- Shah N, Warner J, Blizard B, King M. National survey of United Kingdom psychiatrists' attitudes to euthanasia. Lancet 1998; 352: 1360.
- Emanuel E, Daniels ER, Fairclough DL, Clarridge BR. The practice of euthanasia and physician-assisted suicide in the United States: adherence to proposed safeguards and effects on physicians. JAMA 1998; 280: 507–13.
- Admiraal PV. A physician's responsibility to help a patient die. In: Misbin RI, editor. Euthanasia: The Good of the Patient, The Good of Society. Frederick Md: University Publishing Group, 1992; Borst-Eilders E. Euthanasia in The Netherlands, brief historical review and present situation. In: Misbin RI, editor. Euthanasia: The Good of the Patient, The Good of Society. Frederick Md: University Publishing Group, 1992; Quoted by Herbert Hendin in: Euthanasia consultants or faciliators? Med J Aust 1999; 170: 351–2.
- Maddocks I. Changing concepts of palliative care. Med J Aust 1990;152: 535–9; Saunders C. What's in a name? Palliat Med 1987; 1: 57–61; Angarola RT, Joranson DE. Pain and euthanasia: the need for alternatives. Bull Amer Pain Soc 1992; 2(2): 10,17.
- For example, local chemotherapy is carried out to control pain and weakness caused by bone cancer, endobronchial laser treatment is employed to relieve tumour obstruction of a major bronchus (Maddocks I. Changing concepts of palliative care. Med J Aust 1990; 152: 536).
- When discussing palliative care, reference is often made to cancer pain. This is because pain and suffering associated with progressing cancer include distressing alterations in body image, anxiety, depression and despair. Palliative care, however, is much wider in scope; it includes relief of pain as an aspect of clinical management aimed at curing or halting progress of a disease, as well as discomfort of people in an advanced stage of a motor-neurone disease.
- Mashford ML, Andreoli T, Cosolo W, Day, et al. Therapeutic Guidelines: Analgesic. 3rd edition. Victoria: The Victorian Medical Postgraduate Foundation, 1997: 134.
- Wilson WC, Smedira NG, Fink C, et al. Ordering and administration of sedatives and analgesics during the withholding and withdrawal of life-support from clinically-ill patients. J Amer Med Assoc 1992; 267: 949–53. In this study, patients who were given large doses of opioids by way of palliation following the withdrawal of life-supports lived on average as long as patients who were not so treated. The study suggests that the determining factor of the time of death is the underlying disease, rather than opioid medication.
- Buchan ML, Tolle SW. Pain relief for dying persons: dealing with physicians' fears and concerns. J Clin Ethics 1995; 6: 53–61.
- It is therefore unfortunate that studies continue to indicate that some 40% of dying patients do not get adequate pain medication, because their physicians fear that they would hasten the patient's death through overdose: Buchan and Tolle (J Clin Ethics 1995; 6: 53–61); Solomon (Am J Public Health 1993; 83: 14–23); Von Roenn et al., (Ann Int Med 1993; 119: 121–6); and Cleeland el al., (N Engl J Med 1994; 330: 592–6).
- The issue of terminal sedation is controversial because, although sedation does not kill, death is clearly expected. At the same time, it is uncertain whether heavy sedation relieves pain or merely makes the patient unable to express it.
- The phrase “life-saving treatment” refers to therapies such as antibiotics, blood transfusions, organ transplants, cardiopulmonary resuscitation, designed to cure or stabilise a life-threatening but potentially reversible medical condition. Therapies undertaken from time to time to arrest or stabilise symptoms of incurable chronic conditions (for example, treatment administered to persons suffering from diabetes, chronic renal failure, chronic hepatitis or chronic lymphatic leukemia), also constitute a category of life-saving treatment.
- The term “life-sustaining treatment” refers to constant, rather than intermittent, applications of such medical devices as mechanical ventilators, catheters, or feeding tubes, to keep alive patients whose life cannot be sustained without them.
- Secretary, Department of Health & Community Services (NT) v JWB and SMB (Marion's case) (1992) 175 CLR.
- Medical Treatment Act 1988 (Vic) incorporating Medical Treatment (Enduring Power of Attorney) Act 1990 (No 7) Victoria as amended by Medical Treatment (Agents) Act (No 26) 1992, sec 5.
- Consent to Medical Treatment and Palliative Care Act 1995 (SA) allows persons aged 16 to decide whether or not to undergo medical treatment (sec 6); and persons aged 18 to make anticipatory decisions in case of incompetency about medical treatment related to the terminal phase of a terminal illness, or a persistent vegetative state (sec 7).
- Natural Death Act 1988 (NT), sec 4 allows adult “terminally ill” patients to refuse undertaking or continuing of “extraordinary measures” that prolong life.
- Medical Treatment Act 1994 (ACT), sec 6.
- For further disussion of refusal of life-sustaining treatment, see: Mendelson D. Historical evolution and modern implications of the concepts of consent to, and refusal of, medical treatment in the context of the law of trespass. J Legal Med 1996; 17: 1–71.
- Airedale NHS Trust v Bland [1993] 2 WLR 316 at 393, per Lord Mustill. See also Airedale NHS Trust v Bland [1993] AC 789 at 864 per Lord Goff of Chieveley. In the United States, in the case of Cruzan v Director, Missouri Dept of Health, 497 U.S. 261 (1990) at 278–80. The majority of the United States Supreme Court considered that the “right to die” through refusal of life-sustaining procedures—if it exists—is based on the constitutional concept of “liberty interest” delineated in the Fourteenth Amendment to the US Constitution.
- Select Committee on Medical Ethics was established in 1993 by the House of Lords under the chairmanship of Lord Walton of Detchant. House of Lords, Session 1993–94, Report of the Select Committee on Medical Ethics, London, HMSO 1994.
