A good death: statement on the provision of high-quality end-of-life care

This statement by religious leaders in South Australia regarding the state’s Voluntary Assisted Dying Bill 2020 was sent to all members of parliament for their consideration.

Our vision for South Australia

We, the undersigned, believe that our society should be a caring and compassionate one, founded on the promotion of human dignity, human freedom and the common good.

  • All individuals are worthy of being valued and feeling valued by our society, regardless of the circumstances in which they find themselves. Our leaders and laws should affirm this basic worth.
  • All individuals are essentially free and capable of living meaningful and purposeful lives. The meaningfulness of our lives as free beings and as a community should be affirmed and fostered by society, including our government and government agencies.
  • As a community we should work together to secure the common good. The common good is all the material and social conditions necessary for all individuals to live truly meaningful, purposeful and fulfilling lives in and through their relationships with others. These conditions include access to high-quality health care, aged care and end-of-life care.

Assisted suicide undermines human flourishing

Death is part of our existence. Dying well is an important part of what it means to flourish as individuals and communities. We maintain that so-called ‘voluntary assisted dying’ (assisted suicide) is not dying well. We maintain that it would be irresponsible for the South Australian Government to legalise this practice because it undermines the vision for a flourishing South Australia by undermining human freedom, human dignity, and the common good.

  • Many South Australians do not have the choice of best-practice end-of-life care. ‘Voluntary assisted dying’ undermines human freedom because the law seems to offer a misleading choice: you can choose to die horribly or you can take your own life. High-quality specialist palliative care means that death does not have to be horrible. High-quality specialist palliative care also means that you do not have to take your own life to avoid a horrible death. High-quality palliative care is not merely a third option; it is best practice. South Australians do not yet have universal access to such specialist palliative care. This problem should be addressed by providing everyone with access to this best-practice end-of-life care.
  • Do we really want a law that tells us that we will all eventually be worthless? Assisted suicide undermines the foundational social affirmation of the equal worth of all human individuals by legally enshrining the idea that some human lives are not worth living. It legally enshrines the idea that these ‘lives-not-worth-living’ can be directly and intentionally ended with the aid and ‘blessing’ of the state. By making such ideas law, it gives the impression that this attitude is the proper attitude of and for our society. Such a message puts vulnerable people at risk of coercion and elder abuse.

    People who feel that they are a burden, or who already feel that their lives are worthless are particularly vulnerable. But we are all vulnerable to the suggestion that there may come a time when we, no matter how successful and important we may be, will become dependent on others for our care. We fear the guilt of being a burden on other people, the loss of control over our own lives, and the potential humiliation that can come from having to rely on others for our basic needs. How much more so would we feel this way if the law were to tell us that we are indeed a burden, that we are right to think that we worthless, and that the right and noble thing to do would be for us to end our lives before we become a burden on those we love and on society? Such a law denies the reality that we flourish precisely in and through our caring for others and being cared for by others. Human beings and human societies are at their best when they are involved in relationships of mutual love, concern and consideration, sometimes as givers and sometimes as receivers of such care. The law should foster such interactions, not undermine them.

  • It’s the wrong message when we have a crisis of suicide in our state. ‘Voluntary assisted dying’ undermines efforts to address the crisis of suicide in our country. It is irresponsible for a government and a society to affirm the idea that some lives are not worth living at a time when nine Australians die every day from suicide.

Consequently, we urge Members of Parliament to vote against the ‘Voluntary Assisted Dying’ Bill before the SA Parliament.

Dying well does not mean prolonging life at all costs or living in pain

It is important that we are clear about what we mean. What we oppose is the legalisation of any direct action specifically intended to bring about the death of a person. This includes the provision of lethal substances for that purpose or the administration of such lethal substances by any means for that purpose.

We continue to support the long-held moral and legal distinction between such direct intentional actions to bring about the death of a person and:

  • proportionate refusal, withholding or withdrawal of medical treatments that promise little or no benefit, or that are overly burdensome at the end of life
  • appropriate intentional provision of medication to alleviate symptoms of pain and suffering.

What is clear is that these legitimate practices are not well understood in South Australia. Many people believe that the medical fraternity – or indeed their religion – requires them to prolong life at all costs, regardless of the burden. Many people also think palliative care is like euthanasia because the ‘pain medications will kill you anyway’. Both of these misunderstandings must be dispelled.

We as religious leaders commit to doing our part to support initiatives to educate people concerning:

  • appropriate refusal, withholding and withdrawal of treatment,
  • the distinction between alleviating pain and direct intentional killing,
  • and the benefits of high-quality specialist palliative care.

We strongly endorse government initiatives in this direction. We believe better end-of-life care begins with better conversations about death and dying and how we can die well in ways that don’t undermine the foundational values of our society.

Hearing the question properly to start the right conversations

It is true that some people in our society are experiencing extreme physical, mental or emotional suffering. When these people tell us that they think the best solution would be for us to help them to take their own lives, or even end their lives for them, we should be very concerned. To respond to them by giving them the legal and physical means to do so is to fail in our responsibility as a society on at least two counts:

  • First, it is a failure because we have done nothing to improve the circumstances that lead to people experiencing such unnecessary and avoidable suffering in the first place. This is especially irresponsible when the means do in fact exist as evidenced by the very positive experiences of high-quality specialist palliative care.
  • Second, we have failed in our responsibility to affirm the worth of every individual and the meaningfulness of every life, leading some among us, especially the most vulnerable, to believe that they are worth nothing and that they would be ‘better off dead.’ This can never be regarded as a compassionate response to the crisis of suffering.

We support high-quality palliative care, education and better conversations about dying

The better answer to the suffering we see is to address the circumstances using the best practice available. We support all efforts to empower the people of South Australia to make meaningful choices about their end-of-life care and to develop a world-leading healthcare system that genuinely takes care of South Australians from the cradle to the grave.

  • The problems evident in aged care should be urgently addressed.
  • Palliative care services should be improved both in quality and accessibility.
  • Education about what high-quality palliative care is should be supported and myths that create false and unwarranted fears and uncertainties about the dying process should be refuted.
  • Support and encouragement should be given to research into better palliative care and into how palliative care can foster lives that have meaning and value in a society that affirms human dignity at every point.

Bishop David Altus
South Australia – Northern Territory Lutheran Church of Australia

Bishop Karol Kulczycki SDS
Catholic Diocese of Port Pirie

Archbishop Patrick O’Regan
Catholic Archdiocese of Adelaide

Bishop Silouan of Sinope
Archiepiscopal Vicar of Adelaide
Greek Orthodox Archdiocese of Australia

Mr Ahmed Zreika
Islamic Society of South Australia