Commentary by Professor Kissane AC

Professor David Kissane AC

Professor of Psychiatry, Monash University and Professor of Palliative Care Research, The University of Notre Dame Australia

Professor Kissane brings to bear on the My Life, My Choice report from the majority of the Western Australian Joint Select Committee on End of Life Choices and its recommendations the knowledge and insight gained from his 40 years’ experience as an academic and practitioner in both palliative care and psychiatry.

Professor Kissane published (with Dr Philip Nitschke) a Lancet report (1998) on the patients accessing euthanasia in the Northern Territory. This is directly relevant as a detailed case study of how a euthanasia law, with many alleged safeguards, actually functioned in practice in the Australian context.

Commentary is offered on each chapter of the  My Life, My Choice report, highlighting key challenges that arise from each perspective that is presented. Key findings are offered that arise from this commentary on each chapter.

The key finding on the report’s proposal for a framework for so-called “Voluntary Assisted Dying” is that:

Depression and demoralization in the medically ill are common reasons that bring about a desire to die. Depression and demoralization often pass underdiagnosed and undertreated in oncology and palliative care. Depression and demoralization have a significant impact on decision-making capacity, and if unrecognised, the vulnerable are put at grave risk by VAD legislation. Treatment of depression restores interest in life-sustaining treatments or living until natural death intervenes.

An additional factor is that doctors do make errors in diagnosis and treatment. Furthermore, prognosis is not an exact science. Protection of the vulnerable, the frail elderly, the disabled and the mentally ill is a crucial responsibility of society and its legislators.

Legislators ultimately must make a choice between autonomy sought by a few vocal advocates and the safety of the wider community, whose lives may be put at risk through the difficult regulation of state sanctioned death.

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