Time for euthanasia to be regulated
By David Swanton
Posted Friday, 29 August 2014 in ON LINE opinion - Australia's e-journal of social and political debate
Posted Monday, 11 August 2014 in The Canberra Times
In recent weeks, Australia's most outspoken voluntary euthanasia campaigner, Philip Nitschke, has been subjected to harsh criticism from some euthanasia supporters, including the ACT's Mary Porter and the chairman of beyondblue, Jeff Kennett.
Given that this criticism is based around actions concerning a recent case of 'rational suicide', an issue that has been raised before with barely any public criticism, I suspect these commentaries are part of a broader campaign to undermine Dr Nitschke, the director of Exit International.
It's hard not to be perplexed by the hypocrisy of this criticism. As people with public standing and substantial influence, why don't Ms Porter and Mr Kennett work to fix the voluntary euthanasia regulatory system, rather than complaining about Dr Nitschke operating in an unregulated environment? There are options the pair can explore.
Does Dr Nitschke push the legal limits in the current environment? Yes. Are there risks that people who are depressed, not elderly or terminally ill might access information in the unregulated environment? Yes. But these risks are mitigated somewhat as Exit members are required to be either seriously ill, notionally older than 50, and not clinically depressed. However, exceptions are permitted, and I'm one such exception.
Since I was in my thirties, I have been actively supportive of the fundamental human right to choose what is right for one's own body. I'm not terminally ill and my mental state has never been questioned.
If I had committed suicide, should Dr Nitschke be blamed? No, as I have shown no outward signs of depression, Dr Nitschke is not my physician, and people of sound mind should be responsible for their own actions.
Rational suicide is not a new issue in Australia, but the level of public debate on the issue is immature. For three years, Lisette Nigot warned Dr Nitschke that she would take her life at 80 because she will have had enough by 80. A movie (Mademoiselle and the Doctor) documented her case.
Iris Flounders chose to take her life when her terminally ill husband, Don, took his life with Nembutal. Neither Iris or Lisette were terminally ill, nor were they depressed. In both cases, the women emphatically told Dr Nitschke, friends and relatives to mind their own business.
There was barely any adverse commentary in the press on these matters, although there were ructions in the pro-euthanasia community regarding Lisette Nigot's case, particularly around where the line ought to be drawn. Dr Nitschke was then understandably surprised and caught off guard in his response to media criticism when ambushed on the most recent case of rational suicide.
We should note that while many people commit suicide, it is not illegal. It was not possible to dissuade these women from their suicides, and regrettably, this will sometimes be the case.
While legislative reform is the main objective of the state and territory-based Dying with Dignity organisations, it is also a desired objective of Exit International. Much of Dr Nitschke's time, however, is devoted to complementary activities, in particular research and providing information on end-of-life options to the elderly and terminally ill.
In pushing the boundaries of what is legally permissible, Dr Nitschke has not always endeared himself to some in the voluntary euthanasia movement. That's understandable (though it is always hoped that those working for voluntary euthanasia reform can work together).
However, his information and guidance not only fills the regulatory gap left by politicians who refuse to act, it is also immensely comforting to the many thousands of Exit members in Australia and overseas who attend his workshops and read his books on end-of-life options.
Acting on Dr Nitschke's advice, thousands of elderly Australians, and many hundreds of Canberrans, have acquired their illegal drugs (imported or manufactured, and stashed well away from inquiring eyes) or other equipment. That's also why so many support him. People, including many average grandparents, need information on drugs now and cannot wait for politicians to legislate for voluntary euthanasia.
At Dr Nitschke's ACT workshop in mid-July 2014, about 115 Canberrans were thoroughly engaged for three hours. How did Exit try to mitigate risks at this workshop? Everyone signed disclaimer forms. Anyone who claimed to be over 50 but possibly was not, was approached by me, or others, and questioned.
