'Unproductive burdens' still have a right to live

The Dutch officially legalised voluntary euthanasia in 2002 and some claimed that bringing euthanasia "out into the open" in this way would reduce such abuses. Not at all. The Netherlands' 2007 report on euthanasia states that the rate of patients killed "without explicit request" since legalisation in 2002 is "not significantly different from those in previous years".

And why would we expect a reduction?

Doctors who treated the law with contempt when euthanasia was illegal would be even more comfortable and relaxed about abusing the practice once it was socially approved.

Professors of psychiatry in Brisbane, Frank Varghese and Brian Kelly, warned of the impossibility of protecting patients from "the doctor's unconscious and indeed sometimes conscious wishes for the patient to die" once doctors run the state machinery of mercy-killing.

Even the assertion by euthanasia advocates that psychiatric assessment will protect patients by detecting any depression that might be marring the patient's judgment is shown to be a sham, on the available evidence from the US State of Oregon and the Northern Territory.

In Oregon, for instance, of the 49 patients who died by physician-assisted suicide in 2007 not a single patient was referred for psychiatric assessment prior to taking their lethal drug. In the NT during the period of legal euthanasia (July 1996 to March 1997) there were four deaths, all presided over by euthanasia advocate Philip Nitschke.

Psychiatrist and palliative care specialist David Kissane reviewed Nitschke's cases and made this assessment of the so-called "safeguard" of compulsory psychiatric assessment:

"Nitschke reported that all patients saw this step as a hurdle to be overcome. Alarmingly, these patients went untreated by a system preoccupied with meeting the requirements of the act's schedules rather than delivering competent medical care to depressed patients."

More than once I have urged Nitschke to study palliative medicine, to broaden his awareness of what can be done for people with advanced disease. When we look after such patients well, thoughts of euthanasia often fade. Then, in the words of one hospice patient who had asked me for euthanasia only the day before, but was now pain-free, "It's a different world, doc."

However, I would not use the argument against euthanasia that "palliative care can ease all suffering". We cannot ease all suffering in dying any more than we can ease all suffering in childbirth, even though we have made enormous progress.

Rejection of euthanasia is not dependent on perfecting palliative care for all patients.

Its rejection is on the grounds of injustice to the weak, as Kevin Andrews made clear on presenting his Euthanasia Laws Bill 1996, which overturned the NT's legislation: "The people who are most at risk are the most vulnerable, and a law which fails to protect vulnerable people will always be a bad law."

We must reject euthanasia both as a corruption of the doctor-patient relationship and as an insidious oppression of society's "unproductive burdens".

And parliament must reject the Greens' trivialisation of such a momentous issue, their proposal that five politicians on Norfolk Island or nine in the ACT assembly should have authority to transform national culture on a matter of life and death.