There was a moment of great significance during the euthanasia debate a decade ago that should be brought to the attention of today's legislators. A moment that crystallised the concerns of many that the so-called 'right to die' would come to be felt by the most vulnerable in our community as a 'duty to die.'
The year was 1995, in the midst of the debate over the impending Northern Territory legislation to permit doctors to give lethal injections to terminally ill patients. Our Head of State at the time, Governor-General Bill Hayden, was addressing the Royal Australian College of Physicians about why he supported euthanasia.
It was a scene rich in symbolism. The two key concerns about legalising euthanasia are what it would mean for the relationship between the State and its most vulnerable citizens, and what it would mean for the relationship between doctors and their most vulnerable patients. Here we had a person speaking in his capacity as Head of State advocating euthanasia as a positive duty of citizens once they had passed their usefulness to society; here we had the heirs of Hippocrates, whose Oath forbids them to give lethal poison to a patient, being asked to become society's killers as well as its healers.
The main significance of this address by the Governor-General was his suggestion that voluntary euthanasia is not merely a matter of choice but, more nobly, a positive obligation to society.
Mr. Hayden reminded us of past cultures where the elderly would take poison or wander off into the forests when their usefulness to society was done. He made the connection to our own elderly who, after "a full and satisfying lifetime" can become "unproductive burdens." He then made the portentous declaration that: "there is a point when the succeeding generations deserve to be disencumbered-to coin a clumsy word - of some unproductive burdens."1
Within a day this newly articulated duty of the burdensome to do the right thing by society was given extra gravitas by another ex-Governor, the late Sir Mark Oliphant. Speaking on ABC Radio he praised Mr. Hayden's views, and referred to an aged colleague in Canberra who "should be dead," who is a burden to his family but "likes being looked after." When the interviewer laughed and said "that's his right too," the blank response was that it was not, and that he was cluttering up the world when he shouldn't be.2
These were the sentiments, not of neo-Nazis snarling about "useless eaters," but of thoughtful citizens, respected Governors, shapers of social attitudes. They were seriously proposing that we develop a culture, like those described by Mr. Hayden, where "unproductive burdens" will act for the greater good of society.
Certainly, for a proud stoic like Hayden, the convenience of medically assisted suicide would enlarge his sense of choice and self-determination. But given the psychological vulnerability of the average sick old person, their low self-esteem, the sense they already have of being "unproductive burdens," and the power of insensitive family or medical staff to reinforce this sense, such a decision will be made from a position of humiliation and weakness.
We must have no illusions about the sort of pressures that can be brought to bear on frail people. One patient of mine, a woman with depression and minimal selfconfidence, received a vicious letter from a close relative effectively telling her she was a no-hoper who should be dead, and demanding certain arrangements in her Will. She now has cancer. What are the family dynamics that would feed into this patient's "right to die," given her position of humiliation and weakness?
A similar example of corrupted family relationships is reported from Holland by an Oxford palliative care specialist:
An old man was dying from disseminated lung cancer. His symptoms were well controlled and he asked if he could go and die at home. When his four …