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Let’s be clear about what we mean when we say euthanasia

Debate about euthanasia flares up in Australia every few months but, for some reason, it never gets very far. The latest round started late last month, when urologist and campaigner for voluntary euthanasia…

In the current era of hi-tech medicine, the word euthanasia has been stretched to encompass a broad range of interventions. Guian Bolisay/Flickr, CC BY-SA

Debate about euthanasia flares up in Australia every few months but, for some reason, it never gets very far.

The latest round started late last month, when urologist and campaigner for voluntary euthanasia Rodney Syme confessed to an act of mercy killing, and said he was prepared to be charged and jailed for it. Dr Syme said he believed:

creating a court challenge could set a useful legal precedent and accelerate the public debate on euthanasia.

No doubt, this is an act of individual bravery – a kick at the hornet’s nest. But will it really advance the euthanasia debate?

A contaminated word

As in this instance, the debate usually starts with a demand to “legalise euthanasia”, invoking a “right to die”. But any law permitting mercy killing would be complex as it would have to provide a safe and feasible set of exceptions to the Crimes Act.

More fundamentally, “euthanasia” itself is poorly understood, being not one thing but many. And there is, strictly speaking, no “right to die” in that we can’t oblige other people to kill us.

The modern notion of euthanasia was, in fact, born in the latter half of the nineteenth century, a tumultuous time that saw the birth of modernity and, courtesy of philosopher Friedrich Nietzsche, the death of God.

In Australia, the debate fizzled in the twentieth century, re-emerging 20 years ago when the world’s first law permitting euthanasia in many of its guises was passed in the Northern Territory.

This short-lived act (the Rights of the Terminally Ill Act) unsurprisingly did not use the term “euthanasia”, since its misuse to describe the eugenic Aktion T4 activities of the Nazi regime had by then profoundly contaminated the word.

This might, in itself, be a good reason for abandoning the term altogether, but nowadays there’s an equally cogent motive to do so: nobody agrees on what it means. It’s clearly time to clarify what we mean when we say euthanasia because the debate will neither go away nor progress without it.

Defining our limits

As it happens, this is not a uniquely Australian issue; the definition of euthanasia is evolving rapidly. The simplest comes from philosopher Baruch Brody:

where one person (A) kills another person (B) for the benefit of the second person, who actually does benefit from being killed.

But there are now many more criteria qualifying this broad(ening) concept. In fact, euthanasia is actually a spectrum of interventions, each with unique moral and legal considerations.

The modern notion of euthanasia was born in the latter half of the nineteenth century, a tumultuous time that saw the birth of modernity. Jens/Flickr, CC BY-NC

In the current era of hi-tech medicine, it has been stretched to encompass a broad range of interventions ranging from mercy killing (with or without explicit consent) through the shades of assisted suicide (by doctors and others), into the use or abuse of sedation (terminal sedation, double effect) and decisions to withdraw life-prolonging treatments (burdensome ones such as mechanical ventilators, or harmless ones such as pacemakers). And finally, to decisions not to start treatments that might prolong life.

The law has intervened in all jurisdictions to put a bright line in this spectrum, identifying the point at which we should see an activity as “illegal”. But the position of this bright line differs widely across the globe.

In Australia, it currently lies somewhere in the area between terminal sedation and the double effect (the use of a drug knowing it may kill, but not intending death by its use). The use of opiates and sedation at the end of life with the knowledge that they may shorten life but not intending death is widely accepted in law as an exception to the crime of murder.

And it seems clear from polls that the Australian public would be comfortable if this point moved further up the spectrum, though there would be much disagreement about where it should finally rest.

There’s also good evidence that the overall comfort zone surrounding the allowing of death, the envelope in which this debate is nested, is moving quite quickly, so pressure to change conservative laws will inexorably build.

Saying what we mean

The debate about allowing or encouraging people to die is clearly on – the only question is about the rules. In the spirit of a genuine agnostic, I offer the following:

  • Let’s get rid of the word. If we don’t know what it means, and it carries unfortunate baggage, let’s give euthanasia a fitting death, and instead say exactly what we mean.

  • Let’s all acknowledge where our comfort zone lies, and how arbitrary and easily changed this is. There’s evidence that a bad personal experience of someone’s death will make us enthusiasts for euthanasia, irrespective of our religious backgrounds.

  • Let’s not get side-tracked by media interest in high-profile mercy killings, such as the one by Rodney Syme. This polarises opinion and stifles debate – the very essence of wedge politics.

  • Let’s not focus on the few who would benefit from mercy killing or assisted suicide (in Oregon where there is physician-assisted suicide, this constitutes half a percent of deaths), and instead attend to the remaining 99.5% and their need to be heard.

Regardless of its legality, mercy killing is for a tiny minority. In endlessly poring over the morality or legality of ending the lives of a handful, let’s not forget the experience of everybody facing death in a scary, hi-tech medical world where we rightly fear loss of all control at the end.

Join the conversation

118 Comments sorted by

  1. Rita Joseph

    Writer

    Indeed "to provide a safe and feasible set of exceptions to the Crimes Act" seems to have been an elusive goal so far. The complex problems of human beings, patients and carers, under extreme stress, our personal, social and even financial limitations to maintaining patience and compassionate long term care for those who are dying more slowly than we would like and other factors--all impact on the safety and feasibility of producing a set of exceptions to the Crimes Act that will not have unmanageable…

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    1. Fabian Sweeney

      Agronomist

      In reply to Chris Harries

      Oh but the euphony of the word has been bastardized.

      Eu = good and thanatos = death. That's what I desire; as do a majority of my fellow voters.

      Now to bastardize Propaganda Fide in revenge!

