volunteers, especially if they die at home with the support of a home hospice service. There are some brilliant initiatives, such as the biography project, in which trained volunteers record interviews with a person receiving palliative care and create a biography. It is a task that gives purpose and meaning and a great legacy for family and friends – the questions often revealing much about a life that was unknown to them.
Throughout the Steve Guest saga, my concern was that he was not receiving the care he could have received if palliative care professionals had been involved. It is a major concern that our Dr Deaths seem to be providing an alternative for chronically ill people that lacks the multidisciplinary support and the expertise needed to manage patient care well. The last person I would want to see at the end of my bed would be a lone Dr Death. I would much prefer to see a palliative care nurse and all that her competent presence implies fora team of expertise and support.
The euthanasia proposals are invariably discriminatory against chronically ill people like me. The proposals create a separate category of people, however we are described, whose lives are contingent upon our will to keep living. This is why most politicians have opposed specific legislation even while claiming to support euthanasia. The fact is that legalising the killing of a small category of people changes everything for us.
Living with a chronic illness means dependency upon a team of people who are actively engaged in supporting and sustaining us, and making life liveable. If euthanasia were lawful, my physician, and the nurses providing dialysis, would at least have to advise me of the option. That would utterly change the relationship. It would be like a football coach declaring that defeat is an option.
People with chronic illness struggle with depression. It is simply part of the advance of disease that loss of ability and increased symptoms are very challenging. Making the adjustment, at each stage of the way, needs all the support we can get. We do not need to have our legislators write us off. We do not need a law that would have family members and caregivers conscious of the other option, and the resultant feeling that we could relieve them of our burden.
What we need is better training of health care professionals in palliative care. No one should be tended by a doctor or nurse who thinks that an opiate or barbiturate is the only option. Competent care and the support of a multidisciplinary team should be a given, wherever a person lives. No one should be reliant on a Dr Death.
Nicholas Tonti-Filippini is associate dean of the John Paul II Institute for Marriage and Family, in East Melbourne.
3 comments:
Tonti-Fillipini is a lucky bastard. He can commit suicide on a whim just by ceasing treatment.
You've gotta be a special kind of sociopath to suffer like Nicholas and oppose genuine end-of-life choice.
Your the one who is pre-occupied with death.
Most people are pre-occupied with living and we don't want guys like you thinking that we are better off dead.
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