In a landmark study of decision making capacity of persons with terminal cancer and a prognosis of less than six months to live – that is a cohort that would be eligible for assisted suicide under the schemes in Oregon and other US States as well as in Victoria, Australia – 90% were found to be impaired in regard to at least one of the four elements of decision making – Choice (15% impaired), Understanding (44%), Appreciation (49%) and Reasoning (85%).
Under Victoria’s Voluntary Assisted Dying Act 2017, for example, “a person is presumed to have decision-making capacity unless there is evidence to the contrary” (Section 4(2)).
This study suggests that, at least in the case of persons with cancer and a prognosis of less than six months to live, it would be more prudent to start from the presumption that they are likely to have impaired decision making capacity unless it is demonstrated to the contrary.
It has been widely reported that a 17 year old girl was euthanased on Sunday 2 June 2019 at her home in Arnhem, the Netherlands, on the grounds of her suffering as a victim of rape. However, later reports indicate she died from starvation/dehydration after refusing to eat with the intention of ending her life.
Noa Pothoven had been the victim of rape on three separate occasions between the ages of 11 and 14 years.
On 15 May 2019 three judges on the Court of Appeal of Ontario dismissed an appeal by four individual doctors and three medical associations, including Canadian Physicians for Life, against a lower court ruling upholding the constitutionality of a policy issued by the College of Physicians and Surgeons of Ontario requiring doctors who have a conscientious objection to certain procedures - including euthanasia - to provide any patient requesting such a procedure with an "effective referral" to "a non-objecting, available, and accessible physician, other health-care professional, or agency".
The Court [at 184] cited favourably "evidence" that doctors who conscientiously objected not just to killing their patients but to "effectively referring" them to another doctor who would do so could easily "change the scope of their practice" to a specialty or sub-specialty where they "are unlikely to encounter requests for referrals for" euthanasia such as "hair restoration" or "obesity medicine".
Speaking at the Voluntary Assisted Dying Implementation Conference held in Melbourne from 9-10 May 2018, Dr James Downar, a leading Canadian proponent of legalising euthanasia and the first doctor to carry out euthanasia in Ontario, made it crystal clear that euthanasia was primarily carried out for what he called "existential suffering" and not because palliative care could not adequately treat pain and other physical symptoms.
Dr Downar, who on his own admission has intentionally ended the lives of over 40 people by administering a lethal injection, describes the typical case of euthanasia as involving a "captain of industry, self-willed, a giver not a taker" - or at least, he adds, seeing himself that way - who simply wants to exercise control over the timing and manner of his exit rather than to die in an (ordinary) haphazard manner.
He also stressed that the eligibility criteria for access to euthanasia were all subjective and that "there are no absolute gold standards for identifying coercion."
Twenty two leading Western Australian palliative care specialists who between them "have been privileged to care for tens of thousands of patients and their families" have co-signed an open letter explaining their strong, united opposition to the proposal to legalise euthanasia or assisted suicide in Western Australia.
The proposal to legalise euthanasia and assisted suicide involves a massive change in the ethics of our society. “Do not kill” is a foundational ethical principle which has been observed by every civilisation for thousands of years. Euthanasia and assisted suicide are not medical treatments, and most emphatically not part of palliative care.
Unlike euthanasia, palliative care aims to provide total care (body, mind and spirit) for patients and support for their families.
With modern medications and procedures we can almost always control symptoms. In extreme cases, at the request of a dying patient and his or her family, we have occasionally used deep sedation to control symptoms that did not respond to the usual treatment.
The specialists explain how requests for euthanasia are driven by existential concerns such as loneliness and how holistic palliative care can respond to these concerns.
Rarely, a patient will say to us, “doctor, I just want to end it all”. Contrary to popular opinion, the reason for such requests is not pain, but despair and loneliness, also called “existential suffering”. Euthanasia is not a treatment for despair and existential suffering. Provision of holistic care by a skilled interdisciplinary team of health professionals enables patients and families to acknowledge and attend to distress within themselves and their relationships. The time before death offers unique opportunities for psychospiritual growth and allows for healing even without a cure.
The palliative care experts also point out that:
Western Australia has the lowest proportion of specialist palliative care doctors of any state in Australia. We have 15 full-time equivalents for the state, less than one third the number required to meet national benchmarks. According to the Honourable Jim Chown, whose motion was supported unanimously, WA needs at least another $100 million per year spent on palliative care for staffing and education, in addition to funding for infrastructure such as palliative care wards and beds.
The open letter concludes:
We do not believe euthanasia or assisted suicide are solutions to suffering. We reaffirm our commitment to our patients: we will continue to care for you to the best of our ability, guided by your choices, but we will not kill you.
Read the whole letter here
A significant majority of New Zealanders shift from initial support of euthanasia to opposition once questions are asked about the how such a law might actually work in practice.
An opinion poll conducted in April-May 2019 by Curia Market Research found that although initially 57% of respondents said YES and 29% NO to the question "Should a doctor should be allowed to give deadly drugs to deliberately kill a patient?" these results flipped when respondents were asked "Would you like New Zealand to have a law that would allow a terminally ill person to receive a lethal injection because they feel depressed or that life is meaningless?" - 56% said NO and only 35% said YES.
Similarly when asked "Would you like New Zealand to have a law that would allow a terminally ill person to receive a lethal injection because they feel they are a burden?" 63% said No and only 25% said YES.
Finally when asked "Do you think doctors should be allowed to give deadly drugs to deliberately kill their patients, even if they are NOT in pain?" only 27% said NO and 59% said YES.
In other words majority support for euthanasia can only be elicited when respondents are led to believe that euthanasia is necessary for terminally ill patients with unrelievable pain.
All the evidence shows that this is not a principle reason why people request euthanasia or assisted suicide and that euthansia and assisted suicide are not needed for pain relief.
See the full opinion poll results here .