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    2. Rita Joseph

      Writer

      In reply to Chris Harries

      David Albert Jones gave an interesting summary some years ago:

      "Euthanasia is a euphemism, though not as much of a euphemism as 'assisted dying'. Mercy killing is imperfect as a description (for if 'mercy' is considered as a virtue and not only as a sentiment, then it must be informed by other virtues, especially justice) but at least it clearly identifies the kind of act under consideration, which is a species of killing. Assisting suicide, while also imperfect as a description (for it implies that facilitating this action is 'assisting' i.e. a kind of helping, which is precisely the point of contention) also has the benefit of identifying an action as suicide, self-killing".

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  2. Kay Bennetts

    logged in via Facebook

    The author wrote, “Let’s not focus on the few who would benefit from mercy killing or assisted suicide ……… Regardless of its legality, mercy killing is for a tiny minority. In endlessly poring over the morality or legality of ending the lives of a handful, let’s not forget the experience of everybody facing death in a scary, hi-tech medical world where we rightly fear loss of all control at the end.”
    I feel the real issue is that while we all have some misgivings about our own [inevitable] death, the greatest fear is that either we or someone dear to us will be in that “tiny minority” who are forced to endure an unnecessarily horrendous death. It is essential to continue to examine more humane practices for the “tiny minority”, so that ALL people can live and approach illnesses with confidence that they will not be forced to needlessly suffer at the end of their lives.

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  3. M Lovejoy

    Citizen

    Leaving out the word "voluntary" when discussing the wish that the majority of Australians have, to end their life at the time of their OWN choosing if terminally ill, does nothing to advance an informed debate.
    A pointless article, therefore, IMO.

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  4. Joe Gartner

    Eating Cake

    It gets worse. The Age newspaper, a couple of weeks ago, had an article about a doctor who participated in withdrawing treatment on a terminally ill person. Both the doctor, and the newspaper, conflated euthanesia with withdrawing futile treatment.
    it is not a wonder that the public is confused about euthanasia and wary of medical decisions around withdrawing futile treatment at end of life..

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  5. Pythinia Preston

    writer

    A very thought-provoking article on a scary subject - thank you.

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  6. Rodney Syme

    Urologist

    First let me correct Peter Saul on one important matter - I did not participate in a "mercy killing". I provided Steve Guest with advice and medication for palliative reasons. He made a decision to end his life.
    Second, I agree with Peter Saul that we should discard the word 'euthanasia' - it has no agreed meaning and its use covers a wide range of disparate acts. I very much doubt that the quote he uses was actually made by me. I prefer the term voluntary assisted dying to describe medical…

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  7. Allan Gardiner

    Dr

    If we are to do away with 'euthanasia', then there's no reason why 'mercy killing', among any another term one might like to mention [or not mention], shouldn't also be given the ch_op'en-ended question.

    It's only by giving something a descriptive title that the law is able to deal with it and of course then attempt the punishing of the person[s] involved.

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  8. Robert Molyneux

    Citizen at Drehmex Sales and Services

    "Suicide" - killing oneself - is legal in Australia. "Assisted Suicide" - having a helper assist someone to suicide is legal. What other legal act is OK for the person committing the act but illegal for the person assisting?
    A problem is that the medical profession, sworn to save lives, have been intruded into the situation. Remove them from any critical part. A bit like abortion, but much simpler!
    A problem is that someone wishing to end his / her life has a range of options, some of which are potentially painful, messy and distressing to the witnesses and other people. Provide a simple and tested process - injection of a drug by a little robot controlled by the person involved, in a suitable location. Out a sea, under a favourite tree, wherever.
    The problem remaining is how to set up the robot. From my recent experience, finding a suitable vein and inserting a catheter is quite tricky - people trained in acupuncture seem to be the most skilful - doctors less so!

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    1. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Robert Molyneux

      Oops. "assist someone to suicide is legal" should have been "illegal".
      I am only talking about suicide. Not "euthanasia" of anyone else. I think "mercy killing" is a suitable phrase for the case where sentient creatures (human or animal) are "put to sleep" to relieve them of suffering by people with the necessary skills and equipment.

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  9. Anthony Gallas

    Student, University of Life

    I've been party to what would be called "passive euthanasia" by not insisting on treatment that would have kept a severely demented old man "alive" - if you could call living like a mobile vegetable being alive. It wasn't a pleasant experience, but we all agreed that it was merciful. We kept him pain free and comfortable, and he died peacefully.
    For myself, if I get to a similar state and unable to function, I would prefer that someone would allow or even help me to die comfortable, pain free, peaceful. Dignified.
    If that is still illegal, do me up in animal skin and take me down to the vet!

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    1. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Anthony Gallas

      " a severely demented old man" or a "severely incapacitated young man" are the instances where major ethical issues appear. I think assisting a sane and alert person to escape extreme pain (physical or mental) is one thing. To accelerate death by commission or omission of someone who cannot consent is another. To provide a drug which leads to someone's death as an (unintended) side effect of pain relief is another matter.
      Another condition is where parents are aging and are worrying about leaving behind an incapacitated child. I think parents ought to be able to take such children with them.
      I don't think working through these various human conditions is "a slippery slope".

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    2. Anthony Gallas

      Student, University of Life

      In reply to Robert Molyneux

      Definitely not a slippery slope, Robert. To me it seems more like a very bumpy road. In each of your examples there are ethical issues that those involved have to resolve, often causing conflict among those who are left. Been there, done that, unfortunately.

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  10. Chris Richardson

    Doctor

    This is a great balanced summary of the topic Peter, thank you. I have for a while been uncomfortable with "euthanasia" both in definition and in concept..! You are quite right to say that we have no right to oblige people to kill us. This is the fundamental problem I have with the "right to die" advocates. Unfortunately much of the opposition to euthanasia is on religious grounds, which is disappointing because it prevents a much more important debate from occurring, in my opinion.

