The Response of Health Care Workers to AIDS Patients' Requests for Euthanasia

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In 1995, the Parliament of the Northern Territory enacted the Rights of the Terminally Ill Act 1995 (NT). This legislation attracted worldwide attention as the first statute to actually come into operation authorising the consensual `killing' of a terminally ill patient. Between June 1996 (when the Act came into operation) and March 1997 (when Commonwealth legislation overturning the Northern Territory legislation passed through the Senate),(1) four patients died in accordance with the protocol outlined in the Act, using a computer-controlled lethal injection device advocated by a Darwin general practitioner, Phillip Nitschke.(2) In the years leading up to these dates, there was intense debate over the wisdom of legalising euthanasia in Australia and elsewhere.

A frequent comment made by opponents of voluntary active euthanasia, in the media and literature, was that the push for a legalised `right-to-die' with medical assistance is a `radical' movement, which carries alarming implications for society. John Keown, a leading English critic of Dutch euthanasia policy, points to the `slippery slope' effect (Burgess 1993: 169) which focuses upon the unintended consequences of legalising voluntary euthanasia, arguing: `non-voluntary euthanasia is now widely practised and increasingly condoned in the Netherlands. For inhabitants of such a flat country, the Dutch have proved remarkably fast skiers' (Keown 1995: 289).

B.A. Santamaria (1995: 28), a well-known Australian commentator, argues along a similar vein that `the collapse in the birthrate in all Western societies' is creating `pressure to change the law to legalise the killing of those whose lives seem no longer to have any meaning, and who would otherwise occupy precious hospital beds'. Pollard and Winton, while acknowledging the limitations of palliative care in controlling emotional anguish which is unrelated to pain, nevertheless assert that `[if] a law were to allow the subjective concept of emotional distress as grounds for killing, it would be open to inevitable, uncontrollable, and probably undetectable abuse'. `Killing the failures of medical or social care would be negative', they add, `in that it would not contribute to finding solutions to their problems' (Pollard and Winton 1993: 427, 428). A shared characteristic of each of these arguments is the view that the legalisation of euthanasia is an alarming, extreme or unreasonable solution to the problem of terminal disease and incapacitating injury. Maintaining the status quo, with its prohibition of euthanasia, is the conservative, historically proven, humane solution, whereas legalising euthanasia is a radical option, which invites disaster. In this paper we draw on interview data with `doers' of euthanasia to challenge these assumptions. Our argument is that while the opponents of legalised euthanasia have a legitimate concern about `what might happen' if euthanasia were legalised, they tend to ignore the reality of current euthanasia practices (except to call for the prosecution of doctors who admit to performing euthanasia, e.g. Buchanan 1995a: 1; Santamaria 1995: 28).

Euthanasia presents an important and difficult policy dilemma. In our view, this dilemma involves balancing the potential harm which would be caused by the devaluing of life, and by the potential abuse of vulnerable and ill patients in an environment where voluntary euthanasia could legally be practised in accordance with defined procedures (as it could for a period of time in the Northern Territory), against the current abuses and indignities resulting from unrelieved suffering (the absence of euthanasia), and `backyard euthanasia'. Survey studies (discussed below) suggest a remarkably high level of doctor involvement in euthanasia. However, there has been little research that traces out in more detail the forms which involvement takes and the accompanying attitudes of `doers' of euthanasia. While some studies have included interview components (e. …