In this submission I will argue that the Tasmanian Parliament should not support the Greens’ Dying with Dignity Bill. The legislation is flawed and will most likely be the first step in extending euthanasia to other vulnerable Tasmanians whose “quality of life” does not measure up.
I am not aware of it being mentioned in the media but the Dying with Dignity Bill is virtually identical to the Northern Territory’s Rights of the Terminally Ill Act 1995 (1) and Rights of the Terminally Ill Amendment Act 1996 (2) which were overturned by the Federal Government in 1997.
The only original part of the Dying with Dignity Bill is Section 9, “Requirement to be a Tasmanian Resident”. Otherwise, apart from replacing “patient” with “sufferer” and references to Northern Territory laws and institutions with Tasmanian ones, the Dying with Dignity Bill is basically word-for-word plagiarism of the Northern Territory Acts.
A medically unsound definition of terminal illness
The Australian Medical Association defines a terminal illness as, “An illness which is inevitably progressive, the effects of which cannot be reversed by treatment (although treatment may be successful in relieving symptoms temporality) and which will result in death within a few months at most.” (3)
In contrast, the Dying with Dignity Bill defines terminal illness as “in relation to a sufferer, means an illness, which, in reasonable medical judgment, will in the normal course, without the application of extraordinary measures or of treatment unacceptable to the sufferer, result in the death of the sufferer.” (4)
Whereas the AMA defines a terminal illness as one which cannot be reversed by treatment, the Dying with Dignity Bill’s definition includes illnesses which could be treated but treatment is withheld so the patient dies.
This definition means that diabetes would be a terminal illness since if someone with diabetes decided that his treatment was unacceptable and did not take his insulin, he would die, yet no doctor would think of diabetes as a terminal illness (5). It could also apply to people with disabilities, such as cerebral palsy, which are not terminal illnesses in the medical sense, but if they are not given treatment, such as in the form of being fed, they will die.
These and other concerns were raised in submissions to the Senate Legal and Constitutional Legislation Committee in 1998, yet no attempt, apart from Section 9, has been made to improve the Bill. This raises the question, is the Dying with Dignity Bill simply badly worded and incompetent, or is it intended to lay the foundation for the wider application of euthanasia beyond those who are terminally ill in the medical sense?
The misleading promotion of this bill
Moreover, the Greens have misled the Tasmanian public about what this bill would allow. In a press release dated May 22, 2009, Nick McKim stated that voluntary euthanasia would only be available to “people who are terminally ill and suffering intolerable pain.” (6)
The Dying with Dignity Bill actually says, “A sufferer, who in the course of a terminal illness, is experiencing pain, suffering and/or distress to an extent unacceptable to the sufferer, may request the sufferer’s medical practitioner to assist the sufferer to end the sufferer’s life.” (7) It further defines a sufferer as “a person who has a terminal illness and experiences intolerable suffering as a result” and intolerable suffering as “a profound level of pain and/or distress, that the sufferer finds intolerable” (8).
The legislation does not only cover those suffering from untreatable pain. The wording “and/or distress” which is “unacceptable to the sufferer” allows voluntary euthanasia for those who are not necessarily in untreatable pain, but also for those who are distressed by their illness and its effects.
While physical pain, which cannot be alleviated, is objective, unacceptable distress is more subjective and can vary from one person to another, depending on how well they cope emotionally with their condition.
It is apparent that this is the intention of the legislation by Nick McKim’s endorsement of the right to dies of a motor neurone disease who later committed suicide (9). MND is a terminal illness in which the sufferer’s control over his body progressively deteriorates, however because it affects the body’s nervous system, untreatable pain is not usually one of its symptoms (10).
According to the Greens press release, voluntary euthanasia would be “Only available to people who are assessed by a palliative care expert to confirm that their suffering cannot be treated and relieved.” (11)
This gives the impression that if the patient can be treated with palliative care so their suffering can be relieved, they should not access to voluntary euthanasia. That sounds reasonable but it is not what the Dying with Dignity Bill says. It says that palliative care should “alleviate the sufferer’s pain and suffering to levels acceptable to the sufferer.” (12)
The Bill’s certificate of request says that the sufferer has been informed of the palliative care options and “I am satisfied that there is no medical treatment reasonably available that is acceptable to me in my circumstances.” (13)
This suggests that a sufferer may refuse palliative care and choose euthanasia if palliative care treatment is “unacceptable” regardless of whether or not it relieves physical pain.
The real motive for euthanasia – total dependence syndrome
Many supporters of euthanasia base it on the experience of a family member dying in pain years, even decades, earlier when that person would have probably not died in pain today. Because of advances in palliative care and pain management the whole argument for voluntary euthanasia due to intolerable pain is becoming more and more irrelevant and anachronistic.
Instead, many want euthanasia not because of the physical pain, which can usually be alleviated, but because of the distress and loss of dignity of being a burden and having to be continually cared for, including having to be washed and helped to go to the toilet.