This process is not a grilling but an effort to ascertain the nature of their interest, and whether their attendance could be regarded as suspicious or unusual. We blocked someone whose disclaimer form indicated they suffered a depressive illness a decade earlier, until emphatic assertions, including from their partner, that their condition was no longer present.
We have refused people entry to workshops and Exit membership when their eagerness to procure drugs bordered on the fanatical or their behaviour was otherwise peculiar. And I direct people to an appropriate medical professional if there are doubts about their mental state. Nonetheless, appropriate legislation would give society more certainty about what goes on.
Politicians, parliaments, assemblies and society have so far abrogated their responsibilities for regulating voluntary euthanasia. The onus is therefore on Exit and Dr Nitschke to screen those who may not be suitable for the information provided in his books and workshops.
This is not ideal because such screening cannot be perfect, especially in an unregulated environment. Consequently, given Ms Porter's and Mr Kennett's general support for euthanasia, I propose to outline some activities that they could undertake to further the euthanasia cause, and I would be happy to work with them to ensure this occurs. In this way, their concerns about Dr Nitschke's activities can be addressed.
In addition, it would be a good opportunity for Ms Porter to act on the information she obtained during her three-week European study trip examining euthanasia.
The Commonwealth's Euthanasia Laws Act 1997 prohibits the ACT from legislating for voluntary euthanasia. But, unsurprisingly, there are ways around this. One is an issue I first raised with then chief minister Jon Stanhope, and it was raised again by Queensland University of Technology law professor Ben White at a euthanasia forum organised by Ms Porter earlier in 2014.
It is possible under section 20 of the ACT's Director of Public Prosecutions Act 1990 that the ACT attorney-general could direct the ACT director of public prosecutions (DPP) on the circumstances under which the director should institute or conduct prosecutions for an offence.
For example, the DPP could be directed not to prosecute a physician for assisting with voluntary euthanasia, so long as various conditions are met, including that the patient be assessed for the absence of any depressive illness, or perhaps that the patient is terminally ill etc.
This is not legalising euthanasia. It is only specifying the conditions under which a person assisting with voluntary euthanasia would or would not be prosecuted. Given the minor penalties that have been given to elderly Australians who have assisted a terminally ill spouse or partner to die, this would be an understandable and reasonable direction to the DPP.
The ACT Legislative Assembly would need to be onside with this proposal, and this, I suggest, is one option on which Ms Porter could focus her efforts to achieve regulatory reform.
Mr Kennett is concerned that information on end-of-life options should only be available for the terminally ill, for those for whom the dignity of life has been lost and under special conditions (presumably not for the clinically depressed). This cannot be completely assured, even with legislation. But penalties can be provided to deter regulatory breaches, so voluntary euthanasia legislation is highly desirable.
Society needs to have a clear debate about rational suicide, and given that parliaments struggle with voluntary euthanasia, any such debate is unlikely to be free of invective and visceral reactions for some time.
Unfortunately, many Liberal and Labor politicians nationally, and many Liberal politicians in the ACT Legislative Assembly, do not support voluntary euthanasia. Greens politicians are generally supportive.
Mr Kennett could usefully lobby his Liberal colleagues (even assisting Ms Porter with her proposed discussions) to legislate for voluntary euthanasia and reduce the risk that some people, including those who are depressed, could access information on end-of-life options.
Furthermore, media organisations might want to place greater emphasis on scrutinising the intransigence of politicians who refuse to establish appropriate regulatory systems despite overwhelming public support. The media might also offer a more balanced appraisal of Dr Nitschke's activities, because in a democracy, no public activities should be beyond reasonable scrutiny.
Philip Nitschke won't go away. He has been the strongest activist for euthanasia reform and the provision of information to the elderly and terminally ill for almost 20 years-in Australia, and now overseas. He has ruffled feathers and will continue to do so.
Dr Nitschke cares for people, particularly when they are at their most desperate. People will continue to derive comfort from his advocacy, determination, advice and research into end-of-life options. And despite increased diligence in mitigating the risk of information getting into the wrong hands, it will, no doubt, still occur.
