Physician Assisted Death: Has David Goodall inadvertently undermined the campaign?

In this age of individual rights and ever growing personal freedoms, the recent death of Professor David Goodall brings to the fore new questions surrounding whether or not those liberties should be extended to include the right to die. What has made this case so newsworthy, is that Professor Goodall, though extremely old (104), was generally in good health. Dr. Philip Nitschke, founder of Exit International accompanied Professor Goodall on his final journey. He believes that denying the right to die to a person in David Goodall’s position constitutes “elder abuse”.

Our population is aging. In a report by the Australian Institute of Health and Welfare (AIHW), Older Australia at a Glance , they found that in 2016, 3.7 million people (15% of the population) were aged 65 or over. This figure is expected to rise by 2046 to 8.3 million with 19% of these older Australians being 85 or over. We are also experiencing a rapid increase in the demand for palliative care services. In a recent press release AIHW stated:

Although it’s difficult to be definitive about the reasons for this rise, Australia’s growing and ageing population—paired with a rise in chronic and incurable illnesses—has broadened the type of patients requiring palliative care.

From 2011 to 2015 the numbers of people admitted into palliative care rose from 57,600 to 74,000. This is a rise of 28% in just 4 years. Given all this statistical evidence, it is reasonable to conclude that going forward there will also be a rise in the numbers of people living with terminal disease and terrible pain. According to an ABC Vote Compass survey in 2016, 75% of the Australian population are in favour of physician-assisted dying.  These population trends will surely see an increase in pressure for change.

However, physician assisted dying is a knotty topic. On all sides of the argument we have strongly held convictions; medical, religious and of course those focused on the civil rights of the individual. In the case of opposition on religious or medical principles, those opinions are grounded in historically weighty notions of moral rightness.

From a Christian standpoint all life is God-given and it is up to God to decide how and when a person should die. Medical opposition to the idea of assisted dying stems from the Hippocratic Oath, which specifies that no lethal drug will be given. However it also states that an abortion will not be induced or a surgery with a knife performed. Peter Tyson suggests that the Oath has undergone some modernisation with different medical schools modifying different parts of it in line with the cultural mores of the society around them.  He voices the concerns of some physicians that the classical oath “makes no mention of such contemporary issues as the ethics of experimentation, team care, or a doctor’s societal or legal responsibilities.”

The prevailing consensus seems to be that doctors should do no harm. However, Haider Warraich argues that medical intervention in cases where it prolongs the life of a patient with a debilitating and incurable condition, can be classified as doing harm. In his book Modern Death – How Medicine Changed the end of Life, he contends that the massive advances in medical treatments now available for conditions that previously would have been quickly fatal, mean that death can be postponed for months and sometimes years.

I have canvassed my friends on this subject and broadly, they are in favour of physician assisted dying, in cases of terminal illness exacerbated by severe pain. As a group we are representative of the 50+ age bracket and this may influence our collective thinking but my children, who are in their 20’s and early 30’s now, share my view regarding the hypothetical case of a person dying from an agonising and incurable disease who has simply had enough. Assisted dying in this case seems the humane and compassionate solution, because for us, as for many other families, it is not a hypothetical case.

My mother who had been living with breast cancer and Parkinson’s disease decided that she had had enough. It was 2012 and my father had been dead for four years. She was struggling to maintain her independence. The final straw came one evening, when her legs refused to work as she tried to get up from the dining table. She sat there all night. 

Mum lived in England along with my sisters and brother, it was late August. My siblings were all away for the bank holiday weekend with their families and of course I was here in Perth, 12,000 miles away.  She chose that weekend precisely because none of us were easily contactable. I always rang at 9 a.m. on a Sunday morning, by which time she planned to be gone.

The way in which she tried to end her life is deeply upsetting, suffice to say that her best efforts failed. She was found on the Sunday morning and when I rang as usual, ambulance staff were there and put her on the line. “I’m afraid I’ve done something rather silly, Dear,” she said. I still shy away from trying to imagine what she went through that night, collapsed on a cold stone floor, unable to move but not dying either.

