Euthanasia, the concept of performing, or aiding in the process of a “mercy killing”, is defined by medical journalist Jim Dominguez as “The performance of some act or treatment which has as its explicit or direct intention the termination of a life.” Dominguez also elaborates: “It is not euthanasia to decide to discontinue a treatment which is too futile or too burdensome to the patient.” Typically associated with terminally ill individuals, euthanasia comes in varying forms; which range from merely facilitating the procedure with the appropriate resources, to personally administering the fatal treatment. There are several significant factors in determining the legality of this controversial act, however most cases are judged on their individual circumstances and merits.
There are two main ways to classify euthanasia. The distinguishing factor between the two is if it was the subject themselves who personally stopped medical support in order to die, or if someone else who acted on their behalf. The latter is the more controversial form of the two, with several cases that illustrate strong opposition to the practice.
One such example is that of a prostate cancer sufferer in Darwin, Bob Dent, who on the 22nd of September 1996 was aided in giving himself a lethal injection. Dr. Philip Nitschke, along with the signatures of two other certified practitioners, assisted the man in becoming the first to utilise the Northern Territory's Rights of the Terminally Ill Act; which was in itself, a ground-breaking piece of legislature. The 1995 Act legalised the use of direct euthanasia; whereby a physician physically performs the act for a patient who is not capable to do so themselves, and also authorised indirect euthanasia; where the role of the physician is reduced to just providing the lethal means for the patient to terminate their own lives.
Dent's decision to apply the Act stimulated a wave of ethical debate, most notably, in the religious and medical facets of society. Although Dent described the new law in a final letter as “the most compassionate in Australia”, the national head of the Catholic Church proclaimed the date of his death to be “a shameful day for Australia”. Surprisingly enough, the Australian Medical Association shares the view of the church, stating on behalf of the medical community that “doctors should not be involved in interventions which have, as their primary goal, the ending of a person's life.”
The clergy, even prior to the landmark Northern Territory legislation of 1995, have always expressed a passionate disbelief in the notion of euthanasia. The most vocal are faithful to Catholicism, and claim to base their opposition on three main points. The first is that euthanasia, similar to abortion, devalues life. This is a stance that has been adopted on a wide scale in general society, illustrating the influence that religion has over debates of this nature. The Anglican Archbishop of Sydney also fervently backs palliative care, and believes it should be the standard course of action- rather than even taking euthanasia into account.
The second argument of the church, is that legislation like that passed in the Northern Territory, sets a dangerous precedent for testing of the boundaries of the law. Spokesman for the Catholic Church of Sydney Father Brian Lucas suggests “We decide it is all right to kill people who ask to be killed, so then we say: `What about people who can't ask? Why should they be denied the benefit?' So someone else takes that decision.”
Finally, the religious sects are adamant that ones body is the property of God, and that we do not have the authority over our own beings to be able to kill them, should we so require. Euthanasia undermines the path God has designated for us, hence the passionate resistance of the clergy.
Medicine is the more objective, and practical, party on the topic of euthanasia. Unlike the church, of utmost concern and above all other considerations is the quality of life being experienced by those requesting to be euthanized. Palliative care is the theoretical rebuttal to euthanasia, to alleviate pain and improve life quality; however, doctors are aware of the physical and mental limitations patients often experience in response to this remedy. Furthermore, Dr. Nitschke identifies a legal inconsistency in palliative care; claiming that while active euthanasia is currently illegal in Australia, it is perceived as “good symptom control and a natural death” if a palliative care ward intentionally increase a drug dosage to instigate death. Such is the social character of euthanasia, somewhat underground, due to its status in law.
From a more ethical and moral medicinal standpoint, professionals in the business have a number of issues to contend with when dealing with the question of death. In becoming doctors, all practitioners are bound by the Hippocratic Oath, which is a sworn testament to the inclinations and welfare of the patient above all. However, according to Dr. Philip Nitschke, a degree of autonomy has been conceded by the patient when it comes to life and death decisions, who comments that “the profession and its doctors tend to be paternalistic and all knowing.” This issue has founded the underlying question; what course of action is ethical for a doctor, whose patient wants to end their life due to physical torment? While it is the basic role of those who practice medicine to prevent pain and death, it is also their role to adhere to the desires of the patient. Adding even further ambiguity, is the legal system, which maintains that it is unlawful for a practitioner to assist death (an assistance that would satisfy the patients request), in any way.
This once non existent conflict of interest, reflects the gradual evolution of medicine over time in relation to euthanasia. Before 1970, it was the standard role of a doctor to prolong death using whatever means necessary; often at the physical and emotional expense of the patient and their family. American doctor M. Scott Peck recalls, in 1965, “cutting in half the flow of the I.V drip, so as to decrease it from a pouring stream to a rapid drip.” He returned ten minutes later to find the man under his care, who had been in tremendous pain, dead. Because of the nature of medicine under the law in the 1960's, not even the family could deicide on the mortality of a terminally ill loved one. Dr. Peck's intervention was therefore completely illegal, even by contemporary standards, and prompts the question; does the law in regards to euthanasia reflect morality?
