Euthanasia has been a hot topic recently, mostly because of Andrew Denton’s excellent podcast Better Off Dead, examining the morals, ethics and challenges behind the right-to-die debate.
As it stands, euthanasia is illegal in Australia though there is currently a bill before parliament that - if it passed - would make it a state, not a government matter, possibly opening the way for some sort of legalisation in the future. There are obviously many complicated arguments on either side, but the reality is, whilst governments the world over go back and forth over the legalities, many people are suffering unnecessarily slow and painful deaths.
On Sunday 24 April, How to Die: Simon’s Choice airs at 8.45pm (AEST) on SBS. It is the story of a British man for whom death was inevitable, which made dying on his terms all the more important. Following Simon and his family from diagnosis to death, it’s a heartbreaking yet life-affirming look at the importance of valuing the quality of someone’s life over the sanctity of it.
With that in mind, let’s take a look at some of the issues at play in the right to die debate.
1. The terminology matters
Euthanasia is very different from assisted suicide which is different again from assisted dying.
EUTHANASIA involves a doctor legally administering a fatal dose of medication.
ASSISTED SUICIDE enables someone who might be incapacitated but isn’t necessarily dying to have assistance when choosing death over life, ie, someone with a disability or the elderly.
ASSISTED DYING allows the terminally ill person to have a say over the timing and manner of their imminent death.
2. The law in Australia is black and white, but it’s not cut and dry
Euthanasia and assisted dying/suicide are illegal in Australia. But it’s not a crime for a person to take his or her own life. It is also not a crime to refuse treatment or to elect to have your life support turned off. The problem is that often by the time you get to that point you’re no longer in a position to elect for it to happen. Furthermore, there’s no guarantee of how long that death will take or how painful it will be. With either euthanasia or assisted dying, death comes in the form of a pill, a drink or an injection and usually takes one to four minutes to take effect.
Whilst in Australia it is technically a crime to assist in the death of another person, it is rarely prosecuted here. An exception is Tasmanian woman Cathy Prior who did prison time for assisting in the deaths of her mother and father. You can hear her talk to Andrew Denton on his Better off Dead podcast here.
There are also cases in the UK and Ireland where courts have ruled against the will of the dying and dictated that any spouse, relative or friend who assists in another person’s death will be charged with a criminal offence.
3. For every group in Australia that supports some form of assisted dying there are a number who don’t
Australian groups in support include:
- The Voluntary Euthanasia Party
- Dying With Dignity
- Exit International, which was formed by Dr Phillip Nitschke.
Opposing groups include:
4. Like the legislation, the debate on both sides is complicated
The case for the right to die:
- That the right to live and also die should begin and end with the individual. It should not be up to governments to legislate.
- That a life lived in pain and suffering is not a life worth living. Knowing that some form of euthanasia is an option at the end often sees quality of life improve. Author and assisted dying campaigner Terry Pratchett put it this way: “If I knew that I could die at any time I wanted, then suddenly every day would be as precious as a million pounds. If I knew that I could die, I would live.”
- Euthanasia in some ways happens anyway, through Do Not Resuscitate orders and through doctors and families deciding to let nature simply take its course. Regulating doctor/patient rights regarding end of life simply makes it easier and less painful for all involved.
- That euthanasia actually saves lives. A 2012 study into the NHS in Britain found that 57,000 people die without the knowledge the doctors have given up all hope of saving them - they are just left, waiting for their time to run out. Essentially that means that doctors are already killing patients without their express permission- having euthanasia laws in place would protect the rights of the dying to die if and when they choose.
The case against:
- Religious opposition: many believe - similar to the abortion debate - that any life is a gift and is preferable to death. Furthermore, as God created life, only he should take it away.
- That Euthanasia is a “slippery slope” and that legalising it will lead society down a dangerous road. Opponents argue that if legalised, people who are severely ill, disabled or elderly may feel pressured into euthanasia so as to remove the burden they place on society. Some fear that legalisation may mean cures for terminal illnesses are never found and there’ll never be a need to cure when death is another option.
- Finally, there’s the argument that ethically doctors shouldn’t be asked to “play God”. Whilst many doctors will agree that quality of life is more important than sanctity of life, there is fear that doctors will be forced to participate in another person’s death - either by euthanising or in assisting in their death.
5. Australia was the first place in the world to offer voluntary euthanasia
In 1996, Dr Philip Nitschke became the first doctor in the world to administer a voluntary euthanasia injection under the Rights of the Terminally Ill Act (1995). The law was only in place in the Northern Territory and it was short- lived.
