However, in countries where assisted suicide is legal so-called ‘safeguards’ are not protecting vulnerable people. This is the case in Australia, where assisted dying laws came into operation in the state of Victoria in 2019, with other states following from 2021-2023.
Assisted dying (AD) laws in Australia permit both assisted suicide (where lethal drugs are supplied by the doctor and people take them when they choose) and euthanasia (where a doctor or other health practitioner gives the lethal injection). In this article we used ‘AD’ to denote both.
In the first of two articles we look at unsafe safeguards around: witnesses, suicide drugs, coercion and decision-making.
Unsafe Safeguard Around Witnesses
Having a witness present at death by AD may seem to be a reasonable safeguard for the patient. However, in cases of assisted suicide no independent witness is required to verify that:
By contrast, for cases of euthanasia a witness is required when a doctor gives the fatal injection, to protect the doctor rather than the patient.
Unsafe Safeguards Around Keeping Suicide Drugs
Australian laws have safeguards to ensure that drugs for use in assisted suicide are kept securely by the patient. The patient must have a designated contact person who, in the event that some drugs remain after the suicide or they are not used at all, is obliged to return the drugs. There are three dangers here:
Unsafe Safeguards Against Coercion
While coercing someone into AD is a criminal offence in Australia, detecting and proving that a patient was coerced relies on the doctors involved. This is extremely difficult to do, and moreover cannot be investigated after AD has taken place and the person is dead.
Another serious risk is the time lapse between dispensing the lethal drugs and the patient taking them. The Victorian Act allows drugs to be kept for an unspecified period of time. Remembering that under this Act there is no legal requirement for a witness, dangers include:
Unsafe Safeguards Around Decision-making Capacity
For a patient to be eligible for AD, he or she must have decision-making capacity. Problems arise because:
[1] One disturbing yet reasonably likely scenario is where a family member or someone with an interest in the person’s death turns up and coerces (or worse) the person into taking the poisons then leaves and later claims not to have been present. There would be no perceived need for any investigation because, after all, the person wanted to die, did they not. It’s as if the state doesn’t really care how it happens. Once the desire is expressed at the outset and drugs are dispensed it really looks very much like a hands off approach.
[2] Klein CC et al. (2019) Capacity to provide informed consent among adults with bipolar disorder. J Affective Disorders 242:1-4.
[3] Hermann H et al. (2015) Physicians’ personal values in determining medical decision-making capacity: a survey study. J Med Ethics 41:739-744.
