Part 1 A refutation of some arguments against euthanasia and the Rights of the Terminally Ill (Euthanasia Laws Repeal) Bill

2.1 Possible abuse of the Northern Territory Act

1. As enactment of the Bill would give the Northern Territory’s Rights of the Terminally Ill Act the same status as it had before the enactment of the Euthanasia Laws Act, it is relevant to give consideration to the merit of the Northern Territory’s Act. Four people made use of the Northern Territory legislation, and there were significant measures to ensure that patients are not improperly coerced into euthanasia.

2. Marshall Perron neatly encapsulated some of the more important measures in the Northern Territory’s Act to ensure it was not abused. He said ‘Voluntary euthanasia is patient driven. The Northern Territory law dictates that the patient must personally initiate the process, consider the options for treatment and palliative care, be psychologically assessed, sign a request, obtain second opinions, consider the effect on the family, use qualified interpreters if necessary and endure a cooling off period. The patient can of course change their mind at any time and stop the process instantly. Additionally, detailed records must be kept. Government regulations must be followed. The Coroner must be informed and has a statutory responsibility to report to the Attorney General and parliament any concern regarding the operation of the legislation. To kill another without these conditions being fulfilled is to commit murder under the Northern Territory Criminal Code—penalty mandatory life in prison.’

3. Mr Perron also said that although more elaborate safeguards could have been put in place, the safeguards in the Northern Territory Act ‘prevent people who might opt for voluntary euthanasia simply because they are temporarily depressed, or who are being coerced by others, from being legally able to be assisted’. Any patients who request euthanasia under duress will not convince a jury of doctors that their decision has been made ‘freely, voluntarily, and after due consideration’, as the Northern Territory Act requires. Consequently, such patients will be considered ineligible for euthanasia.

4. No worst-case scenario is impossible, but it is extremely unlikely that the Northern Territory Act could be abused. Most Australian doctors would consider it an insult to suggest that, for example, a group of three doctors would maliciously arrange the death of a terminally ill patient without the patient’s consent.

5. Nonetheless, enactment of the Bill must be preferable to the unregulated voluntary euthanasia activity that occurs now without any controls.

2.2 International experience

6. Many countries and jurisdictions now permit voluntary euthanasia, including Switzerland, the Netherlands, Belgium, and Oregon in the United States, the last three of which having passed laws since the Euthanasia Laws Act was enacted. It seems legislators are starting to respond to the needs of terminally ill patients. Importantly, the legalised use of voluntary euthanasia in these jurisdictions is not out of control as has been claimed by those opposing voluntary euthanasia. Interestingly, but not surprisingly, the rate of euthanasia in the Netherlands has decreased rather than increased. This is probably because, amongst other things, people are aware that a voluntary euthanasia option is available if they need it, so non-voluntary euthanasia, and suicide by premature access of more drastic and less dignified options, is not required.

2.3 The ‘right to life’ and ‘sanctity of life’ arguments

7. The right to life argument in the context of voluntary euthanasia has no ethical merit. The ‘right to life’ is no more than a ‘right’. The right to life is not a duty to live. The right to life does not demand that it must be exercised.

8. t;/span>People have the right to walk in their back yard if they want to, but there is no compulsion to do so. Terminally ill patients who want euthanasia for themselves choose not to exercise their right to life. This choice might not be understood by the clergy and other opponents of the Bill, but it is the choice of those who want voluntary euthanasia.

9. An often touted argument deals with the sanctity of life. A problem is that the word sanctity only has meaning for those with particular religious beliefs. And it seems to be applied selectively. The Christian Bible is littered with instances of murder, sacrifice and torture, including of women and children, so the sanctity of life argument is not even respected by the Christian clergy.

10. People with other beliefs, such as those who might, for example, have an objective of ‘to live my life as long as I am happy and healthy, and, if that is not possible, then to die with dignity’ are discriminated against by the sanctity of life argument.

11. If life were sacred, there would also be strong arguments against the withdrawal of life support (passive euthanasia), self-defence and suicide. It would follow that society should do its utmost to ensure that everyone stays alive no matter what the circumstances, and this would be acceptable to nobody.

2.4 An incorrect patient diagnosis

12. Opponents of the Bill claim that a terminally ill patient could be incorrectly diagnosed, and could possibly recover, so euthanasia should be forbidden.

