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Thursday, 21 November 1996
Page: 7349

Dr LAWRENCE(12.17 p.m.) —My contribution today will, I hope, underline not only the fact that I intend to vote against this legislation, but my reasons for doing so. They are strongly held reasons, and they turn around what I think is a very important principle that is being ignored in bringing this legislation before the parliament. If I can put it very simply and, indeed, quote someone else's words, because I think they are compelling, and if the women of Australia will forgive me for the masculine pronoun, I think it says very clearly what it is that I object to. Professor Ronald Dworkin, in 1993 said, I think, compellingly:

Making someone die in a way that others approve, but he regards as a horrifying contradiction of his life, is a devastating, odious form of tyranny.

I would put it as strongly as that myself. And one of the things that concerns me about this legislation is the fact that it is part of what I would call a growing conservative obsession with legislating against choice, of trying to hustle what is a grave moral decision which is inherently personal into the domain of public law. I partially quote Robert Hughes, in his essay, `The culture of complaint' in making that observation. But, again, it is an observation which I strongly endorse.

I would like to refer briefly to the statement of the honourable Marshall Perron, who was then the member for Fannie Bay, in the Northern Territory. In his executive summary of the Rights of the Terminally Ill Bill he said:

the law as it stands actively ensures that many doctors will not intervene to assist patients to end their suffering because of fear of legal action—

and I intend to return to that point in a minute—

This Bill—

and I think that it is important for its opponents to realise this about the Northern Territory legislation—

does no more than formalise and decriminalise a practice which occasionally occurs now but a practice for which some patients regrettably cannot find sympathetic doctors prepared to risk their careers and liberty.

I guess that is not surprising. He goes on to say:

This Bill is about personal choice. It does not provide carte blanche for euthanasia. It contemplates no externally imposed end of life decisions for the aged, the disabled or for anyone else. In simple language, it provides mentally competent, terminally ill patients with the right to choose to shorten their agony peacefully and with dignity. It is restricted solely to adult patients who are terminally ill and able to make a judgement for themselves after advice from their doctor.

I will return to that last point later because, at the moment, some decisions are made for and on behalf of patients but without reference to their desire and belief. In my view, that was partly what Mr Perron was trying to avoid in his legislation, trying to overturn what, at the moment, is often a decision made by a doctor or doctors without necessarily having the right intention. In other words, the patient may not have decided that he or she wants to die, but the doctors may have found it more convenient to decide that he or she should.

I will briefly touch on one issue before I turn to my substantive arguments. This is the question of the community view on this matter. I think that, as members of parliament, we are certainly entitled to a conscience vote on key issues but we should also take account of the views of the community. This is one area where, for over a decade, for as along as the question has been asked of the community, and in whatever form, somewhere between seven and eight out of 10 Australians say that they favour euthanasia, described in the terms that it was and, indeed, is legislated in Marshall Perron's bill. It is not something that is changed as a result of debate or argument, publicity or lack of it.

It is a very strongly held view. I might say, incidentally, that a significant minority of people with strong religious beliefs, and that includes Catholics, also have a view that euthanasia—in the terms described by a competent adult terminally ill making a decision about his or her own life—is justified. So, in many cases, even those people with the strongest religious convictions support the availability of the choice about this key matter in a person's life.

If you look at the arguments on euthanasia, they tend to be centred on four main issues: firstly, the question of religious belief; secondly, the question of the decisions that need to be made by medical practitioners—the ethics surrounding end of life decisions, if you like; thirdly, the rights of the individual versus the common good; and finally, the value of human life. If you look at the religious considerations, I respect the views of those who are religious and who see it in the same way as the Anglican Catholic bishops in their submission to the House of Lords. They said, `Life is to be viewed as His'—that is God's—`gift, given and taken according to His sovereign will. It is thus not at the disposal of any human being.' That is fine if you share that belief and I can understand people with strong religious beliefs endorsing that sentiment, but for many of those in the community—and I believe the majority—who do not share those views, it simply is not relevant to invoke God's will and God's gift of life because they simply do not share the belief. So, invoking religious arguments is only good enough for those people who share their beliefs. It is not sufficient grounds for the rest of the community to agree that euthanasia is somehow in breach of a universally held belief about the existence of God because it requires the individual to make a decision,

