Church has a duty to be involved in euthanasia debate

Earlier this month, The Australian newspaper reported that Andrew Denton told the church to get out of euthanasia debate. I am not entirely clear why he has decided that there is no place for religious parties in the public square, but apparently he characterized opposition to the legalization of euthanasia in Australia as “denial of the public will."

Let’s consider this for a moment. What do we know about the public will? Up to 85% Australians are reported to be in favour of a change in the law to allow euthanasia according to various polls. But there are other figures we don’t hear as often: that the majority of doctors (those expected to actually do the deed) are against euthanasia, and the size of the majority increases as their work is more involved with the dying. All palliative care organisations against it. And if you talk to those facing the end of their own lives, those who would be eligible for euthanasia if it were legal, the numbers drop precipitously. One Sydney study found that only 2.8% of patients in a palliative care service requested euthanasia when first seen. After palliative care commenced, this number was reduced to less than 1% of those referred. Certainly, as a doctor working in palliative care, I would say that my patients generally want more time, not less. I expect many of the 85% were quite healthy.

Furthermore, how informed are the 85% in favour? There seems to be a lot of confusion in our community about what would change if euthanasia is legal. Many people are worried about being kept alive by technology long after their quality of life has diminished, or in having a long, drawn-out final illness. But no mentally competent adult in Australia has to undergo medical treatment they don’t want, even if it means refusing life-prolonging treatment. Taking someone off life support is not euthanasia. It’s not flicking the switch that kills the patient –it’s the underlying disease that does it, that’s why they were on life support in the first place. We don’t need a euthanasia law for this to happen. It’s already a legal and ethical option.

Another situation which is often confused with euthanasia is adequate symptom control in the terminally ill. Occasionally in the terminal stages of disease the distressing nature of a patient’s symptoms may require the use of strong analgesics such as morphine to keep them comfortable. It is not euthanasia because the intention is not to kill the patient, but to alleviate their distressing symptoms. Some people would call this practice of symptom control passive euthanasia because of a myth in the community that use of morphine shortens the life of the patient. They argue that if we already practice that type of euthanasia, there is no reason not to practice the other type of euthanasia, using lethal injection, which they call active euthanasia. You see the problem.

But it’s all based on a myth – that morphine kills the patient. This myth been around for years, and we don’t seem to be able to squash it. It makes people scared to use what is an excellent treatment for pain. But in fact morphine in therapeutic doses does not shorten life. Indeed, according to the latest research, it may actually prolong it.

Stopping futile and burdensome treatment and maintaining adequate symptom control are good medical practices at the end of life. When the public has a better understanding of end-of-life care it reduces the call for euthanasia because there is less suffering experienced along with an increased sense of control for the patient. This is not to say that no-one at the end of life wants hastened death, just that the polls are misleading.

And what do we know about actual euthanasia requests in the jurisdictions where it is legal? They are usually not related to physical factors but to psychosocial and existential factors - things like the fear of death and loss of control, fear of becoming a burden and of loss of dignity, fear of the future, fear of being left alone.Research has found that when patients expressed their fears at the end of life it was often misinterpreted by healthcare providers as a request for euthanasia when it was really intended to be a cry for help.

The incidence of depression in cancer patients has been measured as high as 45%.A desire to die is a symptom of depression. In any other group, a request for death would alert a doctor for urgent psychiatric review: why is this group of patients being treated so differently?

In 2012 a prominent medical journal published an analysis of euthanasia and end-of-life practices in the Netherlands from 1990 to 2010. It showed an increase in the proportion of euthanasia deaths over the time studied, including dementia patients, who could not request it for themselves. Legal guidelines have not protected these patients.

So this is why it is important that church groups are heard in this debate. Arguments supporting euthanasia laws presuppose a world of ideal hospitals, doctors, nurses and families. But we don’t live in an ideal world. We live in a world where humans make mistakes about prognosis and have selfish motives.

We cannot be sure that euthanasia, once legalised and socially accepted, would remain voluntary. Vulnerable and burdensome patients may be subtly pressured to request termination of their lives, even though they don’t really want to. Remember that fear of being a burden?

The public debate is unbalanced. We do hear the terrible stories of those who have suffered. What we don’t hear are the narratives of the vulnerable patients, those who can’t go on to Q and A to talk passionately about their vulnerability and experiences of coercion. Of those whose families think they would be better off dead.

The strength of a society is judged by how they treat their most vulnerable members. And this is why the church needs to be heard in the public square. Traditional church values aim to protect those in our society who cannot protect themselves. Someone needs to speak up for those who want to live.