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April 16, 2008

After running the gauntlet of court challenges and an appeal to have the Governor General refuse assent, the Act was commenced in July 96 and remained until religious forces in the federal parliament overturned the Act 9 months later. While it was in operation, four people used the law to take their own live peacefully at a time of their choice.

I am pleased to say that I witnessed during the passage of that Bill true democracy at work. Every Member of Parliament was thoroughly familiar with the subject and spoke in the second reading debate. Most used their entire allocated time to speak and several sought and received extra time to conclude their remarks.

The speeches were passionate, every member earnestly seeking to persuade their colleagues to their point of view. In the end the conscience vote was taken. The chamber at that moment was made up of 25 independents, no single member voting the way they did because any other voted the way they did.

Government ministers were on both sides of the chair, as were members of the opposition and shadow cabinet. Even the speaker exercised his right to vote, a rare event indeed.

I had not witnessed such a heartening display of genuine democracy in my 21 years in parliament.

In the decade since the RTIA was vetoed, 30 million people in western democracies have gained a right to access medical help to die in limited circumstances. Oregon was first, followed by the Netherlands then Belgium. I understand Luxemburg is close to doing the same.

It was only through the international fuss created by the NT legislation that we learned the sneaky Swiss (another 7.5 million) have permitted assisted suicide provided the assistance is given for unselfish reasons for 50 years! The law does not require the person assisting to be a doctor nor does the one assisted have to be in poor health.

After 50 years the only sign of slippery slopes in Switzerland are covered in snow.

The push for a legalised assistance to die is very much alive (excuse pun) and for good reason, twelve million Australian adults want the option. (80% of the adult population)

We have never lived so long or died so slowly as we do today.

A century ago we lived about 51 years, most deaths were due to communicable diseases like influenza, cholera, scarlet fever, measles, smallpox and tuberculosis. Today life expectancy for males is 78 and for females its 82. We now die from degenerative illnesses brought on by ageing like cancer and heart disease. A characteristic of these ailments is slow progressive debilitation.

When and how a patient dies today is increasingly the outcome of a deliberate human decision. Decisions to withdraw life support equipment, not to resuscitate and withholding antibiotics are all instances of the intentional termination of life that is routine in our hospitals today.

The majority of people I talk to don’t want decisions about when they will die being made for them by doctors. They want the option to arrange the timing of their own death if the suffering becomes intolerable.

We are an ageing population. A huge wave of educated, articulate baby boomers are now turning 60 + and contemplating their own mortality. (Sadly one’s body starts to bring home the reality of mortality after 60)

Baby boomers are pretty good at getting their own way and many have seen how their parents died and are going to exercise control over their own dying process to the extent they can.

Despite best practice and the good will of palliative care specialists our community knows that palliative care can’t help everyone, they also know some doctors help some intolerably suffering patients to die, but there is no surety you are going to find one prepared to risk their careers and liberty for you.

While no legislation currently exists, it is only a matter of time before an Australian state parliament recognises and acts on the wishes of their constituents.

Two RTD Bills have been introduced in WA, one in NSW. SA is on its sixth Bill with politicians there vowing to continue to keep the issue on the agenda for as long as they are members. Should the Federal parliament support Senator Bob Browns move to return legislative power to the Territories you can expect to see some action there again.

In NZ a death with dignity bill was defeated by just 2 votes. 60/58 in 03. PM Clark was a very public supporter at the time and moves are afoot to introduce another Bill over there.

The right to die bill intended for introduction shortly by Ken Smith and Colleen Hartland contains the preamble:-

"The parliament of Victoria affirms its belief that life is precious, yet recognises that some persons with a terminal or incurable illness may suffer intolerably and have a compassionate right to a death they believe to be peaceful and dignified."

To provide that right to the small number of citizens who would seek to use its provisions, the sponsors of the bill have adopted a different approach to the NT legislation in three important areas – who is eligible for assistance and the role of the doctor involved.

The Medical treatment (physician assisted dying) bill expands the illnesses a patient must have before being eligible for medical assistance to die to include ‘terminal or advanced incurable illness’. Should this bill become law this criteria will bring huge relief to people who are inflicted with a number of conditions that compel them to endure lifelong unbearable suffering, yet the illness itself is not terminal.

The inclusion of this important category of sufferers rightly carries with it a number of additional requirements to be met before being eligible to receive a doctors help to die. These include a psychiatric examination to determine the person is of sound mind and not suffering from a treatable mental illness and an additional 14 day cooling off period is required.

The second major area of difference with the NT is the method of assistance provided to end life. The NT act allowed a doctor to prescribe and administer a lethal drug when requested by the patient and agreed to by the doctor. We allowed the doctor to administer a drug to help those rare cases where a patient was physically incapable of self-administration. eg. An inability to swallow.

Your Bill provides for a patient who meets the criteria and fulfils all the safeguards will be given a prescription for lethal drugs, which have to be ingested personally. The Bill does not permit assistance by direct injection into the patient. In this regard the Bill follows the law in Oregon where it has been in operation for ten years.

