In the same week The Age ran an in-depth expose revealing callous indifference and alleged fraud and coercion of the elderly, we attended a lecture by Professor William Toffler, MD, from the State of Oregon, USA.
Twenty years ago, the State of Oregon passed a bill allowing physicians to assist patients to commit suicide. The legislation was billed as a way to relieve suffering and to increase patient choice. Professor Toffler flew to Melbourne to describe to us the actual, practical consequences of physician assisted suicide in Oregon and around the world.
What follows are our notes from the talk he delivered to 300 people gathered in Premiere Daniel Andrews’ seat of Mulgrave.
Professor Toffler made it clear that he was addressing us not just as a medical doctor, but as someone who has personally grappled with the death of his parents, parents-in-law and wife.
Myth #1 — Opposition to euthanasia is driven purely by religion
While we at The Good Shepherd do point to what the Orthodox Church teaches on euthanasia, Professor Toffler says that his critique of euthanasia is based on an analysis of facts. He suggests that a person’s “religious background” is raised to divert debate from the facts.
Professor Toffler opposes euthanasia because it brings far more harm than good.
Myth #2 — Euthanasia will reduce suicide
When euthanasia legislation was introduced to the State of Oregon, it was expected that the state’s suicide rate would decrease, but in fact the opposite has occurred. The unassisted suicide rate in Oregon is one of the highest in the USA and it is increasing.
Based on the statistics, it is far more likely that assisted suicide leads to suicide contagion than it does to “satisfying demand” for suicide.
Myth #3 — Euthanasia is required for pain relief
Professor Toffler quoted a report from the Lancet medical journal which shows that patients in more pain are significantly less likely to find euthanasia and physician assisted suicide acceptable.
People’s actual end of life concerns include:
- the fear of losing autonomy (91%)
- the fear of being a burden on their relatives (42%)
- the fear of inadequate pain control (26%)
In actual fact, Professor Toffler states that virtually all pain can be controlled with modern approaches to palliative care. The range of techniques available include:
- nerve block
- palliative surgery
Myth #4 — The patient is in control
Professor Toffler gave many examples of where euthanasia legislation reduces patient choice, ranging from:
- doctors failing to recognise and treat for depression and anxiety
- insurance companies refusing to pay for treatment as soon as euthanasia becomes law
- children going doctor-shopping to find a physician who will prescribe euthanasia for their parent despite there being no explicit desire for euthanasia by the parent
- carers conspiring to defraud people
Even more alarming is the way that euthanasia legislation tends to expand over time. In the Netherlands, euthanasia legislation has expanded to include:
- physician-prescribed euthanasia without direct patient consent
- parent-prescribed euthanasia for children under the age of 12
When physicians in the Netherlands were asked to enumerate why they organised for euthanasia without explicit patient consent, some of the reasons given were:
- “I knew he would die within a week and I needed the bed.”
- “I knew it was against her religion so I didn’t talk to her about it.”
In any other country this is called murder.
Myth #5 — Euthanasia is only for the last six months of life
Professor Toffler indicated that doctors are very good at predicting when death will occur within the last few hours of life. Beyond the last few hours though, he indicated that there is no science that will allow doctors to predict how long people will live.
- There are no “crystal ball reading” courses in medical school.
- Not only prognoses but also diagnoses can be (and not infrequently are) wrong.
Within Oregon, there is a push to double eligibility from six months to 12 months. This has been preceded by the Netherlands where the eligibility is defined as “having a completed life.”
Doctor Toffler emphasised that essentially anyone is eligible anytime for any reason. And this is not an idle problem when Australian companies have chosen to railroad elderly into false diagnoses for economic gain.
Myth #6 — Euthanasia occurs without complications
In Oregon, doctors are absent 86% of the time, which means that no one is present to record complications. No medical procedure is without complications, but the secrecy surrounding euthanasia means that no complications are being recorded.
But we know that complications occur, because:
- there are reported cases of people surviving the euthanasia drugs, in one case waking 67 hours after taking the drugs
- an ante medic must be taken before ingesting the drugs otherwise human reflexes would prevent the drugs from being ingested
- the drugs must be ingested at just the right rate — too quickly will cause vomiting, and too slowly fails to ingest sufficient drugs to cause death
So there are people who wake in pain and discomfort caused purely by failed ingestion of the drugs.
