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David Van Gend

(Endeavour Forum acknowledges Quadrant in putting up this article.)

It might have been Seneca himself addressing the sons of Hippocrates in 1995; Seneca who said, "I will not relinquish old age if it leaves my better part intact. But if it begins to shake my mind, if it destroys its faculties one by one, if it leaves me not life but breath, I will depart the putrid or tottering edifice." Mr Bill Hayden, Governor-General at the time, was speaking to the Royal Australian College of Physicians about his views on death and dying, and he echoed Seneca's revulsion and resolve: 

I view the prospect of the closing days of my old age with apprehension. I have visited too many nursing homes, seen too many vegetating old people who were once vigorous, vivacious personalities now dependent on their middle- aged children, much as when those children were dependent on them. This loss of personal control, of autonomy, of human personality for me would destroy my sense of human dignity. 

He identified himself as one of those "who, denied the choice of medically administered, painless, voluntary euthanasia, would wish to exercise the death option themselves". 

In Mr Hayden's speech there were two points to note in passing, and one to dwell upon. First, his judgment that dependency and loss of personal control should be grounds for voluntary euthanasia - an awkward moment for those who claim that voluntary euthanasia will only ever be for the terminally ill in terrible pain. Second, his untroubled assumption that a man acts decently and honourably in asking and expecting another person, in this case a medical person, to kill him - that suicide should be socialised. But the main significance of this address by our head of state was his suggestion that voluntary euthanasia is not merely a matter of choice but, more nobly, a positive obligation to society. 

Mr Hayden reminded us of past cultures where the elderly would take poison or wander off into the forests when their usefulness to society was done. In the absence of forests, "the Inuits left their aged to float away on the ice". Elderly ancient Japanese "retreated to a mountain- top"; in fact the practice was for the elderly (defined as such by the loss of all teeth) to jump from the rim of a volcano for the greater good. But did the elderly Japanese jump or were they pushed! More subtly, did they indeed "choose" to jump but only because of an irresistible cultural push! How much autonomy were the abandoned Inuits exercising! And is such a state of human relations admirable or degenerate! Returning to the present, the Governor-General made the connection to our own elderly, declaring, "there is a point when the succeeding generations deserve to be disencumbered - to coin a clumsy word - of some unproductive burdens". If a shiver did not pass through the ranks of physicians at this point, then they were not paying attention. 

Within a day this newly articulated duty of the burdensome to do the right thing by society was given extra gravitas by another ex- governor, Sir Mark Oliphant. Speaking on ABC radio he praised Mr Hayden's views, and referred to an aged colleague in Canberra who "should be dead", who is a burden to his family but "likes being looked after". When the interviewer laughed and said, "That's his right, too", the blank response was that it was not, and that he was cluttering up the world. 

These are the sentiments, not of neo-Nazis, but of thoughtful citizens, respected governors, shapers of social attitudes. They seriously propose that we develop a culture, like those described by Mr Hayden, where "unproductive burdens" will act for the greater good of society. That is the proposal which our legislators must address in the current federal debate: they must decide whether to leave the door open, just a crack at first, to this new "culture of disencumbering" - to coin a clumsy phrase - or resolutely to slam and bolt it. 

Because the influx of this new coercive culture would be subtle and insidious, the prospect has less emotive impact on our legislators than the immediate and vivid scene of terminal suffering. The urgent claims of mercy for the dying hold the attention better than the long- term concern of protecting the weak, the unwanted and the vulnerable from forms of oppression. But the gradual demoralisation of old people is a form of suffering, however slow and unspoken. The social-suggesting of an "unproductive burden" towards suicide, when that person would never otherwise have chosen suicide, is a form of oppression, however indirect. What message does that unfortunate vice-regal phrase give to his lonely and sick old subjects already suffering low self-esteem and the sense of being a burden! They would know when they had outstayed their welcome, and when to accept society's offer of assistance to die. When we start to hear, in the quiet loneliness of a nursing home, a "vegetating old person" ask us for euthanasia and "not to be a burden to anyone any more", then we will feel the unintended oppression of Perron's liberating law. 

It may be considered far-fetched to talk of broad social pressure on the frail elderly, given the perceived strict limitation of voluntary euthanasia to the terminally ill in terrible pain. There are two main reasons for a broader social view. First, such a view has already been articulated by advocates of euthanasia - the ink had not dried on the Northern Territory's strictly limited right-to-die before men like these two governors were broadening its application to the frail and burdensome elderly. Second, there is in reality no strict limitation on voluntary euthanasia, either in the Northern Territory's Rights of the Teminally III Act, or overseas. The logic of the right-to-die rejects any limitation of the grounds for choosing death, as that would limit the autonomy of the individual. Thus the criteria in Holland, which in 1984 closely resembled the Northern Territory criteria, have been logically loosened up, so that in the 1993 Chabot case the Dutch High Court ruled that a person need not have terminal illness nor any physical pain, nor even be suffering a disease at all and yet qualify for voluntary euthanasia. Once the fundamental human "right" to euthanasia is created, that right must be and is being extended to all who claim fundamental humanity.

