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There are a number of ways that I could approach this perennial issue that rouses strong and often polarising opinions. I have a graduate diploma in bioethics, and a masters in health ethics, so I’m well versed and better qualified than many to take a relatively objective stance and present a robust, solidly-constructed argument based on virtue ethics, Beauchamp and Childress’s Principles, casuist philosophy, or even a Hippocratic perspective. I could present an argument from self, about what I would want, and invoke Mills, who argued that there are limits to the reach of the state over the individual. Or I could, as SA nurse Sandy Bradley has, speak from a professionally dispassionate perspective, with citations and an academic tone.

These are all valid, useful ways to discuss assisted suicide/voluntary euthanasia, and reading these kinds of pieces have informed my position. But what has most strongly strengthened my commitment to the legalisation of assisted suicide isn’t theory, or research, or philosophical argument. It’s the patients I’ve cared for, and those for whom my care was woefully inadequate. The patients whose memories still bring tears to my eyes, a lump to my throat, and a sensory reminder of the frustrated impotence I felt when “everything we can do” wasn’t close to being enough.

I have seen people in kinds of distress I wish I never knew existed, experiencing so much pain it’s been hard to believe it didn’t kill them. The very first person I saw die vomited and retched until the moment she died, despite high doses of antiemetics. I’ve helped a colleague turn a patient whose limbs were so swollen with excess fluid that they wept, constantly, a physical grief reflecting his unending moans. I cared for a frequent flier patient, who I had come to know well over the course of almost a decade, who crawled up the ward corridor crying for pain relief I was forbidden to give her because the doses that would lower her pain would also kill her – she died less than a week later, still in pain. I had to tell the wife of another familiar and dear patient that I couldn’t help him die sooner, though it was what I wanted to be able to do even before she dropped to her knees before me, and begged.

Over a decade ago I heard Roger Magnusson talk about his doctoral research that, in part, described, the kinds of deaths that occurred in the absence of formalized, legalized assistance, and I was horrified by the lack of screening, the lack of dignity, and the effects on everyone involved. Earlier this year, at the ANMF (Vic branch)’s annual delegates conference, I heard Andrew Denton speak about watching his beloved father, Kit, die over an eternity of three days. It reinforced my belief that the time has well and truly come for Australia to join those countries and states that offer their dying and suffering populations another choice at the end of life, if the interventions currently available aren’t enough.

There have been dozens of Bills brought in front of parliaments across the country, with varying degrees of traction, but none with success – in part because there were inadequate safeguards to protect our most vulnerable, but mostly because opposition from organized religion (such as the Australian Christian Lobby) has been better mobilized, and louder; their position may be the minority one, going by every poll on assisted dying, but their voices are disproportionately heard, and that’s neither right nor fair.
 
I understand concerns about both coercion of people who are influenced by unethical family members, and the fear of a slippery slope to wholesale, state-sanctioned murder; I do not agree either or both are reason to prevent those who are dying, suffering, and beyond the reach of palliative care from having the option of a faster, kinder route to the death their condition makes inevitable. Instead any legislation should be informed by these reasonable concerns, by including rigorous safeguards to protect those at risk of underhand manipulation. I will write at some future point about how the ‘euthanasia’ committed by Nazi Germany in the 1930’s and 1940’s was not only qualitatively unrelated, but also the result of very different motivation; for now, suffice it to say that this is neither a likely nor plausible end point when we start by looking at compassionate, patient-centred, voluntary additional options for competent people who are terminally ill.

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