Live and Let Die
You might have thought there was a real debate going on in Australia about voluntary euthanasia but, as Deb Campbell explains, you’d be wrong.
Voluntary euthanasia (VE) has been on the national agenda for more than 20 years, since Australia had the first VE law in the world in the Northern Territory in 1996. This law was repealed by the federal Parliament in 1997. Polls1 show that more than 75% of Australians want changes to the laws relating to death.
But the key question of what sort of changes should they be is not being satisfactorily asked or answered by either side of what passes for the Australian voluntary euthanasia debate. On the one hand, we have those opposed to change, who can be loosely divided into two camps. First, there are those arguing from a theological perspective. Most monotheist religions – Christianity, Judaism and Islam – oppose giving people the right to end their lives when they choose, although some Protestant churches see a need for limited reform. Those opposed to VE on religious grounds have views rooted in hard line theology: that human life is a gift from their god and one that none of us - believers or not - must be allowed to refuse.
The Australian constitution makes it clear that no religion should govern the nation or its laws. Then there are those who argue from a secular perspective, and claim that any change to the law would result in the murder of the old and infirm by greedy relatives and governments intent on cost cutting in health and aged care. Since our 1996 laws were repealed, Canada, several European nations and US states have passed laws allowing forms of VE. Nowhere is there evidence of murder, coercion or other mistreatment of those eligible to use those laws.
We do have advocates arguing for VE law reform, but those with the loudest voices are advocating for reforms that they claim would allow ‘dying with dignity’, but only for a very, very few. Dying With Dignity Victoria, Dr Rodney Syme and, most recently, Andrew Denton are seeking legal changes that would protect doctors from legal sanction when they assist the literally almost dead to die.
What you might have thought were reform proposals designed to give us all control over our own lives and deaths would only help those who:
• have a diagnosed terminal illness, and
• are in the very last stages of that illness when ‘death is imminent’, and
• are not suffering from any mental illness, including depression, and
• are not disabled in any way, and
• have the written permission of at least two, or in some proposals three doctors in the same room at the same time, one of whom is a psychiatrist.
Got it? Just how many of us do you imagine such a proposal is going to help? Take just one potential problem – how many of you have met with your doctor and your specialist in the same room at the same time? Have your GP and specialist ever even met? So, even though a debate appears to be occurring when Andrew Denton discusses the issues, what he is actually saying is the same old mantra of the Dying With Dignity movement: doctors will decide when you die, and that will be when you are nearly dead anyway.
It is pretty clear that what is supposed to be the ‘Yes’ case is not Yes for you and me – it is the Not Only But Also case – not only must you be very nearly dead already, but also you must get permission from doctors. Happily there is a real Yes case, but up to now the only person arguing for it, and actually helping many people to make the choice themselves is Dr Philip Nitschke. His book The Peaceful Pill Handbook and his organisation, Exit International, have helped many people obtain the information they need to make their own decisions about their deaths. He continues to do so, despite being required to give up his licence to practice medicine by the Medical Board of Australia.
Most Australians die in hospitals, others in nursing homes, and in their own homes of course, which is what most of us say we want. Remember that we do have control over all other aspects of our medical treatment, and we can maintain that control even after we are incapacitated by serious illnesses, which may render us unable to speak for ourselves, by empowering others to act for us. Yet, we actually have very little control indeed over our own deaths.
Suicide is not illegal in Australia any more, but the unceasing efforts to minimise it in Australia now mean there has been a blurring of the very real differences between what are often desperate acts taken by people suffering from serious mental illnesses, and what I call chosen deaths.
In my essay, Doing Us Slowly, I advocate what I call the ‘Us’ model, which proposes the re-legalisation of Nembutal to allow anyone over 60 or suffering from a terminal illness to go to their GP and get a prescription for it, which we could then hold as long as we wished. If and when we want to, we could go to the chemist and have it filled, having shown the proper ID – as we do now for pseudoephedrine here in Victoria. Then we can keep the drug securely until we may decide to use it – or not. Simple really: choice about death would really be personal.
In a way, the current VE debate is everywhere but nowhere. It is in literature, in the news, popular culture, in academia and in the commentariat; but there is no end in sight, no mainstream political support. The core aspects of the arguments never develop, change or evolve in any real way. More than 25 attempts to change the laws in line with the Not Only But Also approach have failed. The issue seems to be part of the zeitgeist – but without anywhere to go. The conversation is stalled by a tyranny of political cowardice, lingering religious dogma, media inertia, and the mistaken belief that we, Australian adults, need permission to die.
Doing Us Slowly does not pretend that these issues are without complexity. On the contrary, it explores the intricacies of this intensely personal decision: a decision that many might wish to at least contemplate in the face of modern medicine and its wonderful and ambiguous effectiveness. While most will wish to live for as long as possible, others can and do wish to die, to be done. As the recent deaths – long-planned – of Peter and Patricia Shaw show us, what are counted as ‘suicides’ by Australian government statistics were in fact chosen deaths: conscious, deliberate decisions made by sensible, thoughtful people. If only their daughters, who supported their decision, could have been present to see them off. But no, had they been so, they could have been liable for criminal prosecution for assisting suicide. This too needs to change.
Many Australians want reform of the laws relating to death, but few realise that the current VE debate is not about you and me at all. It is an ideological struggle about us, over our bodies if you like, being conducted by theologians and doctors. Meanwhile, politicians and the media wash their hands of the issue as ‘fraught with difficulties’.4 It may serve us all to start asking: if these guardians of our democracy are unable to discuss, let alone directly address difficult issues, what, if anything, are they good for?