The edifice of public support for euthanasia is built on a lie, that people know what they might want in the face of dying. The truth is almost all of us don’t, especially in a culture where there is a marked taboo around death.
Our inability to consider broader risks in the wake of the pandemic highlights our aversion to even consider facing our mortality. This feeds further misconceptions about painful death and end-of-life care, corrupting informed debate about assisted dying.
It is quite the contradiction when hundreds of millions of dollars are being spent on suicide prevention, yet the act is deemed perfectly rational in the face of life-limiting illness. Existential suffering remains at the heart of both.
There is overwhelming public support for assisted-dying laws. Public surveys in recent years hover around ninety per cent in favour.
Only this month South Australia passed a Bill in its Upper House. Victoria and Western Australia already have laws permitting assisted dying. Draft legislation in Queensland offers earlier access and includes the amorphous concept of mental trauma as a category. New South Wales is likely to introduce a bill in the coming months.
Doctors and religious groups are increasingly the last line against laws for assisted dying, defending what French author Michel Houllebecq calls ‘the honour of civilisation’. The Australian Medical Association is officially opposed but says it will cooperate with the public will, as long there is a right for individual doctors to undertake conscientious objection.
Yet the public aren’t entirely aware that the pain most people associate with choosing an early death is usually more psychic than physical.
‘We wrongly associate those who choose euthanasia with intolerable physical pain, but they usually report an existential suffering, of being a burden or feeling abandoned by loved ones,’ says Associate Professor Leeroy Williams, President of the Australia and New Zealand Society of Palliative Medicine.
The existential torture is worsened in a society that does not have obvious idioms to process suffering. The modern climate is more therapeutic than religious.
The steep rise I see in diagnoses like post-traumatic stress disorder is in part because a psychological language replaces a lost metaphysical one. This is especially the case if life is framed as a quest for pleasure and its associated parallel, an avoidance of suffering.
In a pandemic era when the application of science in public policy has become central, one branch of medicine remains sidelined in the euthanasia debate.
That is the practice of palliative care. While doctors saving lives rightly enjoy hero status, helping people die better is neither sexy nor well paid.
Williams says it’s not just the public. Most health professionals are also poorly trained in end-of-life care. Monash University devotes one day in a six-year course to its medical students. Other medical schools or training programs don’t fare much better.
Yet in the past two decades managing nerve or bone pain has become more advanced. The delivery methods for artificial feeding have improved. There are also better strategies for minimising vomiting associated with cancer medications.
It is also the branch of palliative care that is best aware of the inaccuracies associated with giving a prognosis. Many patients are told they only have six or twelve months to live, yet survive years or even decades. A sizeable minority of patients, as much as between 15 and 20 per cent I am told, who are under palliative care are discharged home — and not to the Pearly Gates.
Given how poor our feelings are in computing probability and mathematics, you can bet a percentage of sufferers who go through with assisted dying would have otherwise survived. This is especially the case in the draft laws drawn up in Queensland where if you’ve received advice that death is likely within twelve months the assisted dying laws may apply.
Discussions about death are taboo in Western culture, something that is brought into striking contrast when burning pyres of corpses are broadcast from India. Cultures like India more readily accept that death is thoroughly intertwined with life.
In a world where assisted dying is legal, doctors are forced to contend with a new medical environment where assisted dying becomes thoroughly intertwined with the curing of illness. The so called ‘double effect’ of increasing pain medications like morphine knowing they are likely to induce death, something I have undertaken in hospital wards and in nursing homes, is in a very different legal and moral territory.
While politicians and well-meaning advocates are cautiously assuring us of the opposite, there can be little doubt there is indeed a ‘slippery slope’.
In Netherlands there is now the ‘tired of living’ movement where there are demands that any elderly person over a certain age should be allowed to administer drugs leading to their death. In Belgium, fifteen thousand deaths have occurred throughout the process since the law was instituted in 2002.
There are multiple cases being fought in Europe over people euthanased for diagnoses like autism, deemed a form of ‘unbearable suffering’ and therefore meeting the legal test.
It is generally accepted that people should be allowed to do what they like with their bodies and their lives as long as they don’t harm others.
But a key facet of modern conservatism must be placing limits on the corrosive hyperindividualism of progressives, including many on the moderate side of the Liberal party.
This principle of autonomy reaches its zenith for rational suicide.
The act is fundamentally at odds with the field of mental health which frames suicide as pathological. There is a marked societal contradiction in prioritising suicide prevention and euthanasia simultaneously. We consider existential suffering unacceptable when there is no defined ‘life-limiting illness’, yet perfectly rational in the alternative setting.
But we live in a culture that struggles to process suffering and avoids all confrontation with death. Few people know what they might think about death when faced with its stark reality.
The polls suggesting widespread euthanasia support, views which inform enthusiastic legislation, wrongly assume the opposite.
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