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    1. Pythinia Preston

      writer

      In reply to Chris Richardson

      Why bring religion in to counteract the dissenters? I would think most religious people wouldn't contest the so called 'Euthanasia debate' to reach the pearly gates would be 'heaven' for them, whereas Atheists would hang on to the nth degree believing there is nothing on the other side.

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    2. Anthony Gallas

      Student, University of Life

      In reply to Pythinia Preston

      Great comment, Pythinia. I know a number of religious people whose main aim in life is to get past Saint Peter and through those pearly gates. One wonders why they wouldn't take the early option if it was presented to them. Others seem to value life to the nth degree.
      I also know some atheists who are in no hurry whatsoever to find out if they are right about the other side.
      But an individual's opposition to euthanasia may change depending on circumstances such as a terminal illness where pain and suffering becomes unbearable. Religious or atheistic, one would have to consider the best way to "go".

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    3. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Anthony Gallas

      It is hardly surprising that a religion that has an instrument of excruciating torture as its main symbol preaches that pain is somehow a gateway to future bliss.

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    4. Chris Richardson

      Doctor

      In reply to Pythinia Preston

      The religious objection is framed around the idea that we humans shouldn't "play god". That is, only god can choose when we leave this mortal coil, and he/she/it will decide when is the right time. Not so much an eagerness to get to the pearly gates..!! I think that's a separate issue.

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    5. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Chris Richardson

      Chris, the contra-deal to not "playing god" is that prayer might persuade the gods to intercede to reduce or remove suffering. As a doctor, have you noticed any difference in the level of suffering before death of religious / non-religious praying / non-praying mortals?

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    6. Anthony Gallas

      Student, University of Life

      In reply to Chris Richardson

      Yes, it is, really. Life is not a race, although a great many motorists seem to think it is. I for one am not in a hurry to reach the finish line.
      How do we categorise suicide? Could this be regarded as a form of misguided self-euthanasia? After all, some view those who suicide as "taking the east way out".

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    7. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Anthony Gallas

      "After all, some view those who suicide as "taking the east (sic) way out""
      A view of those that think that suffering pain on death is an essential prerequisite to getting into Heaven without passing through Hell.

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    8. Chris Richardson

      Doctor

      In reply to Robert Molyneux

      As a doctor, I've not witnessed enough death or praying to make a sensible comment. However there are some attempts at studying the effects of intercessory prayer on outcomes, such as "suffering" amongst other things - the well conducted ones show no effect. As to whether the religious are calmer, less anxious (have less existential suffering) during death and dying, I don't know of any work on this.

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    9. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Chris Richardson

      Chris, thanks for this - I apologise if I came across as hectoring you.
      I read somewhere of a study of the health and longevity of royalty, given the number of prayers directed towards their benefit. Apparently no effect whatsoever... perhaps God is a republican.

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    10. Chris Harries

      logged in via Facebook

      In reply to Robert Molyneux

      No, not a Republican he's a soccer coach. As they say, for all the praying that gets done for sporting victories God sides with the best coaches.

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    11. Bob Thomas

      Retired

      In reply to Chris Richardson

      As an atheist, I believe that prayer certainly has the potential to relieve suffering, because the power of the mind cannot be underestimated. Whether it be via prayer, meditation or any other mental process - one's mental approach can have an immense impact upon the level of suffering which can be endured.

      One of the key facts associated with end of life suffering is the huge advantage individuals have if they have access to lethal drugs. The capacity to die at a point of their own choosing gives them autonomy, and autonomy gives strength. Many people who are given the means to suicide hold out until the end simply because they are empowered rather than helpless.

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    12. Michael Leonard Furtado

      Doctor at University of Queensland

      In reply to Robert Molyneux

      Mr Molyneux, I think you should be better informed about the instruments of excruciating torture to which you allude (and which in the case of Christianity refer to the triumph of life over death) otherwise the enunciation of a general and laudable principle in favour of the humane treatment of the dying can easily get lost within the causticity of your remark.

      This article, after all, is about seeking clarity in a complex ethical field and not about finding an excuse to belittle belief. The fallacy…

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    13. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Michael Leonard Furtado

      Michael, you have responded to two of my posts. I won't go into the exact nature of crucifixion here, and my understanding of just why God chose to sacrifice His only son in this manner. Suffice to say that as an atheist I find the idea of suffering in this life to get entry into a better life is thoroughly repugnant to me. I absolutely accept that people of all creeds might want to assist other people through "palliative" care. I would be very interested to hear the positions of Hindus, Muslims, Buddhists ... atheists regarding palliative care, and assisted and unassisted suicide. So long as people do not impose their superstitions on me, I have no objections to any of these belief systems.

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    14. Michael Leonard Furtado

      Doctor at University of Queensland

      In reply to Robert Molyneux

      This is an open site for all who are registered on it with an interest and ability to read and comment. Until you chose to bring religion into it with an adverse comment that happened to lack theological literacy, there was a general consensus that presuppositions about faith should be set aside until you breached that understanding.

      The fact that the principle of double effect was invoked by me in answer to one of your questions (indeed two, as the record shows), is not contingent upon a religious belief. Elizabeth Anscombe and John Finnis, the Oxford bioethicist philosophers and jurisprudential scholars, have made that consistently clear in their eminent work on this topic.

