OPINION | Assisted death may be appropriate end

I have worked as a doctor since 1978 and as paediatrician in Macarthur since 1984. I have seen many children and babies with highly complex and distressing illnesses.

As medical practitioners, we must relieve pain and suffering and this sometimes means stopping treatments that whilst prolonging life cause ongoing pain and distress.

This includes, for example, ceasing assisted ventilation in someone with severe neurological damage (as was seen recently in Great Britain with baby Charlie Gard).

However, the issue of voluntary euthanasia, where a person requests deliberate intervention to end their own life, is a complex area that requires considerable community debate, and one in which I have gradually changed my view over time.

In Australia, a boy born in 2015 can expect to live over 80 years and a girl over 84 years, compared to 47 years and 51 years respectively in 1890. Australia is now one of the top 10 countries for life expectancy in the world.

However, with the rise in life expectancy there has been a concomitant rise in people entering older age with chronic illness requiring ongoing medical intervention.

This includes chronic neurological disorders, cardiovascular disease, renal failure, chronic respiratory disease and degenerative disorders.

Some of us will be caring for our elderly relatives in advanced older age and will sometimes be faced with situations where people close to us will ask that their pain and suffering be ended.

Some, but not all, prominent people in this public debate seem to focus on what seems to me to be simplistic arguments. These are complex situations and require a great deal of community discussion, before we decide upon an appropriate legislative response.

As a paediatrician, I have been faced with situations where treatment to relieve suffering, or withdrawal of treatment, may shorten a child’s life and this is something that palliative care health workers face every day in adult medicine. However, the idea of dealing with a rational person who requests that their own life be ended, I find quite confronting.

Perhaps naively I believed that suffering could be managed by palliative means and that people could be kept comfortable through the end of their lives without suffering.

I now know through personal experience and with discussions with my medical friends, that this is not always the case.

Yes, we do need better access to holistic palliative care services but there does remain a number of people with chronic illness whose pain and suffering is very difficult to treat. For example, neurological disorders such as motor neuron disease, disseminated malignancy, and intractable heart failure.

The definition of what is intractable suffering can of course vary from patient to patient and from doctor to doctor.

Some people can have extreme pressure put on them by relatives anxious to benefit. Many older people can have treatable causes of depression which may impair their decision making ability.

It is now however clear to me that there are circumstances in which voluntary euthanasia is appropriate and I do believe that an appropriate legislative course is warranted, but we must put in place appropriate safeguards such as:

  1. Death within 12 months in inevitable
  1. More than one doctor should be involved in the decision
  1. There should be legal oversight by an independent legal official
  1. The family should be able to appeal the decision
  1.  No one involved in making the decision should benefit by the decision
  1. Age over 18 years

I am confident that adequate safeguards can be found, but we do need to have community acceptance before we move forward.

The above is my personal view and one that I have come to over a long period of time, through personal experience and discussions with my medical friends.

I realise that not everyone will agree with what I have written and I am happy to discuss this further, but clearly it is time that this discussion is open and we act upon community concerns.

I would be happy to discuss this with any of my constituents and others.

- Federal MP for Macarthur and paediatrician Dr Michael Freelander

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