In a 1996 Senate submission Marshall Perron, the former Northern Territory’s Chief Minister and the real author of the Dying with Dignity Bill, said that a major reason for requesting euthanasia was “total dependence syndrome” which is a lack of control and independence and having to depend completely on others (14). Perron wrote, “Even if the perfect palliative care was available to everyone, it would never satisfy those who find the concept of total dependency so unacceptable that they would rather be dead.” (15)
Since Marshall Perron believed that people should be able to choose euthanasia over palliative care, this further suggests that it was the intention of this legislation that a person may refuse palliative care if having to be cared for and depend on others is unacceptable to them and they may choose euthanasia.
The Dying with Dignity Bill states that the sufferer must be mentally competent and of a sound mind (16). Defence lawyers will often argue that their clients are not mentally competent or responsible for their actions because they suffer from some syndrome. This raises the question , are people, suffering from total dependence syndrome and want to end their lives because they do not want to be a burden and have others look after them, truly mentally competent?
Admittedly, having to be continually cared for must feel humiliating for some people, but “total dependence syndrome” is not limited to the terminally ill. People with disabilities, such as cerebral palsy or quadriplegia, are also totally dependent and need to be continually cared for. They are not terminally ill (although they might be classified as terminally ill under the Dying with Dignity Bill’s medically unsound definition). They are isolated and vulnerable people, who, if they do not have enough to deal with, are now being told that their lives are not worth living and they are better off dead.
Euthanasia and the elderly
Many euthanasia advocates would also like to see it extended to the elderly who do not necessarily have a terminal illness. On July 9, 2009, The Examiner reported that the euthanasia campaigner Philip Nitschke said that euthanasia should also be available to “elderly people afraid of getting old and incapacitated.” (17)
In 1995 the Governor General Bill Hayden said about the elderly and euthanasia that “There is a point when the succeeding generations deserve to be disencumbered – to coin a clumsy word – of some unproductive burdens.” (18)
Many elderly Australians feel abandoned and rejected by their families and society. How are they supposed to feel when they are called “unproductive burdens” by the Head of State? These “unproductive burdens” have worked for over 40 years, raised children and paid taxes to support people like Bill Hayden. When they become too old or too sick to keep working and paying tax, some think they are not entitled to be cared for in their years. It looks like their right to life is conditional on their being economically productive members of society.
In an open letter to Sue Smith published in The Sunday Examiner, Dr Tony Large wrote about euthanasia and the elderly, “There is in my view, an extension of the change in social mores, a strong case to be made for the right of people who are chronically and irreparably sick, whose sense of self-worth has gone and for whom life is utterly burdensome or empty, to choose oblivion.” (19)
No doubt many elderly people, who are largely abandoned by their families and shut way in nursing homes, do lack self-worth, feel their lives are empty and say they want to die. However, if we heard that lots of young people lack self-worth and feel their lives are empty, we would not consider passing a law to make it easier for them to commit suicide. We would see what we could do to alleviate the conditions which make them want to kill themselves.
Suicide and talking about suicide are often a cry for help rather than a serious attempt to kill oneself. When the elderly, who feel abandoned and worthless, cry for help and instead, euthanasia advocates take their talk of euthanasia and suicide at face value, it only reinforces their fears that they are no longer wanted and perpetuated the injustice committed against them.
Human rights are supposed to be universal, but only certain groups of people, the terminally ill, the disabled and the elderly, are allowed to have the right to die. There are numerous anti-suicide organisations and programs which are intended to discourage the rest of us from exercising our right to die. There is a double standard. If you are young and physically fit, your life is valuable and worthwhile and you have the right to protection from suicide. If your physical condition does not measure up, you have the right to die.
Another double-standard is the way many of those, who support euthanasia, are also opposed to the death penalty. Even though the lethal injection is basically the same in both cases, a lethal injection for a murderer is supposedly “cruel and barbaric”, but a lethal injection for a terminally ill or elderly person is “dying with dignity”. This is because for some the lives of murderers are considered more valuable than the lives of the terminally ill and elderly.
The Dying with Dignity Bill says that the decision to choose euthanasia is to be made freely and voluntarily (20). In a society, in which the terminally ill and elderly are told they are burdens and their lives are not worth living, it is impossible to ensure that those, who might request euthanasia, do not feel some form of unspoken pressure about being a burden and using up valuable resources while less selfish people do the noble and kill themselves.
It is true that it is expensive to care for the terminally ill, the elderly and the disabled and euthanasia would be cheaper, but do we want to become a society in which we kill people to save money?
The slippery slope argument
A common objection to voluntary euthanasia is the slippery slope argument. If voluntary euthanasia for the terminally ill becomes legal, they argue that it will not stop there, but will be extended to include those who are not terminally ill, the disabled, the elderly, and will eventually lead to involuntary euthanasia.