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    15. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Michael Leonard Furtado

      Michael, my comment was in response to a couple of other comments about religion. I think that religion, except in how it informs systems of ethics, has no direct relevance to the various issues relating to euthanasia.
      I think that pompous lectures about what I do or do not know about theology are not very valuable.
      BTW: The reason I made that comment is my belief (which you may wish to counter) that the Catholic Church, Roman or otherwise, thinks that suffering on Earth may be rewarded in Heaven…

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    16. Michael Leonard Furtado

      Doctor at University of Queensland

      In reply to Robert Molyneux

      Dr Molyneux, no post of relevance raised religion as an issue other than to bracket it off from the discussion. You dig yourself into deeper waters in introducing a new element, viz. Purgatory, which Catholics haven't talked about or taught since Vatican II (1960).

      Like Hell, which is explained figuratively, it is a Greco-Roman intrusion that has no place in modern times in the theology of non-fundamentalist Christians, especially in relation to life and death issues, in which you insinuate that…

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    17. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Michael Leonard Furtado

      Michael,
      Thank you for your long exposition. I will try to respond succinctly.
      1. Religion: I fully accept that different religions may evolve over time to make obsolete various superstitious elements such as Purgatory and Hell (and hopefully, Limbo) - even if this took about 1960 years. I think the key issue is the belief that suicide is a sin, and that humans must not interfere with the "normal" passage of life.
      2. Suicide: Regardless of religious views about suicide, it is no longer a crime…

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    18. Bob Thomas

      Retired

      In reply to Robert Molyneux

      If I may be so bold as to insert myself into this discussion, none of this conversation advances the fundamental conversation in any way.

      There is a simple proposition here - i.e. whether or not humans should have autonomy over their end of life choices. It's that simple.

      Whether or not you are religious is irrelevant, and so the entire side debate about religious influence is a distraction.

      Individual philosophies are also irrelevant, because legislation on this issue is never intended to apply…

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    19. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Bob Thomas

      Bob,
      "There is a simple proposition here - i.e. whether or not humans should have autonomy over their end of life choices. It's that simple."
      I agree with all your points. However, I think that this conversation is more than simply accepting or otherwise your "simple proposition". The Northern Territory legislated euthanasia, and was then overridden by the Federal Government, especially through the efforts of Kevin Andrews, now back in power. The chances of getting your simple proposition adopted…

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    20. Bob Thomas

      Retired

      In reply to Robert Molyneux

      Yup ... Kevin Andrews and his ilk pose a major problem, I agree. There are two schools of thought as to which route is the best way to go - the "Peaceful Pill" approach or lobbying. My view is that both options working alongside each other constitute the best path.

      My reasoning is based on the traditional reluctance of politicians to act unless they are forced to act. Therefore, if the "Peaceful Pill" option becomes a serious alternative, then the political lobbying will provide a path for politicians…

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    21. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Bob Thomas

      Hi Bob,
      You realise that publishing techniques for killing yourself has been criminalised?
      See http://www.dailymail.co.uk/news/article-2650238/Vic-police-question-Nitschke-deaths.html.
      I agree with your statement "I am always reluctant to ignore those who are no longer "sane or conscious" because that effectively disenfranchises them. From a personal perspective, I would want my views to be paramount even if I have lost the capacity to express them." - except that I think that crosses over into…

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    22. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Michael Leonard Furtado

      Michael, the more I think about it, the more puzzling the criminalisation of assisting suicides becomes.
      Do you have a view on the ethics and law of this matter?

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    23. Bob Thomas

      Retired

      In reply to Robert Molyneux

      "You realise that publishing techniques for killing yourself has been criminalised?"

      Yup ... but in the era of the internet that sort of regressive law really poses no great impediment to those who are seeking to die. It simply illustrates the irrational desire of Governments to repress rather than regulate. This is an argument which ultimately the Government cannot win because the aging population will eventually find ways around laws which essentially lack compassion or common sense. There will be a time in the future when society will look back at this time in history with disbelief at the stupidity inherent in our current laws.

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    24. Bob Thomas

      Retired

      In reply to Robert Molyneux

      Ahh yes ..... there are indeed some odd beliefs and perspectives around - and "bizarre" accurately describes some I have come across!

      Alas, although I have been having this conversation for much of my life, little changes. When or if I find myself in need of a controlled exit, I am sure that I will need to do so illegally. Sad really, to end one's days furtively rather than surrounded by loved ones.

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    25. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Bob Thomas

      Agreed - irrational and repressive - but what does it say about knowledge of basic technology of those who tried this nonsense?
      I am waiting on Michael to explain the ethics and law behind it, but the criminalisation of "facilitation" (to use a new term...) strikes me as some bargain - "we will decriminalise suicide despite our (religious) views, but you must criminalise facilitation" - so that nothing is easy. Along the lines of "stop it, or you'll go blind".
      Note that the Scottish law requires the passenger to specifically and explicitly do something (physical) in committing suicide. Tough if you are paralysed and unable to swallow, but them's the breaks I suppose.

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    26. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Bob Thomas

      Don't be so depressed! Have you seen the recent 7:30 item on ABC TV (Sydney, a couple of weeks ago) of a woman who passed at home, surrounded by her family? Assisted by a private palliative care organisation, so the place and circumstances were chosen - just not the time. I will see if I can get a link.

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    27. Bob Thomas

      Retired

      In reply to Pythinia Preston

      Pythinia, I am undecided whether you actually believe the rather pointless statements you throw in from time to time, or whether you are in fact just a troll - I suspect the latter.

      However, just in case you are actually serious - no, I doubt that many people wish to die alone. I think you may be confusing us with animals.

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    28. In reply to Bob Thomas

      Comment removed by moderator.

