Debate - Euthanasia, Yes or No

Debate - Euthanasia, Yes or No

On August 12, 2003 at the University of Sydney a debate, on the topic Euthanasia, Yes or No, was co-hosted by the medical society of Sydney University, the psychological society of Sydney University, the union, and the Catholic Chaplaincy.

Opponents Dr Philip Nitschke and Reverend Professor Anthony Fisher are both graduates of the University of Sydney. Professor Fisher won the toss and spoke first on Euthanasia No, followed by Dr Nitschke presenting his arguments for Euthanasia Yes. Each speaker then had five minutes for right of reply followed by questions and answers.

Professor Anthony Fisher
Australia's youngest Catholic Bishop, Professor Fisher gave his position statement for the debate as follows:

"The euthanasia debate has moved on. It used to be about a last resort for terminal patients for whom there was no other relief. Now the euthanasia crusaders want death on demand -- cancer patients who don't even have cancer, sick people who aren't terminally sick, people who aren't even sick, depressed people, lonely people, young people...

It used to be about compassion and dignity. Lately it’s been more about media stunts. It used to be about voluntary death for people who have made an autonomous choice. Now the euthanasia fanatics want to foist it on those too young to make a decision, the unconscious, the disabled...

Euthanasia endangers the lives of vulnerable, elderly, sick, disabled, low self-esteem people. They deserve our best care and the protection of our laws. Surely Australians can find better, more creative, more compassionate ways of dealing with suffering than lethal injections and gas bags."

Professor Fisher's argument
Perhaps the most common argument that we hear in our community for euthanasia is that its about freedom of choice, autonomy, voluntariness, empowerment. Now note that this argument is not restricted to the terminally ill, or even to people who are sick at all. It doesn’t matter as Dr Nitschke has said himself whether the cancer patient really has cancer or not, or if the sick person is sick or not.

The issue – euthanasia on demand, the right to die, when I want, how I want, if I want.

As the good doctor told Linda Motram on the ABC, euthanasia pills should be made available in the supermarket, and suicide recipes made available even to teenagers. All people, he told Catherine Lopez, should qualify: the depressed, the elderly, the bereaved, the troubled teenager. We should not erect any artificial barriers.

So lets be clear where the argument from autonomy takes us. The freedom for anyone who wants to die to die when they want, how they want, in the manner of their choosing... the real agenda includes not just voluntary euthanasia, but euthanasia of children and disabled people and unconscious people - non voluntary euthanasia.

Euthanasia of people who can’t be asked, who haven’t been asked. But even if we accept for a moment, which I don’t, that all the crusaders for euthanasia want is truly voluntary euthanasia, for competent adults, fully informed, who’ve been offered all the alternatives, who really understand what they are doing, and that’s a lot of ifs, the case I suggest to you has still not been made. 

What’s more, the fact is that very few euthanasia campaigners or practitioners will, in fact, offer euthanasia on demand to just any one who comes in off the street. They want to know who you are and why and what else you’ve thought of and tried.

Amongst other things then, they recognise that some people who think they have terminal illnesses, don’t; some people who think they want euthanasia, don’t; some people who say they want euthanasia, are really saying “won't somebody care about me please, just for a moment”. They might be depressed, or socially isolated.

So unless the enthusiast for euthanasia is so enthusiastic for that project that they’ll just give it to anyone, in the end it falls back on him or her to decide who and how and when. For all the talk of empowering others and offering freedom to others, in the end the euthanasist will decide.

What’s more, euthanasia, I’d suggest to you, actually reduces the autonomy of terminally ill, and handicapped and frail elderly people, because it sends out the message to our community that these people are expendable.

Once that becomes routine it puts tremendous pressures upon those patients, who come to think of themselves as burdens on their families, on their health carers, on their community; tremendous pressure on them to seek euthanasia. In the name of autonomy then people’s freedom is actually being narrowed, and their very lives, the premise of their freedom, put at risk.

The evidence from societies that have practised this and doctors that have practised this is clear: it is gradually extended to more and more people: from the competent to the incompetent, from the terminally ill to the not even ill at all, from the sick to the depressed, from competent adults to children and the rest. That’s not about autonomy.

