by Andrew Denton
The Stick – Episode 2
In the years since, I’ve been struck by how many others have similar stories about people they love who are dying slowly, in pain, and, seemingly, beyond medical help.
Every time I hear it, I think, ‘why can’t we have a law for assisted dying in Australia?’
So, for eight months, in 2015, I set off to try and answer that question. I’ve spoken with nurses, doctors, politicians, lawyers, priests, surgeons, palliative care specialists, and activists on both sides of this debate, both here and overseas.
Above all, I’ve spent time with those who represent the need for this law in Australia: the dying and their families.
Along the way, I discovered some unexpected things. I was warned that countries where laws to assist people to die exist were ‘slippery slopes’ out of control, with the numbers of people being assisted to die sharply on the rise, and inadequate safeguards making the disabled and elderly vulnerable.
What I found was almost the exact opposite: long-running, heavily scrutinised systems, with multiple safeguards, and an overwhelming acknowledgement that they do work – from the public, medical bodies, and across the political spectrum.
Their greatest safeguards? That only a competent adult can ask for help to die; and that they are entirely voluntary. I found no credible evidence that the elderly or disabled were threatened. In fact, spokespeople for these groups explained to me how these laws had empowered their members by offering them a choice about the treatment they could ask for at the end of their life.
Another surprise: The tiny number of people who use these laws. In the Netherlands, less than 4 per cent of all people who die annually. In Belgium, less than 2 per cent. And in Oregon? A microscopic one-half of 1 per cent.
As one doctor put it: “I cannot imagine why they would expect an avalanche anywhere. It just turns out that people don’t want to die!”
Having seen the careful way end-of-life medicine was practised overseas, I wondered how Australia, with no law for assisted dying, compared?
Here was the next big surprise. It turns out that, even without a law, doctors here have been assisting people to die for years. Not only did I get this anecdotally from most of the doctors I spoke to, surveys over the years confirm it.
The only problem is – unlike overseas – we don’t really know how much it’s happening. Or whether it’s being done well, or for the right reasons, or even with the consent of patients, because the absence of a law here means we have no guidelines, no reporting mechanisms, and no system of review.
All we have is doctors doing what they believe is best, depending on their personal beliefs.
As Marshall Perron, the former Northern Territory Chief Minister, put it to me: “If you want to have a conspiracy with your doctor to put down grandma and inherit the estate, do it here. Because today in Australia, a doctor can assist a patient to die with no witnesses, no second opinions and no cooling off periods.”
I discovered that, despite having one of the best palliative care systems in the world, even with optimal care, 20 per cent of Australian palliative care patients spend their last days enduring moderate to severe pain.
As a past President of the Australian Medical Association (AMA), Dr Brendan Nelson, put it, there is: “… a small group of patients for whom no amount of medical treatment is going to relieve their suffering”.
The stories I heard about what it is like to be one of those patients were harrowing.
Most shocking was this: In Australia today, it is ethically unacceptable for someone in unbearable pain to die quickly and painlessly by taking doctor-prescribed medication as they do overseas. But it is ethically acceptable for that same person to die slowly and painfully, by refusing all treatment, including food and water, until they dehydrate and starve themselves to death.
Hard to believe, but that’s the country we live in.
Why should a competent adult, who is dying, and who begs for help to die quickly, be told they have to die slowly instead?
There is no good answer to that question. But the bigger worry is that not too many of our politicians want to answer it. Worse – and this was the biggest surprise of all – neither, it seems, do the people at the top of our medical professions.
Unlike overseas, where doctors took the lead in framing laws to help people die (an honest acknowledgement they were already doing it and that guidelines to protect both them and their patients might be a good idea), in Australia, the leadership of the AMA, the Royal College of Physicians, and Palliative Care Australia, are all against assisted dying. They won’t even poll their members to see if they feel the same way.
It’s probably no coincidence that the one group of medical professionals who favour assisted dying are the ones who see the suffering up close – nurses.
Then, of course, there’s us. The patients. For 20 years now, whenever we’ve been asked if we want a law for assisted dying, more than 70 per cent of us have screamed ‘yes!’.
Interestingly, when doctors themselves are polled outside the profession, more than 50 per cent of them support assisted dying too.
So how to get things moving? Start by talking to your local state politicians. Then talk to your GP. Ask them, “If I was dying in unbearable pain and wanted help to die, would you help me?” If the answer is “no, because the law says I can’t”, suggest they speak to their leadership, the people who say this shouldn’t happen.
The lesson from overseas: Once the doctors stop saying no, the politicians can start saying yes.
Throughout our life, we have the right to decide what happens to us medically. Shouldn’t we have that same right when we are dying?
December 13, 2018
November 23, 2018
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