13. It is foolish to claim that incorrect diagnoses and prognoses could never occur. But for all practical purposes, they can be ruled out. Dr Alistair Browne has remarked that ‘it is frequently beyond all reasonable doubt that the diagnosis is correct or some cure will not be discovered in time to help, and it is not clear why this should not be sufficient. The law has never taken a “pigs might fly” attitude towards the risks attendant on any activity. We only need to establish “guilt beyond reasonable doubt” to send a person to prison or even to his execution, and it is not possible to require more without making the enforcement of the law impossible. Why a more stringent standard should be demanded in the cases of assisted suicide and active voluntary euthanasia yet needs to be explained.’

2.5 The slippery slope argument

14. The slippery slope argument is a common sensationalist argument of the clergy and other opponents of the Bill. It claims that legalising assisted suicide and active voluntary euthanasia, as occurred in the Northern Territory, will soon lead to an increased rate of non-voluntary euthanasia, then euthanasia of those who are not attractive to society, those with fanatical political beliefs, extreme religious or cultural values and so on. Thus if we do not draw the line where it is, we will not be able to prevent substantial harm to others.

15. This argument has dubious merit. For there to be evidence of a slippery slope there would need to be evidence of more non-voluntary deaths within a tolerant, legalised voluntary euthanasia framework.

16. Studies have found that a ‘group of people being helped to die without consent existed in all surveyed countries, irrespective of whether there was an environment of decriminalisation or harsh legal sanction’. Moreover, it seems that a tolerant environment for voluntary euthanasia, decreases, rather than increases, the number of non-voluntary deaths. This has certainly been the case in the Netherlands. If there were a slippery slope, it is going the wrong way for those opposing the Bill.

17. If the Bill is enacted, the line on what will be permitted will be drawn by the elected representatives of the Australian people in each jurisdiction. Despite scaremongering, there will be no slippery slope. Good governance demands legislative oversight of voluntary euthanasia.

2.6 The palliative care option

18. This clergy and other opponents of the Bill argue that assisted suicide and active voluntary euthanasia are unnecessary because of the extraordinary developments in palliative care and pain control.

19. Advances in palliative care are always welcome. In some, perhaps many cases, the need for assisted suicide and active voluntary euthanasia will be reduced through developments in palliative care. But these developments do not obviate the need for voluntary euthanasia, nor can they control all aspects of a patient’s illness to the level desired by all patients. There are still numerous illnesses or conditions for which pain, extreme suffering, and loss of dignity are difficult or impossible to eliminate. Some patients will suffer the terror of breathlessness or vomit uncontrollably, others will be choking continuously or unable to swallow, others will be paralysed, and still others will be helpless, weak, incontinent and totally dependent on others. Even if pain and distress are not the major problems, there is often a strong fear of the dependency that would result if all bodily functions, mental and physical, were sufficiently impaired.

20. tyle="background: #E6E6E6;">Palliative care is not an option for all people, since no amount of palliative care can relieve all distress. Voluntary euthanasia is a reasonable alternative for those who want it. Clearly, 80% of Australians, including the many thousands of members in Exit International and the state-based voluntary euthanasia societies, want voluntary euthanasia as an option.

2.7 The concept of harm

21. Some who argue against voluntary euthanasia claim that doctors must ‘first, do no harm’. Leaving a person, such as Angelique Flowers, to suffer when palliative care has not provided adequate respite from pain and suffering, is simply unacceptable. For many terminally ill people, staying alive is doing harm. The option of a peaceful death, before one vomits faecal matter, is preferable for many people, such as terminally ill people with colon cancer. They should not be denied the right to have a peaceful death, a right that does not directly affect others.

22. It is arrogant to impose one’s belief systems on another individual, effectively denying the other the right of equality. Only terminally ill individuals themselves know what harm is. Those who opt for quantity of life regardless of the pain or suffering might not want voluntary euthanasia, and they need never request it.However, as many terminally ill patients consider that the quality of their life is more important than staying alive, the option of a peaceful death to alleviate their pain and suffering is a more humane and valid alternative.

23. Denying an individual’s right to die is an arrogance that mostly derives from primitive religious teachings. Other Australians should have the right not to have these primitive religious perspectives forced on them.