Myth #7 — Euthanasia is for people who are certain
A lot of people who apply for euthanasia can and do change their minds. When people present to a doctor asking for euthanasia, what they say and what they actually mean might be quite different.
- “I want to die” might mean “I feel useless.”
- “I don’t want to be a burden” might mean “Am I a burden?”
- “I don’t want to be on a respirator” might mean “I fear losing control.”
- “I’ve lived a long life already” might mean “I’m tired and I’m afraid I can’t keep going.”
- “I might as well be dead” might mean “(I feel) no one cares about me.”
Professor Toffler then cited the story of Jeanette Hall. Jeanette Hall had been diagnosed with inoperable cancer. She fronted her doctor saying, “I don’t want treatment. I voted for euthanasia, I just want the drugs.”
Her doctor took the time to ask her about her life, and discovered that her son was in a police academy. When he asked her whether she wanted to see her son graduate, or marry, or have children, she realised that she really did want those things.
Thanks to the thoughtfulness of her doctor she agreed to radiation therapy. That was 17 years ago. The radiation managed to treat the cancer, and in the last 17 years, she has seen her son graduate, get married and have children.
Jeanette was sure she wanted to die, but thanks to her doctor has relished living another 17 years.
Myth #8 — Euthanasia is painless
In the USA, the very drugs used for euthanasia are ruled unconstitutional for administering the death penalty. Why?
Due to the high risk of pain and suffering, courts have ruled them a “cruel and unusual punishment.”
Myth #9 — Euthanasia is prescribed by doctors who know their patients well
Euthanasia is practised by a small subset of doctors who are willing to prescribe euthanasia. One doctor in Oregon wrote 25 prescriptions in a single year — clearly not all his or her patients.
- The average length of time with a prescribing doctor is 13 weeks and falling.
- There is already a drive-in “death with dignity” clinic in San Francisco, California.
When a death culture takes over, people are put on a conveyor belt of callous indifference. What people need is not a quicker way to die, but to be affirmed as individuals.
Doctors are like defence lawyers. But euthanasia asks doctors to play the role of a prosecuting attorney, and judge, and executioner. Asking doctors to play all these roles undermines people’s confidence in the medical profession.
“You just don’t want to expand the number of people who can legally kill you!”
Myth #10 — Euthanasia is the solution to suffering
Caring is not killing. It is best for Australians to give people hope and to reinforce their self-worth.
Already it takes enormous efforts from family members to ensure their elderly receive appropriate and timely medical care from doctors and nurses in the hospital system. Don’t increase the difficulty by legally entrenching a purely utilitarian way of thinking.
- If a person is in physical pain — treat the source of the pain.
- If a person is fearful — address their fears.
- If a person is lonely — provide companionship.
- If a person doesn’t value their life — work to reflect their inherent value — just as we do with others who aren’t labelled “terminal”
The solution to suffering is not to end the life of the sufferer.
Professor Toffler’s personal experience
After Professor Toffler’s wife was diagnosed with terminal cancer, they had three more years together. Professor Toffler reports that these three years were among the most joyful years of their lives — in part because they knew their time was limited.
The day before she died, Professor Toffler’s wife was in the garden with her grandchildren. There was no sign that she would soon pass.
On the day of her death, Professor Toffler helped her into the bathroom. He then went out to church to bring her communion. Usually she would eagerly reach for the element but this day she did not respond. Professor Toffler then recognised that her death was imminent. Until that moment, no one knew that death would soon occur. She lived a good life right up until the moment she died.
Professor Toffler fully endorses allowing life to take its course, and surrounding the dying with all the love and care that their inherent worth demands.
People aren’t disposable. We oughtn’t treat them as if they were.
What you can do
- Discover the facts of euthanasia.
- Learn what the Orthodox Church teaches about euthanasia.
- High quality palliative care is the ethical alternative.
- Oppose euthanasia in Victoria.