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Euthanasia debate heats up in Victoria

Euthanasia, word cloud concept on white background. Source: iStockphoto

A controversial bill to legalise euthanasia will be introduced into Victorian parliament in the second half of 2017.

Euthanasia has been illegal in Australia since the federal government overturned short-lived Northern Territory laws in 1996. Despite it being a crime to assist in euthanasia, prosecutions have been rare. Four decades’ worth of opinion polls have shown that a majority of Australians appear to support the legal option of aid-in-dying for those suffering intolerably and without relief near the end of life. Although a significant number of countries and US states have legalised euthanasia and assisted suicide in recent years, Australian federal and state governments have continued to debate the political, legal and ethical implications of legalised voluntary euthanasia.

An elderly woman's hands, in Poole, Dorset. PRESS ASSOCIATION Photo. Picture date: Thursday December 22, 2016. Photo credit should read: Yui Mok/PA Wire.
An elderly woman's hands, in Poole, Dorset.
PA Archive

But now, Victorians suffering with an advanced and incurable illness, disease or medical condition would be able to seek a medically assisted death from 2019, under a model to be considered by the Victorian Parliament.

An expert panel chaired by former AMA president Professor Brian Owler has outlined how a Victorian assisted dying scheme would work. Politicians will be granted a conscience vote on the matter later this year. If the law is passed, it would not become operational for another 18 months.

Dr Nirdosh Gogna, a radiation oncologist from Brisbane thinks it might be the only dignified solution to some of the terminally ill patient’s problems. According to Dr Gogna, although medical treatments and palliative care have come a long way in giving terminally ill patients the most comfortable life in their final days, yet, it has not become advanced enough to take away the pain and misery for all patients. In some cases, the pain and suffering is so severe that even the best treatment or management plans fail. These patients, according to him, do not have a good quality of life to live and sometimes the patients themselves wish for their sufferings to come to an end. In such circumstances, voluntary euthanasia can be the best and dignified option for patients to end the cycle of pain.

“Due to modern treatments, the life of a chronically ill patient can be extended, however, sometimes a situation arises where no treatment works and the patient suffers intolerable mental and physical pain. In such situations, voluntary euthanasia comes into question.”

But, all is not as straight forward as it seems. There are major ethical, medical and religious issues to consider before any decision is made around voluntary euthanasia. It’s an ongoing debate between those who champion the ‘right to life’ as opposed to those who assert the ‘right to choose’ when and how to die? Can palliative care always provide adequate pain relief? If legalised, could voluntary euthanasia be the ‘slippery slope’ that leads to involuntary or non-voluntary euthanasia? Is voluntary euthanasia dignity in dying, assisted suicide, or homicide? 

Two elderly hands holding onto a younger hand
Two elderly hands holding onto one hand of a younger adult.

According to Dr Gogna, these decisions are not made lightly in the countries where voluntary euthanasia is legal. While considering euthanasia, apart from the patient’s doctor, an independent physician makes an assessment of the patient’s condition; the patient himself makes a request for voluntary euthanasia multiple times and is given time to reconsider his decision; there is also a mental assessment done on the patient to see whether he is mentally competent to make an informed decision etc.

“The decision is not taken lightly. Palliative care is highly advanced in many countries now and it’s only when all other options are exhausted that a terminally ill patient has the option to request for voluntary euthanasia in countries where it is legal. Even then, there is a proper process to go through to get approval.”

Even though the ‘right to life’ advocates argue that no human has the right to take away life and life and death should be left to the natural course, Dr Gogna argues that only a patient knows how he feels trapped in a body that only gives pain and suffering. He mentioned that even the Hippocratic Oath that doctors take to uphold specific ethical standards also says that a physician must never harm a patient and must never encourage them to end their own life. However, in some circumstances, the actions of the doctors indirectly lead to a patient’s death e.g., increasing the dose of morphine to elevate pain.

Man going to overdose drugs
Close-up of man going to overdose drugs

After an ongoing debate in Australia regarding euthanasia, The Voluntary Assisted Dying Ministerial Advisory Panel (the Panel) was given the responsibility of developing a safe and compassionate voluntary assisted dying framework for Victoria.

Here’s a look at the main points outlined in the model that has been proposed for the Victoria.

  1. Only people over the age of 18, who live in Victoria and are an Australian citizen or permanent resident would be eligible.
  2. Only patients will be able to initiate the request - To qualify, a person must be of "sound decision-making capacity" and the condition they are suffering from must be expected to cause death within 12 months and be "causing suffering that cannot be relieved in a manner that is tolerable to the person". Dementia patients will not qualify.

Only the patient can initiate a request for assisted dying, and the person must be assessed by two doctors, one which must be an expert in the person's particular illness.

One doctor must also have at least five years post-fellowship experience and all will have to complete specialist training to be involved in the requests.

The system is proposed to work in the following way:

  • Firstly, the patient makes a request to their medical practitioner, who will make an assessment
  • Another practitioner makes an independent assessment
  • The patient then makes a written declaration of an enduring request. This is to be witnessed by two people, one must not be a family member or anyone who may be a beneficiary from the person's death
  • Finally, the patient makes a third and final request to their medical practitioner. In most cases there will be a minimum of 10 days between first and last request before the medication is dispensed.

The doctor must ensure the person is properly informed of the:

  • Diagnosis and prognosis
  • Treatment options
  • Palliative care options
  • Expected outcome of taking the lethal dose
  • Possible risks of the lethal dose

The doctor must also inform the patient "they are under no obligation to continue with their request for voluntary assisted dying, and that they may withdraw their request at any time".

 3.The drug will be self-administered after being dispensed from a compounding chemist - The panel has recommended the lethal medication be kept in special locked boxes, with medication to be returned to a doctor in the case of a patient being too incapacitated to take it.

In cases of people who are unable to administer the drug, such as motor-neurone disease patients, a doctor would administer the lethal dose.

Getty images

4. New offence to be created to guard against abuse - One of the concerns was that the system could be open to abuse. The panel has moved to assuage these concerns by recommending new criminal offences for anyone who induces someone to request or self-administer assisted death.

A new charge will also be created for people administering a lethal dose to a person who does not have decision-making capacity.

Doctors will be able to conscientiously object to any aspect of the process.

View the entire proposal here:

So are there any options currently available to patients in Australia that can assist them with their exit strategies?

Molina Asthana, Principal Solicitor with the Victorian Government Solicitor’s Board, says that currently the patients have two options that can lawfully assist them with their exit strategies. Suicide, which was earlier unlawful in Australia, has been rendered lawful under Section 60 of Crimes Act.

Stock picture of a statue of 'Lady Justice' or Themis, the Greek God of Justice, outside the Supreme Court in Brisbane, Tuesday, April 28, 2009. (AAP Image/Dave Hunt) NO ARCHIVING
Generic picture of a statue of Themis, the Greek God of Justice, outside the Supreme Court in Brisbane. (AAP Image/Dave Hunt) NO ARCHIVING

Second can be the refusal of medical treatment by a patient who is competent, including artificial nutritional hydration under the Medical Treatment Act 1988.

“In terms of active voluntary euthanasia, which is physician assisted suicide, in this case, at a patient’s request a medical intervention occurs resulting in the patient’s death. This is unlawful, though it may be lawful if the intention of the medical intervention is to relieve pain, even though the physician knows that the patient is likely to die.”

For anyone seeking help, please contact the following numbers:

Men's Line Australia - 1300 78 99 78

Beyond Blue - 1300 22 46 36

Lifeline Australia - 13 11 14

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