Referendums: one chance to choose

AWhat [ palliation] can’t control is the patient’s own perception of their quality of life.

Oncologist Cameron McLaren

referendum is a big decision. Unlike electing a government, it is not a decision you get to make again in three years. When a question is put to a referendum it is unlikely ever to be asked again. The die is cast, the direction set.

We have two referendums with this election, one that matters, to my mind and one that does not. Let me concentrate on the important one.

A few years ago I mentioned to a long- time Herald columnist, the late Gordon McLauchlan, that I was thinking of writing on the end of life choice and he made only one comment. He said, “Anyone who thinks euthanasia is a simple question is very foolish.”

A lot of people seem to think it is a simple question, a simple issue of individual rights. If someone wants to die at a time of their own choosing, they say, it is simply nobody else’s business. Their death would not harm others, so why should we deny them the right?

There are several reasons, here is the one that most worries me.

Imagine you have become a “burden” to other people, either because you are very old, very ill or permanently disabled. You don’t want to be a burden, nobody does. You hate having to rely on another person for your most intimate bodily care and you know how unpleasant it must be for the person giving you that care.

But you don’t want to die. You always thought when you were younger that if you were ever in this wretched position you would want to die but now that it’s real, you really don’t. Limited as your life has become, you are alive. You wake each day to see the sun and feel lucky to be still alive.

Then the good person who looks after you arrives and you’ve got to go through those indignities again. As you endure them, you have one shred of dignity left and it is this: you can’t help being in this position, there is nothing you can do about it.

That is what would change.

If we vote “yes” in this referendum, we will establish the principle that there is something people can do about it when they become a heavy burden to others. They would have an end- of- life choice.

And when they consider how unpleasant caring for them must be, how many would make that choice not because they really want to die but because they think they ought to? We will never know but I think the number would exceed those who made a truly free choice.

Parliament put a severe restriction on the euthanasia proposed in this referendum. It is to be available only to the terminally ill, defined as likely to die within six months. But that makes no sense. If death by choice is a human right, there is no logic in restricting to people who are soon to die anyway. They have the least need of it. What about people who are enduring “unbearable suffering” at any stage of life?

You may think the End of Life Choice Act is just a foot in the door for an idea that would soon be applied more widely — and you would be right. If the act receives overwhelming support at this referendum, politicians will be encouraged to broaden its reach.

That might not even require legislation. Doctors can interpret restrictions very generously — as they did with the restrictions when abortion was legalised — and courts will generally back doctors who are carrying out a patient’s wish.

This really is a fateful decision. The way to make good decisions is to assess the risks and benefits of what is proposed. The benefit of euthanasia is to release people from agony or, more often the fear of it, especially at death. Is that fear well- founded?

The Weekend Herald reported last Saturday that Victoria, where euthanasia was legalised last year, has had more requests for euthanasia than it can handle, with the oncologists ( just 28 out of 265 in the state) offering to do it. One of them, Cameron McLaren, said the main reason people requested death was “actually not to do with physical pain or symptoms because they are really well controlled with palliative care.

“But what [ palliation] can’t control,” he said, “is the patient’s own perception of their quality of life.” Perception.

Of the 231 people given the goahead in Victoria, only 124 had gone through with it. Many who want the choice do not, when it comes to the point, want to die. Is their choice worth the risks?

If you vote yes, do not delude yourself you will do no harm. You will profoundly change society’s attitudes to dignity in care, to life and death.