In March 1997 it was overturned by the Australian Parliament, but not before four patients used the law to end their lives and their suffering. Since the law was changed there have been more than 27 attempts to repeal it. None have been successful. Despite a lack of success in getting the law overturned, it’s estimated that more than 75% of Australians support some sort of legalised assisted dying.
There is currently a bill in the Australian senate proposing to return euthanasia legislation back to the states. A strong proponent of the bill is former Labour Prime Minister Bob Hawke who told Radio National, “It’s just an unarguable case”.
6. By the time euthanasia is used, recovery is no longer an option
A Dutch study into euthanasia found that in 86% of cases, euthanasia shortened life by no less than a week. More often than not, it was only shortened by a few hours. Furthermore, it was found that in almost every case the patient was suffering unbearably with all other options of care exhausted.
Put in plain terms: there was absolutely no option of recovery. In the Netherlands, assisted dying accounts for around 3000 deaths a year - or 1.7% of all deaths, which is a tiny amount. Plus, two- thirds of all applications for euthanasia are rejected and those that go through require an immense amount of paperwork before they are allowed to proceed: the process is slow - any patient that was going to show signs of recovery would do so before the time came to finally be euthanised.
The main argument for legalizing assisted dying (rather than euthanasia) is that it limits the potential for any abuse at the hands of physicians: the final decision is made by the patient who is in complete control of if and when they die.
7. There are only a handful of countries which have passed nation-wide laws allowing some form of euthanasia
Euthanasia is legal in:
- The Netherlands
Assisted suicide/dying is currently legal in:
Canada is currently in the midst of changing the law. In 2015, the Supreme Court overturned a ban on assisted suicide however it determined that the law would not come into effect for one year, allowing parliament to debate the specifics of the issue. New PM Justin Trudeau has made it a priority and the law will come into effect in June.
In the United States euthanasia remains illegal. In some states, however, physician assisted dying is permitted. Oregon was the first state (in 1994) to allow doctors to assist in the death of a terminally ill patient. Since then, Vermont, Washington, California, Montana and parts of New Mexico have followed suit.
8. Belgium has the most liberal laws in the world regarding euthanasia
Under Belgian law, a person can request to die on the grounds of “incurable, unbearable suffering” - either physical or psychological. They don’t have to be terminally ill and there is no age restriction. This law came under scrutiny last year when Dr Marc Van Hoey euthanized an 85-year-old woman who was not dying but who claimed to be suffering from severe depression. Her story was reported by SBS’s Dateline last year.
Dr Van Hoey has since been investigated for his role in her death, one which he maintains was ethical and in accordance with his patient’s wishes. Since laws were passed in 2002, more than 8000 deaths by euthanasia have been reported. By law, doctors must file a report with a 16-person euthanasia commission detailing the events that led to the death. They must qualify that the person’s request was voluntary and that it was approved by two doctors. For psychiatric patients, three doctors are required to give consent.
9. There is only one country in the world which allows foreigners the right to die: Switzerland
Euthanasia itself is not legal, but assisted dying is. By this definition, a doctor or medical professional may source and prescribe the medication required to end a life can’t actually administer the lethal dose. In terms of the actual suicide, any involvement of family and friends is legal provided that they assisted unselfishly and weren’t looking to gain anything out of the impending death.
According to recent statistics, around 300 Britons have travelled to Switzerland in order to end their life on their own terms since 2002. The total number of foreigners each year is somewhere around 250 according to Bernhard Sutter, vice president of Exit, one of a few organisations - along with the better known Dignitas - offering assisted suicides to foreign nationals.
10. There are a number of dramatized films and documentaries about the right to die debate, not to mention Andrew Denton’s excellent podcast, Better off Dead
- You Don’t Know Jack
Susan Sarandon stars as a terminally ill patient and Al Pacino as right-to-die advocate Dr Jack Krevorkian.
- A Short Stay in Switzerland
This film stars Julie Walters as a real-life British doctor afflicted with a terminal illness who travels to the Dignitas clinic in Switzerland to end her life. The film is available in several parts on YouTube.
- How to Die in Oregon
A documentary about Oregon’s dying with dignity laws and the people that have made use of them.
- Dateline: Allow Me to Die
SBS' Dateline got rare access to film a woman’s journey to the end in the most liberal country towards euthanasia, Belgium.
For information about motor neurone disease (MND) and support contact the MND Association in your state or territory on 1800 777 175 or visit the MND Australia website: www.mndaustralia.org.
Watch How to Die: Simon’s Choice on Sunday, 24 April at 8.45pm on SBS and on SBS On Demand after it airs.