As someone who has discussed euthanasia on talkback radio, I am concerned that a significant proportion of the community is confused about what euthanasia is. I worry that euthanasia may become legal in Australia through sheer ignorance.
I define EUTHANASIA as an act where a doctor intentionally ends the life of a person by the administration of drugs, at that person’s voluntary and competent request, for reasons of compassion. A doctor killing a patient, no more, no less. The terms active/passive, and voluntary/involuntary should be avoided when referring to euthanasia as they are ambiguous and confusing. There is no such thing as involuntary euthanasia. It is by definition voluntary. If someone is killed without their consent, even in a medical setting, it is not euthanasia, it is murder.
It is also important to differentiate euthanasia from what it is not. Euthanasia should not be confused with stopping unhelpful treatment or the use of medication to control distressing symptoms or turning off life support machines when all hope is lost.
1. WITHDRAWAL OF FUTILE OR BURDEN SOME TREATMENT
When a patient is in the terminal stages of their illness, a time may come when treatments aimed at cure either no longer work (they are futile) or the burden of side-effects such as nausea and vomiting may be so overwhelming that they cancel out any benefit of treatment. At this stage the treatment may be not prolonging life so much as prolonging the process of dying. At this time a decision may be made to stop, or decide not to start, such a treatment. It is not euthanasia because the intention is not to kill the patient, but to allow the underlying disease to take its course. Full supportive care will remain in place so the patient is kept comfortable.
2. SYMPTOM CONTROL
Sometimes in the terminal stages of disease the distressing nature of a patient’s symptoms may require the careful sedation of the patient. Once again this will be done carefully in consultation with the patient, and the sedation will be lightened periodically to allow the patient to communicate. It is not euthanasia because the intention is not to kill the patient, but to alleviate their distressing symptoms. Similarly treatment with morphine is often equated with euthanasia. Research has shown that morphine in doses used to manage pain does not shorten life. In fact, it may prolong it.
3. REMOVAL OF LIFE SUPPORT
If life support is removed from a patient because the hoped-for improvement has not occurred, it is not euthanasia, even if we expect the patient will die. The patient is not killed by switching the machine off. The underlying disease kills the patient. That’s why they were on life support in the first place.
These strategies are already legal and ethical treatment options and are appropriate medical practice at the end of life. They should be encouraged. People in our community are calling for a euthanasia law so that they can have more control at the end of life. But if you have requested them in an advanced directive, there is no reason why they won’t happen. We don’t need a change in the law for dying people to have control over what happens at the end of life.