Letting Go

dying with dignity

By Deb Bennett

In western society death is rarely discussed, perhaps because it stirs the deepest of emotions and raises the most profound existential questions. So it is to be expected that when the Victorian government introduces a Bill into parliament later this year to allow voluntary assisted dying in the state it will generate an intensity of passion and clash of fundamental beliefs rarely seen in public debate.

The Bill follows a wide-ranging inquiry by a bipartisan parliamentary committee set up to look at end-of-life issues. The committee outlined 49 recommendations in its Inquiry into End of Life Choices Final Report.

The majority of the report examines issues around access to quality health care, choices in care provision and increased funding and training for palliative care services.

It is the last point in the report that is the most contentious. Recommendation 49 reads: “That the Victorian Government introduce a legal framework providing for assisted dying, by enacting legislation based on the assisted dying framework outlined in this Report in Annex 1, Assisted Dying Framework Summary.”

The model the Victorian Parliament will consider a number of safeguards to allay some of the fears of those who oppose assisted dying on the grounds people will feel pressured into taking this option.

They include:

  • The request must be made by the person with a terminal illness and an expected lifespan of less than 12 months
  • The person must be of sound mind
  • Independent assessment by two medical practitioners
  • The patient must then make a written request witnessed by at least one independent person who does not benefit from the person’s death
  • A third and final request must be made by the patient, followed by a 10 day ‘cooling off’ period before the medication is provided.

Doctors involved in the scheme will undergo specialist training. Medication will be self-administered by the patient.

While advocates of assisted dying feel the Bill is long overdue, the government acknowledges the moral anguish and ethical concerns of those who are opposed. Politicians will be allowed a conscience vote on the issue.

Some groups will advocate strongly for the rights of the individual to choose, while others will argue passionately for the sanctity of all human life.

Many Christian churches have been very vocal in their opposition to the Bill. Australian Christian Lobby Victorian director Dan Flynn has suggested such legislation puts the lives of vulnerable people at risk.

“The elderly, especially those experiencing elder abuse at the hands of family members or medical staff, and those with disabilities or from a non-English speaking background would be particularly vulnerable if state-sanctioned assisted suicide was legalised,” Mr Flynn said.

The Catholic Church in Australia acknowledges on its website that calls for people to die with dignity are motivated by compassion, but believes they are, “misguided and even dangerous”.

“Killing people is wrong, and this principle is fundamental to our law,” the church says.

Victorian premier Daniel Andrews, himself a Catholic, says he was initially against assisted dying during his time as health minister, when he feared ‘economic rationalism’ would influence medical decisions.  He has spoken publicly about his change of heart after watching his father suffer a painful death from cancer.

“As his quality of life deteriorated and as I realised that he’d passed away from us long before he died – I knew our laws needed to change,” Mr Andrews told The Sunday Age.

As a Uniting Church minister, Rev Carolyn ‘Caro’ Field is perhaps more familiar with death than most people, having offered pastoral care to parishioners when they, or a loved one, are dying. She thinks that if society re-thinks ideas around death and dying, the arguments against assisted death would be different. People naturally fear death, so to hasten it seems unnatural.

Since caring for her mother in the last months of her life, Ms Field has reflected on what it truly means to ‘die with dignity’.

“Towards the end, it would take two hours for an Endone (painkiller) to work effectively, it was doing nothing for her,” Ms Field said.

“I would sit with her on the side of her bed rubbing her back waiting for the pain to go. She would say to me ‘This is so bloody cruel, why can’t I just die?’

“On the wall were wedding photos of her and Dad taken back in 1957. Here was this beautiful young woman full of life and here is this shell of a woman in agony just wanting it to be over. It was just so cruel.”

Opponents of assisted dying often cite improvements in palliative care and pain management as options for those facing a painful death. But as Ms Field explained, even though her mother’s palliative care team was terrific, towards the end of her life her mother’s body was unable to absorb medication efficiently, so she would endure hours of unbearable pain.

Ms Field has little doubt that, had her mother been offered the choice to continue suffering or end her life, her final days would have been less traumatic.

But, because the legal option wasn’t available, it was something they never considered.

“Mum wouldn’t do anything unless it was legally recognised or advised by a doctor,” she said.

“She would have been worried that if we’d ‘accidently’ given an overdose it could have had implications for me as her carer, and I could have been in trouble with the law.”

Ms Field is also aware of the religious objections to assisted dying, but says her faith enables her to see the importance of ending life with dignity and self-determination.

“I’m not going to throw around a whole lot of Bible verses, I’ll leave that to the scholars,” she said.

“My reflection is more of my experience and my own personal journey of faith.

“Human life is sacred and God holds the key. The dice had already rolled; God had made the decision that Mum was going to die. Whether it was tomorrow or next week was immaterial in the scheme of things.

“It was interesting for me that I never once thought about praying for God to miraculously cure Mum of the cancer. I just thought ‘OK she’s got this cancer and it’s going to kill her’. So my prayer was for a good death.

“Certainly for Mum and I both, if there had been a legal option to end her life sooner we would have both grabbed it with both hands. Because the level of suffering that she had towards the end – I’m talking the last two to three weeks – there was nothing that could be done.”

While religious groups are expected to be the most vocal opponents of  the Victorian legislation, surveys reveal adherents to faith differ in their opinions. Polls suggest more than 80 percent of Australians support legislation for voluntary euthanasia. A 2012 Newspoll found that 77 percent of Catholics and 88 percent of Anglicans  supported medically assisted euthanasia to “end unbearable suffering for terminally ill patients”.

