End of Life Care
The Rights of the Terminally Ill Act 1995 (NT) was a controversial law legalizing euthanasia passed by Australia’s Northern Territory in 1995. However it was nullified shortly afterwards by the Howard Federal Government which has the power to overrule a law in a territory.
The Act allowed terminally ill patients to commit medically assisted suicide, either by the direct involvement of a physician or by procurement of drugs.
It required that a patient was mentally competent to make the decision and was actually terminally ill. A patient had to be over 18 and be mentally and physically competent to request his or her own death. The request had to be supported by three doctors, including a specialist who confirmed that the patient was terminally ill and a psychiatrist who certified that the patient was not suffering from treatable depression. Once the paperwork was complete, a nine-day cooling-off period was required before the death could proceed.
The Green Party took up the issue and Senator Bob Brown has proposed legislation in the Federal Parliament hoping the Labor Government would be more sympathetic. He can only have laws passed to impact upon the laws of the Northern Territory and the ACT. The Commonwealth has no power over the laws of each State. So the Green Party is now trying to have state laws passed to do the same.
We will debate the Rights of the Terminally Ill Bill 2010 next week in the NSW Parliament. This debate will bring support from “death with dignity” and right to die groups, and widespread condemnation from euthanasia opponents, such as the Australian Medical Association, Christians and right to life groups.
It is patently obvious that the Green Party politicians in NSW do not know what they are talking about – they are simply ideologically driven.
They promote Euthanasia ‘the intentional killing, by act or omission, of a person whose life is felt not to be worth living’. Assisted suicide can be defined as any act which intentionally helps another to commit suicide.
Pressure for the liberalisation of the law with respect to euthanasia has grown considerably in recent years. In some ways this is odd, given that within this same period palliative care has actually developed by leaps and bounds, such that most pain can now be managed and controlled.
When one presses the politicians who promote euthanasia or assisted dying and argue it is now usual to manage pain, they make it clear that their fundamental objective is not concerned with avoiding pain but rather with a very individualistic, philosophical commitment to human autonomy – and the belief that if I am sick and want to end my life I should have the freedom to do so via euthanasia or assisted dying.
That is where I as a Christian disagree. Liberalising the law is problematic for at least three reasons: First, human life bears God’s image and it is not for us to terminate. Second, according to the Christian worldview we are part of community, joined to each other. We are not completely autonomous. The decisions we make impact other people. Finally, if the law was changed there would be a great risk that terminally ill people would feel pressured into accessing assisted suicide or euthanasia. At present if you are sick and a burden on your family, and or the state, and have a sensitive conscience, you don’t need to feel guilty about being a burden in the sense that there is not much you can do about it. However, if assisted suicide or euthanasia became available, there would be a mechanism – sanctified with legal approval – which you could take.
I became involved in considering end of life care in the 1960’s when as I pastor I was visiting every week people in hospital receiving end of life care. In the 1960’s I had graduated in Clinical Pastoral Care and was very active in supporting the dying. I read an important book by Dame Cicely Mary Saunders, OM, DBE of St Christopher’s Hospice, South London, England. She was a prominent Anglican nurse, physician and writer, involved with many international universities. She helped the dying and terminally ill end their lives in the most comfortable ways possible.
She is best known for her role in the birth of the hospice movement, emphasizing the importance of palliative care in modern medicine. At the time hospices were sanctuaries provided by religious orders for the dying poor. They offered food, clothing, shelter as well as minimal medical care.
But in 1967, St Christopher’s Hospice, the world’s first purpose-built hospice, was born. The hospice was founded on the principles of combining teaching and clinical research, expert pain and symptom relief with holistic care to meet the physical, social, psychological and spiritual needs of its patients and those of their family and friends.
In 1979 she was promoted to Dame Commander of the Order of the British Empire (DBE) and became known as Dame Cicely Saunders. In 1981 Dame Cicely was awarded the Templeton Prize, the world’s richest annual prize awarded to an individual. In 1989 Dame Cicely was appointed to the Order of Merit by Queen Elizabeth II. In 2001 she received the world’s largest humanitarian award – the Conrad N. Hilton Humanitarian Prize, worth £700,000 – on behalf of St Christopher’s.
A doctor friend of mine trained at St Christopher’s Hospice and on his return Dr Trevor Banks established a remarkable Palliative Care work in Geelong Victoria. When in l979 I became the Chairman of The Lottie Stewart Hospital Dundas, I saw we had a wonderful opportunity to do the same and under the leadership of Dr Damaris Russell set up an incredible work in care for the dying both in homes and a clinical setting. The Hospital was owned by Wesley Mission Sydney, and I was responsible for this hospital for 27 years including making it the main NSW centre of care, treatment and research with people with Huntington Disease.
The Lottie Stewart Hospital became a 136 bed, third schedule hospital. It provided specialised residential and subacute services in the areas of Palliative Care, Huntington’s Disease, Spinal injuries, Aged care, Transit, Respite, Geriatric Rehabilitation, CADE and Psychiatric units. It also provided clinical training placements for student enrolled nurses.
What can be done in the NSW Parliament? First, the current law regarding assisted suicide must be preserved. Parliament, not the judiciary or civil servants, must maintain its exclusive role in determining any changes to the law. Second, there is a real need to increase funding for palliative care. Any strategy for Care at the End of Life, needs increased funding to improve coordination of clinical, social and other services with special support for non-specialist health care professionals, such as GPs and nurses, who typically have the most interaction with those who are terminally and chronically ill.
I will be arguing for the defeat of the Rights of the Terminally Ill Bill 2010 next week.
Rev The Hon D Gordon Moyes. A.C., M.L.C.