What euthanasia is not

The experience of serious illness can be complex and confusing, leaving us unsure about the right and ethical thing to do. It is important to know that some life-and-death decisions, while they may cause us concern, have nothing to do with euthanasia – they are simply good medical practice.

The reasonable refusal of treatment is not euthanasia

We have a responsibility to take reasonable care of our own life and health. But in some cases a suggested medical treatment may not offer me great benefit, or I may judge it to be overly burdensome. This is more likely to occur in the final stages of a very serious or chronic illness.

Everyone has a legal right to decide which medical treatments they will and will not receive. No doctor or hospital can force me to accept a treatment against my will.

Since no-one can be obliged to do what is futile or to endure what is unreasonable, I have the moral right to refuse any medical treatment if I judge it to offer me no reasonable benefit or to be overly burdensome.

Refusal in this case is legally and ethically justifiable even if death occurs as a result. Reasonable refusal is not euthanasia.

Palliative care is not about euthanasia

Doctors have a duty to offer every reasonable means to relieve pain and other symptoms. The aim is to leave patients well enough to conduct the business of their lives.

The science of pain and symptom relief is always advancing. These days a patient in expert hands can often be kept pain free almost indefinitely, if their treatment begins at the right time and is delivered by an experienced palliative care team.

Even in very serious cases when pain can sometimes ‘break through’, treatments can usually be adjusted to restore an acceptable level of comfort.

Good palliative care is about enabling a person to live well even if there is no cure for their illness. It provides all necessary medical treatments as well as many other forms of non-medical care. When death eventually does occur, it occurs because of the illness. Palliative care is not about euthanasia.

Wanting to die is not the same as wanting euthanasia

In very old age or the final stages of chronic illness it is not unusual that a person may express a wish to die.  They may feel that age or illness has reduced their dignity, and death seems the only way out.

It is important to recognize this for what it is: a desire to have dignity restored. It is not a desire for death or euthanasia, yet euthanasia is sometimes promoted as ‘the only answer’.

In a research project conducted in Perth WA and Winnipeg Canada, Harvey Chochinov offered palliative care patients a psychotherapeutic intervention called ‘dignity therapy’. Their results were published in the Journal of Clinical Oncology and showed that with this therapy increased a sense of dignity, purpose, meaning and will to live

What euthanasia is

Euthanasia’ describes any deliberate action which both of itself and by intention causes a person to die in order that in this way their suffering may be ended.

It is important to be very clear. ‘Euthanasia’ occurs only when one person both directly intends to end the other person’s life, and performs or omits some action which itself kills that person.

For example, a patient wants to end his or her suffering, so asks the doctor for euthanasia. The doctor, fully intending to end the patient’s life, gives a lethal injection  –  and the patient dies.

Euthanasia occurs when both the doctor’s intention and the action taken aim directly at the patient’s death, and actually cause death to occur.

‘Assisted dying’ or ‘assisted suicide’ occurs when the patient asks the doctor to supply information or drugs so that the patient can end his or her own life – effectively, the doctor provides assistance in suicide.

While there may be a legal distinction between ‘euthanasia’ and ‘assisted suicide’, there is no ethical distinction: in both cases the doctor is knowingly and willingly complicit in causing another person to die.

It has never been considered good medical care for a doctor to kill a patient. Good doctors don’t kill.

Isn’t euthanasia necessary when pain in uncontrollable?

Euthanasia is sometimes proposed as ‘a reasonable solution’ when a person has a terminal illness and is experiencing considerable pain, suffering or debilitation related to that illness.

This reflects out-dated thinking. Pain control is a precise specialisation today, using multiple modalities and combinations of medications and other means to address each patient’s specific needs. If a patient’s pain is such that the patient wishes to die, then their pain is not being managed effectively. The problem is not the pain, buts its inappropriate treatment.

Palliative care is best offered through specialist doctors leading multidisciplinary teams that attend to all aspects of the patient’s needs.  These days the vast majority of such patients, in the right hands, can be kept comfortable if the best contemporary medical practice is applied.

General practitioners working on their own often do not have the ability to deliver the kind of excellent palliative care available from the specialised teams described here.

There are no objective medical reasons to permit euthanasia.

There are no ‘medical indications’ for euthanasia.

Isn’t euthanasia alright as long as it is purely voluntary?

The argument that euthanasia will always remain strictly voluntary is false. In the Netherlands, the Government’s own studies have found that ‘termination of life without request of the patient’ has become more or less routine.[1]

In every country to have legalised it so far, euthanasia has proved to be ‘difficult or impossible to control’. The elderly, chronically ill and vulnerable always come under threat.   In practice, whatever the laws say, euthanasia never remains ‘purely voluntary’.

If a Government today permits euthanasia, there is no way to guarantee that a future government won’t extend it to other class of citizens as has happened in the Netherlands and Belgium.  The only way to ensure that this doesn’t happen is to maintain our absolute prohibition on euthanasia and assisted suicide.

[1] Richard Fenigsen (2004), “Dutch Euthanasia: The New Government Ordered Study.”  Issues in Law and Medicine 20:1 (2004), 77.

Isn’t euthanasia a personal matter?

Supporters of euthanasia eventually admit that this option should be freely available to anyone who, for whatever reason and regardless of their state of health, wishes to determine the time and manner of their own death.

Australia’s already high rate of suicide is increasing: more than 8 people commit suicide each day, one person every 3 hours. Far from addressing a national tragedy, legalising euthanasia will send the confusing message that sometimes suicide is alright.

In fact, euthanasia is never a purely personal matter: by definition it requires someone else (usually a doctor) to assist.  A law authorizing euthanasia would commit the medical profession and our whole society to the path of killing rather than caring.

No wonder almost all medical associations around the world reject euthanasia. The American Medical Association sees it as fundamentally incompatible with the physician’s role as healer’. In similar vein, the American College of Physicians affirmed in 2017 that physician-assisted suicide is ‘inconsistent with the physician’s role as healer and comforter.

Don’t I have a “right” to die?

Shouldn’t I have the right to choose death by euthanasia if I want to?   Don’t I have the right to dispose of myself as I wish?

In practice, anyone can dispose of themselves – that is, commit suicide – but we have a law against assisting in suicide. Why is that? Because such a law could so easily be abused: it can be very difficult to tell the difference between ‘murder’ and ‘suicide’ once the only other material witness, the victim, has died.

Laws against assisting suicide protect all of us, and so do laws against euthanasia. Laws permitting either assisted suicide or euthanasia would open up many opportunities for abuse.

Doesn’t euthanasia give me “death with dignity”?

Other arguments for euthanasia revolve around more subjective issues, such as the person’s perceived loss of dignity as they age or become less able to look after their own needs.

Harvey Chochinov’s research shows that the desire to recapture dignity can be fulfilled in other ways. A strategic psychosocial intervention known as ‘dignity therapy’ trialled in Canada and in Perth WA in 2005 showed that in most cases when patients are offered better and more targeted palliative care, the desire for death quickly disappears.

In any event, euthanasia or assisted suicide often fail to deliver ‘death with dignity’ at all: as noted below, Oregon’s own official reports on its Death with Dignity Act reveal horrific failures including regurgitation of drugs, long delays in drug effectiveness, and in some cases complete failure to deliver death at all.  These are not dignified deaths.

If the person really seeks dignity, we should offer them dignity, not death.

Don’t most people think euthanasia is OK?

One of the most emotive arguments made for euthanasia is that it is simply democratic: it is claimed that opinion polls consistently show that 80% of the population want access to euthanasia.

In fact there is ample evidence that when people are offered more balanced information about euthanasia and assisted suicide, the rate of support collapses: in one study in the UK, from 73% support it collapsed to 43% support, 43% opposed and 14% undecided.

Why is that?

First, no reputable researcher would agree that a simple opinion poll can cater for complex social questions such as euthanasia. Opinion polls are fine for one-dimensional issues (‘do you vote Labor or Liberal?’), but they are manifestly incapable of managing more complex social issues.

In order to be reliable, genuine research has to ‘control for’ (take into consideration) any variables that could ‘confound’ or confuse the potential results. If many people are confused over what euthanasia actually is, and most are not aware of the extent of abuse in countries that permit euthanasia, can the results of a simplistic poll really be trusted?

Second, opinion polls are notoriously easy to manipulate, simply by asking a question in a particular way. For example, euthanasia advocates in New South Wales posed this question in a 2009 opinion poll:

‘If a hopelessly ill patient, experiencing unrelievable suffering, with absolutely no chance of recovering, asks for a lethal dose, should a doctor be allowed to provide a lethal dose, or not?

Simply by making the answer ‘no’ seem manifestly cruel and unreasonable, the question leads you down a one-way street to an obvious ‘yes’, which is the preferred answer.

The sponsors of this poll want you to ignore the fact that some incredibly complex medical, social and personal issues have been reduced to a single black-or-white question that is clearly designed to produce only one outcome.

Exploring how further information corrects the erroneous ‘findings’ of simplistic opinion polls, Katherine Sleeman rightly says, “Public opinion polls, in the absence of public debate, may gather responses that are reflexive rather than informed.”  Read her report here.