    29. Michael Leonard Furtado

      Doctor at University of Queensland

      In reply to Bob Thomas

      Hi Bob

      Thanks for your point about individualism. The law has no objection, generally by default, in people doing themselves in in any way that they can. Sadly, but realistically, that is what some people do everyday, if the stats are to be believed. This does not make it legal but suicide by definition and on its own cannot carry a penalty, since in carrying out their desire the suicidee involves no one else and in any case is dead and therefore unable to stand trial for breach of a legal code…

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    30. Michael Leonard Furtado

      Doctor at University of Queensland

      In reply to Robert Molyneux

      Hi Robert

      Thanks for your succinct reply. I doubt if we would agree on this matter, and that brevity would assist. My position however is this:

      1. A person has a moral obligation and a right to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or community.

      2. A person may forgo extraordinary or disproportionate…

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    31. In reply to Bob Thomas

      Comment removed by moderator.

    32. Bob Thomas

      Retired

      In reply to Michael Leonard Furtado

      Michael, I agree that the law must ensure that assisted suicides must be investigated, I would certainly not suggest otherwise. However, until we establish a legal framework which accepts that assisted suicide is not illegal by default, we shall continue to force the participants to act furtively.

      I was recently watching a video of an assisted death by Dignitas, and the process was efficient and legal, with the death filmed, documented and reported. There was no question of illegality or immorality but of course those involved had to travel to the other side of the world to achieve the desired end.

      The fact that this happens on a regular basis, without fuss or bother illustrates that a legal process is possible without the feared "slippery slope". As a first step, this would be something Australia could emulate without having to be a trailblazer.

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    33. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Michael Leonard Furtado

      Michael, the criminalisation of suicide meant that if a person survived an attempt, they could be charged for a criminal offence, and punished, including by gaol. As I understand it, this no longer applies in any part of Australia.
      While skimming documentation about this, I noticed in one jurisdiction it is legal to use "reasonable force" to prevent a suicide - presumably to protect police etc from charges of assault while laying hands on bridge and railway jumpers.
      The problem with arguing by analogy…

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    34. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Michael Leonard Furtado

      Hi Michael,
      1. I agree a person has a right to preserve his life. Whether he has a "moral obligation" seems to me to smack of the view of suicided as a sin.
      2. I agree a person has a right to make a judgment about treatment, including a "cost benefit" analysis. The issue here is that some people cannot validly exercise this right. Where someone else makes the judgment (ranging from the State through to blood-relatives) there are all sorts of problems to be addressed.
      3. There are all sorts of cases…

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    35. Michael Leonard Furtado

      Doctor at University of Queensland

      In reply to Robert Molyneux

      Yes; thanks, Robert, for the Asimov and Scottish references which I shall pursue. At this stage and on the face of it, and as a supporter of the double effect principle, my inclination would be to attach importance to the idea of intention, which in the case of a robot or other form of artificial intelligence, would suggest human complicity in the decision to euthanase or not, no matter how far removed from the actual decision-making process and result.

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    36. Michael Leonard Furtado

      Doctor at University of Queensland

      In reply to Robert Molyneux

      Yes; thanks for your post, Robert. I take your point and that of your brother but would respectfully disagree.

      The justification for involving the citizenry alone and excluding medicos and lawyers, appears to rest on cases where evidence alone, as in the case of a jury decision, is the key arbiter or determinant of what is yet to eventuate, which is of course in effect tantamount to a sentence of death or reprieve.

      Whereas a jury (of twelve angry men and/or women, chosen randomly) would not of…

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    37. In reply to Bob Thomas

      Comment removed by moderator.

    38. In reply to Bob Thomas

      Comment removed by moderator.

    39. Michael Leonard Furtado

      Doctor at University of Queensland

      In reply to Bob Thomas

      Bob; sorry to interject but take it easy. Old age, which we all experience is usually accompanied by neuro-degeneration and it is reasonable to expect that a topic which fascinates is also one that looms large in our collective unconscious as something we'll have to deal will sooner or latter.

      Unfortunately this forum isn't ideally placed for the easy exchange of personal information which makes it incumbent on all of us to reach out for a sweetener (purely metaphorically, of course) rather than a brickbat.

      Having said that, I note that you are more than usually polite and user friendly except for being given like me towards being a tad relentless when in full rhetorical flight, so to speak.

      When overcome with self-righteousness I have learned to remind myself that most of us don't know one another from a bar of soap, and even though such items can end up in the most awkward of places ;) it helps to be patient and availing especially on this issue.

      Thanks for listening.

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    40. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Michael Leonard Furtado

      I think a "jury of peers" of volunteers, with appropriate training, could be wise, just and merciful. The current criminal jury system selects people at random (unless they are working / too busy / teachers / public servants...) to make life and death decisions.
      I envisage this body would meet with the "passenger" and the "facilitator" beforehand. The passenger would state "My name is Fred. I want to pass with dignity", and the facilitator would state "I want to help Fred by holding his hand / hugging him - and by setting up equipment (if necessary) and to handle routine matters (calling an undertaker) and emergencies such as things going awry".
      You keep talking about quasi-legal analogies - eg sentence of death or reprieve. The passenger (like all of us) is going to die. There is no reprieve.

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    41. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Michael Leonard Furtado

      Michael, apart from implying that Bob is getting senile, you raise an interesting point.
      "Unfortunately this forum isn't ideally placed for the easy exchange of personal information which makes it incumbent on all of us to reach out for a sweetener (purely metaphorically, of course) rather than a brickbat."
      It would be easy to contact you directly at the University of Queensland, whereas Bob Thomas's profile simply shows he lives in Melbourne. My profile gives a link to my LinkedIn profile, which includes my contact details.
      LinkedIn has the facility for people to contact each other and to ask politely if further contact / exchange of views etc is OK. I think this would be a good way for people to develop friendships around their shared interest in various topics.

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    42. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Robert Molyneux

      Bob, the item was broadcast in Sydney on 30 May. It sounds a bit like the Dignitas item you mentioned. Very sympathetic, and a very interesting interview with the NSW Health Minister by Quentin Dempster. She agreed that in fact "home deaths" were cheaper in terms of capital buildings and staff. The cost of analgesics (about $500 per week) is currently covered by "hospital deaths", so this is potentially an issue - easily resolved?

