Humanist Society of NSW Inc.

Euthanasia
(Compassionate Death)

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Prepared by a Sub-committee of the N.S.W. Humanist Society
and adopted, February 1973

INTRODUCTION

This report is based on the concept held by most humanists, that every individual has the right to choose the time of his or her own death.

Although the general tenor of the report is in the direction of a permissive attitude towards euthanasia and suicide, with the suggestion that one or the other might be the best solution to certain insoluble problems, it must not be assumed that we would oppose all attempts at dissuasion from suicide. At no time do we seek to discredit the concept of the value of human life; but we maintain that life must be considered to be worth living, by the person who has to live it. We recommend that the best counselling advice should be available and brought to the notice of intending suicides, but not that they should be stopped at all costs.

The word euthanasia means something like 'pleasant death', but the meaning has come to include the idea of a planned death which may be administered by another person.

While many would wish to extend to humans the comfort of release from final suffering which we are prepared to afford to animals, they are aware that under present legislation this would be branded as murder, even though it be requested by the sufferer. Politicians are reluctant to introduce legislation because they know that public opinion is still to a great extent opposed to such a change, either for religious reasons, or for fear of abuse.

Britain appears to lead the world in consideration of this topic, and on three occasions bills to legalise euthanasia have been introduced into the British Parliament, but all were defeated. The history of these events, and the arguments for and against release from human suffering by death, have been well covered in publications of the Voluntary Euthanasia Society, 13 Prince of Wales Terrace, London, W85PG. They are pleased to supply information, and it is not proposed to cover the same ground here. Their arguments for voluntary euthanasia are based on the avoidance of suffering. Those against are concerned mainly with medical ethics and religious prohibitions.

The Voluntary Euthanasia Society did not cover the full field of related topics on which humanists might hold opinions. Our report aims to cover these additional topics, and we have arranged our material under the following headings:

SUICIDE

(See also the Appendix for statistics on suicide in Australia)

We regret the stigma that still appears to be associated with suicide, and we reject the reasoning that all who commit suicide must be of unsound mind at the time. The quality of life for these people may have deteriorated beyond endurance, and we respect their right to decide.

Successful suicide carries no legal disabilities, as, for instance, in determination of the estate. However, life insurance policies may be void if suicide occurs within a stated time after taking out the policy.

Attempted suicide is a common law felony, punishable at the judge's discretion, but no case has ever been brought to court in N.S.W.

The humanist view is that attempted suicide should not be regarded as an offence, but it would not be illegal to resuscitate a person in the process of attempting suicide, unless that person had given clear instruction not to attempt resuscitation. We consider a child should always be resuscitated, unless suffering from a terminal or incurable illness, or gross physical handicap.

ASSISTED SUICIDE

Intending suicides should be able to seek and obtain assistance for the act of suicide, but safeguards against abuse are necessary. Assistance is needed if the individual is incapable of carrying out suicide, or if he wishes the procedure to be made easier, more dignified or less distressing.

The following safeguards and limitations should come into operation before assistance for suicide is made available.

  1. The person must be at or above the age of 18, unless suffering from a terminal or incurable illness, or gross physical handicap.
  2. Applications should be accepted only fro persons of sound mind, or from those of unsound mind providing they are clearly able to understand the nature of suicide and assisted suicide.
  3. There should be a time delay of perhaps a month from application, during which time it might be compulsory for the person to seek suitable counselling advice. There would be no compulsion, however, to accept any advice given.
  4. No time delay would be necessary in the case of a person suffering from an incurable and fatal physical illness.
  5. Persons currently involved in a civil law suit or a criminal case should be excluded.
  6. In all cases a referee would issue permission for assisting suicide on evidence of compliance with the above conditions, provided he was satisfied that no undue pressure had been brought to bear. The referee would not be able to vote assistance for any other reason, and no other person would have a right of veto. The referee might be a legal person or a criminologist. He would require appropriate medical evidence in case 1, 2 and 4 above.

The difference between assisted suicide and voluntary euthanasia shown by the following example. A lethal injection is prepared. If such an injection were given by a doctor or a nurse, at the patient's request, this would be voluntary euthanasia. If, however, a doctor or nurse set up the injection, but the individual pushed the plunger home this would be a form of assisted suicide. Merely supplying a lethal pill would be a simpler form of assisted suicide, and might not involve a doctor or nurse at all.