Isn’t euthanasia practiced safely in the Netherlands?

Wherever it has been introduced throughout the world, euthanasia has proved impossible to contain or control even when accompanied by the strictest legislative safeguards.

In 1995, the Dutch Government’s own study reported that 945 patients had had their lives ended without their explicit consent, of which 37% (350 individuals) were legally competent to give consent had they been given the choice.

Ten years later the situation had not changed: the Dutch Government’s 2005 report found that 1 in 7 patients who had been ‘euthanised’ in the previous year had not given explicit consent.

Dutch laws have been upheld as a model because they impose strict controls over euthanasia, yet the Dutch themselves admit that 20% of cases of euthanasia go unreported. No wonder one writer believes that ‘this is a system out of control.

Euthanasia laws have also caused a radical shift in public trust in the medical professions: in 2001, 55% of Dutch citizens believed that doctors no longer have the right to refuse requests for euthanasia,[1] while doctors themselves report suffering personal trauma from performing euthanasia.

There is no reason to believe that outcomes would be any different in WA.

[1] Richard Fenigsen, “Dutch Euthanasia: The New Government Ordered Study”.  Issues in Law and Medicine 20:1 (2004) 73-79, at 77.

Isn’t euthanasia practiced safely in Oregon USA?

The recent debate on euthanasia in Victoria resulted in legislation being drafted on the Oregon model of Physician Assisted Suicide (PAS). This model is held out as being a stable law for nearly 20 years. Its adoption by Victoria was largely in response to concerns about safe regulation and legislation creep. So let’s consider how safely PAS is practiced in Oregon:

Regarding safe regulation:

Proper reporting is the only way to know whether PAS is being safely regulated as intended. Oregon’s questionable reporting by the Oregon Public Health Department [OPHD] belies claims of safe regulation:

  1. The OPHD does not gather information from parties other than the prescribing physicians. Other parties of interest include: physicians refusing to prescribe, psychiatrists, nurses, social workers, family, patients. So who is to know what is really going on?
  2. Some patients receiving prescriptions have lived for 12 months or longer. This indicates that some patients are keeping their lethal medications much longer than expected, and we still don’t know how these medications will be used, or who will use them. Legally, terminally ill patients can only ask for a prescription when they have a 6 month prognosis.
  3. In 2010, a “Procedure revision” was undertaken to “standardise reporting on the follow-up questionnaire”. The OPHD freely admits that the consequence of this will be an under-reporting of how patients died. Aside from saving time and money, this “procedure revision” means that the OPHD can save face; it no longer has to report as many gruesome details about:
    1. patients who regurgitated their lethal drugs [choose any report here], or
    2. patients who took many hours if not days to finally die, or
    3. patients who regained consciousness and died of their actual disease months later.
  4. Known cases of (illegal) euthanasia which the OPHD has not prosecuted include:
    1. Patrick Matheny’s brother-in-law helped him ingest the drugs
    2. Two Oregon nurses Rebecca Cain and Diana Corson, gave Wendy Melcher overdoses of morphine and phenobarbital without her doctor’s knowledge, claiming Melcher had requested an assisted suicide. Her daughter denied her mother’s intention and was left traumatised. No criminal charges have been filed.
    3. Annie Jones, John Avery, and three other patients were killed by illegal overdoses of medication given to them by a nurse. None of these cases have been prosecuted.

… and these are just the ones we know about.

Regarding legislation creep:

When there are problems with ‘completing’ assisted suicide, euthanasia advocates recommend progressing from PAS to euthanasia – in other words, moving from the patient committing suicide with a lethal prescription to some one else (a nurse, doctor, friendly relative) finishing them off.

This is exactly the proposal that is before the Senate in Oregon in Bill 893. Currently euthanasia is unlawful in Oregon, but if passed, this Bill would allow euthanasia under an Advance Directive.


If not euthanasia, then what?

There is a better way.

What we need is more dignified care for all people at all times.

We need better access to compassionate, coordinated, state-of-the-art acute and palliative care, both at home and in dedicated facilities, throughout WA but especially in our rural and remote areas that are desperately under-serviced.

We need a better planned and resourced aged-care sector, and more options for those with disabilities.

We need medical professionals, administrators and legislators to truly respect the dignity of each and every human being at every stage of life.

Any laws on euthanasia will not address our real needs. They will provide no help whatever for the sick, the aged, the disabled or the dying.

They would commit our health care system, our resources and our society as a whole to the path of killing rather than caring.

We need to reject euthanasia as an option.

We call on our legislators to ensure that excellence, care and compassion continue to be the hallmarks of the health professions and of our healthcare system.