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    43. Bob Thomas

      Retired

      In reply to Robert Molyneux

      Thanks for that link Robert, I'll sit down and listen to it.

      The concept of a panel to facilitate these situations is an interesting one, although inevitably the delays which would arise would possibly mean that the parties were still forced into taking matters into their own hands!

      I am always hesitant when bringing cost savings into the discussion because some people then place the whole discussion into a "cost saving" basket, thereby tainting the discussion with economic rather than compassionate arguments.

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    44. Bob Thomas

      Retired

      In reply to Michael Leonard Furtado

      Thanks Michael, for your comments, and I accept that I am certainly forceful in my opinions on this topic. Although not yet senile or unduly impacted by the failings of age, I nonetheless become frustrated when individuals either divert the conversation away from the central topic or otherwise stray from the main thread.

      As you say, the forum is not ideally placed for in depth conversations, which, to me, places us all under the obligation to keep on track, so to speak.

      In any event, the moderators…

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    45. Michael Leonard Furtado

      Doctor at University of Queensland

      In reply to Robert Molyneux

      Thanks for the info. No I wasn't implying or inferring that Bob was senile. I was simply saying that because of the likelihood of the topic attracting the participation of older persons, who may be slow on the uptake, and also because of the heated nature of disagreement on this topic, special consideration should be given to giving the 'other side' the benefit of the doubt rather than to reach for an all too easily available jugular vein with which to dispatch the vulnerable.

      Such practices are imperceptible and occur on the spur of the moment but I am conscience of at least one incident, not involving me, where a better way would have been to adopt an attitude and wording more congruent with the overall plea for compassion.

      Thanks for asking.

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    46. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Bob Thomas

      Bob, by "cost / benefit" I mean a consideration of the pros and cons of decision(s), some of which are financial, some ethical, some practical, some compassionate. I think one of the "resources" that a panel might use would be a decision tree and flowchart of the options to guide the parties' considerations.
      It is interesting that of the 1200 or so people "licenced" in one scheme, about 750 chose to go ahead. Presumably (and, Michael, hopefully!) the remainder selected other options in some sane / voluntary / informed way. .

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    47. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Bob Thomas

      See http://en.wikipedia.org/wiki/Three_Laws_of_Robotics.
      I keep banging on about robots because I see this as a way of avoiding having a human assisting with the suicide.
      The Scottish proposed law seems to be that suicide is OK, but the passenger must specifically and voluntarily do something (not yet explained?), unaided by anyone else - presumably to prove that the deed was in fact voluntary and intended, right up to the last minute. No second thoughts.
      Presumably if a facilitator propped up a shotgun with a piece of string for the passenger to work the trigger, this would be OK, if rather painful, messy and potentially non-fatal.
      I suggest you look at Texas as the way the American justice system bumps off its citizens with gay abandon. And Obama's use of extra-territorial murder using drones could well bring sudden death to someone near you in the near future! But I digress!

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    48. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Michael Leonard Furtado

      Older persons slow on the uptake?
      There have been well documented cases of people suiciding when they became aware / afraid of themselves becoming demented / slow on the uptake, and of their loved ones being prosecuted for helping them.
      I suppose I should be compassionate and ascribe your comment to incipient senility. Just joking!

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    49. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Michael Leonard Furtado

      There you go again!
      My mother was "put to death" by a nurse who injected a large dose of morphine with my mother's full knowledge and consent that this was likely to happen. This is what happens in palliative care all over Australia. Are you really calling this "execution"?

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    50. Michael Leonard Furtado

      Doctor at University of Queensland

      In reply to Robert Molyneux

      No, I'm not. I'm aware that this goes on all over Australia and in most of the developed world. My beef is with those like you who are dissatisfied with such an arrangement which perfectly meets the conditions of the principle of double effect.

      Your evident dissatisfaction with the status quo is dismal and depressing, it scares the elderly and terminally ill and distracts from the little that may be pleasurable for them in what remains of life.

      But worst of all, it makes of the euthansiac mind…

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    51. Bob Thomas

      Retired

      In reply to Michael Leonard Furtado

      Michael, I think we would agree that this form of euthanasia is commonplace, however I would suggest that this avenue only exists once a terminally ill individual is virtually dead anyway. It does not help those with some way to go, or whose status falls into the category of "unbearable" rather than "terminal".

      I would also suggest that those of us who favour euthanasia (for want of a better word) are not obsessed with death simply because we seek better end of life options. One might use that logic to suggest that virtually anyone who has a "special interest" is obsessive, or indeed that those who are anti-euthanasia are obsessive.

      Perhaps you personally haven't encountered a demand for euthanasia, but that doesn't mean that it doesn't exist - simply that you haven't encountered it. The huge majority of Australians who do in fact support better end of life options illustrates that there is in fact a great demand for reform.