A close reading of the Northern Territory's right-to-die law shows it is not strictly limited to the terminally ill in terrible pain; this legislation is already wide open to any old "unproductive burden" with an ordinary illness and a fixed resignation to die. There is no requirement in the Act, contrary to popular opinion, for the patient to be in pain; a non-specific subjective claim of "severe suffering" is sufficient, and not open to dispute (Section 7d). Regardless of the expected efficacy of palliative measures undertaken, the doctor must honour the request for euthanasia if such measures fail to reduce suffering "to levels acceptable to the patient" (Section 8). Such subjectivity is quite proper, but means virtually any old person can, for reasons of their own, declare they are suffering "unacceptably", and proceed under the letter of the law. Nor does any objectivity intrude via the definition of "terminal illness". In the first draft this was deemed to be an illness where the patient would be expected to die within a year. Now that has gone, and there is no requirement that the patient be likely to die within even the next decade or two. A truer title would be the Rights of the Interminably Ill Act, for terminal illness is defined in terms that encompass such chronic afflictions of the frail elderly as diabetes, congestive heart failure, or coronary artery disease. Each of these can fit the definition of "an illness which, in reasonable medical judgment will, in the normal course, without the application of extra- ordinary measures or of treatment unacceptable to the patient, result in the death of the patient". None of these illnesses need lead to the patient's death, but may well do so if ordinary treatment is rejected under the key term "unacceptable", by a patient resolved to end it all. And each of the illnesses can qualify as causing suffering "unacceptable to the patient" - nerve pain, leg ulcers, angina, difficulty breathing - if the patient wants to declare it as such. Thus the Act has the public persona of something stern and scrupulous; on more intimate acquaintance it will accommodate almost any adult who presents with a chronic illness and a desire to disencumber. 

That would be all very well if such a desire was the free and proud resolve of a stoic like Seneca or Hayden. But given the psychological vulnerability of the average sick old person, the sense they already have of being "unproductive burdens", and the power of insensitive family or medical staff to reinforce this sense, such a decision will be made from a position of humiliation and weakness. The Quadrant editorial of July 1995 is the best exposition I have seen of this central concern: 

Even the most elementary knowledge of human nature will tell us that while some families will treat older parents afflicted by terrible illness with love and respect, others will find the pain of their elderly parents merely ugly and their obligation of endless hospital visits over weeks or months distinctly tiresome. In such circumstances is it not at least possible that in the family discussions concerning the future, pressure will be applied which will suggest to someone who is terminally ill that no good can come from their purposeless clinging to life, that they have become a mere burden, and that they owe it to their suffering family to request an officially sanctioned death! Will it not be the case even among those of the afflicted who are genuinely loved that some, in the depths of depression and fear, will imagine falsely that it is their death that their families most desire! And is it not precisely because of the recognition that, in a situation of legalised euthanasia, we cannot protect all of the terminally ill from insidious pressure of this kind that thus far no legislature in the world - other than that of the Northern Territory - has passed such a law! 

Proponents of euthanasia tend to dismiss the whole idea of pressure being brought to bear on vulnerable people to "do the right thing" by family or society, and yet that is the concern which has tipped the balance against legalising euthanasia in all the major inquiries worldwide. The best of these was the British House of Lords inquiry in 1993. The majority of the Select Committee's members were on the record as supporting euthanasia. But after thorough research, public hearings, and a trip to Holland, the committee came unanimously to oppose the legalising of euthanasia, concluding: 

It would be next to impossible to ensure that all acts of euthanasia were truly voluntary. We are concerned that vulnerable people - the elderly, lonely, sick or distressed - would feel pressure, whether real or imagined, to request early death. We believe that the message which society sends to vulnerable and disadvantaged people should not, however obliquely, encourage them to seek death, but should assure them of our care and support in life. 

This is the heart of the matter, and must be weighed against the equally heartfelt motives for mercy killing. This subtle and unavoidable pressuring of the elderly, lonely, sick or distressed "to seek death" is the injustice we did not need to have. In the last two years of debate, no advocate of euthanasia has stood and squarely answered this. There was no serious grappling with the question when the patron of the Voluntary Euthanasia Society, Professor Baume, was asked on Radio National if he could guarantee that no person again and again that their death be hastened, that's a voluntary request on their part." Which says precisely nothing about why they might be asking that their death be hastened - is it "truly voluntary", a pure and proud assertion of self-determination, or is it the demoralised whimper of someone experiencing "pressure, whether real or imagined, to request early death") In federal parliament in October none of the speakers supporting euthanasia addressed this question, except for a dismissive caricature by Mr Albanese: "The logic of this 'the kids will knock off their parents' argument reflects badly and, I believe, inaccurately, on our society." Nobody suggests it will be that crude or overt. The subtle corruption in relationships is better captured in this recent case history from Holland, reported by an Oxford palliative care specialist: 

An old man was dying from disseminated lung cancer. His symptoms were well controlled and he asked if he could go and die at home. When his four children were told about his wish, they would not agree to take care of him. Even after repeated discussion, they refused. Instead, they pointed to their father's suffering and the need to finish things quickly "in the name of humanity". When the doctor refused, they threatened to sue him. As the patient insisted on going home, a social worker went to investigate. She discovered that the patient's house was empty and that every piece of furniture had been taken by the family. 

This scene would never occur in Australia, because here the intimate nastiness of family dealings can be prevented by Senate decree. One senator, after a long and thoughtful discussion, wrote, "I do have some concerns about how traditionally disadvantaged members of our community will be affected by euthanasia legislation ... but I will work to ensure ... that no patient ever is subject to psychological, financial or any such pressure when deciding to take their life." Omniscience and omnipotence, that's all. With these superficial and naive responses, the proponents of euthanasia show little interest in thinking beyond the mindless mantra of "choice", which is no basis for sane public policy, no matter how compassionate and well-meaning their motives. 

When the senators come to vote on the Andrews bill, they may be no less compassionate but less naive, accepting that the construction of the social machinery of mercy killing cannot be seen purely as a matter of private choice. They may face up to the shadow side of human society and our capacity for despising "unproductive burdens"; and perhaps come to concur with the Supreme Court of Canada (1993) that "the responsibility of government to protect vulnerable people from abuse outweighs and individual right to assisted suicide". 




Member Organisation, World Council for Life and Family

NGO in Special Consultative Status with ECOSOC of the UN