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The lottery in which we all participate

By Geoff Wall - posted Wednesday, 27 March 2013

Each year in NSW, from just over 7 million people there are 50,000 deaths, yet death and dying still remains an awkward, taboo topic. This is a problem because death and dying is the one lottery in which everyone eventually participates. You have to be extremely unlucky, but from 50,000 deaths annually, with 100% certainty, a tiny number of people will have awful deaths. There's no way around this statistic. It's just a fact because medicine is not perfect and disease can be cruel.

What are the chances of it happening to you?

A good estimate can be made from data published in communities which have carefully monitored laws aimed at reducing the incidence of awful deaths. Oregon USA is a community comparable to NSW, which legalised Voluntary Assisted Suicide (VAS) in 1997. This means that Oregonians, provided they are fully aware and fully informed, have the option of drinking a lethal sedative and dying tranquilly, if they are incurably ill with only suffering left in their lives.


Oregon is smaller than NSW with 30,000 deaths annually of which an average of 42 are by VAS. This comes to 1 in 700 or 0.14% of total deaths over one and a half decades. By this reckoning NSW might reasonably expect 70 such deaths annually. So the good news is that well over 99% of us will die relatively peacefully, with or without medical care.

The bad news is that palliative care will prove sadly inadequate for a tiny group of patients. These are the lottery losers, where medicine is ineffective and suffering is untreatable. Although it is not widely understood by the general community, if NSW were to legalise VAS, this group and this group only would be affected in any way at all, as has been the case in Oregon now for 15 years.

So if you are unlucky enough to suffer pain from a cancer eroding the spinal cord, fracturing bones or erupting through the skin, legal VAS would allow you to avert senseless suffering. If faced with a slow death by choking or suffocation from a progressive paralyzing disease, you will have the option of deciding for yourself when you have suffered enough.

It's easy to turn a blind eye to an issue which is very unlikely to affect us personally. But the fact that only a tiny fraction of deaths are awful, doesn't stop tens of thousands of patients every year ,who are diagnosed with a terminal cancer, from fearing how their own deaths might play out. For these patients, knowing that a tranquil death is always an option is deeply reassuring.

Opposition to VAS is led by the Catholic church which will never change, despite not having the support of a majority of christians. The other major anti-VAS institution is the AMA, though it too lacks the support of a majority of doctors.

When challenged by the polite but resolute group, Doctors for Voluntary Euthanasia Choice, the AMA has procrastinated and failed to communicate responsibly. Whilst its charter says all the right things about respecting and listening to patients, it fails to act on the hard evidence that palliative care is not and will never be perfect in every case. The AMA's current policy means that when palliation fails, patients must choose between more treatment that doesn't work, committing suicide by whatever means are at hand or enduring for however long death takes.


At some stage in the future the right to control one's own life and death will prevail, because it is no less a human right than freedom of speech or gender equality, and it has the massive support of 87% of NSW citizens (Newspoll 2009). Once one state legalises VAS, others will observe and follow, as is happening in the USA where 3 states now permit VAS and the fear-mongering by opponents has been shown to be empty noise. The law will then be protecting the rights of all parties, by respecting individual choice.

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About the Author

Geoff Wall is an independent researcher and Sydney doctor with 3 decades experience working in public and private health in Australia. Primarily an Anaesthetist, he has worked in General Practice, Emergency Medicine and Intensive Care.

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