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    52. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Michael Leonard Furtado

      Michael,
      Your statement "My beef is with those like you who are dissatisfied with such an arrangement which perfectly meets the conditions of the principle of double effect." simply reflects that you are very happy with the status quo. Some of us are not.
      Your statement "Your evident dissatisfaction with the status quo is dismal and depressing, it scares the elderly and terminally ill and distracts from the little that may be pleasurable for them in what remains of life." is rather strange. I am…

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  11. Peter Saul

    Senior Specialist in Intensive Care and Head of Clinical Unit in Ethics and Health Law at University of Newcastle

    Thankyou for all the comments so far. I apologise to Rodney for placing his actions at the wrong place on the euthanasia spectrum, and thank him for his considered remarks. Like Rita and others, I struggle with a set of terms that accurately capture both the actions and the intent behind those actions. In surveying ICU staff, Charles Sprung used the term "shortening the dying process" and got a lot of positive response. For myself, I'm fond of playing with the Greek origins, and talking about the…

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    1. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Peter Saul

      For those not speaking Greek:
      http://lifeinthefastlane.com/education/ccc/avoiding-nosocomial-dysthanasia-promoting-eleothanasia/
      Peter, with respect, playing around with Greek words to an English-speaking audience illustrates the problem of involving medicos at the end of life, when medical intervention has no value at all.
      I can see why someone in an ICU whose whole life has been devoted to valuable work for the living might struggle with applying drugs and catheters to end life - but frankly…

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    2. Bob Thomas

      Retired

      In reply to Robert Molyneux

      Many of us have similar experiences with ageing/dying parents. My own mother constantly sought death, having reached the point where continued living was pointless to her. As she lay on her deathbed a nurse asked me if I felt she was in pain. I hesitated before realising that this was just one of the rituals we have to undergo in order to end life. I replied that "yes" I did think she was in pain, and the resultant morphine injection effectively ended her life. We should not have to participate in charades to achieve peaceful deaths.

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  12. Bob Thomas

    Retired

    The key misconception of this article is to trivialise the suffering of that "tiny minority". Dying with Dignity (the preferred term for euthanasia) is primarily about that small group of people, and therefore the whole essence of the debate should be focussed upon their needs. The huge majority of us will meet our deaths in a reasonably controlled manner, hopefully with the aid of palliative care. It is the minority, for whom palliation is impossible, that we seek newer, more humane laws.

    The attitude expressed in this article essentially suggests that minority groups deserve representation only in proportion to their numbers in society. This is an appalling philosophy upon which to build a compassionate society. We should instead be constructing moral and ethical frameworks in which the needs of the few are embraced by the laws for the many, and a society which recognises that every life which ends in suffering is unacceptable in a caring society.

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  13. Anne Riddell

    logged in via Facebook

    The Oregon experience seems to me to be a worthwhile starting point in thinking about how Australia could legislate to make assisted suicide available to the terminally ill. The workings and outcomes of the Oregon Death With Dignity Act are well documented at http://www.deathwithdignity.org/in-oregon . Since the law was passed in 1997, a total of 1,173 people have had DWDA prescriptions written; 752 patients have died from ingesting those medications. This equates to a rate of 22 DWDA deaths per 10,000 deaths in Oregon. The role of medics is only to prescribe . . . after a stringent evaluation process. Dr Saul, would you care to comment on this?

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  14. Hamish Kelly

    Student

    I agree with many points you have made throughout this article, but taking into account the stance you have taken on euthanasia in the past tends to add another shade to this article that I believe readers should have been informed of beforehand (http://www.ted.com/talks/peter_saul_let_s_talk_about_dying#t-707364).

    I do believe that Australian society should have a discussion about how individuals/partners/families should approach death, but ignoring the will of terminally ill people does a great…

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    1. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Hamish Kelly

      Hamish, I assume you are aware that the Northern Territory introduced legislation and a couple of people used it to die with peace and dignity? The legislation was overturned by the Commonwealth Government led by Kevin Andrews, He was on LateLine last night as Minister for Social Services. He seems to have developed an alarming wheeze, so perhaps he is getting close to experiencing end of life processes more personally. Anyway - we do not need to go outside Australia for experience and debate of the issues.

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    2. Hamish Kelly

      Student

      In reply to Robert Molyneux

      Robert, I am aware. We might not need to go outside of Australia and I believe we, as a civil society, could work our way through this controversial issue, but to ignore the lessons and experiences of doctors, their patients and families from the Netherlands, Belgium, and Luxembourg (where euthanasia has been legal since, April 2002, May 2002, and March 2009, respectively) would be naïve at best. We could save time, energy and suffering by learning from others that have gone before us. There is no need to make the same mistakes.

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    3. Bob Thomas

      Retired

      In reply to Hamish Kelly

      Hamish, you are spot on. This is a complex and emotional issue, and one of the key strategies of those who oppose it is the "slippery slope" argument. Using irrational fear is a tool that has worked well for years. However, as many societies have introduced legislation we have evidence that the sky does not fall in, and civilisation remains civilised.

      There is no need to re-invent the wheel here, simply to adjust it to Australian needs. It is no longer a question of how it might work - it does work, and that's something opponents of dignified and compassionate deaths try very hard not to see.

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  15. Anthony Gallas

    Student, University of Life

    Before I leave this conversation, I'd like to express my appreciation to all of you for your input, regardless of whether I have agreed or not with everything said. It has, as with every Conversation I have joined, been very educational.
    My personal wish is that when I decide to fall off my perch, is that I can drift off into the hereafter surrounded by beautiful images and listening to the music of my choice. As long as I'm not turned into Soylent Green!
    'Bye!

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  16. Sonia Fullerton

    logged in via Facebook

    Thank you Paul for your marvellous article.

    I am a palliative physician - a doctor who looks after people with life limiting illnesses. A lot of my work is symptom control; decision making at the end of life and "terminal care", which is care of the actively dying person, are also my bread and butter.

    I agree with Paul here
    "Regardless of its legality, mercy killing is for a tiny minority...... let’s not forget the experience of everybody facing death in a scary, hi-tech medical world where…

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    1. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Sonia Fullerton

      Hi Sonia,
      Regarding "Rarely, very rarely, control of a dying patient's symptoms is not possible without high dose sedation. The intention of the sedation is to make the patient unconscious usually to relieve their severe agitated delirium (confusion) at the end of life."
      Sorry, if by administering a "high dose sedation" the intention is to "make the the patient unconscious...." but oops, the patient dies, then surely this needs to be reported as a premature death following a medical procedure?
      What…

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    2. Bob Thomas

      Retired

      In reply to Sonia Fullerton

      Thank you for the "inside" clarification of what happens in palliative care facilities. I agree that this is a little different to "active" euthanasia (and I agree that the term itself is highly emotive and inappropriate).

