Euthanasia is not the answer to bad deaths

The answer to bad deaths is not euthanasia. The answer is a better understanding of basic medical ethics, of palliative medicine, of what happens to the body when it is dying, and how to care for someone at the end of life.

Dr Amanda Landers, community palliative care physician and senior clinical lecturer at the University of Otago, Christchurch

In an opinion piece published in Stuff, Dr Amanda Landers, a community palliative care physician, addresses some of the myths and fears surrounding bad deaths.

One of these misconceptions is that euthanasia and withdrawing medical intervention is one and the same.

I was asked to see a lady in her 80s with heart failure who lived in a rest home. She was asking her doctor to stop all her heart medication. The woman had discussed it with her daughter who was present and I could see she understood the decision may shorten her life, allowing nature to take its course. I agreed to her request and she thanked me profusely.

Withdrawing treatment is legally, ethically and morally her choice. But ultimately she will die of heart failure, not a lethal injection. This is the difference between a natural death and euthanasia.

In relation to pain it is sometimes a relative or carer who sees this as unbearable and a major issue rather than the person themselves.

I also constantly read about people dying in pain. Usually these are reported by the relatives for obvious reasons.

I am often asked to see a patient in the community because of their pain. I recently saw a woman with rectal cancer who experienced pain on sitting. Her partner told me that she was experiencing discomfort and a poor quality of life. When I spoke with the patient I asked her a general open-ended question about how she was doing. She made comments about fatigue, shortness of breath on walking, decreasing appetite and concerns over finances.

After half an hour I had to ask her about pain, since she hadn’t mentioned it, and I was able to make multiple suggestions to help. If I had only spoken with her partner I would have had a very different impression of her condition and would have missed the other issues that were more concerning to her.

Dr Landers also addressed the issue of dying from motor neurone disease, which is of particular relevance in Victoria where persons with a neurodegenerative condition can be euthanased or assisted to suicide if a specialist determines that the person is expected to die within 12 months.

In the mandatory training which doctors in Victoria have to undergo before being licensed to kill by euthanasia or prescribe poison for suicide the video on the initial conversation features a woman called Martha who has motor neurone disease and is concerned about choking to death:

Martha: Well, it's basically all over for me, so isn't there some way that we can speed this up? I couldn't handle a slow decline and maybe choking to death.

Nowhere in the rest of the conversation does the doctor seek to allay her fear of choking to death. 

However the doctor does offer her help in accessing assisted suicide.

Doctor: Yes, Martha, the law has changed. If you want to access voluntary assisted dying, you need to meet certain criteria. So, you have to have a terminal illness, like you do have, but you have to make a formal verbal request to your treating doctor. So, I know you're seeing Gary after you've seen me, so if you want to ask him that question, you can. There's quite a process that you need to go through to decide if you're eligible. But I can give you some information on that if you'd like.

By contrast Dr Landers explains:

Severe neurodegenerative disorders such as motor neuron disease have also been discussed in the media. There is a strong perception that these people have bad deaths. Evidence shows they do not choke or gasp at the end of life. In fact, I have never seen anyone choke to death. People do become sleepier because they have decreasing oxygen levels, but they are not aware of this. If they are aware that they are lacking oxygen we are legally and ethically allowed to use muscle relaxants in response to symptoms. In these cases a palliative care specialist is often needed to help support the local medical team.

View a video here where Dr Landers explains more about palliative care and how it can help people have a good death.