MY RESPONSES TO THE SOUTH AUSTRALIA VOLUNTARY EUTHANASIA BILL 2006
An
Open Letter to the Authors of the bill from James Park,
advocate
of more and better safeguards for life-ending decisions.
In general the bill seems too long.
Busy health-care professionals will not have the patience
to read thru all this legal language.
So they will leave it to lawyers to sort out later if needed.
And (more likely), they will avoid the explicit requirements of this
bill
and go ahead with their own practices,
reassured that what they are doing would have been approved
if they had taken the trouble to do all that (unnecessary) paperwork.
Because there is so much bureaucracy involved in
such life-ending decisions,
the pattern observed in the US state of Oregon
might be even worse in South Australia,
namely that fewer than 1 death in 1,000 uses the provisions of this
bill.
Patients, proxies, & doctors making life-ending decisions
will probably be aware (at least in a vague way)
of the requirements of this bill if it becomes law,
which might result in fulfilling some of the safeguards informally,
even if everyone involved agrees not to apply formally
for approval for voluntary euthanasia.
Nothing in this bill seems to
make it more likely to be used
than the Oregon Death with
Dignity Act.
And since most of the safeguards do not address
how to make medical decisions at the bedside
and who should be asked to evaluate life-ending decisions,
they will seem largely irrelevant to the crisis of one life coming to
an end.
The most useful safeguards will provide operational ways
to separate wise life-ending
decisions from foolish
life-ending decisions.
Preoccupation with requests for death from the patient
properly witnessed, recorded, reported, & not revoked
does little to discourage irrational suicide and other forms of
premature death.
If there are premature deaths now taking place in South Australia,
how much difference will this bill make if it becomes law?
In my view, there is too much preoccupation with
paperwork
and recording requests and revocations of requests.
The explicit penalties are
all for paperwork violations.
The penalties should rather be directed
at what we want to prevent: premature
death.
I realize that paperwork violations could result in premature death,
but the focus should be on the
actual harm to patients
rather than not having the paperwork in correct order.
The bill tells us at the beginning that safeguards
are included.
And I have identified several of these safeguards embedded in the text:
http://www.tc.umn.edu/~parkx032/SG-SA-VE.html
And there is a list of these safeguards here:
http://www.tc.umn.edu/~parkx032/SG-LAWS.html
If there are other safeguards that I have not made
explicit,
perhaps they should be drawn to my attention
so that I can highlight them and describe how such safeguards
prevent irrational suicide and other forms of premature death,
as I have done with all of the safeguards I have identified so far.
In general (in my view), it would be better
to gather all of the
safeguards into one place
in any bill that permits life-ending decisions.
This will facilitate discussion of the value and efficacy of each
safeguard.
And it will make it much easier to make a list of the safeguards
—and
then to see which ones have been fulfilled.
Also (in my view) each safeguard should be described
somewhat more fully than found in this and other similar bills.
Opponents will focus on the lack of safeguards.
So we need to explain our
safeguards as completely as possible
within a piece of legislation.
Patient
autonomy seems to be the reason
for focusing so much on requests for death from the patient.
But just because a patient
repeatedly asks for death
does not mean that death
would be the wisest course for that patient.
Sometimes patients (like anyone else) can have suicidal urges.
And the safeguard of requiring repeated requests
is one way to
discourage irrational suicide.
But I believe there ought to be other safeguards in place
that have the real possibility of preventing irrational suicides.
Here is a listing of over 30 possible safeguards:
http://www.tc.umn.edu/~parkx032/SG-CAT.html
See if there might be some additional safeguards here
that you would like to add to your bill.
At the beginning of the bill,
it is announced that there will be a limited number of patients
who will choose voluntary euthanasia under this bill if it becomes law.
But there is no place inside the language of the bill
that shows how this number of patients who use it will be limited.
In my view, this would be as foolish as deciding ahead of time
that only a certain number of abortions
would be permitted in a certain jurisdiction in a certain year.
What happens when the next patient
wants to have an abortion or a voluntary death
and the Registrar says that the quota for that year is already full?
One note that seemed off to me
is including the withdrawal
of life-supports in this bill for voluntary
euthanasia.
The practice of ending all life-support measures
is now well established in medical practice
in every part of the developed world.
Why include withdrawing life-supports in a law on voluntary euthanasia?
Doctors who are planning (with the approval of patients and/or their
proxies)
to discontinue any form of medical treatment or life-support
are going to do so following only the safeguards now in place
in the hospital where the patient is being is being treated
or being maintained on life-support.
The doctor will not take
additional time to apply for voluntary
euthanasia.
Only if the doctor feels compelled
to apply for voluntary euthanasia for other reasons
would your bill provide the most appropriate pathway towards death.
In short, if they are going to 'pull the plug',
they do not need to apply for voluntary euthanasia.
Now a tiny technical matter:
Somewhere in the middle of the bill---10 (3)---
a mysterious Board
appears and then disappears.
This Board should either be defined or dropped.
Perhaps you mean Registrar.
This seems most likely since this section is about the Registrar.
Or (less likely) it refers to the Monitoring Committee described at the
end.
If you make this or any other changes,
please let me know,
so I can change the text as presented on the Safeguards Website:
http://www.tc.umn.edu/~parkx032/SG-SA-VE.html
Probably the next version of this bill will be in some later year,
showing improvements from the 2006 bill posted here.
Thus there should be a change of date in the title
if there are any changes in the text.
Finally, there will be objections to this bill
because of its name:
Voluntary Euthanasia.
Even tho the right-to-die movement has a long history
of using the expression "euthanasia"
and various modifications of it, such as "voluntary euthanasia",
this expression has been so distorted by those opposed to voluntary
death
that it might be better if the bill had a different name.
For further discussion of this question, see:
"euthanasia"—"gentle
death":
http://www.tc.umn.edu/~parkx032/C&C-EUTH.html.
At least giving it a different name
will arouse curiosity about what practice is being authorized.
For example, exactly what is a "voluntary death"?
Some people are automatically against anything called "euthanasia".
Yours,
James Park, advocate for the right-to-die
living and writing in Minneapolis, Minnesota, USA.
Created January 31,
2007; revised April 7, 2007; 5-13-2010
Go to
the beginning of this website
James
Leonard Park—Free
Library