However, if politicians don't like the fact the voluntary euthanasia agenda and Dr Nitschke's activities are moving into areas they don't agree with, they should establish a voluntary euthanasia regulatory framework.
Legislation will provide sureties for society and reduce the risk of inappropriate access to information. If politicians won't act, they should stand aside for those who will.
Discrimination must not be tolerated
By David Swanton
Posted Thursday, 7 February 2013 in ON LINE opinion - Australia's e-journal of social and political debate
The equality of all humans should be one of the most fundamental principles embedded in the moral frameworks and legal systems of civilised societies. It rightly forms the basis of Article 1 of The Universal Declaration of Human Rights.
Unfortunately, such a fundamental principle has not been properly established in many countries. Equality is denied when discrimination occurs. Discrimination is relatively commonplace, and particularly firmly entrenched in many religious organisations. Widespread discrimination can lead to intolerance and conflict, because, unsurprisingly, those who arediscriminated against object to being treated as second-class citizens.
Australia's recently drafted Human Rights and Anti-Discrimination Bill 2012 is commendable in its objectives but does little to reduce discrimination. It claims aspiringly 'to eliminate discrimination, sexual harassment and racial vilification, consistently [sic] with Australia's obligations under the human rights instruments and the ILO instruments'. However, this proposed legislation offers special measures, including exemptions to religious organisations so they can continue to discriminate on such attributes as religion, sexual orientation, gender identity, pregnancy etc. It would seem that most governments lack the courage to stop religious organisations from discriminating. Some religions discriminate against people if they are not of the requisite religion (and subjective religions are related to race/culture), or preferred sex, sexual orientation, and marital status. Australia's proposed legislation does not remove this inequity.
A distinction should firstly be made between invidious discrimination, which should be eliminated, and appropriate differentiation, of individuals or groups. Invidious discrimination occurs when a person or organisation treats others unfavourably because of their particular attributes, whether that be a person's sex, sexual orientation, marital status, race etc. In contrast, appropriate differentiation would allow, for example, without claims of discrimination, segregated sporting events to occur for men and women, and an age limit to be applied to learning drivers, because a reasonable and objective explanation can be developed in these cases.
Within this framework, it is apparent there is no reasonable and objective explanation why a mathematics teacher at any school could not be an unmarried, pregnant, multi-coloured lesbian of no religion (or of another religion). The ability to teach mathematics is independent of the aforementioned attributes. To be denied a job because of a person's particular attributes is a denial of equality that ought not be tolerated in a civilised society.
The discriminatory and bigoted values of some of the mainstream churches are no more ethically 'right' than the racist values that were relatively commonplace in the middle of the twentieth century. How can racial discrimination be ethically wrong but sexual discrimination be permitted? How can there be a moral basis for an Islamic black man who discriminates against women complaining that he is being discriminated against? How can a religious male politician who denies lesbians the right to marriage or to be a leader in his church claim that he treats people equally? There is no justification for any of these situations because there is no moral distinction between these types of invidious discrimination. Intolerance of, and discrimination against, people with particular attributes is bigotry.
Many religions try to justify their religious discrimination as a right, the freedom to practise one's religion. But such a right impacts adversely on others. So what happens when there is a conflict between religious freedoms and the rights of an individual, such as an individual's right to be treated equally and not to be subjected to invidious discrimination?
Many religions preach some variant of the ethical golden rule, or doing unto others as they do unto you. Members of one religion would not like members of other religions to exercise their religious freedom if that involved the imposition of the other religion on them, or allowing the other religion to kill them (if that were a 'view' of the other religion). Even if it were something more trivial, such as having another religion's eating rituals being imposed on them, this would be a cause of stern objection.
That people do not want their individual rights to be violated by another religion (or any other person, organisation or government for that matter) is the key. It is then straightforward to conclude that a freedom of religion should only extend so far as to where it does not impinge on the rights of other individuals. People can believe in and practice what they wish, no matter how profound, or silly and deluded, that might be, but not if it denies other people's equality or human rights, causes discrimination, or otherwise adversely affects other individuals. A regime of religious discrimination juxtaposed on a principle of doing unto others as they do unto you is hypocrisy.