Well, someone might say it wasn’t really about autonomy in the first place, it was about compassion for people who are sick or in pain. What we want to do is address their pain by killing it, and if needs be, killing them.

But surely if that’s what drove us, our first concern would be to do everything possible to deal with their pain, whether it’s physical or psychological, existential.

We’d be ensuring that all the terminally ill and handicapped and frail elderly have access to high quality health care and hospital and community care in the home, to the whole range of non-medical social and human supports as well. At the very least that they were being kept as free as possible of pain.

For all the compassion talk, it seems to me, very often, that what this is really about, is not putting granny out of her misery but putting her out of our misery. Its for our sake, the bystanders, who want the way out of caring for her because caring can be really hard.

And no one should pretend there’s quick fixes in some of these situations. It will take an enormous investment of ourselves, of our love and our care and all our energies to really give people the best of dying, the best of deaths.

When we offer them the best we can, investing all of ourselves in them I think it calls for some of what is most noble in the human spirit, and often we find there is much more we can do than first we guessed. Above all we give those people a sense that they are still loved and respected.

Dignity for the terminally ill is not about telling them that we think they’d be better off dead, and we’re willing to help that to happen. That we think that being old or incontinent or burdensome on others is, somehow so awful, that we want to help hurry up your death. Rather, it is to say that, even amidst all that, we still love and support and protect you till the end, that no one may kill an innocent person, even one who is at such a low ebb.

You can read the full transcript of Professor Fisher's argument here.
Read Dr. Nitschke's 5 minute right of reply here.

Dr Philip Nitschke
Dr Nitschke is Australasia's foremost euthanasia campaigner. His position statement reads:

"This last great social reform, access to a peaceful death at the time of one's choosing, is being frustrated by the medical profession and the church. The church wants to force us to accept their truth that our life is not ours to dispose of, the medical profession want to extend their tentacles into yet another area in which their role and authority is questionable.

Meanwhile the people clamor for knowledge and the empowerment and control it brings, no longer content to sit back passively accepting other people's assessment of what's in the best interest of individuals or the collective good of modern society."

Dr Nitschke's argument
"As my opponent has said in his summary statement, the euthanasia debate has moved on, indeed it has moved on and we'll be looking in my presentation today exactly why it's moved on and where it's going. I think our opponents need to take some responsibility for those changes.

"Now what goes on right now, this euthanasia that goes on all the time, why is there a need for any change at all? And this is a very reasonable question, because you can, as they say, get help from a doctor, if the circumstances are right, you can, for example, get access to very good palliative care, you may find that there's no suffering at the end of life if one accesses that very good palliative care, you can go out and suicide, suicide is legal, why is there any need?

You can find a doctor who's prepared to make use of the so called 'Doctrine of Double Effect', the doctor who will give you a little bit more morphine, a little bit more morphine, so that eventually you will die, the doctor's quite safe, because they have been able to argue that all that they're doing is providing pain relief and that's legal and lawful and to be encouraged, and our opponents will say you have no need to accept vexatious and intrusive treatment that you don't want, you can refuse all medical care, that's a right which is enshrined, so why is there a need to change? Well, the reason we need to change is because it's just not working.

People are coming along looking for options because they're worried that they might get caught up in some difficult final end of life scenario. And so telling someone that you can refuse medical treatment is of only limited comfort.

People ask, what about palliative care?. Look, palliative care can make sure there is no suffering at the end of life. Well, why do people come along worrying about this issue if it is such a success? And that, of course, is because it is not such a success. It's very good as a modern medical strategy for addressing certain physical symptoms. Now, if we define suffering as being associated with physical symptoms, you can perhaps expect good relief from modern palliative care. But of course suffering is far broader than that.

If pain is your problem, maybe - and mostly - you can get good help from palliative care. But of course, it's not always the issue. The problem that people come to me with saying is: 'I don't want to feel trapped. I don't want to be in a situation where someone else is having to clean up after me'. Palliative care can often have very little to say in that regard.

People are always telling us: 'Be careful here, this is individual freedom taken too far. Freedoms come with responsibilities. You must not have that degree of freedom'. This doesn't cut much ice with the people who come along seeking this degree of knowledge that they've got that degree of control.

And so how do we deal with these issues? One of the ways it has been attempted, and I know quite a bit about this because I took part in the introduction of the world's first legislation on this issue, is to introduce a law. And of course that's had some success.

