This piece was originally published in The Australian under the title 'Granting terminally ill right to die with dignity is good policy'.
The South Australian parliament almost made history on Thursday morning. It was one vote away from passing a voluntary euthanasia bill through the lower house. Yes, there was still the upper house to negotiate, but suddenly the first voluntary euthanasia law in Australia for 20 years was a real possibility.
After eight hours of debate a final vote delivered a deadlock of 23-23. It fell to Speaker Michael Atkinson, a leading member of the ALP’s religious conservatives and a committed opponent to voluntary euthanasia in any form. He delivered the final blow to the Death with Dignity Bill at 4am on Thursday. Thus ended attempt number 16 to have voluntary euthanasia legislation passed in the South Australian parliament. The near passage of the bill shows that Australia is well and truly ready for a voluntary euthanasia law. The legislation being proposed was moderate and with safeguards modelled on laws running successfully in North America for 20 years.
By being deliberately narrow in scope — aimed at competent adults, dying of a terminal physical illness, with 12 months or less to live, as diagnosed by two independent doctors — it received the support of both the Premier and the Opposition Leader as well as a near-majority of MPs. Significantly this included the centre-right faction of the Labor Party, traditionally aligned to the Catholic Shop Distributive and Allied Employees’ Association union powerbrokers.
The message here is clear: when presented with a law that balances the serious need to address undisputed suffering at the end of life with the equally serious need to protect our most vulnerable from abuse, MPs can rise above factional, or faith-based, pressure and create a voluntary euthanasia law that will work for Australia. It also demonstrated that parliamentarians are listening to their electorates. Through newspapers, news websites and radio, the people of South Australia had, for months, expressed their desire for a more compassionate law. Many had personal stories chronicling horrible deaths of loved ones.
One was the daughter of 91-year-old Eileen Dawe. Last year, dying of cancer and wishing to hasten her death, Eileen took the only legal option available to her (other than suicide): she began to starve herself. It took her 17 weeks, a process that has left her family with scars that will never be erased. As Eileen wrote in her diary: “My country’s laws decree, death by a thousand cuts for me.”
So why did South Australia’s law not pass? While some MPs did openly oppose it on religious grounds, it would be unfair to suggest that this is what, ultimately, guided the decisions of others. Having sat through the marathon session that ended in the wee hours of Thursday morning, I can only commend both sides for the way in which they engaged in the debate.
However, it is fair to suggest that many MPs approached this debate heavily influenced by a carefully orchestrated campaign of fear and misinformation, propagated by religious groups and also some sections of the medical community.
Sometimes it was covert — Family First putting pressure on those in marginal seats, threatening to preference against them. Sometimes it was in private briefings by doctors — assurances that giving more resources to palliative care will solve all the problems. Sometimes it was public — priests instructing congregations to complain to their local members about the dangers of “state sanctioned killing”.
Perhaps the thing that surprised me most about the debate was how many MPs took up this phrase, even though the law being proposed was to help those being killed by a disease, not the state, and which, being entirely voluntary, placed the decision about whether or not to end the suffering caused by that disease solely in the hands of the patient.
The narrative for the fear campaign goes like this: if you introduce voluntary euthanasia you open the door to a world of unbridled killing where the elderly, children, the disabled and the mentally ill will be under threat. Yet these groups are covered by the safeguard restricting the legislation to competent adults with a terminal illness.
MPs were continually bombarded with this including, on the eve of the debate, a warning that, once the law was passed, there would no guarantee that doctors and nurses wouldn’t start murdering people (there is no guarantee under our existing laws, yet we still allow medical professionals to every day make life and death decisions). This fear campaign worked. One MP who changed his vote from yes to no did so because he feared a “broadening of the law to people with diseases that aren’t terminal”. Another cited as his reason that he wasn’t convinced there were people who couldn’t be “adequately comforted by palliative care”.
That this thought could have determined his vote when palliative care nurses themselves admit that “even with optimal care we cannot relieve all suffering” is disturbing. Even more so when you consider the unprecedented involvement by nurses in this debate urging, on behalf of their patients, a more compassionate law.
As the primary caregivers in our medical system, the ones who dispense the pain relief and who are with patients 24 hours a day, their testimony was surely compelling. Yet it was not proof enough for this MP who ultimately sided with fear rather than facts.
As the focus turns now to Victoria, the next state to confront voluntary euthanasia, you can be sure the same tactics will be employed to try to derail it.
However, I believe that in Victoria they have far less chance of success. Primarily this is because of the cross-party parliamentary committee whose report into end of life choices was tabled this year.
After 10 months of hearings looking at how Victoria’s laws affect the way people are dying, the committee recommended by a majority of 6-2 that Victoria introduce a voluntary euthanasia law.
Their recommendation was largely informed by evidence received from doctors, nurses, coroners, families and patients of terrible and untreatable suffering at the end of life.
But it was also guided by travelling to countries where voluntary euthanasia laws exist. There they found “rigorous safeguards, monitoring procedures and high levels of compliance”, sitting within “robust regulatory frameworks focused on transparency, patient-centred care and choice”. They also found “no evidence of institutional corrosion or the often cited ‘slippery slope’ ”. It’s worth noting that the two dissenting voters, MPs Inga Peulich and Daniel Mulino, declined to join the committee in travelling overseas to see for themselves if their objections have merit. In the committee’s report, Victoria’s MPs have a well-reasoned, evidence-based argu-ment on which to frame a voluntary euthanasia law.
Just as important, however, is the committee’s recognition that any such law has to work hand-in-hand with increased resources for good palliative care. They are not oppositional and need not be seen as such. In the face of suffering that even palliative care can’t treat, voluntary euthanasia must be there as an option for patients needing help at the end of life.
As the debate looms in Victoria I am encouraged by the words on Friday of its Health Minister, Jill Hennessy: “I think if we are ever to see any law reform in this space it would have to be a modest model that has been the subject of good scrutiny that addresses the issues of exploitation, checks and balances and really engages the clinical community.”
She’s right. What is being debated here is not an ideological battle about a “right to die”. It is about good public health policy.
Hopefully this time commonsense and compassion will win out over fear.