One of the main arguments in favour of the legalisation of euthanasia and assisted suicide in New South Wales and other parts of the country was that of choice. Advocates said that those who wanted to choose the timing of their death should be able to do so, and that allowing this choice for some would not have an impact on others.
It is a reasonable enough argument to make and, while I think those making it are misguided, I can accept that their motivations were not malicious.
However, if their true motivation is ensuring end-of-life choice for every person, then I hope we will see pro-euthanasia lobby groups argue as passionately and intensely for a person’s right to access palliative medicines as they did for a person’s right to access lethal drugs.
Earlier this month, The Medical Republic reported that in the past 12 months alone, at least six pain-relieving medications used by palliative care doctors and nurses to alleviate a person’s pain as they approached the end of life were removed from the market.
Dr Michelle Gold, President of the Australia New Zealand Society of Palliative Medicine, told The Medical Republic that the scarcity of these types of drugs meant doctors and nurses who had found a treatment plan that worked to relieve a patient’s suffering were being forced to start treatment from scratch when the drugs were no longer available. Some of these replacements end up being unsuitable for the patient, either because they are less effective, or have additional side effects, or cannot be tolerated for some reason.
For example, liquid morphine can be taken by patients as an oral medication and is widely used for young patients or others who have lost the ability to swallow tablets, but it is no longer available in many parts of the country. Another drug used for patients who cannot tolerate morphine because they have liver or kidney problems has also been withdrawn.
Often, Dr Gold said, while the main drug is part of the Pharmaceutical Benefits Scheme, the alternatives are not, making them much more expensive and sometimes, prohibitively so. For example, a person could be paying 10 times more for the overseas version of liquid morphine, and the cost of an overseas brand of drug used for patients who cannot tolerate morphine is $42 per tablet, compared to $1.80 for the one listed on the PBS but now withdrawn.
It was also reported that the situation is particularly dire in regional and rural parts of the country.
What does all of this have to do with euthanasia advocacy, you might ask.
The euthanasia laws in NSW have now been in place for 8 months. As The Catholic Weekly has previously reported, NSW has the highest rate of euthanasia deaths in the country. While our laws require that a person requesting euthanasia must be told of the palliative care and treatment options available to them, there is no obligation for palliative care to be provided. And if the reality of pain medicines being withdrawn means a patient cannot access best practice palliative care, is that really end-of-life “choice?”
The Catholic Weekly also noted that two-thirds of those who have taken drugs to end their lives living in regional or rural parts of the state. However, we do not know whether euthanasia was the first choice for these people, or whether they felt they had no other choice because they could not access palliative care drugs.
What we do know for certain is that patients who want to live are having their own end-of-life choices limited by the withdrawal of palliative medicines from the market.
Dr Gold says that the way to fix this is for the government to ensure that when a palliative care drug is being withdrawn, the alternative drug is promptly listed on the Pharmaceutical Benefits Scheme. If those who lobbied so hard for euthanasia were really motivated by “compassion” and “choice,” then surely they would use their campaign infrastructure to lobby for this now. I’m not holding my breath.
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