banner.jpg

The hidden implications of assisted suicide and euthanasia

Professor Peter Hudson - The Age
October 2017

A feature of the current debate on assisted dying, particularly among its proponents, has been the personal stories of distress involving the death of loved ones.

Premier Daniel Andrews and Labor MP Jill Hennessy – among others – have shared powerful and moving accounts of the deaths of family members that deserve our attention and compassion.

It is not surprising that euthanasia's supporters conceive it as a means of eliminating that distress, not just for the dying person but also their families. The responsibilities of being a family carer to a person with a terminal illness can be extraordinarily demanding. Rates of psychological distress among family carers have been reported as high as 40 per cent. Indeed, family carers are often referred to as "hidden patients" with emotional and support needs that often exceed those of their terminally ill family member.

Without suitable professional support many family carers feel isolated and overwhelmed by the many tasks and emotional implications of caring for a loved one with a life-threatening condition. In such circumstances, the promise of a painless and uncomplicated death via assisted suicide, must sometimes seem attractive.

If only it were true. The fact is, assisted suicide may simply add to the anxieties and pressures felt by families. While the specific role of family carers in the process of assisted suicide is relatively underexplored, some instances of post-traumatic distress disorder and depression in families who witness assisted suicide have been reported overseas. We shouldn't think that Victoria's assisted suicide model is immune from similar unintended consequences.

Under the proposed Victorian legislation, before a person is prescribed their lethal dose of medication they must appoint a contact person – who will invariably be a family member or close friend – who is responsible for securing the lethal medication, checking whether or not it has been administered, and returning any unused substances to the pharmacist after the person has died. One might expect the same trusted family member – a partner, a son or daughter – to inevitably bear the responsibility of removing the lethal substances from the locked box and mixing them with a liquid to be consumed by the patient. Imagine taking on such potentially harrowing duties on top of the already complex physical, social, and emotional responsibilities associated with being a family carer to a person with a terminal illness.

Think too about the impact of assisted suicide on family members when the arranged death doesn't go as smoothly as expected. No medical procedure is foolproof and no medicine can be guaranteed to remove all suffering. Evidence from overseas is that some people undergoing assisted suicide suffer complications – vomiting, seizures, failure to experience coma, and a protracted dying process. The longest death recorded in Oregon's assisted suicide system is 104 hours: just over four days.

Given the Victorian legislation doesn't require a healthcare professional to be on hand during a patient's suicide – to help with any complications or to simply observe that it occurs in accordance with guidelines – consider the potential trauma families may face when, alone, they try to comfort a beloved family member having a terrible physical reaction to their lethal medication?

Participation in assisted suicide also takes its toll on healthcare professionals, a fact that's been completely overlooked in our debate. In a survey of randomly selected United States oncologists who had participated in euthanasia or assisted suicide, 24 per cent regretted doing so, and 16 per cent reported that the emotional burden of participating adversely affected their practice.

One Dutch clinician appearing before a House of Lords inquiry into euthanasia said about his participation: "It is not a normal medical treatment. You are never used to it."

Even with the ability to opt out, some doctors overseas report feeling intimidated and coerced by patients and family members to participate. And yet despite this, specific details on how Victorian doctors will be trained and supported if they participate in assisted suicide have been completely ignored. It's inevitable that other health workers – nurses, for example – will also be asked by patients for advice regarding a hastened death. How will the wider health workforce be trained to respond professionally and compassionately?

Yes. Too many Victorians die undignified deaths. Too many family members suffer unnecessarily alongside them. But in our efforts to address this major public health failure we are at serious risk of complicating matters even further. One of the key principles explicitly acknowledged as core to the proposed Victorian assisted suicide bill is that every person approaching end of life should be provided with quality care to minimise suffering and maximise quality of life. Yet this standard cannot be met given our present inequitable and under-resourced palliative care system.

Why on earth – when most Victorians with a terminal illness and their family carers cannot access the standard of care they deserve – are we not putting all our efforts into remedying that situation rather than investing scarce resources into a highly questionable and untested model of euthanasia?

Sadly, many seem determined to shrug their shoulders and usher in the latter, whatever the consequences.