Killing me softly


Voluntary assisted death with dignity challenges our most intrinsic beliefs about the value of human life and mortality. THIS is the ‘…one glaringly obvious and indisputable truth to emerge from the euthanasia debate…’, not the need for more palliative care as recently suggested (The Mercury, Editorial, The art of dying, Saturday 9 March 2013).
In the West, we have distanced ourselves so far from dying; preferring to prepare and celebrate the beginning of life, and sanitizing death from our day-to-day experience. Dying engages our moral values but there are commercial values at play too. The medicalisation of health focuses acutely on highly specialist and technical responses to health problems that sustain life. This is the high end of town in the medical world: ground breaking technology; new pharmaceuticals; highly skilled professionals. Staying alive is sexy and it brings in the money.
But at least some of the time, we should be facilitating death.
The Mercury’s editorial voice proceeds momentarily with care. Of course it’s true that we are not keeping up with demand for palliative care services. Anyone who has supported someone terminally ill knows how difficult it is to negotiate the system and get the care needed for the dying. Few would argue that more investment in palliative care is not warranted. It’s humane.
Our friend also advocates for an end of life care plan; an empowering strategy that accepts death and our responsibility to prepare for it.
End of life planning is a broad church. Most people know they need to get their Will sorted, lots of people have signed up for organ donorship, and if you have a Will, then you’ve probably made funeral arrangements – even if it took your plans for a long overseas trip to do it.
But Advance Care Directives, Enduring Power of Attorney and Enduring Guardianship is where the money’s at. An Enduring Power of Attorney handles your finances and business affairs when you are unable to. An Enduring Guardian nominates a person who will advocate for, and facilitate, your treatment wishes on your behalf when you are also unable. In an Advance Care Directive you also nominate your treatment wishes but the difference is a matter of common rather than statutory law. It’s subservient to Enduring Guardianship and less precise, if precision is something you will need, but you can do it yourself and there are training courses available and resources on the internet to assist.
A simple example might be that you have suffered a stroke and are at risk of another, you might decide because of your condition and prognosis that you don’t want to be resuscitated. Completing an Advance Care Directive is a precautionary principle in action, whether or not you are immediately at risk of dying.
Regardless, whether we inject a gazillion dollars into palliative care or whether Advance Care Directives become more common than muck, these things are not enough.
That’s why the Dying with Dignity Bill 2009 is a step in the right direction.
‘The big fear is that euthanasia will become a treatment option that is like so much in our contemporary society – a quick, cheap, easy fix to an issue that is worthy of much more gravity; life.’
And unlike what The Mercury’s editorial voice has to say, if anything, it is not enough.
We need to get over the fear that support for a dignified death suggests we do not appreciate life, that we are simply animals that should be put down when we are in pain. There are Judo-Christian
undertones that underpin this fear when really there is little need, the will to live is primal, the drive is fundamental.
And it is precisely this drive, and the capacity to make this decision in the face of an overwhelming desire to live, which sets us apart from other animals.
It is the worst truth that we can suffer unbearable and un-relievable suffering. Pancreatic cancer is one terminal illness whose sufferers are often unable to be relieved.
If there are concerns to be had with the proposed legislation, it is hardly that it might present a ‘quick, cheap, easy fix’ as suggested. It is simply not possible to minimise the enormity of a decision
of this nature.
There is no doubt that this proposed legislation is tremendous and brave in may regards. But it is also safe in just as many respects. Explicit is the notion of terminal illness which relates to the
advanced stages of an incurable and progressive condition that can be reasonably expected to cause death. Implicit is that this relates to the last weeks and days of life.
This is unlikely to give relief to the motor neuron disease sufferer with hyper-sensitivity, where every crease in their sheets causes pain daily but they are not dying. The progress of their illness may be rapid or slow. They are likely to not be able to swallow or talk and need language aids that don’t contain advance care terminology; nomenclature that must be programmed on to physical aids by speech pathologists.
For people with a progressive incurable disease they need to be supported in their the right to self-determination and to be able to make a binding directive before they are physically unable to decide.
There is also existential suffering that sets us apart from other animals, where life loses its meaning. This is a deeply personal experience where meaning no longer exists for the person. This will be different for each of us and should be accepted and respected. Under the proposed legislation, the dying person must be mentally competent and not be suffering from a psychiatric or psychological condition. Whilst this resonates intuitively, the social construction of these conditions may misdiagnose existential suffering for depression.
Assisted dying requires clearances from two doctors. The same situation that is subject to reform in the pregnancy termination debate also now underway in Tasmania. This allows doctors to opt out, leaving vulnerable, sick people out on a limb. The underlying premise here is that the matter is moral when it is in fact medical. There are also legal concerns for doctors that they may not be able to administer what is needed to help you die.
Dying is just as important as living and preparing for dying is simply a part of living. There is no need to fear the proposed Dying with Dignity Bill 2009. Rather like life, it should be part of
our preparations for death and embraced. It is an important first step that will bring relief to many people.
Submissions for the community consultation on the proposed Dying with Dignity legislation closes Friday, 15 March 2013. Let the Department of Premier and Cabinet know you support it. Let your local Members of Parliament know too.
You can find out more about the process and look at the background information here, including a link to where you can give your feedback, but act fast:
You can get more information on dying with dignity from these fantastic organisations:
And don’t forget there are some important events coming up:
National Palliative Care Week, 19-25 May
World Hospice Day, 15 October

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