No shades of grey

Dr Paul Dunne AM is no shrinking violet when it comes to publicly defending his profession as a palliative care specialist. Dr Dunne spoke out strongly and often during the euthanasia debate in Tasmania in 2013.

On one occasion he offered a stinging rebuke to the pro-euthanasia lobby, many of whom, he contended, "deliberately confuse euthanasia with current lawful medical practice, including the withdrawal of treatment or administration of pain relief. There is no reliable evidence that doctors currently intentionally kill their patients in Tasmania, they are simply providing lawful and compassionate end of life care".

He went on to criticise the false dichotomy whereby euthanasia is presented as the only alternative to dying in pain:

The proponents of euthanasia are fostering a climate of fear and distress through the constant repetition that death is always painful and people must end their lives to avoid suffering.

These claims undermine the excellent work that occurs in the palliative care sector and also undermines the doctor patient relationship.

Theirs is a 'bait-and-switch' technique: put in the readers minds the image of a grotesque death and then offer them a 'peaceful' solution. This kind of behaviour deserves to be called out for what it is: a false remedy built on the false premise that we'll all die in awful circumstances.

There are many variations on this theme, like the one published recently on The Drum website and postulated by Professor George Williams. He says:

As it stands, Australian law allows a doctor to provide palliative care to ease a person's pain and suffering. It has long been assumed that this is permissible even where it has the double effect of hastening the person's death.

On the other hand, the law forbids a doctor from acting on a request from a terminally ill patient to end their life. The result is a grey area for people experiencing great pain and suffering due to an incurable, but not life-threatening, illness. They are not permitted by law to gain the assistance of a doctor to end their life.

In one sense Williams is right when he says that the double effect principle is 'assumed' to be permissible. There have been, to my knowledge, no legal cases where this principle has been tested in Australia. In some states this stands as a common law while in at least three states it is codified in law. But reading the entire thread of Williams' thinking and it becomes clear that by 'assumed' he means to introduce doubt. We also saw this card played out in the Tasmanian debate; the argument being that this putative legal 'grey area' needed to be sorted out for the protection of doctors, ergo: enact euthanasia law. There is no 'grey-area' as Dunne points out; modern palliation techniques have removed the risk of death as a secondary consequence of pain and symptom management.

What precisely this other 'grey area' is where 'people experiencing great pain and suffering due to an incurable, but not life-threatening illness' is not entirely clear. Is Williams suggesting that non-terminally ill people should have access to euthanasia? Williams' article was part of the text for a talk to a New South Wales pro-euthanasia group who say they advocate for law change only for the terminally ill. Maybe that line is easier crossed than many would have us believe. Perhaps 'only' really means 'for the moment'.

When he talks about 'incurable, but not life-threatening illness' I have friends in the disability community that would say: 'He means me!' That was precisely their response to the recent judgement of the Canadian Supreme Court in the Carter case where euthanasia for disability, depression and mental illness is entirely as possible now in Canada as it is in practice in Belgium. Williams may well opine that Australia does not have a bill of rights, but in Canada there are many now who see the court ruling using their charter as the formulation of a death warrant.

Over all of this Williams suggests that this argument is all about rights. I agree. The first principle right here is about the inviolability and protection of human life as codified in the UN Charter on Human Rights and repeated in various other UN Charters to which Australia is a signatory. We simply cannot get around the fact that euthanasia laws would violate a prime mandate of a just and fair society to protect all its citizens equally. It is this pivotal point, I suggest, that is the reason for the variance between public polling on this issue and the votes in various legislative chambers.

Not convinced that there are risks, that there are people for whom the criminal code prohibiting deliberate killing is a bulwark against abuse? Why then do we need those supposed 'safeguards'?

There is no 'right-to-die', not in any bill of rights anywhere. It is a logical fallacy to try to claim as a right something that we will all ultimately experience. But it sounds good, doesn't it? Talk about 'my rights' and people sit up and take notice. None of us wants to see people denied their rights, right? Then it is about time we began to listen to the voices of those for whom euthanasia laws would represent an egregious abandonment of their most basic of rights.

Societies change and develop. Still, I'd like to think that the majority of Australians retain that wonderful, egalitarian character of putting the needs of others on a par with their own and actively considering social cohesion as the cement that binds. Retaining the prohibition on euthanasia and assisted suicide is foundational to this expression of solidarity and the equal protection of the law.