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Right time to die: why rational suicide should be legalised

Australians are living longer. But not everyone wants to live as long as they can. People sometimes have good reasons for wanting to end their lives: they may be suffering from a terminal illness; they…

Evidence from the Netherlands shows that common fears about legalising voluntary euthanasia aren’t warranted. Image from shutterstock.com

Australians are living longer. But not everyone wants to live as long as they can. People sometimes have good reasons for wanting to end their lives: they may be suffering from a terminal illness; they may be experiencing unbearable pain; or they may have decided their life has gone on long enough.

A well-constructed legal framework could ensure Australians who make a rational decision to end their life can get the assistance they need to do so, while protecting people from the dangers opponents of euthanasia fear.

Some worry that legalising voluntary euthanasia will take us down a slippery slope to state-sanctioned murder. If a society allows doctors to kill or assist in the death of people who find their lives intolerable, then what is to stop it from allowing them to kill the senile, the disabled or others who are judged not to have lives worth living?

Some fear that legalising euthanasia means that greedy relatives will start pressuring old people to ask for death. Others worry that making doctors into agents of death will undermine their primary duty to preserve life.

So far those who oppose voluntary euthanasia have won the political battle. It is illegal for doctors in Australia to grant requests of patients who want to die or to assist them in committing suicide. But in Australia, as in other countries, doctors do sometimes allow their patients to die when further treatment would only prolong suffering.

Lessons from the Netherlands

Since 2002, Dutch law has allowed doctors to grant requests for euthanasia or assisted suicide without being prosecuted, provided conditions are met: patients must request death and they must be suffering unbearable anguish with no end in sight. Two independent doctors must be consulted. And afterwards, the doctors must report to a committee of review.

The law allowing euthanasia is popular. A majority of doctors and 95% of Dutch people support it, according to recent surveys.

From the beginning, the law had its critics. The UN Human Rights Committee worried that reviews only take place after life has been terminated. But a report published in the Lancet medical journal shows that the system is not having the results many people feared.

An extensive survey of doctors in the years preceding and following the introduction of the law shows the law did not prompt an increase in cases of euthanasia. In 2010, deaths by euthanasia or physician assisted suicide were 2.8% of the total number of deaths in the country. This is a slight increase from 2005 but is no higher than before the law was introduced.

Ending life without the explicit request of a patient happens less often now than it did in 2005 or before the law was enacted. The authors of the report conclude that the euthanasia law in the Netherlands has resulted in a transparent practice not seen in other countries.

There has been no epidemic of euthanasia in the Netherlands. The law has not encouraged doctors to euthanise people against their will. And there is no sign that relatives are using the law to hound old people to their deaths.

Australia could make use of and improve on the proposed Dutch model. Image from shutterstock.com

The Dutch experience shows that laws can successfully regulate voluntary euthanasia and physician-assisted suicide. However the law does not accept requests to die from people who fear the disabilities of old age or think that their life is complete.

Some Dutch citizens think people over 70 ought to be able to request death under strict provisions. They propose a system where those who want to end their lives would have to consult specially trained health care professionals. They would have to show that their desire to die is rational and not the result of depression or impulse. All cases would have to be reviewed by a committee, as is now the case for voluntary euthanasia.

An Australian framework

Legislation in Australia could make use of and improve on the proposed Dutch model. Those who want to end their lives could be required to attend psychological counselling conducted by professionals with special training. Their request would need to be approved by an ethics committee appointed by the government. Perhaps the law would also require a “cooling off period” of six months or more before their request could be fulfilled.

Any proposal for a law that allows doctor-assisted suicide for older people has a lot of hurdles to get over. We would not want a system that encourages neglect of the aged or the running down of services for elderly people. We certainly don’t want anyone to think that encouraging elderly people to ask for death is a good way of dealing with the problem of an increasing population of old people or the shortage of medical facilities.

But these fears are not a reason for refusing to consider how we can respond to those who have a rational reason for wanting to die. They should be able to end their lives without pain, anxiety, or law-breaking and the risk of prosecution.

We are at the beginning of a discussion about how the law should respond to the widespread support from Australians for legalising voluntary euthanasia.

Later this year the Tasmanian Parliament proposes to debate a private members bill which, if passed, would legalise voluntary euthanasia for some people with terminal illnesses. This may be the first step.

Join the conversation

26 Comments sorted by

  1. Henry Verberne

    Once in the fossil fuel industry but now free to speak up

    As long as they are acting as free agents, I support (using the Dutch guidelines as a model) the right of people to end their own life. If this right became legally supported I hope that I would never use but it would be comforting to know it will be an option.

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  2. robert roeder
    robert roeder is a Friend of The Conversation.

    retired

    Janna, thank you for your summary of the situation.
    In a utilitarian sense people should have the right to make their own decision, as the situation stands now religious dogma holds sway against logic. People in acute pain are forced to endure, we put down animals in a similar situation and call it humane, does that mean the current system is inhumane.
    At this time people who assist run the risk of criminal prosecution, what a tragedy it must be for love ones who are confronted with this decision.
    The dilemma for many people is timing, should they do it sooner while physically capable or rely on a relative or friend who may in the end not have the courage needed or are opposed to the idea.
    A debate on this topic is long overdue in Australia, the current royal commission into child sexual rape may provide be a good time to confront religious convention on this issue.
    Death the adventure of a lifetime.

