“No solution” to euthanasia

EXPERTS debating proposed legislative changes to provide a legal defence for doctors who administer medication that hastens or causes the death of a terminally ill patient, have cast doubt over consensus on euthanasia ever being reached.

Associate Professor Will Cairns, director of the Townsville Palliative Care Service, told MJA InSight that it was unrealistic to view euthanasia as a problem that could be solved.

“First of all it is not actually a problem; it’s just that our community cannot agree with how to deal with it. Second, there is no solution that would ever be satisfactory for both sides of the divide, because they are deeply entrenched and probably irreconcilable.”

Professor Cairns was responding to a “For debate” article published this week in the MJA which proposes “simple changes to Commonwealth and state legislation” to provide a “minimalist” solution to the ongoing debate over euthanasia. (1)

Professor Paul Komesaroff, of the Monash Centre for Ethics in Medicine and Society, and Stephen Charles QC, a former Victorian Court of Appeal judge, wrote that while the Australian community remained deeply divided on the issue, the acrimonious tone of the debate obscured the fact that there was widespread agreement that people with terminal illnesses were entitled to adequate treatment, and should be allowed to make basic choices about when and how they die.

They said a key problem with current laws was that doctors who followed current best practice by providing the necessary care to alleviate pain could not be confident that they would be protected from criminal prosecution should they be actively involved in the death of their patient.

The authors said a possible answer to this problem was to make simple changes to federal and state legislation that provided a defence to a charge of homicide or manslaughter when a doctor prescribed medication that hastened or caused the death of a terminally ill patient.

“This defence would be allowed if the doctor: (a) reasonably believed that it was necessary to prescribe or administer the drug to relieve the pain or suffering of the patient; or (b) prescribed or administered the drug with the intention of relieving such pain or suffering.”

The change would affirm the legal doctrines of necessity and double effect that were well established in common law, but had been rarely tested in the courts, they wrote.

Earlier this month, the Victorian Legislative Council called for an inquiry into “the issue of dying with dignity (voluntary euthanasia) and the need for laws in Victoria to allow the terminally ill to make informed end of life choices”, with a report to be completed by April 2016. (2)

Dr Stephen Parnis, AMA federal vice president, told MJA InSight that the inquiry would represent “a positive contribution to the discussion regarding euthanasia”.

He said he hoped the Victorian inquiry would help mediate the increasingly polarising public debate on euthanasia, which he said had been driven by fear on both sides.

Dr Parnis said the proposals in the MJA article validated the longstanding ethical principles of double effect — avoiding futile care and preventing the unnecessary suffering of patients.

He acknowledged that while the AMA had long been opposed to the notion of euthanasia, “if the AMA gets stuck on either end of the spectrum, no one will benefit”.

The next step was to achieve legislative clarity across the different states and territories, which would involve each jurisdiction establishing its own “sensible” framework in relation to end-of-life care, Dr Parnis said.

Professor Cairns agreed, saying the legislative changes would eliminate doctors’ fears of prosecution, and “increase their confidence to deliver what most of us already consider as good medical practice — that is, to administer whatever it takes to keep people comfortable”.

Professor Peter Ravenscroft, conjoint professor of palliative care at the University of Newcastle, said he believed “the law as it stands adequately protects the terminally ill person from any misadventure, or malice, of medical professionals or carers”.

“I consider any law designed to protect the doctor runs the risk of being open to abuse by those not following best practice in patient management, or misusing the agents available to them to manage patient symptoms”, Professor Ravenscroft said.

Dr David van Gend, a GP and senior lecturer in palliative medicine at the University of Queensland rural clinical school, rejected the assertion that the proposal discussed in the MJA was in any way minimalist, telling MJA InSight that it represented “fully fledged euthanasia in its classic definition”.

Dr van Gend claimed the authors had misrepresented palliative care, saying it “is emphatically not current best practice for doctors to intentionally end the life of a patient by using drugs to relieve suffering”.

He said existing legislation should not be changed because it “protects doctors, nurses and patients alike from the corrupting effects of a culture of mercy killing”.

1. MJA 2015; 202: 480-482
2. Legislative Council, Victoria: Notice papers, 7 May 2015

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