Can voluntary Euthanasia be contained?

Avoiding misdiagnosis is obviously crucial in any process and is protected against by requiring multiple opinions from qualified persons. A written opinion from a specialist 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 (and other conditions are met) 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. More than one compulsory delay can be required and they may range from days to weeks. 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 voluntary euthanasia 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 as not suffering treatable clinical depression, translators should 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 the 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.

To avoid the perception it is alleged may develop that some patients in aged care institutions or hospitals will fear doctors if voluntary euthanasia is legalised, provision could easily be made for private organizations to determine that VE would not be conducted on their premises. It is also open to Government to determine that VE will not be permitted in any public hospital.

Providing for VE would in fact allow for the first time, the opportunity for patients and doctors to discuss end of life issues openly, something which is near impossible at present.

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 VE death and have full powers to investigate. Statistics should be collated and tabled in Parliament. A parliamentary committee could be established to monitor that the legislation is operating as intended.

The suggestion that no adequate safeguards can be devised is ludicrous when you examine the question closely. The fact is of course, that safeguards can be as tight as Parliament dictates.

It would be easy to be overly prescriptive and restrictive to limit the number of patients who could access medical help to die if that was desired. For example, if one were uncomfortable about the possibility of misdiagnosis, or perhaps there might be a conspiracy between medical personnel and a family to do away with a patient, then the number of doctors, specialists, psychologists, psychiatrists etc. involved could be increased. The point is made simply to demonstrate that legislatively Parliament can do whatever it likes. You can include as many hoops and hurdles to jump through and over as you want.

A reasonable list of safeguards might include : -