To avoid claims of having hypocritical bigoted views, one would think that religious organisations would reject their current discriminatory views and advocate legislative change that condemned and prohibited all invidious discrimination. Unfortunately, enlightened change is not the way of the bigot.
To explore further the nature of religious discrimination, consider the following scenario. What if a new religion were to be established tomorrow, and an inspired person drafts a religious text that reflects the views of the newly conceived and perfect God. The newly drafted religious text includes the following verses attributable to the new God.
- A black person should learn in quietness and full submission. I do not permit a black person to teach or to have authority over a non-black person; the black person must be silent.
- Any black person who is arrogant enough to reject the verdict of the priest who represents your God must die.
- A black person who works on God's holy day will be put to death.
- If a person has sex with a black person, both of them have done what is detestable. They must be put to death; their blood will be on their own hands.
The above verses are racist and abhorrent. They deny black people equality. Such a religious text must be treated with the contempt that any racially discriminatory text deserves. The proponents of the new religion would say that their God moves in mysterious ways or that the text is not meant to be taken literally. Neither explanation conceals the underlying racism and discrimination.
The astute observer would realise that these verses have been extracted from the Christian Bible and reworked to substitute the phrase 'black person' in biblical verses that condemn women, non-believers, a person who works contrary to God's laws, and homosexuals. It is clear that the terms 'woman', or 'gay, lesbian, bisexual, transgender, intersexperson', 'Caucasian male', or 'pregnant person' could have been similarly substituted.
If the newly drafted religious text is abhorrent, discriminatory and unacceptable in modern society, then so too is the Christian religion. Other discriminatory religions and organisations should be condemned with equal vigour.
It follows that public funding or support of any discriminatory religious organisations should be handled in the same manner as that for a body that might discriminate on the basis of race: governments should condemn them and never support or finance them, directly or indirectly.
It is absurd in modern society that governments give massive tax exemptions, and exemptions from discrimination legislation, to religious organisations. Many religions teach that only people of their religion are worthy of reward in a speculated afterlife. They discriminate in churches and hospitals, educational institutions and nursing homes. In recent times a horrendous record of child sexual abuse in religious institutions has become public. Furthermore, many churches indoctrinate children to worship a god or gods that, according to their scriptures, are guilty of indiscriminately killing humans-the most warped of moral messages. Religions peddling discrimination and perverse moral messages deserve condemnation.
It would seem that the Universal Declaration of Human Rights is no more than an aspirational piece of paper. People must work hard to secure the most fundamental of rights, because, while governments continue to allow people, organisations and religions to invidiously discriminate, there can be no equality.
Euthanasia: the clergy and religious politicians are wrong
By David Swanton.
Posted Thursday, 17 February 2011 in in ON LINE opinion - Australia's e-journal of social and political debate
Senator Bob Brown’s Restoring Territory Rights (Voluntary Euthanasia Legislation) Bill 2010 will be debated soon in the federal parliament. If passed, the Bill will repeal the Euthanasia Laws Act 1997, which removed the right of the Territories to legislate for euthanasia (a voluntary act, defined below). It will not legalise euthanasia.
Catholic Auxiliary Bishop Pat Power (Who can tell when it is right to die? , 8 February) recently argued against euthanasia, in response to my earlier article advocating support for euthanasia and Senator Brown’s Bill (Canberra Times, 31 Jan 2011). It is highly probable that he and many religious politicians will try to defeat Senator Brown’s Bill. It is disturbing that an ACT, NT or Norfolk Island citizen, or any competent Australian citizen, could argue that Territorians should not have the same rights as Australians living in States to legislate for euthanasia.
