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South Australian Voluntary Euthanasia
The following is from the SAVES Newsletter, The VE Bulletin, Vol 16 No 3, November 99
The national peak body for palliative care, Palliative Care Australia, issued their most recent Statement on Euthanasia (Why not voluntary euthanasia?, one might ask.) in March 1999 at their National Conference in Brisbane. While praise is due for trying, it contains flaws that ensure that it must be replaced at their next annual conference if the organisation is to retain credibility.
Dr Rodney Symes, President of VESV, explains why in the following report in their August Newsletter, reproduced here with permission.
The most recent Position Statement on Euthanasia (March, 1999) of Palliative Care Australia:
'States that palliative care practice does not include deliberate ending of life, even if this is requested by the patient.'
'Acknowledges that while pain and other symptoms can be helped, complete relief is not always possible, even with optimal palliative care', and
'Recognises and respects the fact that some people rationally and consistently request deliberate ending of life.'
There is a very obvious inconsistency in these statements which creates a serious dilemma. It is exactly those patients whose pain and other symptoms are not completely relieved and who rationally and consistently request deliberate ending of life whom Voluntary Euthanasia Societies aim to help by establishing legislation. Palliative care says it respects their views but denies them assistance. Presumably it would continue to do so if voluntary euthanasia were legalised because its objection is not based on legality. It does not state what its objection is but I presume it is based on religious dogma since the hospice movement was founded by Christian idealists who wished to improve the very poor care provided to the terminally ill in the 1960s. They should be applauded for that, but as palliative care becomes the mainstream government supported model for the dying, religious dogma should no longer underlie its fundamental principles.
It is pertinent to ask palliative care how it deals with patients who fulfil (2) and (3). Is it respectful to deny them their request? These patients are in fact offered either terminal sedation, or the opportunity to dehydrate themselves to death.
Terminal sedation deliberately creates coma by morphine and sedatives, a process which inevitably leads slowly to death, but which is justified by the doctrine of double effect. This is a religious doctrine which justifies treatment which hastens death if the intention is to relieve pain and suffering and the possibility of hastening death, whilst foreseen, is not intended. This doctrine provides moral and quasi-legal protection for the doctor but "respectfully" commits the patient to some days of deliberate futile undignified coma.
The concept of deliberate refusal of food and fluids based on a legal right to refuse unwanted interventions is gathering force as a legitimate response to requests for physician-assisted suicide. How a palliative care physician can say "recourse to physician-assisted suicide, however, seems less rational with the availability of such options as refusing oral intakes" defies intelligence and compassion. Palliative care must address this inconsistency and resolve this dilemma to retain ultimate credibility. I doubt it can.
VESV Newsletter, August 1999
Further information on these and related issues is available from:
Hon. Sec., SAVES, PO Box 2151, Kent Town, SA 5071, Australia - Fax + 61 8 8265 2287