Most proposals for law reform to allow voluntary euthanasia focus on the dying. This is perhaps due to a perception that it will be easier to succeed with law reform if it is limited to the terminally ill.
Whether this is so can be debated, but there is no necessary conceptual link between voluntary euthanasia and the dying. To suggest there is ignores the plight of those who are not dying, but have a quality of life so diminished that they have a rational case for requesting assistance to die. Moreover, this approach leaves the movement open to “slippery slope” claims — first terminally ill, now hopelessly ill, what next?
The fact that one may be dying does not in itself justify a request for hastened death. Many experience a rewarding life right up to its closure. It is also philosophically and medically contentious to suggest that it is consistently possible to distinguish between patients who are dying and those who are not.
For instance, the ability to predict imminent death is not always easy, leading to terminology such as “the terminal phase of a terminal illness” in the South Australian Consent to Treatment and Palliative Care Act 1995.
The length of time one has left to live is neither the sole determinant of its quality, nor the measure of suffering which will be experienced. In fact those suffering greatly are relatively fortunate if they have only a short time to live. Their plight is worse the longer they survive.
We must never lose sight of what must be the central focus in seeking reform, the best interests of a patient for whom no acceptable treatment is available. It is well understood that physicians have a particular responsibility towards patients who are hopelessly ill, dying, or in the end stage of a terminal illness.
Withdrawal of treatment
Courts around the world now accept the view that patients have the right to die, whether or not they are terminally ill or suffering. There is a right to withdrawal of treatment for those who are permanently unconscious, thereby allowing alleviation of an unacceptable situation, even if the patient is not perceptibly suffering or close to death.
For these reasons, the South Australia Voluntary Euthanasia Society (SAVES) uses the term “hopelessly ill” rather than “terminally ill”, as one of the criteria that would need to be met in legalized voluntary euthanasia. [3,4] The care of the hopelessly ill encounters a dilemma when the preservation of life is not compatible with the relief of suffering, and a hopelessly ill patient for whom life has become an intolerable burden earnestly wishes to die.
The focus on pain alone is also unhelpful in the debate.[1,2] Physical pain can usually be alleviated at least to some extent. The paramount focus should be the irreversible loss of a quality of a life worth living, as determined by the patient. Quality of life refers to more than the patient’s physical condition, and includes life experience and consequent value system. Any patient who concludes, after thorough medical assessment and exploration of all available options, that there is no hope of gaining an acceptable quality of life, should have the choice to relinquish it and receive compassionate assistance to that end.
The moral case for voluntary euthanasia is based on three major principles: respect for personal autonomy, compassion for those who are suffering with no prospect of relief, and concern for the dignity of the person. With the marked increase in life-span over the last few decades, due to the outstanding advances in medical technology, the number of people facing the prospect of prolonged terminal illness, loss of faculties, and total dependence has inevitably increased.
Chances of survival after severe accident or disease have been improved, but can be accompanied by gross permanent disability. While death may be postponed for those permanently ill or incapacitated patients who will still have no prospect of a cure, there is no guarantee of an acceptable quality of life. We can salute advances in medical technology while still recognizing that it does not guarantee those qualities, which give human life its value.
While we may admire, and even envy, those who have triumphed in spirit over great suffering in these situations, our compassion should ensure that we never demand of others that “you should be like them”. We each have the right to face life and death in our own way, according to our faith and capacity.
It is for these reasons that SAVES endorses the focus on the “hopelessly ill” in the Dignity in Dying Bill currently before the South Australian Parliament. An essential feature of this bill is that persons requesting euthanasia must be hopelessly ill, i.e., have an injury or illness that either results in permanent deprivation of consciousness, or irreversibly impairs the quality of life to the extent that it becomes intolerable to them.
As Sir Mark Oliphant, former patron of this society argued: “If we choose, the end of life need not be preceded by intolerable pain, or by senility and loss of bodily functions. Death with dignity is the right of every person who faces an incurable, painful or degrading future.”
Julia Anaf, Vice President South Australian Voluntary Euthanasia Society
1. Wanzer, Sidney H. et al. The Physician’s Responsibility to Hopelessly Ill Patients’, New Eng J Med 1984; 310.13
2. Wanzer, Sidney H. et. al. The Physician’s Responsibility to Hopelessly Ill Patients : A Second Look, New Engl J Med 1989; 320.13
3. SAVES Fact Sheet No 9.
4. “Voluntary Euthanasia and the Medical Profession: An Invitation to Dialogue”. SAVES 1990