31 May 2023

Someone has suggested to my mother that she ask for voluntary assisted suicide. What do I say to Mum? 

Voluntary Assisted Dying Act was passed in 2017 in Victoria. Picture: iStock

John Buchanan 

22 April 2023

Someone has suggested to my mother that she ask for voluntary assisted suicide. What do I say to Mum? 

This suggestion of “voluntary assisted dying”, is now more common in public hospitals, after legislation introduced into the Victorian parliament in 2017. Some hospitals have “navigators” to “inform patients of their options”, also called Physician Assisted Suicide. 

Firstly, some background. Let us assume a terminal diagnosis. We need to understand the illness experience of people with serious health problems, which may include grief (at the loss of previous functions), a partial understanding of the disorder and complications, anxiety, specific fears – maybe to do with past family deaths – sometimes depression, and effects on the patient of attitudes of family, nurses and doctors. 

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Unresolved questions contribute to anxiety. All seriously ill patients are vulnerable to influence and misunderstandings. Is a decision to have “voluntary” Physician Assisted Suicide really voluntary if a person is acting on misunderstandings about assumed complications, or a belief that no relief of symptoms is possible, or experienced poor palliative care, or family attitudes that they are a burden? 

Many people are especially fearful about pain, although pain management can always be improved with specialist palliative care expertise. One of the difficulties is that GP care may not be expert palliative care. Palliative care is a young discipline, and the number of trained specialist palliative care physicians needs to be increased. Funding the training of more such specialists would have been a better government initiative than the 2017 legislation. 

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So, the first question in this scenario is: why did someone suggest Physician Assisted Suicide to your mother? Did she disclose a hidden problem, such as inadequately treated pain or depression. There is a need to find out what “the problem” for the patient is. It may be anxiety about some feared consequence, or undisclosed pain. Some even do not take medication for pain, anxiety or depression because they fear becoming addicted. 

Many seriously ill people feel they are a burden. Not all families or professionals are benign or caring and may have mentioned phrases like “use-by date”, or “good innings” which can give a message they should “shuffle off”. Ill people are vulnerable to feeling unwanted, hence an obligation to assess if a terminally ill person is being “pushed”. 

The Physician Assisted Suicide legislation is actually loose, despite the so-called 68 safeguards. Section 9, the consulting process, does not require the patient’s treating doctor to be consulted, or the diagnosis checked. A doctor consulted for Physician Assisted Suicide may just take a “request” at face value and is supposed to check for coercion, but usually they are not the treating doctor. How can they check for coercion with an unknown patient? 

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So to return to you and your mother. You can refuse a suggestion of Physician Assisted Suicide, but should discuss hidden fears or poorly controlled symptoms, and should ask for a referral to a Specialist Palliative Care physician. 

A broader issue is what effect such legislation has on future patients, who may think palliative care involves pushing people into Physician Assisted Suicide. The World Medical Association considers Physician Assisted Suicide unethical. 

Dr John Buchanan is a recently retired consultant psychiatrist, who initially trained and practised as a consultant physician. He is a former chair of the Victorian branch Royal Australian and New Zealand College of Psychiatrists.

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