Dying is Not the Point

National Palliative Care Week this week is once again turning the spotlight on euthanasia with doctors saying assisted suicide is not an issue of individual rights and has serious and wide-ranging consequences for society.



Palliative care to control pain, discomfort, depression and anxiety in the terminally ill and to give them comfort and peace in their final days, has made enormous strides over the past decade. It is also far better understood by the public at large.



But the advances and research into the multi-disciplinary approach needed to care for those in the last months of their lives would be undermined completely if the legalisation of euthanasia was adopted. Instead "cost-effectiveness" would become the criteria.



In this "brave new world" there would be no economic justification for research into improved palliative care techniques or funds to improve the quality of care for those suffering delirium or dementia, warns Dr John Obeid, Senior Staff Specialist in Geriatric Medicine and Stroke at Blacktown Hospital.





"A century ago, when we had very little in our therapeutic armamentarium, few doctors or patients would have considered killing patients a sensible or ethical option. But now in the 21st Century with all we possess in the way of therapeutic interventions and palliative care options, why is it that we are even considering euthanasia?" he asks.

"Euthanasia belittles our abilities to do what we in the medical profession do best - care for frail older people, heal suffering and advocate for those with geriatric syndromes such as dementia. Suddenly, though despite our years of training in improving function, diagnosing and treating delirium, improving mobility, managing incontinence and providing good quality end of life care, our role as a geriatrician might be reduced to working out the lethal dosage of potassium chloride."



From 20-26 May Australia celebrates National Palliative Care Week. This year, under the heading "Dying is not the Point," the week has been designed to give families and individuals up-to-date information on accessing high quality palliative care to give the terminally ill as much control as possible over their final days, as well as an option to die in their own bed at home surrounded by their loved ones.





"If a family member or friend is diagnosed with a terminal illness, what they need is full knowledge of how a doctor, backed by a team of palliative care psychologists, physiotherapists and other medical professionals can help at this time," Dr Obeid says.



What is definitely not needed, he insists, is a lethal injection, and cites the 2003 case of a 70-year-old Australian woman who took her own life due to "severe pain due as a result of terminal cancer."

An autopsy after her death, however, revealed no sign of cancer. The pain instead was due to adhesions from previous surgery and was not only "treatable" but non life threatening at all.



But if assisted suicide became legal this sort of tragic mistake could become far more prevalent with conditions that could be diagnosed, successfully managed and even cured by trained geriatricians and medical practitioners, overlooked in favour of euthanasia as "the treatment of choice," he warns.





Dr Obeid also takes issue with the argument that euthanasia should be a "right" and that the decision to die left up to the individual. "This is a fatuous argument as once you involve another person, such as a doctor to deliver a lethal injection, you are asking society to sanction killing," he says. As an example he compares a person who commits suicide with a person who asks someone to shoot them. "Suicide is not a criminal offence and is a matter for the individual. But when you bring in a doctor to administer a lethal injection, taking a life becomes the doctor's decision and this involves serious consequences for society as a whole."

Opposition to euthanasia and physician-assisted killing should not be confused as a "religious" issue, Dr obeid says pointing out that abhorrence at so-called "therapeutic killing" dates back to the time of Hippocrates who lived 400 years before the birth of Christ.



Hippocrates was the ancient Greek physician who formulated the oath of ethics still taken today by the medical profession which promises above all to "prescribe regimens for the good of my patients...and never do harm to anyone. I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan."

Dr Obeid says opposition to killing by doctors was accepted almost universally for thousands of years, and it is only in recent times with the growth of the eugenics movement in Europe, the US and Australia in the late 19th and 20th centuries this began to change.



"Even though eugenics was primarily concerned with breeding people free from incurable or undesirable illnesses, it was not long before eugenics morphed into the elimination of people with those same undesirable or incurable diseases," he says citing the atrocities by the Nazis during World War II where the old, infirm, mentally ill, physically disabled and others considered to be "socially unacceptable" such as homosexuals, were put to death.



Horrified at the idea that under legalised euthanasia, medical schools would be forced to "educate" students on how to kill and the correct doses of lethal drugs required, Dr Obeid asks "is this something we want added to the curriculum?"



Dr Obeid is equally scathing of another of euthanasia advocates' claim that insists "mercy killing" should made available on a voluntary basis to those who request it.

"Once you allow voluntary euthanasia there are no grounds for not allowing involuntary euthanasia as well," he says and gives the example of a patient with pneumonia rushed into an Emergency Room in a life-threatening situation.



"Before treating with antibiotics, they are asked to give their consent and have a right to say no. But if they are unconscious, antibiotics are given with or without consent to save their lives," he says. "It's all very well for someone who thinks euthanasia is a good idea to give their consent, but what about those who can't consent because of dementia or other factors? For basic equity you can't deny consent to people who are unable to make the decision which means this goes to their carers or family. Then we will see what has happened in the Netherlands, where euthanasia is legal and has quickly moved from voluntary to involuntary physician-assisted suicide."



Dr Obeid insists that frail, older people who are delirious, confused and at the weakest point in their lives are in no position to make an "informed decision" about ending their life. He is also unimpressed with surveys and polls that seem to suggest the majority of Australians want to see euthanasia legalised.



"The polls are always maliciously designed and full of emotive language, asking people if they were in terrible pain with no help of relief would they want a lethal injection? The question instead should be, if a doctor couldn't work out why you are suffering and in pain and couldn't be bothered putting in the time and effort, or spending the resources to find out, should society decide to kill you? Phrased that way, you would get the opposite result!"