Melbourne bioethicist Dr Nicholas Tonti-Filippini is dying and in severe pain, but has declared his unwavering opposition to legalising euthanasia. Here is a short extract from an open letter he wrote to South Australian Premier Mike Rann on the eve of SA’s recent parliamentary vote on euthanasia.
Dear Mr Premier,
Re: Voluntary Euthanasia Bill 2010
I write this letter to you in my own name only and not in the name of my institute, of any government committees in which I am involved, or of any organisation.
Relevant to this matter is the fact that I am dealing with my own terminal illness (combination of renal failure, advanced ischaemic heart disease and rheumatoid auto-immune disease) and am dependent on haemodialysis and palliative care.
I have undergone 15 angioplasty procedures and the placement of eight stents to attempt to recover some blood flow after the failure of coronary bypass surgery. The last such procedure was unsuccessful as the blocked artery could not be accessed. The rheumatoid disease causes chronic pleuropericarditis.
I mention these matters only to establish that I am no stranger to suffering and disability, and am well aware of the limitations of palliative care. It is particularly difficult to control chronic pain because the effectiveness of most forms of pain relief is of limited duration, given the development of therapeutic tolerance. I have reached the limits of what palliative care can offer.
I cannot speak for all people who suffer from illness and disability, but think I can speak more credibly about suffering, illness and disability than those people who advocate for euthanasia presenting an ideological view of suffering and disability. Facing illness and disability takes courage and we do not need those euthanasia advocates to tell us that we are so lacking dignity and have such a poor quality of life that our lives are not worth living.
I would like to record my own view that it would not benefit seriously ill South Australians, particularly those who are terminally ill and suffering intractably, if the Voluntary Euthanasia Bill became law.
The current legal situation in South Australia, while not perfect, does provide a measure of protection against the terminally ill being regarded as a burden.
As a chronically ill person, I know well what it is to feel that one is a burden to others, to both family and community, how isolating illness and disability can be, and how difficult it is to maintain hope in the circumstances of illness, disability and severe pain, especially chronic pain.
For several years, until I objected, I received from my health insurer a letter that tells me how much it costs the fund to maintain my health care. I dreaded receiving that letter and the psychological reasoning that would seem to have motivated it. Each year I was reminded how much of a burden I am to my community.
The fear of being a burden is a major risk to the survival of those who are chronically ill. If euthanasia were lawful, that sense of burden would be greatly increased for there would be even greater moral pressure to relinquish one’s hold on a burdensome life. Seriously ill people do not need euthanasia. We need better provision of palliative care services aimed at managing symptoms and maximising function, especially as we approach death.
The proposal to make provision for a terminally person who is suffering to request, and a doctor to provide, assistance to die makes it less likely that adequate efforts will be made to make better provision for palliative care services. Legalised euthanasia would give those responsible for funding and providing palliative care a political “out” in that respect.
In Australia, too little is done to make adequate palliative care available to those who need it. Few doctors are adequately trained to provide palliative care. Most pain clinics are over subscribed and have long waiting lists. For people who are left suffering, such waiting is unconscionable.
Euthanasia requests cannot be taken at face value but require in-depth exploration of their covert meaning, in order to ensure that the patients’ needs are being addressed adequately. In Australia, what is needed is often not available or not available in time.
If euthanasia is lawful then the question about whether our lives are overly burdensome will be in not only our minds, but the minds of those health professionals and those family members on whose support and encouragement we depend. The mere existence of the option will affect attitudes to our care, and hence our own willingness to continue.
Nicholas Tonti-Filippini, PhD, is a senior lecturer and associate professor at Melbourne’s John Paul II Institute for Marriage and Family. He has been involved with the care of the terminally ill for many years, having been Australia’s first hospital ethicist, 28 years ago, at Melbourne’s St Vincent’s Hospital, where he was also Director of Bioethics for eight years. The full version of the above open letter is available at Melbourne Herald Sun columnist Andrew Bolt’s blog: