Assisted dying: the devil’s in the detail

“IT’S not that I’m afraid of death; I just don’t want to be there when it happens,” film-maker Woody Allen wrote in his 1975 book Without feathers.

Most of us would probably agree. Perhaps it’s why we so often find it hard to have clear-headed conversations about death and dying.

Nowhere is that more apparent than in debates around the practice that you may call – depending on your perspective – euthanasia, assisted dying or, for some, just plain killing.

Is it the humane response to intractable suffering or a fundamental threat to civilised society? Can it be effectively managed, with appropriate safeguards put in place around it, or is it the top of a “slippery slope” that will lead to the abuse of some of the most vulnerable people in our community?

All the terms used to describe the practice are loaded in some way, but I am going to use “assisted dying” as it seems the most neutral to me (though I understand not everybody will agree).

Whatever you call it, surveys show that most of us support the idea, at least in principle.

I should declare that I am part of that majority. I would want the option of an assisted death to be available to me if I ever found myself facing unbearable suffering.

That said, the devil is definitely in the detail.

Legislators in Victoria and NSW have recently been grappling with the many questions raised by proposals to make assisted dying legal.

In Victoria, legislation expected to be introduced later in 2017 would make doctor-assisted dying available under certain circumstances to adults with decision making capacity who have a serious and incurable condition and are close to death.

NSW currently has draft legislation that would make this service available to terminally ill people aged 25 years and over who are expected to die in the next 12 months and are experiencing severe pain, suffering or physical incapacity.

Both proposals are flawed. Well, of course they are. There is no perfect system for dealing with such a complex practical and moral issue.

If safeguards are too lax, the system could be open to abuse. If they are too stringent, people could be unjustly denied access.

Speakers at the recent Sydney Writers’ Festival raised questions about both states’ plans to limit the option of assisted dying to those who are already close to death.

What about people with debilitating chronic illness, motor neurone disease or profound stroke, asked Dr Rodney Syme, a Melbourne surgeon and vocal advocate for voluntary assisted dying.

Dr Syme also questioned the age limitations in the legislative proposals, saying: “It’s very strange that before you turn 18 years you are not supposed to have any suffering.”

With perfection out of reach, it is understandable that legislators tend to go for the cautious approach.

Perhaps, though, they could take comfort from another speaker at the writers’ festival, British neurosurgeon Dr Henry Marsh.

“There’s plenty of evidence that assisted dying does not cause the collapse of society,” Dr Marsh told the audience.

The experience in the US state of Oregon, which has allowed doctors to prescribe a lethal dose of drugs to terminally ill adults since 1997, would seem to support that view.

The most recent figures show that just 204 people received lethal prescriptions under the scheme in 2016. By the end of the year, 56% of those people had used their prescription to die. Nearly 18% had died of other causes without taking the medication, 5% had died of unknown causes, and 22% were still alive.

Some of those 22% may still go on to use the drugs, but it seems that a sizeable minority of terminally ill people may want to have the prescription “just in case” and will not necessarily end up using it.

Another of the festival speakers, writer Nikki Gemmell, believes the availability of an assisted dying service might have saved her mother’s life.

One of Gemmell’s friends has recently been preparing to die with the help of Dignitas, the Swiss organisation that provides doctor-assisted dying to terminally ill patients and to patients with severe physical or mental illness.

“The process is just so exhaustive,” Gemmell says. “If Dignitas existed here, Mum would have had her depression and pain investigated further, instead of suffering in silence. She may not have felt the need to end her life the way she did.”

Legal assisted dying carries some risk of unintended harm – of course it does – but so does a system that bars people from making decisions about the way their life will end.

Jane McCredie is a Sydney-based health and science writer.

 

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