We reject the suggestions that sufficient safeguards would be provided by a simple law such as one saying that aiding and abetting suicide would not be illegal unless it was shown to have been done with malice or for selfish motives.

VOLUNTARY EUTHANASIA

The V.E. Society has provided a sound but limited suggestion as the basis for a proposed law on V.E. covering only cases of illness that are likely to prove fatal in the not distant future and to cause suffering which cannot be relieved.

The following is taken from the booklet of the Voluntary Euthanasia Society of London (1962, p. 16):

The usual procedure would be as follows:

(1)The patient's application

When it became clear to a doctor that his patient, being over 21 years of age and "of sound mind", was in a hopeless condition and earnestly desirous that his life should be brought to an end in a painless manner, he would provide the patient with the necessary euthanasia application form for signature. The wording of this would be simple and clear, e.g. "It is my wish that my life may be ended in a painless manner as soon as possible."

(2)The doctor's recommendation

The doctor would prepare a brief written report on the patient's condition and the probable future course of his illness, and on his patient's expressed wish to be spared further suffering by death. On the basis of this report he would recommend the granting of the patient's petition for merciful release, and would forward that recommendation without any delay to the local euthanasia referee, asking that he will meet him in consultation.

(3)The referee's authorisation

The referee would at once visit the doctor and the patient and make himself personally aware of all the circumstances of the case. Having satisfied himself that the patient's application and the doctors recommendation were in order, and himself believing that this was a case deserving of euthanasia, the referee would sign an authorization for the euthanasia.

(4)The administration of Euthanasia

The referee after signing an authorization of euthanasia - would be nominally responsible for the administering of the euthanasia or its cancellation; but the painless termination of life would usually be brought about either by the patient's doctor, or by the patient himself acting under the doctor's guidance. At the request of the patient, or of his doctor, or on account of any alteration in his own view of the case, the referee, after informing the patient's doctor, would cancel his authorization. Also, after a time limit - stated on the authorization was passed, an authorization would automatically become void.

In view of the statement already made, that any individual should have the right to choose the time of his dying, we consider the British plan extremely restricted. In fact it covers only those suffering from terminal illness. It is therefore our opinion that in the case of V.E. as in the case of assisted suicide, the function of the referee should be limited to prevention of foul play or undue influence. He would have no power to veto for any other reason. Consider for instance, the case of a person who went through the procedure outlined by the V.E. Society, and as then refused euthanasia on the ground that he was not yet close enough to death; this person might well feel incensed and consider that the decision should have been his own. Provision for V.E. becomes, then, the same as the provision for assisted suicide, and the two might well be linked in one parliamentary Act.

There should of course be no compulsion on any individual to assist suicide or provide euthanasia if they do not wish to do so. There are some who say that anybody can commit suicide, so why euthanasia or assisted suicide? They fail to realise that there are many instances where suicide is impossible. These may include being physically incapable, having no access to the means, or simply being ignorant of an effective method which would be reasonably painless. For these reasons suicide is not always a solution and the need for voluntary euthanasia does exist.

Finally, since V.E. is not yet legal anywhere in the world, patients and the public in general, should be reminded of their legal rights to refuse operation, to refuse injection, indeed to refuse any kind of treatment. Further it is quite legitimate for patients to refuse certain forms of treatment aimed at prolonging life, yet remain under medical care for relief of symptoms. Such an approach is not inconsistent with maintaining a friendly relationship with one's doctor. Patients tend too readily to "do what the doctor says" without asking questions or insisting that their own rights be respected. For example, consider a common situation: cancer may cause obstruction of the bowel which is fatal within a few days if unrelieved. An operation may relieve the obstruction and the patient then lives on with a temporary or permanent colostomy. If the cancer is incurable the operation prolongs the patient's life for perhaps 6 or 12 month, which will inevitably involve physical discomfort and mental distress, The patient could ask for all the details, and consider refusing the operation if a quick death is preferred. Morphia will give considerable relief for the final few days.

CONVERTIBLE EUTHANASIA

Because of moral and other difficulties associated with non euthanasia (N.V.E.), the idea of converting some forms of N.V.E. to V.E. is very desirable.