- Idem, para 255.
- Withdrawal of mechanical ventilation may lead to the patient dying within a few minutes. This outcome, however, is far from certain. At least one study has demonstrated that 11% of “terminally weaned” patients survived and were discharged from the hospital (quoted by Carlson, Campbell and Frank (1996) in Brody H, Campbell M, Faber-Langendoen K, Ogle K. Withdrawing intensive life-sustaining treatment—recommendations for compassionate clinical management. N Engl J Med 1997; 336: 652–657 on page 653.
- For a moving, yet humorous, description of the vibrant intellectual and emotional life of a person suffering from a locked-in syndrome, see: Bauby JD. The Diving Bell and the Butterfly. London: Fourth Estate, 1997. The author who, following a massive stroke, was rendered paralysed, speechless, and only able to move one muscle—his eyelid—‘dictated’ the book by blinking to indicate each individual letter of the alphabet.
- R v Adams [1957] Crim LR 365.
- R v Adams [1957] Crim LR 365 at 375.
- In Airedale NHS Trust v Bland [1993] AC 789, the House of Lords distinguished R v Adams and R v Arthur from the case of R v Cox, to be discussed below.
- At the trial, Sister Simcox, one of the nursing sisters involved with the infant, who was called as witness, testified that: ‘if “nursing care” appears on the sheet of the mother and the baby, the child goes to a different ward. The nurses would cherish him and remain in the ward until he died’ (R v Arthur (1981) 12 BMLR 1, Farquharson J's summing up to the jury).
- In this particular case, the jury's decision may have been substantially influenced by the fact that two weeks into the trial, the defence produced evidence of the damage to the infant's brain which occurred before the birth and which, to use the words of J Farquharson in his charge to the jury, made the baby ‘a likely candidate for death within days’ due to “a disease of the brain”.
- Today, in cases where a ‘nursing care only’ decision is made, ordinary feeding (if the baby is able to suck) as well as palliative care is routinely provided.
- R v Cox (1992) 12 BMLR 38.
- The complaint in the Cox case was laid by a nurse who realised the implications of the entry in the patient's records (‘KLC, 26 millimoles’) made by Dr Cox.
- According to expert witnesses, when injected into the vein, one ampoule of undiluted potassium chloride would certainly kill: the injection given by Dr Cox was therefore twice that necessary to cause certain death.
- The Report about Dr Cox's action was made to the Director of Nursing 5 days after the death. The Director, however, did not prevent the cremation taking place 2 days later, without an autopsy being carried out. To reveal actual levels of potassium within the body, samples of blood must be taken within 20 minutes of the patient's death.
- Vacco v Quill(1997) 117 S Ct 2293; Washington v Gluckberg (1997) 117 S Ct 2258. Renhquist CJ in Quill said that ‘Logic and contemporary practice support New York's judgment that the two acts are different, and New York may therefore, consistent with the Constitution, treat them differently.’ (unreported judgment, pp. 3–13).
- For example, injecting patients with muscle relaxants or phenobarbital without respiratory support.
- Received assent by the Administrator on 16 June 1995.
- Under sec 4 of RTLA provided that “a patient who, in the course of a terminal illness, is experiencing pain, suffering and/or distress to an extent unacceptable to the patient” could request “the patient's medical practitioner to assist the patient to terminate the patient's life”. Part 1, sec 3 defined the medical practitioner's assistance “in relation to death or proposed death of a patient” as involving “the prescribing of a substance, the preparation of a substance and the giving of a substance to the patient for self-administration, and the administration of the substance to the patient”. By virtue of Part 4, sec 18(2), this kind of “assistance” was to be “taken to be medical treatment for the purposes of the law”.
- The Parliament may make laws for the government “of any territory surrendered by any State to and accepted by the Commonwealth, or of any territory placed by the Queen under the authority of and accepted by the Commonwealth, or otherwise acquired by the Commonwealth, and may allow the representation of such territory in either House of the Parliament to the extent and on the terms which it thinks fit”.
- The Euthanasia Laws Act 1997 (Cth.) No. 17 of 1997. Item 1 of Schedule 1 amended the Northern Territory (Self-Government) Act 1987 by inserting sec 150A, regarding Laws concerning euthanasia. Item 1 of Schedule 2 amended the Australian Capital Territory (Self-Government) Act 1988, and Item 1 of Schedule 3 amended the Norfolk Island Act 1979 in a similar fashion. These Acts reaffirmed the power of the Legislative Assembly of the respective Territories unicameral Parliaments to make laws with respect to:
- the withdrawal or withholding of medical or surgical measures for prolonging the life of a patient but not so as to permit the intentional killing of the patient; and
- medical treatment in the provision of palliative care to a dying patient, but not so as to permit the intentional killing of the patient; and
- the appointment of an agent by a patient who is authorised to make decisions about the withdrawal or withholding of treatment; and
- the repealing of legal sanctions against attempted suicide.
- At the same time, the Commonwealth Parliament removed the power from the Territory Legislative Assemblies to enact “laws which permit or have the effect of permitting (whether subject to conditions or not) the form of intentional killing of another called euthanasia (which includes mercy killing) or the assisting of a person to terminate his or her life”. 41 At the time, the Northern Territory's government vowed to overturn the Federal Euthanasia Laws Act 1997 by becoming a State. Upon obtaining statehood, its first act was to be the re-enactment of the Rights of the Terminally III Act. To this end, a referendum was held in the Northern Territory concurrently with the 1998 Federal election. The question the Northern Territorians were asked was: “Do you agree that we should become a State?” Although both major parties agreed to support this proposition, the majority of voters (at least 53%) answered “no” (Northern Territory referendum: 47.20% - “yes”; 52.80% - “no”. Total votes: 80,286).
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