Perth, 1 Jul 07 -- THE POLITICS OF MAKING PHYSICIAN ASSISTED DYING (PAD) LEGAL: "Why are so many politicians against PAD?" [excerpt]

The answer will probably come back from either major party: "because it may be abused".

So what do political opponents of PAD really mean by 'abused'? To answer that, here is a summary of points made to the NSW Parliament by one of PAD's fiercest opponents, Rev. Fred Nile:

Let us examine Nile's points:

1: The prohibition by society of intentional killing.

In Australia, as well as many other countries, judicial killing (i.e. capital punishment) is no longer used, while illegal killing is punished heavily. So legalising PAD can be seen as upsetting society's determination to outlaw killing.

But what happened to the free will of the individual to end his or her life? In recent years I have become aware of the unnecessarily painful deaths of two friends, both in their last days in an aged care facility, who were refused adequate pain relief by the doctor concerned. Even one such case is too many! It is partly because of cases like these that we seek the legalisation of PAD.

2: PAD may be appropriate in individual cases but this does not mean it should be institutionalised in law.

If it is not regulated by law, what happened to my two friends will continue to occur.

Nor is palliative care always a panacea. A recent South Australian study found that it failed to adequately relieve pain in a quarter of patients with terminal cancer, failed to help a third who had difficulty breathing, and also over half of those with vomiting and nausea. Yet some doctors decide on the basis of their religious and/or ethical beliefs not to give adequate relief. At present the wishes of such doctors are allowed to prevail over a patient's clearly expressed wishes.

3: The death of a person will involve his/her nearest and dearest.
4: There may be coercion by others, e.g. family, to induce the patient to decide on what is actually involuntary euthanasia, for the benefit of those others.
5: The patient may be induced to consent to what is actually involuntary euthanasia because he/she is elderly and/or poor, or is a member of a minority group such as indigenous Australians.

These points are placed together because they form an apparent majority view on why PAD should not be legalised: they all relate to a sufferer's being part of Australian society.

The word 'apparent' is used because it is strongly suspected that, in part, they also conceal another deeply rooted objection to PAD: the religious views of some politicians.

On the one hand, there are few or no cases where a patient's request for active PAD is known to have been opposed by his/her spouse.

On the other hand, coercion by others, for their benefit, or because the patient was elderly, poor or of a socially disadvantaged minority, should make us stop and think.

The often-quoted Northern Territory Rights of the Terminally Ill Act, 1995 (ROTI) was overthrown by the Federal Parliament nine months after its enactment. The Commonwealth would have no powers to overthrow such an Act passed by any of the State Governments, such as that of Western Australia [or Victoria--Ed.].

ROTI required the sufferer of a terminal illness, who sought PAD, to be referred by the treating doctor to (a) a registered, independent psychiatrist, who must certify that the patient is not suffering from treatable depression, and (b) if the second doctor is not also qualified in palliative care, another independent doctor, who is so qualified. Only if all the doctors concerned agree with the patient's request for PAD, could it be administered. None of the doctors concerned might benefit from the sufferer's death. (This is a very short summary of the former ROTI Act and omits some aspects of it.)

The social circumstances of the patient should be investigated to confirm that their request is autonomous, and this is one of the crucial factors in the process. The ROTI Act allowed for a 'cooling-off' period after all the requirements for the granting of PAD had been completed, but when a patient is critically ill and in great pain, clearly there is a need for balance between 'cooling-off' and prolonging the agony.

Dr Philip Nitschke has written of his frustration in finding medical colleagues in Darwin, who had the necessary special qualifications and who were prepared to cooperate. If a new criterion of social qualification were to be added, then obviously the process would have to begin even further back in time.

It could be done, however, and with the addition of the 'social aspect', the process of writing a new ROTI-like Act can be made in such a way as to satisfy those who are concerned that patients are going to be 'terminated' for someone else's convenience.

I do not think this will satisfy politicians who use the social reasons surrounding PAD as an excuse for denying it to the great majority. I think that if such an Act were proposed and debated, some politicians would then have to own up to their real, religious faith-based, beliefs.

Those with religious objections can deny themselves the right to request PAD. What seems fundamentally wrong is that they, the minority who oppose PAD, should inflict that same standard on the majority of Australians.

Originally published in WAVES journal, contributor's name withheld on request.