With the advent of the controversial Terry Shiavo case in the US earlier this year, the issue of euthanasia is once again in the spotlight.

Typically, euthanasia creates a passionate polarization of beliefs and zeitgeists, where both sides of the 'Right to life and death' camps fight fierce public relations battles, not only win the 'hearts and minds' of their populations, but more importantly to procure their votes.

Nowhere is this battle fought as hard, or as bitterly as it is within the medical community.

The position currently taken by the AMA is one where medical practitioners may not assist terminally ill patients commit suicide, or euthanize them at their request.

The AMA also states that a doctor has the right to a) withdraw treatment at the patients request, with the full knowledge that such an action will result in their death; and 2) administer pain killing medication which, although will also result in the patients death, is permissible if administered with the primary intention to relieve pain.

Regardless of how these practices may be protected by slippery legal language and vague, fundamentally undeterminable notions as 'intent', many doctors agree that technically these actions still classify as euthanasia. A non-action is still an action, it still has a cause and effect, and it still has the final end result of death.

Research shows that although other all forms of voluntary euthanasia are criminal offences, there is widespread evidence of these illegal practices regularly taking place.

In the absence of any independent 'end-of-life' associations to watchdog over these areas of medical care, the issue is neither these legal or illegal euthanasia practices are taking place out in the open under careful legal scrutiny. They occur in the shadows, existing under the radar in uncontrolled, unregulated and potentially insidious environments.

The palliative care units and other end-of-life medical environments are the darkened corners of the medical world, corners where without proper supervision both patients and doctors are vulnerable to pressures and manipulations of parties whose vested interests may not be in-line with the patient's desires.

We only need to look to the UK and the horrific case of Harold Shipman a.k.a. "Dr Death" to see the dangers of inadequate supervision and policing in aged palliative care.

I believe the only way to avoid such abuses taking place is to take the issue of VE out of the hospitals and into in the open court rooms, where precise and stringent procedure and screening can take place.

Opinion polls prove 70-80% percent of people approve of VE, yet governments continue to vote down bills which propose its legislation. Why? Whose interests are really being protected? We must bond together to fight for legislative changes, and we must fight to get this done now.

What evidence is there of euthanasia already going on?

Surveys repeatedly show that around 95% of all medical practitioners have been asked at some point in their career to euthanize a patient. Out of this 95%, 15% admit to have fulfilling their patient's or their patient's family's 'illegal' euthanasia requests in some form or another.

This means that out of the 61,261 or so registered medical practitioners in Australia, 9,189 doctors have actively participated in illegal euthanasia over the last 20 or 30 years. The bottom line of such statistics means that at least 9,189 Australian citizens have died as a result of illegal euthanasia practices to date.

It also means that over the next few years, at least 1 in every 2,176 people will die at the hand of a doctor. In order to protect the welfare of our patients and to professionally protect ourselves we must:

1. Not only rethink what are and are not the medical professions responsibilities in end-of-life decisions, but also move to define and set in legislative concrete these responsibilities.

2. Consolidate this shift in authority through establishing a specifically trained 'end-of-life' ethics committee in the courts and specialized 'end-of-life' medical units in each state created with the sole purpose of supporting eligible euthanasia requests. These two bodies will be autonomous agents, independent of governmental influence or interest group pressure.

These ethical structure and mechanical workings of these bodies will first and fore mostly be informed and formed by the people's desires; secondly be guided by the pragmatic and ethical concerns of the medical profession; and thirdly be effectively and stringently safeguarded and defended by the law.

3. To decriminalize, then legalize medically assisted suicide and amend the section 13a of the 1983 Amendments to the Criminal Law consolidation Act 1935 to read rather than "a person who aids and abets or counsels the suicide of another ... shall be guilty of an offence."; to read 'a person other than an appointed VE medical practitioner who aids, abets or counsels the suicide of another... shall be guilty of an offence.'

The fact of the matter is the majority of the existing anti-euthanasia arguments made by the AMA are not based solely upon concerns for the welfare of our patients. Although the AMA shares broader societal considerations regarding the potential of a 'slippery slope', the majority of protests are based around the negative impact VE would have on the medical practitioners themselves, not on the patients.

When viewed in the light that VE could be performed by any registered medical practitioner, here are the four top medical objections, which I have complied from a wide range of health care surveys and literature.

1. Palliative care can meet the needs of hopelessly ill.

This is simply not true. Some diseases and subsequent pain and suffering are beyond the scope of medical intervention. Medicine is not infallible, and many palliative workers acknowledge its shortcomings.

Also, access to adequate, or indeed any sort of palliative care is difficult for many Australians, either because of poor proximity or cost, but mainly due to a severe lack of facilities and properly trained staff.

