Euthanasia is happening, legal or not

"I thought an overdose of an anti-depressant would be best, so in the notes I wrote that [my patient] was depressed and I gave him a prescription of [amitriptyline] - enough to do the job" (Gary, GP).

Gary is one of many doctors and nurses who are involved in assisted suicide and euthanasia in Australia today. In terms of frequency, Gary’s career is fairly unremarkable. He gave me six detailed descriptions of his involvement, although that was years ago and he has doubtless been involved since then. Others I spoke to claimed to have been involved 40-60 times.

The "euthanasia underground" is the underbelly of nursing and medicine – a dimension of health care work that professional medical bodies choose to ignore. My own understanding of covert euthanasia comes from 49 detailed interviews I conducted with HIV/AIDS health care workers in Sydney, Melbourne, Canberra, Brisbane and San Francisco. Many of those I spoke to wanted to challenge the complacency and silence of their professions, to let people know the burden of involvement in illicit, yet compassionately-motivated killing. Some saw themselves at the vanguard of a new ethic of caring: one that encompasses assisted death as part of the professional role. Others don’t even try to make sense of it anymore.

Despite their mostly good intentions, the picture they paint is not a pretty one. Take Stanley, a therapist, who presided over the death of a patient who swallowed 15 Seconal tablets (a barbiturate), but who failed to take an anti-emetic, to prevent vomiting. It was only after the patient had eaten his own vomit that the drug took effect. There were numerous cases where participants miscalculated the dosages required to achieve death and resorted to suffocation, strangulation and injections of air in their desperate efforts to finish the job. One doctor injected a young man on the first occasion they met, despite concerns from close friends that the patient was depressed. Another gave a lethal prescription for the benefit of a man he had never met. In one case, a patient brought his death forward by a week so as not to interfere with the doctor’s holiday plans. In another instance, a hospital physician instructed a nurse to send the mother of a debilitated patient home for a shower, and to set up a death infusion. The physician’s words were: "get it up and get him out of here by sundown".

Illicit euthanasia has spawned a culture of deception. Deceit is all-pervasive. It encompasses the methods used to procure euthanasia drugs, the planning of the death itself, and the disposal of the body and associated paperwork. One funeral director revealed that 10% of his business, or 15-20 deaths a year, were pre-arranged. While euthanasia is easier to perform in community settings, I documented many examples of hospital and hospice euthanasia.

How should the community respond to illicit euthanasia? Moral conservatives may prefer to ignore it, since the present reality of illicit killing disrupts the logic of the claim that if euthanasia is legalised, society will plunge down a slippery slope and terrible things will start to happen. In fact, the criminal law neither effectively inhibits the practice of euthanasia, nor adequately protects the vulnerable patients who most desire it. Euthanasia policy is not a choice between having euthanasia and not having it. It is a choice between driving it underground, and seeking to make it visible. Many in the medical profession know that euthanasia is practiced, but believe the issue is best left to the integrity of the "medical fraternity". There is a sub-text here. Some of those who are most actively involved do not want euthanasia legalised for fear that any resulting law will further constrain their clinical discretion.

Some believe that the police should work harder to prosecute offenders. This would be counter-productive. Any closer policing of the administration of morphine and other potentially lethal drugs would have a devastating impact on the quality of care received by those in pain and those who are dying.

My own view is that a legalised regime, incorporating statutory safeguards, may go a long way towards minimising the harm and sadness caused by the poor judgments of both patients and their physicians. In the meantime, the euthanasia underground issues a challenge to professional bodies to take their heads out of the sand. Regardless of whether euthanasia is legalised, these bodies have a responsibility to encourage their members to better explore the issues, risks and pitfalls that are present when patients make these final decisions.