Bishop Power’s case against euthanasia is fundamentally flawed, based as it seems to be on the assumption that his religion’s views against euthanasia should be imposed on everybody, as I discuss later. There are also significant errors in his arguments. Bishop Power regrettably quoted out of context my definition of euthanasia to suggest that bankrupt people could access euthanasia if they were depressed. Nothing could be further from the truth. I noted that there are many legislated means of ensuring euthanasia is voluntary, including having patients examined by a number of doctors, including a psychiatrist. Clearly doctors are engaged to examine patients with terminal illnesses, and not to attest to their bankruptcy.
Legislative models used overseas and proposed by euthanasia advocates only allow euthanasia as an option for articulate, lucid terminally ill people not suffering from clinically treatable depression. If an additional condition was required, terminally ill people could be required to place their names on a euthanasia register for six months before being permitted to request euthanasia. The ACT Greens MLA, Amanda Bresnan, has proposed a legislative model involving a voluntary euthanasia board, and assessments by doctors (Canberra Times, 7 February). Such precautions are necessary and commonplace around the world to protect people whose minds might be easily swayed, and they are effective because such people would not have the mental resolve to convince a psychiatrist that their euthanasia decision was made voluntarily.
Euthanasia is defined as a deliberate act intended to cause the death of a patient, at that patient’s request, for what he or she sees as being in his or her best interests (often called active voluntary euthanasia). Clearly, euthanasia’s voluntary nature is implicit in this definition, and this is recognised by the 85% of Australians who support it. It is precisely the voluntary nature of euthanasia that makes it ethically right. Bishop Power mistakenly disputed the popular support for euthanasia in Australia. If he had checked the Australia-wide poll conducted in 2009 by Newspoll he would have indeed discovered that 85% of those surveyed support the right of a “hopelessly ill patient, experiencing unrelievable suffering, with absolutely no chance of recovering” to ask for and gain assistance with a lethal dose (euthanasia). I would encourage Bishop Power to base his arguments on evidence.
Despite the overwhelming public support for euthanasia, the voluntary nature of euthanasia still confounds euthanasia’s outspoken opponents: mostly religious politicians, leaders and zealots. They claim that euthanasia is not voluntary, that people would be coerced into a decision, and that people would be killed without their consent. The simple analogy “consensual sex is to rape as euthanasia is to murder” highlights the relationship that almost everybody comprehends: that consensual sex and euthanasia are voluntary and should be permissible. It is patronising and arrogant to suggest that articulate, lucid individuals of sound mind are vulnerable and cannot make their own end-of-life decisions. Individuals can choose their own sexual partners, make financial decisions, write their wills, and even choose to have life support withdrawn, and without Bishop Power and religious politicians acting as their moral guardian.
If Bishop Power and religious politicians legitimately oppose euthanasia with appropriate legislative measures because they are concerned about a patient’s vulnerability, then they should also oppose the withdrawal of life support for terminally ill patients (currently legal and supported by everyone) because the same vulnerability concerns exist. But they don’t, and nor should they. So it would seem that patient vulnerability (as it can be protected legislatively) is perhaps but a ploy to deflect attention from their main purpose, which one can reasonably surmise is their determination to impose their religious beliefs on other people. Regrettably, many religious politicians follow this lead.
Barack Obama , as a Senator, correctly recognised that governments must not legislate based on politicians’ religious beliefs. He said “Democracy demands that the religiously motivated translate their concerns into universal, rather than religion-specific, values. It requires that their proposals be subject to argument, and amenable to reason. I may be opposed to abortion for religious reasons, but if I seek to pass a law banning the practice, I cannot simply point to the teachings of my church or evoke God’s will. I have to explain why abortion violates some principle that is accessible to people of all faiths, including those with no faith at all.”
Many Australian politicians lack the ability of President Obama to separate their religious beliefs from their political responsibilities. They must understand that their religion is not amenable to reason and must not be forced on others. Bishop Power and the clergy must do likewise.