The synod of Victoria and Tasmania has yet to make a definitive statement regarding voluntary euthanasia. A response submitted by the Presbytery of Tasmania considered the complexity of the issue and stated the church was neither for nor against the introduction of the Bill.

The Church’s stance contrasted with that of other denominations, who expressed their opposition to the Bill. In a conscience vote, Tasmanian politicians voted eight for and 16 against the Bill.

For a brief period of time in the mid-1990s, Australians could legally decide the manner in which they died. The Rights of the Terminally Ill Act 1995 was a law passed by the Northern Territory Legislative Assembly in May of that year. The Act allowed a terminally ill patient to end their life with medical assistance, either by the direct involvement of a physician or by procurement of drugs. The law came into effect on 1 July 1996.

The Bill caused controversy throughout Australia, with churches and right-to-life groups lobbying the federal government to intervene. The Bill was overturned by an Act of federal parliament in March the following year.

In 2001, Rev Professor Andrew Dutney (former president of the UCA assembly) wrote about euthanasia in his book Playing God.

Writing in response to media reports at the time that spoke of ‘Christian’ opposition to the NT legislation and euthanasia in general, Prof Dutney expressed frustration at the assumption that Christians speak with one voice.

“Both inside and outside the churches there is a general ignorance of the diversity of Christian opinion on the morality of euthanasia,” Prof Dutney wrote.

“For, contrary to the journalist’s confident assertion, the fact is that there have been Christian voices raised in support of forms of euthanasia.

“In the case of teaching on euthanasia, Christians who support some form of euthanasia may be led to believe falsely that they have fallen into doctrinal heresy.”

Prof Dutney discusses theological responses to euthanasia from a variety of Christian scholars. He concludes the chapter by stating:

“The belief that Christians and churches are united and unambiguous in their opposition to voluntary euthanasia is false.  There is in fact strong support for voluntary euthanasia among both nominal and active church members.  There are also numerous Christian thinkers and theologians who have set about to show that the holding of Christian faith and doctrine is consistent with supporting voluntary euthanasia.”

Along with the work of other theologians, Prof Dutney cites research of former UC minister Kenneth Ralph. His 2015 book Your Final Choice – Hastening Your Death When Terminally Ill suggests that euthanasia is compatible with Christian principles. 

Mr Ralph spoke to Crosslight about how his faith developed over time and he began to question the doctrines and beliefs he had been taught.

“Originally I was very much against IVF and abortion because I had been trained in the traditional scholastic Presbyterian reformed tradition in NZ,” he said.

Mr Ralph said his support for euthanasia developed when he was a young minister faced with the reality of watching people die in terrible pain.

“In my first parish a lady died in excruciating agony with stomach cancer. I thought ‘There’s something dodgy about this, watching this lady die in agony’,” he said.

“She was very stoic though, she believed that Jesus was alive and was present to her, so she suffered through it.

“Her husband remarried. Two years later, his wife was diagnosed with the same cancer and she went badly, was screaming and yelling and really suffering.

“I began to think that earlier view I had was, too rigorous, lacking in compassion and not respectful enough for individual people making their own judgement.”

Mr Ralph believes the church has a role in reassuring people of faith who are struggling with end-of life decisions.

“For an older person in their 80s, and more traditional in their faith, to go through the questioning that I went through as a younger man would be very confronting for them,” he said.

“I would say to such people ‘don’t take too much notice of what the hierarchy tell you’. The ordained, professionally-paid professors are very much bound to the traditions and the creeds of the church with its conventional view of a very loud ‘No’.

“I would question if they are the only people who speak for Christianity. I would introduce them to about 10 or 15 wonderful people who are professors of religion who are writing wonderful books about this subject.”

Mr Ralph feels there are two main benefits to dying with dignity legislation.

The first is that it will bring peace of mind. People who feel they have no control over their lives will have options, even if they choose not to take them.

The other is that it acknowledges the fact that throughout Australia, pain relief is already being used as a method to speed up death. He believes the legislation will return autonomy for such decisions to the patient and remove it from the doctors or family members.

Mr Ralph acknowledges the concerns of those opposed to assisted dying. However, he contends those who speak of a ‘slippery-slope’ or persuading elderly relatives to end their life early for convenience are not examining the evidence in places where voluntary euthanasia is legal.

“To me that smacks of paternalism and treating people as if they don’t have the capacity to think things through for themselves,” he said.

“You decide who you will marry, when to have babies, where to plant your tomatoes. You have done all that, so don’t be a limp lettuce leaf at the end of your life.”

Although the Vic/Tas synod will not make a submission to the Victorian parliament, the church recognises the issue is important for its members. Director of the Justice and International Mission unit, Dr Mark Zirnsak, said the unit will hold a series of discussions throughout the synod to discern the views of members.

“The churches are united in support of better support for people through measures like palliative care, it is in the area of assisted dying/suicide there will be significant controversy,” Dr Zirnsak said.

“The discussion paper released by the unit will contain a variety of theological reflections on assisted dying/suicide.

“It will also examine the experience of places around the world that already allow for such a measure. We are keen to get as much feedback as possible from church members on this issue to establish where discernment on this issue has led member’s views.”

To obtain a copy of the discussion paper email: jim@victas.uca.org.au

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