The following six months were harrowing. I flew to England twice in that time. They removed all her pills and she was hospitalised. She never got to go home again and spent that last period of her life either in hospital or in a nursing home, requiring someone to wash, toilet and feed her. She had no sense of agency and was stripped of her dignity. It was heartbreaking to visit day on day and watch her lying there incapacitated, simply enduring.

I have come to view her attempted suicide as heroic. It would have been far better if she had had the option to openly choose an assisted death, knowing that the procedure itself would be peaceful and pain-free.  As a family we could have gathered, she would not have been forced to try and manage things on her own.

The inspiring and emotionally charged account of the death of John Shields in British Colombia, diagnosed with a rare and incurable illness, amyloidosis, offers a viewpoint and an approach to the idea of assisted death against which the unconvinced might measure their attitude to this divisive and problematic issue.

In June of 2016 the Canadian government legalised “medical assistance in dying” Mr. Shields was informed that he qualified by his doctor, Stefanie Green. His condition was worsening rapidly.  His ability to coherently indicate his wishes was also deteriorating. Canadian law requires that the patient be of sound mind, so the decision needed to be taken while he was still able to express himself clearly.

Having made that decision, Mr. Shields set about planning his own wake, with his family and friends around him. Together they created a highly personalised ceremony filled with love and gentle humour that offered everyone a chance to celebrate a life well lived and to say goodbye. Everyone got closure but most importantly, Mr. Shields was able to take back control of his life from the disease that was slowly killing him.

No one reading the article would doubt that Mr. Shields had not long to live or that his medically assisted death saved him from unnecessary pain and suffering. It also released his family and friends from the pain of helplessly watching his inexorable decline.

I wish my mum had had that choice.

I believe that rather than assisting with the argument for voluntary assisted dying, David Goodall, though well intentioned, has complicated the debate with his highly publicised exit. He has added an extra layer of controversy to a question that is already profoundly complex.

This will quite possibly lead to a slowing of progress toward any sort of change in the law. There are so many implications. If old age is to be considered a factor, at what age is one old enough? How about a person with extreme depression that is not responding to treatment? Or a single parent who just can’t cope?

If legislators are asked to consider not only cases of terminal illness and extreme suffering, but also the civil rights aspect for individuals, as Dr. Nitschke feels they should, it is quite possible that nothing at all will happen. I feel Dr. Nitschke’s rather radical aims may be undermining the efforts of more moderate organisations like Dying with Dignity and Go Gentle Australia .Their philosophy’s are geared toward perceiving death as a fact that comes at the end of life and working towards solutions for enhancing end of life choices in cases of “chronic and irreversible illnesses”.

 I hope I am proved wrong and that compassion wins the day. The same compassion we have for our pets.  Assisted dying has been available in Switzerland since 1942. The Dutch introduced their law in 1984 and since then these two pioneering countries have been joined by Belgium, Canada and many states in America. Until last year, Australia makes one brief appearance on the Chronology of Assisted Dying , with the Northern Territory’s brief success in 1996 in passing a Voluntary Euthanasia law. It lasted all of nine months when the Federal Parliament stepped in and quashed it. Finally the state of Victoria has passed legislation that will come into effect for terminally ill Victorians in 2019.

When talking about death, the fear that most people articulate, is not of death itself, but rather the manner of their dying. If this choice was available to the terminally ill, it would relieve that anxiety. Within Western culture, this conversation is generally taboo but actually we need to remember that as John Irving put it, “we are all terminal cases”.  If it happened to you, what would you want?

Whilst I can understand Professor Goodall’s desire to end his life and can empathise with that desire, it would be tragic if his case diverted the attention of law makers from the plight of many who, unlike him, are dying drawn-out and excruciating deaths from terminal diseases.

For people like my mother, that would be a tragedy.

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