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Why Active Euthanasia is Quite Different to Current Medical Practices (Despite What Some People Say)

Monday, 5 October 2015  | Denise Cooper-Clarke



Submissions have now closed to the Victorian Parliamentary Inquiry into End of Life choices and their report is due next May. Over 900 submissions were received (viewable here).

In a public hearing held by the inquiry, pro-euthanasia advocate Julian Savulescu argued that euthanasia and physician-assisted suicide should be legalised because they are not morally different from two currently morally and legally accepted medical practices, namely the administration of pain relief which might foreseeably shorten life (but which is not primarily intended to do so), and the withholding or withdrawal of potentially life –prolonging medical treatment under certain circumstances.

PROVISION OF ADEQUATE PAIN RELIEF

Sometimes there is uncertainty on the part of doctors, patients and/or relatives as to whether the administration of pain relieving drugs might also shorten the patient’s life. Morally and legally such pain relief is justified by the principle of double effect (PDE), so long as the possible hastening of death is foreseen but not intended. But it has been claimed that this encourages hypocrisy, with doctors claiming that their intention is pain relief when in fact they intend the patient’s death and their practice is really euthanasia. How, it is asked, can someone prove what the doctor’s intention really is?

There are two points to be made about this. First, that there is no evidence that effective pain relief necessarily hastens death, despite this being widely believed in the community, and often stated in the bioethics literature, as well as in case law. The belief has been labelled a ‘fallacy’ and a ‘myth’ by palliative care physicians. Narcotics are used quite safely in palliative care, and it has even been demonstrated that effective pain relief tends to prolong life rather than shorten it.  In other words, the PDE need not be invoked to justify the use of these drugs by skilled and experienced practitioners, because they simply do not have a “double effect” of causing death as well as treating pain. According to commentary in the Journal Palliative Medicine (2007): “Numerous studies of opioids and sedatives worldwide are clear that they do not hasten death or alter survival”. Effective pain relief is not a form of euthanasia.

Second, the intention of someone prescribing pain relief is not difficult to demonstrate: in practice it is easily determined by the pattern of their prescription. A competent doctor will use small repeated doses of opioids, tailored for the individual and their tolerance to the drug, usually in conjunction with other pain relieving measures. But a single large dose, suggests either negligence or an intention to kill (though it may sometimes be required).

All medical practitioners should be adequately trained in the administration of pain relief and palliative care at the end of life.

WITHHOLDING OR WITHDRAWAL OF MEDICAL TREATMENT

The Victorian Medical Treatment Act 1998 protects a competent patient’s right to refuse unwanted medical treatment, including potentially lifesaving or life prolonging treatment. In addition, doctors may withhold or withdraw treatment that is futile or unnecessarily burdensome. Such situations are examples of permissible ‘letting die’. The medical profession and the current law maintain a clear distinction between ‘letting die’ in such situations and killing a patient (active euthanasia). Statements of medical associations worldwide affirm the distinction. Even life prolonging treatments such as the provision of artificial ventilation or artificial nutrition and hydration (ANH, also sometimes called tube feeding) to seriously brain damaged individuals may be discontinued at the request of family members. When medical treatment can offer no hope of pursuing the spiritual goods of life, as for example when a patient is in a persistent vegetative state, there is no duty to preserve life and the patient should be allowed to die.

In the Christian tradition, maintaining the distinction between killing and ‘letting die’ has to do with the virtue of humility. It is to understand that life is a gift from God, which we cannot take from another person, nor even from ourselves. To give the medical profession the power and authority to determine when someone will die is to usurp God's authority- to ‘play God’ as is sometimes said- and to demonstrate the vice of hubris or unbridled arrogance. When a decision is made to withhold or withdraw medical treatment, it is often described as allowing nature to take its course, but it is really an admission that we've reached the end of our power to keep this person alive. We don't know what will happen, but we stop interfering and leave the person (it may be ourselves) in God's hands. Medicine is generally about healing, resisting disease and death; and this is godly work, because God is on the side of healing and wholeness, and death is an enemy. At the same time, at some point for all of us, death must be accepted. It is the necessary pathway to resurrection and new life. To be human is to be mortal, and so the time does come to stop fighting death. Death is an enemy that need not always be resisted, but we should never collaborate with it.  Knowing when this time has come for each of use calls for wisdom and discernment.

Some U.S. studies have shown that Christians tend to ask for futile treatments at the end of life more commonly than non-believers. This is probably related to the respect for human life which they (rightly) have. And they may believe that withholding or withdrawing treatment is morally equivalent to killing. But I believe they are mistaken. Christians of all people ought to be willing to accept when the time has come to die, rather than clinging to life at all costs, since they have a sure and certain hope for a future beyond the grave.

 


Comments

Geoff Jay
October 6, 2015, 9:27PM
Thank you for your clear thinking which helps me to engage with unbelieving friends and acquaintances in this debate.
Rob Sunderland
October 7, 2015, 9:03AM
Nice to know someone makes sense in this area!
Janice N
October 23, 2015, 11:53AM
Thanks so much, Denise. A personal reflection...
It is coming up to the first anniversary of the death of my friend R. Her last days and treatment for cancer are well documented on Facebook, but in summary: breast cancer diagnosis in 1998, followed by secondaries in bones, liver and with hot spots detected in the lung and brain. Trusting in God for her timing, and for every day, she felt pain when ribs were cracked but otherwise only discomfort from fluid retention and restrictions in walking towards the end. She engaged the palliative care people early and from her nursing background knew that she would have adequate pain relief when needed. She died in peace, still able to whisper goodbye to her friends and family and her dear Ian. In the last couple of weeks she had a few panadol. Her most recent course of chemotherapy was abandoned when it seemed to be ineffective and was becoming toxic for the liver. It was the liver cancer which was the deadly one. R recognized she was fortunate to have little pain over the 16 years, unlike what others experience with cancers, and was thankful she lived a full life until the end. At all times she encouraged others who struggled in life. She talked about "living well and dying well".

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