Bishop Power is very supportive of palliative care, and rightly so. Compassionate people would agree that the best possible palliative care be available to all who want it. But when palliative care can no longer alleviate the suffering of people such as a young Angelique Flowers , who suffered a bowel blockage and vomited her own faecal matter before dying, then euthanasia is clearly an option that many people would like to choose. All people, including Bishop Power and religious politicians, should view Angelique’s video and they would realise that the current legislative environment is inhumane and deplorable. Anything short of legalised euthanasia with appropriate controls would be a shameful reflection on the politicians who govern us.
A better-funded palliative care system could benefit those terminally ill patients who want to stay alive at all costs, regardless of their quality of life (which of course is their choice). Unfortunately governments must make decisions about allocating finite resources; that’s the nature of a modern economy. Currently governments are choosing to spend billions of taxpayers’ hard-earned dollars keeping alive terminally ill people who do not wish to be kept alive rather than spending billions of dollars on additional palliative care for people who wish to stay alive. Every rational terminally ill person, whether they would choose euthanasia or not, would disagree with them. Religious politicians and the clergy seem oblivious to this irony.
Bishop Power also commented that it would be a “frightening prospect to be governed by people lacking in any deeply held principles” if religious politicians were to leave their religious principles at the doors of parliament. He is scaremongering. Many people, and most people supportive of individual rights, have very strong principles; it’s just that they are not Bishop Power’s. Although I disagree with Bishop Power’s religious beliefs, what he and religious politicians believe is not the problem here, rather it is that they deny others the liberty to make their own end-of-life decisions. Ordinary, well-meaning religious people do not impose their views on others, and they comprise much of the 85 per cent who support euthanasia. Fantastic. I, and others who make the case for individual liberty and euthanasia, must continue to stress that it is the imposition of politicians’ values, religious or otherwise, on the individual lives of other people that is offensive, and contrary to libertarian principles. Euthanasia advocates simply demand individual choice for all and object to other peoples’ religious views being forced on them by legislative fiat.
Liberty is paramount in any democratic society, and the classic declaration of John Stuart Mill is as relevant now as ever: “over himself, over his own mind and body, the individual is sovereign”. If liberty is being threatened, by organised religion through religious politicians, then all free-thinking people should rally against the threat. The threat is more reprehensible when it is terminally ill people who suffer pain and indignity as a consequence of being denied the liberty to make their own end-of-life decisions. Individual liberty demands that everyone is responsible for his or her own body, not Julia Gillard, Tony Abbott, Ron Boswell or Pat Power. Before imposing their views on others, perhaps Bishop Power and religious politicians should consider their own religious principle of “do unto others as you would have them do unto you”.
Bishop Power and religious politicians would do well to accept Barack Obama’s challenge and translate their concerns against euthanasia into universal values, “amenable to reason”. They should consider the following ethical thought experiment. How would each of them rationalise his or her presumed beliefs that death and horrendous murder is good and permissible if the biblical god he or she believes in causes it, while the peaceful death of terminally ill patients, at their own request, when acute or chronic suffering is the alternative, is unacceptable? A belief that death is only acceptable when the deity of your religion causes it is not something that Barack Obama would state is a “principle that is accessible to people of all faiths, including those with no faith at all”. If euthanasia continues to be banned in the absence of a satisfactory argument amenable to reason, then democracy fails us.
It will nonetheless be a difficult task to change the quite entrenched views of many religious politicians when they vote on Senator Brown’s Bill, even though it is a Bill supporting Territory rights. However, if Senator Brown’s Bill does not pass and the Legislative Assemblies in the Territories continue to prohibit euthanasia, then there is a solution. Dr Philip Nitschke, through his organisation, Exit International, is empowering many Australians and people around the world with information, much to the ire of religious politicians, so that people can, and do, order their euthanasia drugs, as they have been doing for some years. Australia’s federal politicians can either vote for Senator Brown’s Bill, or bury their heads in the sand. If the latter, politicians will be ignoring the fact that most Australians want the option of euthanasia and many are doing something about it in the absence of real political leadership.