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“ … If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.” 

These are the words of Greek physician, Hippocrates, written as a pledge for safe and compassionate practice. The Hippocratic oath was a reminder to physicians of their duty of care to the lives they cradle in their hands.

The polarizing issue of legalizing assisted dying is now being faced in Western Australia. On 4 September, the Voluntary Assisted Dying (VAD) Law passed through our lower house with a vote of 44 in favor and 12 against the legislation; the bill would allow adults with a terminal illness to choose whether to end their life. A 20-hour debate followed days later to discuss clauses in the bill; the longest held in state parliament since the 1990s. The bill is currently sitting with the Upper House for debate.

Jo Sternberg, is a Western Australian who has experienced first-hand the deterioration of her father. She said that her experiences with her father’s death influenced her support for the euthanasia bill.

“He just gave up on life, he just decided that this was not how he wanted to live.”

Mrs. Sternberg said her father would beg her to ‘put a pillow over my face’, and that if he still lived in Holland he would be able to access the euthanasia laws to end his pain. Now Jo assists Dying with Dignity, a lobby group in favor of voluntary Euthanasia.

Euthanasia is legislated at a state level and only one state, Victoria, has legalized the practice. The bill passed in the Senate by a single vote. Prior to this, Western Australians that wanted to access voluntary assisted dying would have to go overseas to a country that has legalized the practice. A 61-year-old terminal cancer patient died August this year using the new VAD laws in Victoria. According to the Guardian, it is expected that up to 150 people will use this scheme.

Featured: Full interview with Jo Sternberg

A Doctor’s Choice?

The Australian Medical Association is the professional body for doctors and medical students, which stands in opposition to the bill and maintains “that doctors should not be involved in interventions that have as their primary intention the ending of a person’s life.”

Currently, physicians tat assist a terminally ill patient with end of life treatment in Western Australia are criminally liable. Under the terms of the proposed act, patients wishing to undergo voluntary assisted dying, will have to get two written permissions and evaluations from a doctor. Dr Richard Lugg, the Deputy WA convener for Doctors for Assisted Dying Choice, said the whole philosophical underpinning of the voluntary assisted dying legislation revolves around patient autonomy.  The AMA has formally adopted the World Medical Association Code of Ethics which prioritizes the autonomy of patients. Dr Lugg said that the AMA’s position against VAD is in direct contradiction to this code.

“19 out of 20 people will get their suffering properly managed under palliative care processes, but we estimate that [for] a small group, around 5 per cent of those in palliative care, that it does not provide enough in terms of stopping suffering,” said Dr Lugg.

Dr. Lugg believes this bill provides the public with an additional choice at the end of life, which most people will never need, but which others will suffer without.

The Doctor-Patient Relationship

Health literacy, defined by the Australian Institute of Health and Welfare, is a person’s ability to understand, find and use health information to help them when navigating the health system. The AIHW reports that low individual health literacy can implicate worse health outcomes for patients. Growing concerns about the unequal balance of power in doctor and patient relationships has been a criticism against the bill.

AMA’s president, Andrew Miller, has warned the public of commercial euthanasia clinics that would profit off this new industry of death, and patients who are vulnerable and could be pressured by family and doctors. Labor MP Tony Buti writes similar concerns in an op-ed in the West Australian:

“…the Bill does not prohibit a medical practitioner from initiating discussion on voluntary assisted dying. People are influenced by what their doctor says and the power in-balance between a doctor and patient, particularly one with a terminal illness, can be great.”

Lugg said in response, that when you study the health literacy of Australian people, there are a lot of people that feel an imbalance in their relationship with their doctor and feel hesitant to talk about options for end of life.

“A lot of people feel that they need some sort of permission from the doctor’s to even raise the subject.”

Lugg said the unwritten conspiracy, in which the doctor won’t talk about euthanasia treatment, leads the patient to feel like they can’t raise it. This is just not fair; patients need to feel free to raise this subject.

The bill is currently with the Upper House for debate and if it passes, WA will be the second state in the country to legalize voluntary assisted dying.