Under an appropriately worded law a senile degenerate who would not be capable at law of giving consent at the time could have signed consent it a prior stage while still in full possession of his faculties in case he degenerated at some future time. Such consent could become common place and kept with one's Will.

This type of consent in advance was one of the principles involved in the latest Bill introduced in Britain in 1969, and defeated by a vote of the order of 60 to 40, in the House of Lords. A lot of the provision of this Bill were satisfactory, but a delay of 30 days before such a declaration comes into force seems quite unnecessary, as this Bill was concerned only with irremediable cases. The delay of 30 days was probably intended to distinguish convertible E. from V.E., however the delay seems superfluous as the two are complementary, and should both be covered in any egislation.

NON-VOLUNTARY EUTHANASIA (N.V.E.)

Non voluntary euthanasia could cover:

It does seem undesirable to keep these unfortunates alive. Their continued existence burdens relatives, friends and the community, and often, though not always, themselves.

By the nature of their disability they are unable to consent to E., and this poses severe moral and legal problems. Two possible avenues of escape from these problems have been mentioned. One is the giving of consent in advance, as described under Convertible Euthanasia; the other is mentioned in Item 2 on page 2, where we suggest that there is a case for restoring to the mentally ill, the right of consent to E. under certain conditions. Careful legislation would be required to cover this category, because at present no person legally under protective jurisdiction is regarded as capable of giving consent to anything. However doctors, and others, are aware of many cases of patients suffering from major mental illnesses such as schizophrenia, paranoia, or prolonged depression, who have sought and obtained the best medical advice over the years, with little benefit. They have eventually committed suicide, and one feels that it is the sanest thing they ever did, and they should have been assisted to do so, if this was their wish.

The only one of the categories of non voluntary euthanasia listed above on which the Society wishes to make recommendations is the case of the newborn baby with gross defects.

THE NEWBORN BABY

If a baby is born with severe mental or physical disabilities, such as are sure to make it a misery to itself or to those who have to look after it, its life should be terminable by legal process before any person becomes emotionally attached to it.

Doctors may sometimes take no steps to sustain such a baby, or may even hasten its end.

Whereas there appears to be a good deal of sympathy for such action or inaction, the position is not really morally tenable because the right of parents to take this decision plainly overrides that of a doctor, and the right of society to grant any rights at all in this area could be taken to override those of the parents, as they do in any case regarded as murder.

Sympathy for a doctor in this position derives from a situation of expediency, because he is present, alert, knowledgeable and in a position to take swift action.

The difficulty is that this expedient is not morally justifiable. It is the hypocrisy and moral cowardice of society which forces such a decision on a doctor. By failing to face up to the problem, and by failing to arrive at a standpoint on the issue, society washes its hands of the affair and expects the doctor to act as final arbiter, without any social or backing.

The problem could be met by passing a law granting to parents a right to assign certain discretion to a doctor. Such granting of discretion would have to take place during the pregnancy, and would take a legal form.

In the absence of such discretion legally granted before the birth, the consent of both parents would be required at the birth, unless the father was unknown or could not be located in a reasonably short time - in which case the mother's permission would be adequate, and her wishes should be respected and regarded as final.

APPENDIX

SOME SUICIDE STATISTICS - COMMONWEALTH OF AUSTRALIA

In 1968 the listed number of deaths throughout the Commonwealth for "suicide and self-inflicted injuries" was:
Males 1022 (1.7% of total deaths); Females 505 (117, of total deaths).
In all age groups, male rates (given per million of population at risk) exceeded female rates. This excess of males over females was most marked at both ends of life.
e.g. Age 5-14 M/F figure 6:0. Age 75+ M/F figure 398:87.
Popularity (or success) of suicide methods ran as follows:

Poisoning by solid or liquid substances 626
Firearms and explosives 353
Hanging, strangulation, suffocation 153
"Other gases" 117
Gases in domestic use 112
Drowning 80
"Other and unspecified means" 38
Jumping from high places 24
Cutting and piercing instruments 23

Some 1970 statistics show that suicide ran high among the categories of causes of death in the following age groups:

15-24 Third - behind motor vehicle accidents and all other accidents;

25-34 Third - behind motor vehicle accidents and all other accidents;

35- 44 Fifth - with heart disease and cancer leading;

45-54 Fifth - with heart disease and cancer leading;

55+ Not in the first six places.

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