By limiting their proposal to Physician Assisted dying where the patient is required to die by their own hand the sponsors have removed a major arrow from the inevitable opposition by Right to life groups and churches. The claim "this law permits one human being to kill another’ cannot be made. This factor was a major reason the NT RTIA was overturned by federal parliament.

The third difference is the requirement to be a resident of Victoria. We did not have such a condition in the Territory; two of the four people who used our legislation were from interstate.

In the debate about wether we should legalise medical assistance to die the statement is often made that "No adequate safeguards could be devised to protect the vulnerable in our society." The vulnerable are described as the poor, the uneducated, the frail aged and the disabled.

Opponents to Voluntary euthanasia have been very successful at convincing politicians that no law could be drafted which would prevent the ‘vulnerable’ becoming unwilling victims, put to death against their will or at the very least being afraid of doctors who would have a ‘licence to kill.’

Politicians reluctant to become embroiled in this subject have seized upon these unsubstantiated claims as a convenient scapegoat to avoid addressing the issue.

The fact is safeguards can be drawn up that would ensure only genuinely suffering, hopelessly or terminally ill adults, acting voluntarily, were able to receive medical assistance to die peacefully at a time of their choosing. To claim this cannot be done is to ignore or misrepresent the authority Parliament has to enact laws for the benefit of our society.

Any responsible law on voluntary euthanasia would include safeguards covering seven important areas: -

To ensure the patient and others are acting voluntarily.
To avoid misdiagnosis.
To ensure the patient is fully informed.
To ensure the patient is not acting hastily.
To prevent a conspiracy between the family and the doctor to murder the patient.
To avoid perceptions that patients need fear doctors.
To monitor VE as practiced.
These topics must be covered to ensure that the system is not abused and that no person has anything to fear from enabling legislation .

The first requirement (the patient is acting voluntarily) is absolute, and must be included in any responsible legislation, only the patient can initiate a request for euthanasia.
The worldwide voluntary euthanasia movement is based on the principle of individual autonomy. In the words of John Stuart Mill "The only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others … over himself, over his own body and mind, the individual is sovereign."

Legislation must clearly provide that a spouse, members of the family and/or the doctor, cannot initiate a request on behalf of the patient.

Voluntary euthanasia is not simply voluntary for the patient, it’s voluntary for everybody involved in the process and each individual’s right to retain autonomy in this respect must also be protected by legislation. Any doctor, specialist, psychiatrist, chemist or nurse required to be involved in fulfilling a patients request for assistance to die, must do so voluntarily.

This is a voluntary process between consenting adults.

Avoiding misdiagnosis is obviously crucial in any process and is protected against by requiring multiple opinions from qualified persons. A written opinion from an independent doctor experienced in the particular disease is an obvious minimal requirement. Draft legislation often stipulates that doctors must have been in practice for a minimum period and they cannot be in partnership or from the same medical practice.

It is worth noting that there are no laws requiring adults who choose to die by refusing medical treatment to obtain even one second opinion regarding diagnosis or prognosis. Nor are they required to be assessed psychologically.

Ensuring an individual seeking assistance to die is fully informed can be done by prohibiting assistance until the doctor(s) are satisfied that the patient is fully aware of diagnosis, prognosis and palliative care options. The patient may be required to consider specific palliative treatment and the effect of their request on their family. Only when a doctor is satisfied that the patient fully understands their situation would the patient be eligible for assistance.

Cooling off periods are intended to ensure that a patient seeking help to die has been forced to reflect on their intentions. Care needs to be taken when considering cooling off periods that the already suffering patient is not forced to endure more - simply to satisfy society that they really are ‘suffering enough’ to want to die.

Many of the safeguards contained in current and draft right to die legislation would prevent the process being used as a cover for murder. That only a terminally or hopelessly ill patient can initiate the request, that multiple medical personnel from different practices must personally sign off that the request is made freely and voluntarily, that the patient has been assessed for clinical depression, translators may be required where necessary and doctors cannot benefit from the estate of an individual assisted to die, all mitigate against a plot to murder.

Anyone eliciting to aid of a doctor to do away with a relative to inherit the estate would be more likely to succeed under current Australian law, whereby very sick patients are assisted to die daily under the convenience of ‘double effect’ without safeguards or scrutiny. No second opinions, no witnesses, and no telling the coroner.

Legalising PAD would in fact allow for the first time, the opportunity for patients and doctors to discuss end of life issues in frankly and openly, something that is near impossible at present. Doctors today cannot discuss a patients intention to take their own life, they can only try to talk them out of it otherwise they could be accused of aiding or abetting.

It is important that a legislative regime include compulsory reporting and monitoring requirements. Patient records should be kept for a specific period; the coroner should be advised of every death and have full powers to investigate. Statistics should be collated and tabled in Parliament.

In my experience, the draft Victorian Bill has sufficient and appropriate safeguards to ensure that only those citizens who the Bill is targeted to assist will receive assistance, yet the very existence of such humane legislation will bring comfort to many thousands who will never seek to use it.

Thank you for the opportunity……

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