If you look at the medical considerations, the profession itself makes a very fine distinction between the methods that they might use to relieve pain, which may inevitably lead to death—distinguishing those means of allowing a patient to die, from agreeing to take part in assisting a patient to die. A great many organisations, including the AMA, do not support what they call active euthanasia but they are quite happy, indeed, to participate in passive euthanasia. I might say that, at times, and I have this on first-hand experience having worked in a medical faculty for some time, those decisions are not made with reference to the patients. It is decided that that person is in pain, that the palliative care is no longer working and, therefore, they will increase the dose of whatever pain-killer is available until such time as the patient dies.

Interestingly, when you ask people about the euthanasia question, they are often less enthusiastic about that doctor determined decision than they are about the one they make themselves. It is difficult to expand on that important point in a short time, but I have the view that it is not good enough to make this distinction between active and passive euthanasia from the point of view of the patient. So-called passive euthanasia often takes away the dignity and choice that he or she would wish. Whether the doctor intends or merely allows death, it seems to me is not a distinction that makes a great deal of sense from the point of view of the person—the patient or his family and friends.

Looking at the individual versus the common good, a lot of people would argue that, while it may be reasonable for the individual to ask to die on their own terms, it is not in the interests of society as a whole. Under this heading, you often get the thin edge of the wedge arguments that, if you allow the state to intervene in taking a person's life, it will open the floodgates of things such as the murders—and I do not call it euthanasia—undertaken during the Nazi regime of people with intellectual, physical and mental illness. Euthanasia does not contemplate that. It contemplates the individual making the decision not the state. So, in fact, it is precisely the opposite situation to that where the state intervenes to take a patient's life.

I just ask members to contemplate this scenario. Doctors A and B, I will call them for the moment, are in all respects similar. They are caring, respected doctors with impeccable backgrounds. Dr A's patient, Mr X, is suffering from a fatal illness which is now in its final stages. He is near death and in great pain and he has asked the doctor to put him out of his misery. Dr A explains that he cannot do so but he will steadily increase the amount of pain-relieving drugs. The effect of this will be that, over a period of time—perhaps a few days—the dose will be such that Mr X will in fact die, albeit, he adds, as a consequence of his attempt to relieve pain. Two days later Mr X does indeed die.

Contrast that with Dr B's patient, a Mrs Z, who is in virtually the same situation. In response to her entreaties, Dr B says that he will give her something to bring about the release she seeks and injects her accordingly. She dies within minutes without pain and suffering.

Now according to the traditional moral principle in this individual versus common good reference to passive euthanasia, Dr A would have performed a permissible act and Dr B would not. Currently it is not uncommon for palliative care, for life-sustaining treatment, to be withheld by doctors with the primary intention of ending a patient's life. I think that is a much more damaging failure by the state to intervene to protect patients against a decision that they may or may not have been party to.

An often quoted fear is that legally sanctioned, assisted dying would threaten the lives of powerless and vulnerable people. Again, as I say, if it is properly legislated, if there are constraints on the doctors' behaviour, that is less likely, not more likely, to happen. And doctors are less likely to make decisions based on extraneous factors such as the level of disability, the cost to the community and other matters that really should not be at the forefront.

Finally, it is often argued that euthanasia devalues human life and that human life, however, should be measured only in terms of its longevity. I would argue that quality is critical, and one of the key things that determines the quality of life for any individual is the ability, within limits, to control one's own life, to maintain a sense of authority over one's own destiny. If that is important while one is healthy and fit and able to make clear decisions, how much more important is it at that moment when the question is, `Do I want to continue to live or not?' I think every citizen deserves the right to determine the moment and means of their going in a dignified and civilised fashion.