It's the idea of introducing a legislation that would allow those who fit certain criteria to legally killed by a doctor. It's a very significant change in legislation. It cuts across previously understood concepts of the way medical care is delivered, but it does provide a degree of comfort. It was a very popular initiative politically in the northern territory.

Now before I get too enthusiastic about laws, there are problems. Some of them have been quite well described by my opponent. And I agree with many of those difficulties about the question of legislation, but look I was one of the few people in the world, in fact the only person for a year, who had ever been able to experience and compare the difference between a world where there was a legal strategy to allow help to these people and a world where there was not. And to my mind, there was no doubt, it was so much better when we had a law in place, with all the problems of that law.

One recent prime minister said to me: He said, 'look, don't expect me to stand up on this issue, Philip. The last thing I want is to be railed at from the pulpit at preselection time'. And so politicians have been frightened into this idea of backing away from this issue and the church can feel proud it's been able to subvert and wreck decent legislation.

We are looking at ways where the individual can say 'I don't care about whether you introduce a law, I don't want to go and satisfy all these safeguards. I want to know that when my time comes, I can exercise that control. I want to know that beside the bed is a bottle of Nembutal which I will be able to use if and when my time comes'.

"And that's where I find myself increasingly working and that's where the activities of Exit are becoming increasingly focussed. People are saying, 'develop something please. Don't waste our time trying to lobby recalcitrant political process to pass legislation which they are showing such reluctance to develop'. And so that's what's happening.

You've heard about the idea of plastic bags, more sophisticated things like carbon monoxide generators. More money is coming in. More effort is being put into strategies which will ultimately produce a world where anybody can peacefully end their life at any time.

When those people come along and ask, what options are available and we tell them, we are effectively describing a world in which this is going to be the norm. More work is going on. We've effectively got a technical solution to an issue which is a technical problem. We're not going to get a legislative solution. We've effectively abandoned it. We've moved towards what will be a technical solution.

The stable door will be wide open, the horse will be 100km down the road. No good coming along then and saying to your politicians, 'why didn't you introduce decent legislation?' And I get a little bit galled by those who sit around. They've done everything they could to wreck responsible legislation such as we saw in the Northern Territory, and they say, 'oh my goodness, what's happening now? They're working on things like carbon monoxide generators'. Of course they are. And that's what's going to happen. And you will then find a world where any of you can die at any time when these strategies are developed.

We're not, after all, looking for a cure for cancer here. This is not a hard technical problem. And my opponents will have to take responsibility for that. If they wanted to control this process, they should have engaged in the political process and not wrecked it. They should have engaged in the idea of establishing controls and safeguards, and not ruined it.

What they'll have is a world that they may well feel great disquiet about, certainly one that I feel apprehensive about, but nevertheless one which is just on the horizon, and I ask you today to consider; is this where we want to go? Or, should we rapidly rethink the position we're at?"

You can read the full transcript of Dr Nitschke's arguments here.
Read Prof Fisher's 5 minute right of reply here.

Audience response
A psychology student, Nicola Lam, admitted that she had been pro-euthanasia before the debate "probably because I wasn't informed enough about both sides of the debate and what each side was proposing." She felt that Dr Nitschke's attack on the Church was a means of avoiding the main issues and an attempt to distract the audience.

"I basically left with the impression that under his proposed legislation, if someone went home after a really bad day at work and felt like ending their life, then they should have the right and the means to- as if everyone should have a life-ending tool in their bedside cupboard. How ridiculous and insulting."

Dave Bradshaw, Medical Education Officer, felt that the debate "provided an opportunity to hear the points and language of both sides, and as such provided an opportunity to better understand this complex issue."

Another student, Daniel Hill, commented:

"A telling point was when he argued that we should at least give 'his' new laws a go, and if they don't work to change them back again. This seemed all to close to using peoples' lives as guinea pigs for a social experiment.

"It was also very noticeable that Fisher did not mention the Church or morality once; he argued solely from a reasonable and ethical premise. His opponent, on the other hand, was complaining about the Church well within the first minute of his presentation, which was something I found slightly irrelevant, since the debate was about the ethics of euthanasia, not on who's fault it was that legislation was not passed."