EUTHANASIA: by Dr Ivan StratovNews Weekly
What must patients do to avoid being killed?
, March 19, 2011
If South Australia and Tasmania legalise medically-assisted suicide, will people fearful of being killed by their doctors be forced to carry "sanctuary certificates" stating they do not want to be euthanased?Since 1992, I have practised in many sub-specialties including general medicine, oncology, cardiology, endocrinology and nephrology, and I am now a specialist in the area of infectious diseases, with a private practice based at Victoria's Knox Private Hospital and a public appointment with the Alfred Hospital, primarily in HIV medicine.
I've worked in Australian capital cities, rural and regional communities, Aboriginal health and abroad with Médecins Sans Frontières (Doctors Without Borders) in war-torn Abkhazia, a small Black Sea nation.
I have treated thousands of patients including those with terminal illnesses such as advanced HIV, cancer, end stage heart, liver or kidney failure, crippling arthritis, chronic gastrointestinal syndromes, severe Parkinson's disease, stroke, dementia, depression, chronic pain syndromes and plain simple generalised debility from old age.
Among all the patients I have treated, I have only ever had one request for euthanasia, and that was just recently.
The woman concerned was distressed and in pain, having undergone major surgery, complicated by infection. She was at her wits' end. No doubt her pain was debilitating and very distressing, and perhaps her pain relief was not optimal. Her request for euthanasia, however, was deadly serious and repeated.
She even explained that for several decades she had been a supporter of "Dying With Dignity", an organisation advocating euthanasia.
As part of my duty of care, I spent time explaining her medical situation and that the pain could be managed and her distress alleviated. Three days later, with her pain relief better managed, she was bright and smiling. Her problems are not fully behind her and she has undergone further surgery but she is continuing to recover.
As stated, this is the only request for euthanasia I have come across.
How easy it could have been for a medico to agree to her request and end her life, had medically-assisted suicide been legal. How tragic this could have been for her, her family and friends.
I recently spoke with a cardiology colleague about the issue of euthanasia. He said that he couldn't think of one single instance of a patient requesting euthanasia. Furthermore, I spoke with two oncology colleagues, neither of whom saw the need for euthanasia.
My father quoted to me the words of Catherine the Great: "It is better that 10 murderers go free than that we execute one innocent man." We reject capital punishment because history shows that mistakes have been made and innocent people executed. There is no redress following execution. Similarly, there is no redress for a person who has been killed by his doctor following a wrong medical diagnosis or inadequate care.
Australians should never forget the case of Nancy Crick, who committed suicide, "supported" by euthanasia campaigner Dr Philip Nitschke. She had been treated for bowel cancer, yet tellingly she herself said, "I don't know what I've got and they don't know what I've got!"
After her medically-assisted suicide, a post mortem revealed no evidence of cancer. Rather, she appeared to have a twisted bowel and some minor illnesses. The euthanasia zealots then claimed she was not "terminally" ill but "hopelessly" ill.
Euthanasia is no substitute for making a proper medical diagnosis, proper counselling for a suffering patient and family, and comprehensive care - physical, mental and psychological.
It is too easy for vulnerable people suffering from illness to be preyed upon by ideologues like Philip Nitschke, peddling their "peaceful pills", sugar-coated with assurances like "You're very brave" or "You have the courage of your convictions".
Professor Stuart Horner MD, former chairman of the British Medical Association's medical ethics committee, has argued that euthanasia undermines the basis of law and public morality.
He points out that euthanasia requests are often associated with depression and apprehension and are used by patients to assess their worth and value rather than as direct requests to have their lives terminated.
Furthermore, euthanasia undermines the proper financing of geriatric and palliative care. It fundamentally undermines trust between patients (who "don't want to be a burden") and their families and healthcare professionals.
Most importantly, Professor Horner says that it's impossible to put adequate "safeguards" in place so as to limit euthanasia to those suffering terminal, incurable illnesses. "Safeguard" clauses have not worked in Holland where 20 per cent of euthanasia patients are being killed without their consent.
Can we countenance the scenario reported from Holland where people are terrified of going to hospital for fear of being euthanased? Some feel they need to carry "sanctuary certificates" stating that they want to die naturally and not by medical euthanasia.
Is this the level of distrust that caring Australians want to permit to develop between patients and doctors?
We need caring, not killing!Dr Ivan Stratov, MBBS, FRACP, PhD, is a phthisiologist (specialist in infectious diseases) who works at both Victoria's Knox Private Hospital and the Alfred Hospital. He has worked abroad with Médecins Sans Frontières (Doctors Without Borders).