11 October 2017

Assisted dying: choosing the lesser of two evils

Clinical

There are few matters in human affairs where the solution is straight forward and easy. Simple solutions to complex problems are often advocated by extremes, both political and religious.

In real life, there are many situations where no entirely satisfactory solutions exist, and one must pragmatically choose between the lesser of two evils.

All problems should be open to human enquiry and be subject to reason. Terminal illness often leads to much suffering and the arguments in favour of assisted dying are motivated by reason, compassion and by humanist tradition. Great evils come from those who are not only sure of their righteousness, but wish to impose their ideas on others.

Most discussions about assisted dying take place in a factual vacuum, by those who have not seen many people die, or those, who are blinkered by dogma. To the latter there is nothing much to say, since their position was not formed by reason. It is, however, unreasonable, that in a pluralist, liberal society, people must suffer to assuage others’ consciences.

Those who believe that suffering ennobles, should be free to avail themselves of suffering. In a liberal society, however, people should be allowed to choose for themselves.

The dreadful facts are that people die in circumstances which would invite prosecution if domestic animals were involved.

Palliation of symptoms is inadequate in a substantial minority of dying patients.  Pain can be relieved more often than nausea, breathlessness, immobility and other forms
of indignity.

For example, people with motor neurone disease tend to inhale their secretions. Society does not impose such punishments for the most serious crimes.

Furthermore, palliation and euthanasia are complementary rather than mutually exclusive.

In countries where assisted dying has become legal, only a small proportion of dying people avail themselves of euthanasia, and only a proportion of those given the means go on to use them.

It is not implied that assisted dying is an entirely satisfactory solution nor that it cannot be open to abuse. Nevertheless, it represents the lesser of two evils, where turning away would expose us to the sin of omission.

Repeated polling shows euthanasia is thought to be morally acceptable by the great majority in our country.

In assisted dying, the patient accepts responsibility for their actions and the doctor merely provides the means for a patient to end their life. Certain safeguards need to be introduced. These are, that the patient is an adult in possession of their faculties, that they are terminally ill without hope of improvement and that depression has been excluded. This excludes children and the potentially curable.

To those who envisage the possibility of abuse (such as that some may be made to feel a burden), there are two points to be made.

The first of these is that present actions should be based on current circumstances and that a lesser evil is preferable to a greater one. Societies continue to evolve in response to technological change. We no longer exorcise demons, nor do we fear the evil eye.

Future generations will adapt to their own circumstances, as we should adapt to ours.  Present laws will not, and should not, endure forever.

The second argument for acceptance of assisted-dying legislation is that the present situation is inequitable and irresponsible.  Euthanasia in various forms continues to occur on a significant scale and will remain with us unless society succeeds in producing stone-hearted technocrats rather than caring physicians.

In general, it is the well informed and the well-to-do who “shop around”, and who thus manage to retain some dignity in their last days and weeks.  Even more alarming should be the fact that euthanasia is carried out furtively and without accountability to society, or even to the dying patient. By default, the decision is often left to the discretion of the attending doctor, and even the patient may not be a party to the decision-making process.

Public disclosure would lead to fewer abuses. It is the present situation, lacking as it does both equity and accountability, which is the too radical. The legislation as proposed by the Victorian government is the less radical option.

We are born in tears. There is no reason why we should not leave in peace and with dignity.

Dr Peter Valentine is a retired cardiologist who spent much of his professional life at the Royal Melbourne Hospital

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12 Comments on "Assisted dying: choosing the lesser of two evils"

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Donald Rose
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Donald Rose
1 month 29 days ago

It worries me that the proponents keep stating they have put together the safest legislation in the world with the most stringent safeguards. It makes me worry about what is happening in other parts of the world. Is unsafe practice occurring? Should we be advocating for other jurisdictions to relook and redo their “ unsafe“ legislation? Do countries that have legalised suicide realise Australians believe their legislation to be inadequate?

Penny
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Penny
1 month 19 days ago

No-one thinks the other regimes are inadequate but our MPs are so conservative and fearful that only extremely conservative laws could get passed.

Chris Hazzard
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2 months 4 hours ago
Being born and dying are possibly the two most significant events in an individual’s life in which the medical profession has an opportunity to ensure a good outcome. After nearly 50 years as a GP, I have found that by being open to the discussion of end of life wishes, it is almost always possible to manage without resorting to assisted dying, although I have in instances accelerated the process The good deaths that I have been involved with have needed time and trust, a knowledge of and relationship with the family and an open, non-judgmental ear to hear what… Read more »
Mark Yates, Geriatrician
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Mark Yates, Geriatrician
2 months 14 hours ago
We can all agree that we should aim such that no one should suffer but is it a reasonable request of the medical profession that we should relieve all suffering in the world.? As well articulated by the American College of Physicians Statement on Physician Assisted Suicide, which opposes such legislation ,this is not within the possibility of medicine. We can address, somatic, psychological and interpersonal suffering but not existential distress, the sense of hopelessness, the belief that biographic life has completed without parallel biological completion. We can also agree that dying and VAS/euthanasia ( which is included in the… Read more »
Paul Jenkinson
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Paul Jenkinson
2 months 15 hours ago

Depressed patients are NOT excluded under the safeguards from proposed legislation in Victoria as you suggest Dr Valentine.
There is No requirement for palliative assessment.
This is Not a question of conscience as is the universal claim of pro-euthasiasts like yourself.
Euthanasia and PAS in other countries is an abuse of vulnerable aged,sick,disabled and mentally unwell people.There is no credible reason that would not be the case here .
No wonder disabled groups are universally opposed to passage of this legislation.

Penny
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Penny
1 month 19 days ago

Many disability groups are comfortable with these laws Overseas and wish to benefit from them should they suffer a terminal Illness, just like everyone else.

Max Kamien
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Max Kamien
2 months 17 hours ago

Says nearly all and says it well-a beacon of reason. I know it is too early in the Victorian legislation to have compassion for those with degenerative neurological diseases who are terminally ill but the terminus is an indeterminately long way off. They too should have the right to decide when they no longer wish to live in a tortured state.

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