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euthanasia:
the medical divide
The political debate is heating up, but is the medical profession in favour of legalised euthanasia? Jane Lyons reports.
WHEN Don Flounders and his wife, Iris, entered a Mexican pharmacy in 2008, it was Valentines Day and they considered their purchase of Nembutal just another act of love in their 60 years together. On the evening of 28 April this year, Don, 81, terminally ill with mesothelioma, and Iris, 88, took the Nembutal. They were found dead the next day, holding hands. A video, later posted at their request on YouTube, captured their last thoughts as they spoke of their decision to end their lives. Originally from London, the Flounders and their two children had made the Victorian town of Warragul their home. In 2007 Don was diagnosed with mesothelioma, and the following year, with the help of euthanasia advocate Dr Philip Nitschke, he and his wife travelled to Mexico to purchase the barbiturate commonly used to euthanise animals. When we got the drugs, I thought I might not want to live on without Don. Three years on, my thinking is the same. We decided this together, Iris, who had no reported terminal illness, told the camera. I knew that I would want to have the choice at the end as to how and when I die, said Don. I have reached the point where my quality of life is dreadful. I am dependent on Iris and my world has shrunk to this small

bedroom. This is no life. The couple also said they resent the fact they had to travel halfway round the world to have the choice of a peaceful death. They hoped their video would help force a change in Australian laws, preventing prosecution of those who attend or assist such a suicide. Recent court cases have highlighted the very real threat of prosecution and, with public support for voluntary euthanasia polling at 75% to 85% and attempts by state Greens to legalise it, the euthanasia debate is again in the political and media spotlight. In May, a NSW Supreme Court judge ruled in a retrial of a woman sentenced to manslaughter for assisted suicide that she would serve no further jail time. Shirley Justins, 62, had already served a 22-month periodic detention sentence after she had placed an open bottle of Nembutal within the reach of her late partner, Graeme Wylie, 71, who had Alzheimers disease. The manslaughter charge was quashed last November and she pleaded guilty to aiding and abetting a suicide in the retrial. On leaving the court, her only comment to the waiting media was: It is a relief. For the medical profession, the euthanasia question sits within a wider debate about end-of-life care. Last year a survey of 500 doctors by Exit International found that 6070% of GPs in Victoria, SA, NSW and WA were in favour of euthanasia laws. AMA president Dr Steve Hambleton says the organisation recognises the divergent views about euthanasia among the medical community and even within its own ranks, but it does not support the push to legalise it. We believe that medical practitioners should not be involved in interventions that have their primary intention of ending the persons life. With technology allowing doctors to keep people alive for longer, the question of choice raised by the euthanasia debate should focus more on the unnecessary prolongation of life, he says. We have to give people back the ability to make that decision, but we dont want to do it at five to midnight; we want to do it much earlier, he says. It may be that were pushing people into desperate places. Dr Hambleton acknowledges that even with greater control some patients will find themselves in that desperate place where euthanasia is seen as the answer. We do hear about the extremes but the reality is that the majority are not page 24

MEDICAL

1 july 2011

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page 22 going to be in the extremes, he says. Dr Scott Blackwell, the president of the Palliative Care Association, agrees. He points to the rate of euthanasia deaths in the Netherlands, arguing that at 2%, they underline the small role of euthanasia in the bigger issue of quality endof-life care. Euthanasia is a common preference but a rare choice, he says. Our experience is that even [with] those people who ask, the

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question goes away with good palliative care. He is concerned that providing what he calls an easy solution will stop the search for real answers. We need to maximise funding of palliative care services in this country, and euthanasia doesnt change that. While the association neither supports nor opposes legislation, Dr Blackwell admits: In some ways I think lets legislate it and let it just find its place. Dr Roger Hunt, the director of Western Adelaide Palliative Care

and an ambassador for advocacy group YourLastRight, believes its time for voluntary euthanasia to find that place. He says too much has been

fact a vehicle for promoting palliative care, Dr Hunt says. Nor can palliative care manage all suffering and ameliorate the desire for euthanasia, he says.

in some ways i think lets legislate it and let it just find its place Dr Scott Blackwell
invested in the myth of its incompatibility with palliative care and its ability to undermine good endof-life care. The [euthanasia] debate is in We cant eliminate all suffering no matter how good palliative care becomes To expect to eliminate all requests for a hastened demise in people who are dying is

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setting an impossible task. He points to his own surveys of patient requests done at Adelaides Daw House Hospice from 1991 to 1993. Out of 323 patients, 35 stated I wish it would hurry up, 19 said could you hurry it up, and 20 said please do something now. But whatever the views of the medical profession, the political wheels are starting to turn in the euthanasia debate. The Greens believe that doctors and people such as Ms Justins should not fear the threat of prosecution any longer. They want Australia to follow in the footsteps of Belgium, the Netherlands and the US states Oregon, Washington and Montana, and enact voluntary euthanasia legislation. In Tasmania, Premier Lara Giddings has announced that she and Nick McKim, the Greens leader, will introduce a private members bill seeking to legalise euthanasia, early next year. In NSW, Greens MP Cate Faehrmann will do the same within the next 12 months. In South Australia, Greens MLC Mark Parnell has co-sponsored a bill with the Labor MP Stephanie Key, which provides a legal defence for doctors involved in medically assisted suicide. It has been defeated in the Legislative Council but is still waiting for a House of Assembly vote. The West Australian euthanasia bill was defeated in September. But what has perhaps ruffled the most political feathers is the push by federal Greens leader Bob Brown to repeal the legislation preventing territory governments from legalising voluntary euthanasia. In 1997 the Federal Government overrode the Northern Territorys Rights of the Terminally Ill Act, the countrys first euthanasia law, only eight months after it was enacted. And with some doctors already acquiescing to these requests, its better to bring it out from under the carpet and make it safe with legislation, says DrChristopher Ryan, a psychiatrist and honorary associate at the University of Sydneys Centre for Values, Ethics and the Law in Medicine. People worry about it thats fair enough... so you have safeguards in place, says Dr Ryan, who was instrumental in ensuring the NT euthanasia legislation included a psychiatric review. Its not a slippery slope to Nazi Germany, as opponents would have us believe, he says. In Oregon, twice as many people get the tablets as actually use them. They didnt need to because all they needed was the choice.

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