The clearest proof that the slippery slope argument is correct comes from the mouths of euthanasia advocates themselves who want to see euthanasia extended to include the elderly and even the insane (21). Otherwise, supporters of voluntary euthanasia would be addressing the flaws in the Bill and advocating for a better voluntary euthanasia bill with proper safeguards and restrictions.
The Dying with Dignity Bill has been promoted as though it would only be applicable to the terminally ill in untreatable pain. In fact, it is worded in such a way so that a much wider group of people, who are not terminally ill in a medical sense and are distressed by their condition, would also be eligible. I believe that this bill is intended to be the wedge which will open the door to the wider use of euthanasia which many, if not most, euthanasia advocates clearly want.
Nazi Germany is an example of the slippery slope argument. Before the Nazis came to power, in the 1920s and earlier some German intellectuals were arguing that some lives, such as the disabled, were not worth living. In 1939 Hitler enacted euthanasia laws using carbon monoxide gas chambers. After the euthanasia program was closed down in 1941, many of its personnel were transferred to Poland where they used the same technique to kill Jews.
According to Dr Leo Alexander, who worked with the German euthanasia doctors at their post-war trials,
“Whatever proportions these crimes finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of physicians.
It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as a life not worthy to be lived.
This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, and finally all non-Germans. But it is important to realise that the infinitely small wedged-in lever from which this entire trend of mind received its impetus was the attitude toward the nonrehabitable sick.” (22)
I am not suggesting that euthanasia advocates are Nazis or that if the Dying with Dignity Bill is passed, we will have gas chambers in 20 years. Then again, German euthanasia advocates in the 1920s would have never conceived of the Auschwitz gas chambers. When Josef Mengele’s university lecturers said that some lives were not worth living, they could not imagined how Mengele would have built on their ideas in Auschwitz and applied them to selecting which Jews would be allowed to live for a while based on their capacity to work (23).
Likewise, euthanasia advocates might believe that it should be voluntary and limited to the terminally ill, but they cannot foresee how once the line has been crossed, attitudes and values might change and subsequent generations might build on this legislation.
This is the second inquiry into euthanasia by the Tasmanian Parliament. In 1998 the Community Development Committee in their Report on the Need for Legislation on Voluntary Euthanasia concluded;
“The Committee found that the legalisation of voluntary euthanasia would pose a serious threat to the more vulnerable members of society and that the obligation of the sate to protect all its members equally outweighs the individual’s freedom to choose voluntary euthanasia.
From the evidence presented the Committee found that in the majority of cases palliative care was able to provide optimum care for suffering patients.
The Committee recognises that in a small percentage of cases palliative care is ineffective in relieving all pain, however whilst regrettable this is not sufficient cause to legalise voluntary euthanasia.” (24)
Other than the election of new politicians, who are unaware of these conclusions, nothing has changed since then to justify the introduction of euthanasia laws.
(1) Rights of the Terminally Ill Act 1995, http://www.nt.gov.au/parliament/committees/rotti/rotti95.pdf
(2) Rights of the Terminally Act Amendment Act 1996, http://www.nt.gov.au/parliament/committees/rotti/rottiammendmentact96.pdf
(3) Senate Legal and Constitutional Legislation Committee, Euthanasia Laws Bill, 1996, Submission No. 3229, p 4
(4) Dying with Dignity Bill 2009, p 6
(5) Senate Legal and Constitutional Legislation Committee, Euthanasia Laws Bill, 1996, Submission No. 4031, p 10482-10488
(7) Dying with Dignity Bill 2009, p 6
(8) Ibid., p 5,6
(9) The Examiner, June 8, 2009, p 5, The Mercury, July 4, 2009, p 1-2
(10) Motor Neurone Disease, More Facts, MND Australia, 2007, p 6
(12) Dying with Dignity Bill 2009, p 11
(13) Ibid., p 17
(14) Senate Legal and Constitutional Legislation Committee, Euthanasia Laws Bill 1996, Submission No. 3117, Attachment b, p 2
(15) Ibid., p 7
(16) Dying with Dignity Bill 2009, p 5,8, 9
(17) The Examiner, July 9, 2009, p 11
(18) Simon Chapman and Stephen Leather, The Last Right?, Reed Books, Victoria, 1995, p 69
(19) The Sunday Examiner, May 31, 2009, p 8
(20) Dying with Dignity Bill 2009, p 5,8, 9
(21) The Last Right, op cit., p 69, 117, The Mercury, June 16, 1997, p 19, The Examiner, June 2, 1995, p 16, The Examiner, May 25, 2009, p 12
(22) C. Everett Koop, To Live or Die?, Word Publishing, England, 1987, p 12-13
(23) Gerald Posner and John Ware, Mengele, The Complete Story, McGraw-Hill, New York, 1986, p 9
(24) Community Development Committee, Report on the Need for Legislation on Voluntary Euthanasia, Report No. 6, Parliament of Tasmania, 1998, p 47