The Covid pandemic brought into focus management of the elderly in nursing homes; those with dementia or with chronic morbidity likely to have a lower treatment priority. What is missing from this difficult discussion is the view of those elderly patients who have no wish to prolong their lives. As a retired hospital doctor, I regularly encountered those prolonged, end-of-life situations, painful to both patient and relatives, when palliative care had nothing to offer. This important issue is again topical, with the recent parliamentary lifting of euthanasia restrictions on the Northern Territory and ACT governments, the first step to introducing their own laws.

The vexed question of management of what used to be called euthanasia (Greek for good death) is increasingly raised, the name changed because of its misuse in Nazi Germany. Leaders of Christian, Jewish, and Muslim religions are all against euthanasia, but their adherents are less so, with a survey in NSW showing 64 per cent of Catholics and 79 per cent of Anglicans in favour. Even the former Archbishop of Canterbury, the leader of the Anglican Church, George Carey, is now a supporter.

South Australia, at its 17th attempt, passed legislation, Tasmania at its 4th attempt, the NSW Parliament also has given final approval. Western Australian and Victorian VAD legislation covers only the terminally ill with a life expectancy of fewer than 6 months (compared with Queensland’s 2022 legislation of 12 months). They all fail to address the situation of those with chronic ill health whose quality of life has faded. The original Northern Territory legislation of 1995 was overturned by the Federal government two years later.

Figures, released for the first two years of VAD operation in Victoria, show that there were 807 assessments of patients and 700 were found eligible. Six hundred permits were issued to obtain lethal medication, with 282 self-administered and 49 doctor-administered; other applications did not proceed because of prior death. Most of the applications were for terminal cancer (around 80 per cent) with a small number for neurological disorders and a handful with cardiac and lung problems, average age around 70. These numbers are higher than originally anticipated, but a minute proportion of the around 80,000 annual deaths in Victoria. A recent audit from WA showed 682 applications, with 171 euthanized, mainly for cancer.

My own experience as a doctor exemplifies the difficulties. Whilst working in a private hospital in the Middle East, the father of the hospital’s owner was admitted having had a stroke paralysing one side of his body; soon after he had another stroke, affecting the other side. He was unable to move, feed, or communicate and, at his son’s instruction, he was kept alive at all cost. This poor man, locked into his body, survived another year. Palliative care kept him alive but could not give him quality of life. I have no doubt, should he have been able to communicate, he would have preferred to die.

The assisted death of 40 years old Marieke Vervoort in Belgium would not have fulfilled the Australian requirements. She had achieved fame by winning multiple sporting medals at international events over 10 years. She had a neurological condition and had coped with the physical problems of pain, side-effects of drugs, increasing dependence on others, incontinence and debilitating urinary infections, paralysis ascending to involve her arms, and finally, failing eyesight. When her quality of life had become unbearable, she was able to end her life with assistance, in October 2019.

Currently, assisted dying is legal in many countries and some US States. The Netherlands was the first country to legalise euthanasia in 2002, followed by Belgium later that year, Luxembourg in 2008, Columbia in 2015, Canada in 2016, New Zealand in 2021.

Canada’s Medical Assistance in Dying legislation covers those with a ‘grievous and irremediable’ condition, as opposed to a terminal illness. This is due to be extended in 2023 to those with mental illness. The Canadian Human Rights Commission sees it as an invasion of rights, rather than being given the right to choose. The Act has resulted in 6,000 deaths annually, and polls continue to show strong support; this compares with an annual death rate of around 250,000, with 15,000 Covid deaths and around 4,000 suicides in 2021.

Nowhere has this resulted in an epidemic of involuntary deaths, nor has it resulted in doctors being forced to kill their patients; nevertheless, it is predictably compared with euthanasia of Nazi Germany.

Repeated surveys have shown the Australian population support the concept. The latest showed nearly 90 per cent in favour, but politicians remain reluctant. For Australians, the only option available is an often logistically difficult, costly, and emotionally challenging trip to another country. David Goodall, 104 years old Australian, who had to travel to Switzerland in May 2019 to end his life, exemplified the problem. Another Australian example in December 2019, was the final journey of 90 years old Laura Henkel who also travelled to Switzerland to end her life. Her quality of life had become unacceptable, but the current legislation covers only the terminally ill.

Legislation still fails to cover most in need, like David Goodall, Laura Henkel, and Marieke Vervoort. The debate should not revolve around religion, morality, or legality; it should be about compassion and the relief of suffering, fundamental requirements of the medical profession. Ultimately, it should be about freedom of choice.

Whenever the prospect of VAD legislation is raised in this country there is the counter argument from religious sources (Christian, Muslim, and Jewish). Whilst palliative care can help with pain relief and nursing care, it can only achieve so much, it cannot make someone walk or talk again. There is no evidence it has led to forced euthanasia. As a retired doctor I have seen people of all ages whose quality of life is unacceptable, but who have no alternative to end their suffering. A comparison with care of our pets is often used by supporters; we would not allow them to suffer like this.

With a falling birth rate, we have an ageing population; in 2014, 15 per cent were over 65, this is predicted to rise to 20 per cent by 2040, over 6 million people. This population demography will result in a dramatic increase in the number whose quality of life may become unacceptable, with dementia an increasing complication, it will also add dramatically to the cost of health care. As someone of that age, but not yet in that condition, I would like the certainty of knowing I could end my life if I find it no longer bearable.

Dr Graham Pinn, retired Consultant Physician