      The role you play is valuable, but to an extent is closing the door after the horse has bolted. Many people will die as you have described, but then there are those who wish to "cut out the middleman" and choose death at a time of their choosing. I have visited palliative care…

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  17. John Davidson

    Retired engineer

    The reality is that most adults have the capacity to end their life without assistance when they choose to.
    The cruel irony is that those whose health has reached a point where ending their life may be a very logical thing to do no longer have that capacity. In some cases this irony may mean that people choose do die before they really want to because they don't want to to end their days lying in pain with bowels they can no longer control etc. etc.
    I have watched someone die who made a logical decision that it was time to die. This person got her wish by refusing to eat or drink until she was dead. The process took days and was clearly not a very comfortable experience despite all the morphine she was receiving.
    The person i am thinking about would have had a far better end if the person had been able to make the decision, wait for relatives and friends to gather and then died quickly.

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  18. Heather White

    logged in via Facebook

    I first came upon Dr Peter Saul via his 2012 TED talk

    https://www.ted.com/talks/peter_saul_let_s_talk_about_dying

    I agree with Dr Saul's assertion that the word "euthanasia" is not used consistently, and therefore is not an appropriate word for such an important debate.

    The euthanasia debate appears to follow a similar path in England as in Australia, with test-case after test-case being lodged with the High Court and Court of Appeal to allow an individual to be assisted to end their life…

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    1. Bob Thomas

      Retired

      In reply to Heather White

      Heather, that all sounds quite valid until you dig more deeply into what you are suggesting.

      You suggest that we may find ourselves having death forced upon us, and this clearly runs contrary to every single tenet of the Dying with Dignity movement. This is about the right to choose - not about abrogating that right.

      You also reference UK laws which doesn't necessarily have relevance in Australia. However, the most glaring problem I have with your comments is the use of the word "Most". It is easy…

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    2. In reply to Bob Thomas

      Comment removed by moderator.

    3. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Heather White

      Heather, a few minor quibbles (apart from the fact that we are not all in England and Wales). From your interesting list, where do you get the idea that "b) to protect a loved one from prosecution should they assist in life termination" is catered for by "all these reasons are catered for within existing law"?
      Suicide is legal in Australia. Assisting suicide is illegal. Even discussing euthanasia by publicising the techniques is illegal.
      "Most people with a terminal illness adapt to their reduced…

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    4. Michael Leonard Furtado

      Doctor at University of Queensland

      In reply to Bob Thomas

      Thank you, Bob. I suspect with the number of retirees participating here that the issues under discussion are more than real and life-terminating for some. When that happens it is hope that people require rather than a discussion about assisted suicide.

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    5. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Michael Leonard Furtado

      I agree that discussion of issues affecting people towards the ends of their lives is more than just suicide, assisted or otherwise. I agree that hope versus despair is critical to living a "good" life. What do you mean by " it is hope that people require"? How do you promote hope?

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    6. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Heather White

      Palliative:
      : something that reduces the effects or symptoms of a medical condition without curing it

      : something that is intended to make a bad situation seem better but that does not really improve the situation
      I suggest that "palliative" is actually NOT a good description of what is needed for people handling the issues towards the end of their lives. For a start, medical conditions are not the only issues.

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    7. Michael Leonard Furtado

      Doctor at University of Queensland

      In reply to Robert Molyneux

      Hello Robert.

      Thanks for your questions,

      One promotes hope for the dying in a number of ways, primarily by according to them resources, both human and material, and, for those who seek it, spiritual, that comfort and sustain them at a very difficult and invariably terminal time of life.

      Secondly, one should adhere to the principle of double effect, which reads approximately as follows:

      'One should always strive to sustain life but should do so with regard to other effects impacting on the dignified…

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    8. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Michael Leonard Furtado

      Michael, I happen to have a Ph.D. I sometimes call myself "doctor" - especially on credit cards, since it seems to evoke extra levels of service. I call myself "Citizen" in these sorts of discussions because generally speaking special qualifications are not necessarily relevant. I am not sure why you enter this conversation as "Doctor at University of Queensland".
      I have posted before that (1) I think that medicos have no special standing in euthanasia and palliative care (since by definition there…

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    9. Michael Leonard Furtado

      Doctor at University of Queensland

      In reply to Robert Molyneux

      Robert, your sly aside on what The Conversation chooses to call me indicates that you know more than you think you know just as you know less than you might want to.

      I having been following this correspondence assiduously and chose to post a response to an intemperate remark of yours first, while politely responding to a question from you a second time.

      Had I realised that you were being rhetorical, I would have left you to your preferred status of being a 'no-hoper'. Thanks and good-bye.

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    10. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Michael Leonard Furtado

      Michael, I accept that it was a "sly aside" and apologize.
      I suggest you edit your profile to be more appropriate to your special expertise - educationalist, for example.

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    11. Robert Molyneux

      Citizen at Drehmex Sales and Services

      In reply to Michael Leonard Furtado

      Michael, I have read your profile. I assume you know that you can edit your "subtitle" to reflect whatever you like. Perhaps "Philosopher" would fit?

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    12. Kelvin Varnsen

      Topiarist

      In reply to Michael Leonard Furtado

      "My special expertise extends over several fields, among which bioethics is but one."

      Michael, can you please detail what constitutes your "special expertise" in bioethics? It is not clear from your profile on The Conversation.Thanks.

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