Professor Mark Yates has written for The Courier on multiple occasions on how the assisted dying laws will change practices in medical care for the sick and elderly. Here the leading geriatrician expresses his concern on the new law.
On June 19, Victoria became the only jurisdiction in Australia to legalise euthanasia by enacting the voluntary assisted dying legislation.
This legislation will enable doctors, at the request of a patient who meets the legislative requirements, to inject their patient with a combination of drugs that have the sole purpose of ending their life.
The fact that this will be a rare occurrence is irrelevant to the majority of the medical profession. The issue is that the role of the doctor is fundamentally changed by this legislation, from treatment to protect life and relieve suffering to now include intentionally causing the death of a patient.
This legislation is not only a paradigm shift in medical care. All patients will now have the opportunity in the last six months of their life to choose to die. With that choice comes the need to weigh up options based on the implications of that choice for self, those you care for or who care for you. No longer is "living" a given in Victoria if you have a terminal illness. You have a choice and if you perceive yourself to be a burden on others this will now have to be included in how you weigh up your options.
As a geriatrician who cares for frail older people, I know many who perceive they are a burden to society or their family. I am saddened by the additional burden they must now carry. The burden of choosing to continue with life or to have it terminated. Sadly, knowing both the best and worst of human nature and that 10 to 15 per cent of elderly people experience abuse, I now also fear for the risks some will be exposed to as a result of this new legislation.
This legislation not only exposes the elderly to risk - there are risks for families and doctors as well. The legislation cannot safeguard families from medical error because case review is always after the death with a seven-day window before the necessary paperwork is required to be submitted - long after cremation in many cases.
Also, what happens in homes stays in homes and while coercion carries significant penalties in divided families, true coercion will be difficult to prove and accusation of coercion could be weaponised.
For doctors there is plenty of room for challenge and risk of accusation of unprofessional behaviour or worse, whether a doctor declines or accepts to head down the voluntary assisted dying pathway. The blanket protection included for doctors once the person is dead does not protect them from accusations of errors in process. Predicting prognosis, assessing capacity and the self-definition of "expert in the field" are all open to interpretation and challengeable.
Mostly I am saddened by legislation that weakens the fabric of our society and puts the frail elderly at risk.
Victoria, like NSW, the UK House of Commons and the Australian and American Medical Associations could have rejected voluntary assisted dying. It sadly did not and so should reconsider its position as a matter of urgency.
Mark Yates is an associate professor at Deakin University, Ballarat.
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