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  3. Peter Ormonde
    Peter Ormonde is a Friend of The Conversation.

    Farmer

    Personally I have no qualms at all about relatives giving gran a nudge on their biannual visits to the nursing home... feel the love gran... just in case you thought it had all been worthwhile.

    Beats being left out on the ice floes for the polar bears and might encourage gran to make a new will leaving her vast wealth to something useful rather than enriching her grasping descendants.

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  4. Colin MacGillivray

    Architect, retired, Sarawak

    The problem is the politics. How many politicians who might agree with this very good article in private, fear how the media (and voters) will interpret their "coming out"? And which party will put it in their manifesto in September?
    Every aspect of the debate has been covered by the Dutch example. How about a media blitz educating people followed by a referendum.
    And read "Dancing with Mr Death" by Bert Keizer

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    1. Dianna Arthur

      Environmentalist

      In reply to Colin MacGillivray

      Colin

      Christopher Pyne is well known for his objections to euthanasia, I am not sure about the would-be, PM Tony Abbott, as much as he may claim to not let his belief in Catholicism influence his politics, that he will "govern for all Australians", I posit that Abbott's Australians are not quite the same as yours truly or many other Aussies.

      What is it with the so-called libertarian right that they act with such high levels of authoritarianism towards the rights of others?

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    2. Peter Ormonde
      Peter Ormonde is a Friend of The Conversation.

      Farmer

      In reply to Dianna Arthur

      Ah yes Ms A ... these "libertarians" have very interesting notions of "small government" and the "nanny state" ... more CCTV cameras - you bet!, more powers for the police - always!, wars on drugs - most certainly!... gay marriage - outrageous!, abortion ... never!, euthanasia - not in my lifetime!.

      In reality they love big government - providing it directs its efforts to telling "other people" what they can and cannot do.

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    3. Dianna Arthur

      Environmentalist

      In reply to Peter Ormonde

      I hear you Mr O. Don't forget the recent "free speech" battles. With these "libertarians", apparently their rights trump all others.

      Small government, my arse; their spending on police, defence and 'security' cameras (as you have pointed out) cost a lot of dollars. They want to control women's fertility and both men and women's choice to die with dignity.

      Many years ago I used to think I was a libertarian - what we are seeing is an Orwellian change of distortion and doublespeak geared to protect those who wish to retain or aspire to power.

      Exercising control over people's lives from birth to undignified end - these people posses a degree of hypocrisy that leaves me frequently speechless.

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  5. Marshall Perron

    Ret. politician

    It is not only the Netherlands that has demonstrated voluntary euthanasia or assisted suicide can be permitted under strict conditions safely. Belgium, Luxemburg Oregon and Washington in the USA have legalised the practice without the doomsday predictions that religious opponents said would occur.

    Also in Switzerland assisting someone suicide has not been an offence for over 60 years if the person assisting does not benefit from the death. Switzerland is the only country where foreigners can go to and access medical assistance to die lawfully.

    Perhaps Australian politicians should use their generous overseas travel allowance to go to some of these places and see for themselves how the laws operate. Maybe then they will find the courage to proceed to meet the needs of their dying constituents.

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    1. Felix MacNeill

      Environmental Manager

      In reply to Marshall Perron

      Or at least not block sensible, cautious first steps by the NT or ACT, as Kevin Andrews did.

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  6. Gary Myers

    logged in via LinkedIn

    It is a road than needs a gentle stroll rather than a headlong charge. There are difficult challenges if there isn't a physical diagnosis that indicates a painful path.

    My grandfather was, understandably, very depressed when his wife died. Whether he would have taken this path if available is a question only he could have answered. Whether we allow people in such a time of grief to choose that path is a question we prefer to avoid.

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    1. John Newton

      Author Journalist

      In reply to Gary Myers

      I don't think under the Dutch guidelines this would have been allowed. I recently got some advice from a friendly GP.

      If you find yourself on oxygen at the ned, by turning it up, you will drift off peacefully. I think I might find myself on oxygen.

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  7. Christine Millier

    logged in via Facebook

    Abortion is legal, and I totally am so opposed to this, as every one has a right to live, to me abortion is murder, the unborn has no say, they have no RIGHTS. It seems crazy to me that for an adult of sound mind, to end their own life with assistance it is illegal. If I were to ever have some condition that rendered my life to be of suffering and without dignity, I would most definitely like to be allowed the RIGHT to seek assistance to end my life.

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    1. Felix MacNeill

      Environmental Manager

      In reply to Christine Millier

      Christine, while I disagree with your views on abortion, you do have a point about choice and will.