An answer is still yet to be established. Contrary to the arousal of interest the Rights of the Terminally Ill Act created in 1995, it was overturned on the 26th March 1997 by Liberal MP Kevin Andrews. As a result, all forms of euthanasia in Australia are currently illegal, however in a legal anomaly, suicide is not. This has lead to many avoidable situations in which people in suffering have unsuccessfully tried to take their own life, raising yet another moral issue as to whether it is contradictory for the law to support one `unnatural' means of death but not another.
Because of the contentious nature of the matter, the Australian Legal System has been slow in responding to the topic of euthanasia. Intensified by the landmark decision to pass the law allowing voluntary euthanasia in the Northern Territory on the 26th May 1995, the government was obliged to seriously address the issue. South Australia and Victoria had recently ratified “Dying With Dignity” legislation, however this mainly concerned the withdrawal of all forms of life support, and sanctioned the right of a doctor to give life shortening prescriptions to dying patients. It did not endorse direct or indirect forms of euthanasia, which is what stalwarts like Philip Nitschke have been pushing for.
Since 1995, a series of bills with the purpose of legalising voluntary euthanasia have been defeated in New South Wales, South Australia, and Western Australian. Contrasting standpoints have been expressed, by the NSW parliament especially, over time in relation to the legal acceptance of assisted suicide. Leader of the NSW National Party first said in 1996 that “The euthanasia law is never likely to see the light of day in this Parliament.” Although there have been times in which this statement may not have eventuated, it seems more accurate than ever from a current perspective.
As of 2006, four in five Australians and 77% of citizens in New South Wales support voluntary euthanasia. Regardless of this clear long term trend, the Australian Liberal and Labour parties show little interest in adapting the public's wishes into law. Only the Greens under NSW parliament representative Ian Cohen are active on the issue, as he believes: “I support end of life choices. This stems from my belief in the individual's right to choose and that another's religious convictions should not impinge on the decisions of those who do not share particular beliefs.” However, such a small minority is not sufficient to initiate a bona fide drive towards legalisation, proven by the opportunity for a Citizen Initiated Referendum in 2004; that was quickly quashed by the Australian Democratic Party. Because a federal election has occurred since this time, any newly proposed legislation on euthanasia would face a standard lengthy period of evaluation before being ratified.
In a global context, Australia legal views on euthanasia are significantly behind international standards. This is due to the fact that the most important institutions of our society are in conflict with one another, keeping each other down, and continually hampering unified progression. While Australia has an overwhelming majority of social acceptance for the legalisation of euthanasia, this fails to be reflected through the medical, religious and legal perceptions of the concept.
In the American State of Oregon however, the Death With Dignity Act 1997 is pushing forward the state of `physician assisted dying'- a form of indirect euthanasia. The patient must administer the lethal drug themselves, however two doctors must concur on the diagnosis, prognosis and the patient's capability; which in turn evades any unpleasant situations. While law explicitly forbids euthanasia per se, Oregon's approach is a step towards long awaited patient autonomy in matters of death.
In the Netherlands and Switzerland, the state of euthanasia in the penal code is what many Australians are hoping for in future legal reforms. In the Netherlands, a gradual twenty year implementation process has lead to a system that is successful and widely accepted. The Termination of Life on Request and Assisted Suicide Act 2002 stipulates that any terminally ill person over sixteen, who has voluntarily considered the option, may request to be euthanized with the approval of an independent physician. The Swiss also, have allowed assisted suicide since the 1940's, provided that the motivation was altruistic. A Remmelink Report conducted in May 2003, documents that deaths have remained in normal proportions in both countries, since the introduction of euthanasia laws.
The Australian Legal System's ineffectiveness in addressing euthanasia is of concern, because of the broad negative impact, and the cycle it perpetuates. Because suffering individuals want to end their trauma, they turn to family and friends to be with them in their final moments. This is illegal, and seen in the eyes of the law as assisted suicide. If the patient then elects to commit suicide in solitude; apart from the obvious detracting factor of feeling lonely and isolated, they run the risk of improperly executing their attempt, resulting only in worse pain. However, if this risk is observed and avoided by requesting someone else to terminate their life, this assistant is liable for murder. The position of those with incurable ailments in Australia who want to avoid a drawn out passing, is practically unrecognised under the current legal structure.
The way to best summarise the shape of euthanasia in this country in medicine, religion and law, can best be achieved by the first man to legally engage in voluntary euthanasia, Dr. Philip Nitschke. He states “Medicine, like the law, has responded mostly to the problem of death by postponing it.” Because of the intimidating moral and ethical questions associated with the issue, the Australian Legal System has responded to euthanasia with apprehension. Fungoides Mycosis victim Janet Mills encapsulates the voice of many of Australia's terminally diagnosed, pleading “I've had enough.” Their legal system has continually promised the provision of appropriate legal remedies to no avail, and as Dr. Philip Nitschke concludes “An Australian voluntary euthanasia law is years away from being enacted. Yet I have people who do not have the luxury of time. These people are sick now. They face painful and drawn out deaths now…”