'A right to die will become a duty to die'

Laws to enable assisted dying are closer than ever, however, many doctors are strongly opposed to the move. Australian Doctor speaks with Adelaide neurologist and euthanasia critic Dr Tim Kleinig (pictured).

Australian Doctor: Can palliative care alleviate all suffering?

Dr Kleinig: I accept that palliative care cannot completely alleviate all suffering, just as doctors cannot completely alleviate all suffering for many of our patients with all sorts of physical and psychological illness, most of which are non-terminal.

But as doctors, our responsibility and response is, and always has been, ‘to cure sometimes, treat often and comfort always’.

For the ‘hard cases’ of severe, intractable pain or dyspnoea at the end of life, palliative sedation titrated to response is an entirely ethical and appropriate intervention.

Related News: The case for assisted dying - is palliative care failing?

AD: Do you think the proposed assisted dying laws would affect only a few patients?

Dr Kleinig: At first, yes, I agree.

But one need only to look at what has happened over time overseas, especially in the Netherlands and Belgium, to observe that once killing is allowed as an ethically acceptable response to suffering, wide extension cannot be logically opposed.

In the Netherlands, one in five doctors would personally consider euthanising an elderly patient not suffering other than being tired of life. One in 50 have actually done so.

This I find personally horrific and a debasement of medical practice.

AD: Doctors who have actively hastened death have been legally protected by the principle of double effect, where alleviating one symptom, such as pain, might also result in another effect, such as death.

Do you think the double effect is in reality a version of assisted dying?

Dr Kleinig: The double effect principle is absolutely not a version of assisted dying.

One in 100 patients I treat with thrombolysis for ischaemic stroke die who would not otherwise die, or die sooner than they would otherwise. But this is not euthanasia.

AD: Why not?

Dr Kleinig: Intention is the key to interpreting the action.

Many medical procedures and treatments may incidentally hasten death in individual patients — like fractured hip surgery in the frail elderly. But death is incidental, not intended.

AD: What is your greatest fear about the assisted dying laws?

Dr Kleinig: If euthanasia legislation is allowed, we cannot rationally or logically oppose expansion over time to any individual who deems death preferable to life, or whose proxy decision-maker deems death for the patient is preferable to life.

Our ability to confront and treat suicidality in mental illness will be diminished, and the sad reality of elder abuse will take on a dangerous new face.

AD: What do you mean?

Dr Kleinig: Disabled children, cancer patients, the frail elderly and demented consume a vast portion of our growing medical budget.

The temptation to society will be too great to avoid consciously or unconsciously exerting pressure, and a right to die will become a duty to die.

AD: What rights do you think patients should have on how they die?

Dr Kleinig: All patients have the right to decline life-sustaining medical treatment, including parenteral hydration and nutrition.

I am very active in promoting the widespread adoption of advanced care directives and the avoidance of futile or unwanted medical care.

We need as a society to promote ‘death talk’, so that all people have their wishes about levels of care in various medical scenarios documented.