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    2. Christine Millier

      I am retired from welfare work

      In reply to Felix MacNeill

      We have free will to make a choice and also be accountable for the outcomes of choices we make. To kill an infant by abortion was once an illegal act now it is legally accepted. The mother has the right to kill her unborn child, the unborn have no choice in the matter and are no longer protected by law, only the mother and whoever attends to this are the only ones who have this LEGAL RIGHT. After birth it is murder. This debate has been ongoing and I am not interested in debating this. I am however making the point that an adult of sound mind aught to be given the right to lawfully engage in assisting another human being to end their own life as could be written into an advanced healthcare directive.

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  8. Mick Mac Andrew

    Rev Father

    Any argument for the provision of legalised assisted-suicide needs to be accompanied by all the facts concerning the matter. Mere philosophical underpinnings, no matter how stridently put, are not alone, the stuff that creates a basis for change to a a society's laws and mores.
    What would be the economics of such a change to the law? And not only the change to the medical budget. There are dollars involved in educating the community, there would be associated costs to add on when additions are made…

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    1. Anna Young

      Project Manager

      In reply to Mick Mac Andrew

      Some things - like dignity and personal choice - should rise above good economics.

      With all due respect Rev Father, having a public discussion about the right to die cannot be fairly described as 'stiring the pot'.

      The fact of the matter is there are successful working models in other parts of the world. The fact of the matter is that there are people living in pain or facing slow deaths without dignity. The fact of the matter is that they want to be able to leave this life at a time of their…

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    2. Felix MacNeill

      Environmental Manager

      In reply to Mick Mac Andrew

      Mick, to attempt to put forward an argument that voluntary euthanasia will cost more than the current costs of extending 'life' at all costs is simply absurd.

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  9. John Clark

    Manager

    The contribution again prompts me to ask the question. Why is it that the act of euthanasia is treated as a medical procedure? Is this simply because doctors control the means? Would the debate not be more rationally conducted if this component were removed?

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  10. annie hastings

    logged in via email @gmail.com

    I think the system works very well the way it is now. Good palliative care, as it's practiced in Australia, ensures the comfort of a dying person. Analgesia is given to ease pain, even when the level of analgesia is not consistent with continuing life. Provided it is given to ease suffering, and not with the intention of ending life, nothing illegal is occurring.

    There's a documentary about euthanasia which features Terry Pratchett, which explains a terrible connundrum involved with the…

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    1. Anna Young

      Project Manager

      In reply to annie hastings

      You wouldn't be required to take your own life if you didn't want to Annie. The point of such provisions it to give choice to those who want to.

      Despite the good intentions of palliative carers, there is insufficient comfort in it for some. Analgesia isn't successful for all and many die horrible, horrible deaths.

      And as someone who had to make a decision about when to withdraw life support from my mother, I beg you most wholeheartedly to never, never, never inflict such a horrid decision on those you love. It's bad enough dealing with the grief of inevitable loss - when you're faced with choosing the time of death because all the doctors tell you there is no other choice...well, I cannot even begin to describe what it's like to say "yes, OK, let's kill her at 3pm on Tuesday".

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    2. annie hastings

      logged in via email @gmail.com

      In reply to Anna Young

      I understand what you're saying, Anna, and I'm so sorry you were put in that situation. We are incredibly clumsy and awkward and immature (our medical profession, that is) around these very sensitive and difficult situations. I was involved personally in a situation where the specialists said we will not take heroic measure to keep this person alive. We will make her comfortable and control her pain, even when I knew this person desperately wanted to live. She had a sudden change of heart the…

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  11. Bob Down

    logged in via email @bigpond.com

    Allowing the wishes of a dying person to end their suffering along the lines of the Dutch experience can only be a good thing. People think of only the negatives of such a course of action, when the opposite is true.
    Would we want to go down the path of the so called Liverpool Care Plan? Where in my lay-mans understanding of things, it seems to be a collection of the fears of the wavering euthanasia commentators. This pathway seems to enable the very things we should prevent happening, like the…

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  12. John Kelmar

    Small Business Consultant

    It's a pity that the politicians are not listening to the people on this issue.

    I believe that each person has a right to decide who to marry, where to live, which job to take, what food they eat, what medicine they take etc. They also have a right to decide when to get pregnant and bring another life into this world. The laws of Australia impose a right on people, once they reach 18 years old, that they are responsible for their actions, and as such the individual is the only one who can decide whether they live or die.

    When I become bed-ridden and/or unable to care for myself then I believe that my "time is up". What is the point of spending Billions of dollars to keep people alive who do not wish to be kept alive, and who are unable to contribute anything to society? We are experiencing massive over-population in many parts of the world, with Australia's population now far beyond a sustainable level.

    I decide - Not Government.

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  13. Darron Wolf

    Analyst

    Thank you, Professor Thompson, for your sensitive and thoughtful work.

    From a philosophical perspective, I support a dignified death, but I hope that this does not blind me to the potential hazards and risks involved.

    Nonetheless, other (arguably more liberal and forward thinking) jurisdictions have allowed the choice of a dignified death for their citizens. I hope that we may soon be permitted this simple human right as life approaches end.

    Interesting to note from last night’s deeply…

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