When you’re ‘better off dead’

Andrew Denton watched his father endure a drawn-out and painful death. Now he wants nurses to support his quest to legalise assisted dying.

Television presenter and comedian Andrew Denton says watching his father Kit die slowly and painfully of heart failure “remains the most profoundly shocking experience of my life”.

Kit Denton, 67, was given ever-increasing doses of sedatives to settle the pain.

“But morphine never did settle the pain – not his and not ours. The images of those final three days 19 years ago will never be erased,” Andrew Denton told the NSWNMA annual conference.

In 2014 he set out to investigate the issue of assisted dying and to test the arguments of its opponents.

He spent “hundreds of hours” talking to nurses, doctors, politicians, lawyers, academics, priests, surgeons, palliative care specialists and activists on both sides of the debate here and overseas.

“Above all I spent time with those who embody the need for this law in Australia –the dying and their families,” he said.

The result was a podcast series “Better off dead” freely available online and a lobby group to campaign for law reform called Go Gentle Australia.

It argues for “a right to have a choice about what happens to us at the end of our lives and not to be coerced, when we are at our most vulnerable, into cruel and avoidable suffering.”

Denton travelled to Belgium, the Netherlands and Oregon in the United States, which have assisted dying laws.

He found they operate with rigorous safeguards and transparency, are closely supervised by medical peers and strongly supported by the public, though only a tiny fraction of people use them – ranging from less than one half of one per cent of the dying in Oregon to less than four per cent of the dying in Holland.

Laws that give a choice

“They are not being killed by the state – they are dying. These laws give them a choice and some measure of control over how hard that dying needs to be,” he said.

How does Australia, with no law for assisted dying, compare?

Denton cited a June report by a Victorian parliamentary inquiry which recommended legislation to allow people to seek assistance to die.

The inquiry found that in the absence of such a law Australians were forced to take their own lives often in horrific circumstances.

Denton said: “Coroner John Olle gave examples including a 90 year old man with prostate cancer and a poor prognosis who shot himself with a nail gun. And a 93 year old woman with crippling arthritis who smuggled a razor blade into her aged care facility and bled to death.”

“Coroner Olle went to out of his way to stress these were people without a history of mental illness faced with the slow irreversible decline of chronic disease.”

He said the national coronial information service estimates that two people over 80 take their lives in Australia every week. The most common method used is hanging.

Denton said the Victorian inquiry found that doctors practice unlawful assisted dying despite its prohibition.

“It’s happening without regulation, support, transparency or accountability – and from the evidence received sometimes without patient consent.”

Denton cited evidence by Sydney University professor of health law and governance Roger Magnusson that almost 20 per cent of doctors he interviewed reported being involved in mismanaged attempts of assisted dying.

“Professor Magnusson found that in many cases doctors and nurses miscalculated the dosages required to achieve death and resorted to suffocation, strangulation and injections of air.”

Denton said he was amazed that society considered it ethically and legally acceptable for a dying patient “to choose a slow and psychologically painful death by dehydration and starvation” but legally and ethically unacceptable to choose a quick and painless death.

“Why should a competent adult who is dying and suffering and who asks to die quickly be told they have to die slowly instead?”

Public support is strong

He said opinion polls showed public support for assisted dying at between 70-80 per cent and support among doctors running at around 50 per cent.

However it was still opposed by the leaderships of most medical organisations such as the AMA and Royal College of Physicians.

“There is only one medical organisation in this country that officially supports a law for assisted dying. Significantly it is an organisation whose members see the suffering close up and on a daily basis – the Australian Nursing and Midwifery Federation.”

Overseas research indicated nurses were “the most trusted voice” on assisted dying because “you, not doctors are the ones who are with the patients 24 hours a day. You are the ones who see the suffering and you are the ones who hear our patients’ pleas for help to die.”

“An assisted dying law will not only offer choice and dignity to your patients it will also offer protection to you and clear guidelines as you negotiate good palliation with doctors.

“I would encourage you to read the AMMF’s position statement and if you’re in support of it to discuss it with your colleagues.

“Of course if you’re not in support that is your absolute right. The very core of these laws is that they’re voluntary – for nurses and doctors every bit as much as patients.”