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Facts must win out over smear campaigns in NSW euthanasia debate, expert warns

Kate Aubusson

Australia's voluntary euthanasia debate has been mired in misinformation, political agenda and extreme views, a leading Sydney euthanasia expert has warned. 

As a NSW cross-party parliamentary group prepares to release draft legislation next month, palliative care physician Dr Linda Sheahan​ urged the public and politicians to seek out the evidence among emotionally-charged arguments from all sides of the debate.

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"A lot of what people hear, and will continue to hear, is miscommunication and driven by a political agenda," said Dr Sheahan who investigated the implications of legalised physician-assisted suicide and voluntary euthanasia in overseas jurisdictions for her 2012 Churchill Fellowship report.

Dr Sheahan is personally opposed to euthanasia but stressed such a decision needed to be made by the community as a whole.

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"It's crucial we engage with this incredibly important issue in a deep and reflective, robust way," she said.

At the core of much of the misinformation was the "slippery slope", or fears of euthanasia creep. 

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The pervading slippery slope theory warned legalising euthanasia would expose the most vulnerable in society – people with disability, dementia patients and the very frail – to an increased risk of assisted suicide through coercions, the belief they are not valued in society or the feeling they have become a burden.

Dr Sheahan's investigation found international data was reassuring on this point, finding no increased incidence in people with disability or frail, elderly patients from low socio economic groups accessing euthanasia.

"However, this does not look at the underlying values issue; the belief that they are not valued in society, or they feel they have become burden," she said.

The Victorian Parliament's End of Life Choices inquiry found "no evidence of institutional corrosion or the often cited 'slippery slope'," when it handed down its report last year.

There had been an increase in the incidence of people undergoing euthanasia in jurisdictions where it had been introduced, though the proportions were small.

In the US state of Oregon, roughly 0.5 per cent of all deaths were due to euthanasia almost a decade after it was introduced. In Belgium the proportion was less than 2 per cent, and in The Netherlands roughly 4 per cent. 

"We're talking about small numbers, but there has been a gradual increase," Dr Sheahan said. 

Opponents also argued that once voluntary euthanasia laws are enacted – no matter how restrictive – they can be watered down or expanded to include people who were initially ineligible.

Belgium's euthanasia laws have bolstered this argument for opponents, where national legislation now allows access to euthanasia for people with mental suffering alone and minors, with no life expectancy time specified, Dr Sheahan said.

"But supporters in Belgian would argue that the law was created this way and what you are seeing is the application of our law changing over time," Dr Sheahan said.

Opponents also argue legalising euthanasia would foster a cultural shift towards devaluing human life and would implicitly condone life-ending acts that could lead to doctors or anyone feeling justified ending life without explicit consent.

"Again the data is reassuring on that point," Dr Sheahan said, citing international research that found no increase in the incidence of life-ending acts outside of euthanasia laws, though she had some reservations about the studies' methodology. 

"As for a fundamental cultural shift, it's impossible to measure at this time. We don't know what that will look like in 100 years," Dr Sheahan said.

"If as a society we decide it is legally permissible to end life that is a very significant communal value shift and I don't think we should underestimate how significant that is," she said. 

"These are deep and difficult questions. It's a big decision, a community decision. It can't be reduced to individual journeys." 

Physician and conjoint professor of palliative care at the University of Sydney, Roderick MacLeod, said palliative care was capable of addressing the vast majority of suffering at the end of life, but services needed to be improved. 

"Australia needs to have palliative care coverage for everybody for every aspect of end of life care, not just cancer but dementia and the very frail in aged care homes. It hasn't been diligent enough," he said. 

The sector internationally has acknowledged that palliative care was inadequate to alleviate the suffering of a small proportion of patients (between 2 and 4 per cent).

Go Gentle Australia, spearheaded by Andrew Denton, advocates for the terminally ill to have the right to choose euthanasia as part of a palliative care framework and is supported by public polling, which has found overwhelming support for assisted dying at end of life. 

"This debate should not be about supporting one or the other [palliative care or euthanasia]," said Coral Levett, president of the NSW Nurses and Midwives' Association (NSWNMA) and Go Gentle advocate.  

She said the sentiments expressed at the union's meetings suggested NSW nurses overwhelmingly supported voluntary euthanasia laws.

"Nurses know what it's like to watch someone die a terrible death. It's one of the worst things you'll ever see or experience. You never forget it," Ms Levett said. 

"It's very hard to ignore that and not be supportive of euthanasia. I do respect people's decision not to support a law change. If you're opposed to euthanasia, don't use it, but don't deny others that option."  

Legalising euthanasia would also regulate a practice that is already being undertaken by clinicians in small numbers, Ms Levett said. 

"It would create a more humane, safer environment for the patient, their family and everybody concerned," she said. 

Euthanasia in Australia

The Northern Territory became the first jurisdiction in the world to legalise euthanasia in 1995.

The legislation was overturned by the federal parliament in 1997.

South Australian lawmakers' 15th attempt to push through a euthanasia bill was narrowly defeated when it was put to parliamentary vote in November 2016.

Victoria is set to consider a voluntary euthanasia bill in 2017 after the landmark End of Life Choices parliamentary inquiry.

International euthanasia laws

US states California, Colorado, Oregon, Vermont and Washington: Physician-assisted suicide for terminally ill adults with less than six months to live.

Canada: Access for adults with a grievous irremediable condition who endured intolerable suffering where death is foreseeable. The drug can be self-administered, or administered by a doctor or nurse. 

The Netherlands: Doctor-administered euthanasia for adults and competent minors of 12 years old who endured unbearable suffering with no prospect of improvement with no specified life expectancy limit. Mental suffering alone may be acceptable. 

Belgium: Doctor-administered euthanasia for patients (including emancipated, legally competent minors), with a medically futile condition, constant and unbearable suffering with no specified life expectancy limit. Mental suffering alone may be acceptable.

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