Introducing voluntary euthanasia, rather than exacerbating these pitfalls will in fact serve to do the opposite. Legalized voluntary euthanasia will force the government to increase the availability and level of palliative care to an acceptable level.

How?

2. Doctors would abuse the trust placed on them. How can I trust a doctor's primary 'intent' is to soothe my pain? There is no way of measuring these intentions, and currently there is no monitoring system in place to test the ethical or moral validity of doctor's motivations.

Clearly, there must be a definitive line between those invested with the power to facilitate such huge decisions, and those not. Just as it would be 'unethical' to get a GP to perform brain surgery, it must be unethical for any one other than an appointed VE practitioner to perform these duties.

As the ultimate decision would be done via a democratic judicial process, this takes the onus away from the doctors thus eradicating the opportunities for abuse to occur.

3. Euthanasia would become a cost saving measure. As the legal board to make the final decision would be totally autonomous and independent of the medical profession, the government or any agent other than the patient and his/her family, this would be unlikely to happen. The only 'interest groups' the courts may take into consideration are the patient and his/her family, no-one else.

4. That it will place an unfair burden on doctors, and it would undermine the fundamental therapeutic doctor/patient relationship.

Yes, it would. And yes, it does. The way things are, even though doctors may be legally protected by the 'double effect' maxim and hazy concepts as 'intent', many doctors involved in these decisions have expressed deep anxiety and concern regarding their role. Such actions, despite being attractively 'cloaked' in semantics still essentially run contrary to the medical professions guiding philosophies of 'respecting and protecting human life'. At least the patient and appointed euthanasia team will not be in confusion over what the team's duties and responsibilities are.

And finally, who is to say a doctor is morally equipped to make such decisions in the first place? I mean really guys, if you can pardon the pun, who died and made us Gods? Just because we are the bearers of the instruments of death, what gives us the right to make any intimate, personal and autonomous decisions for other human beings? Our role should purely be a technical one, and one that does not impede on our patient's autonomy in any way.

The AMA states that a doctor's primary duties are to a) preserve life; b) relieve suffering; and c) to always act in their patient's interest; and they are to be enacted specifically in that order. Failing the ability to preserve our patient's life, we must then aim to relieve their suffering. Failing to relive their suffering, we must respect the patient's wishes and should the patient desire to die a 'good death' via a needle we must represent their case honestly and ethically in a court of law.

We must do this without imposing our own individual religious or philosophical beliefs and without acting in their own interests or any other body. We must offer our expert, rational and unemotional opinion on the state of our patient's health and sanity, and nothing else. Anything beyond this simply is not our responsibility.

Doctors, through their proximity to death and dying have unfortunately and unfairly been given the role of judge and jury for terminally ill patients.

In the current legal environment they have also been given only two final roles to play: to either wear the heavy mantle of jailor, or the darkened cloak of a back-yard executioner.

Like Prometheus we are the bearers of many technological and medical revolutions to this world. However, we must remember that it is not we who suffer the consequences of our gifts. It is not we who remained chained for an eternity to Caucscus. While we sit around in our comfortable consulting rooms philosophically debating the intellectual and moral relativism of voluntary euthanasia, it is not our bodies being unavoidably mauled by creatures of death day in and day out, without an end in sight, filled with pain and suffering, and without respite.

No. We must remember it is our terminally ill patients who suffer, not us.

In light of the evidence I have presented today, we can't pretend that there isn't a need for VE, or that illegal and unregulated euthanasia practices don't take place. All this evidence does is highlight the fact that such the matter must be legislated in order to regulate these practices.

Voluntary euthanasia must be a decision for the courts; it must be a group evaluation that is talked about, publicly and legally debated, not shoved under the carpet because politicians believe it is too hard to legislate or too risky a topic for elections. It is not too hard to legislate.

Current protocol leaves too many grey areas between so called passive and active euthanasia, leaving patients vulnerable to abuse, and doctors wide open to legal malpractice suits. Voluntary euthanasia requests from terminally ill patients is not a 'problem' that will just go away by itself. We have to admit truthfully and publicly that sometimes palliative care just isn't enough.

I would like to end on the by reminding you all that voluntary euthanasia for the terminally ill does not undermine the basic tenet that human life, all human life is precious. It simply does not enforce that it is an obligation.

The AMA clearly states that although they take the position that it is unethical for doctors to contribute to voluntary euthanasia, yet they do not believe it is unethical for someone to take their own life.

As I have shown, yes it would be unethical for non-specialized doctors to contribute to this act. However this does not mean the medical profession as a whole does not have the responsibility to ensure that when it is legislated, and it will be legislated, it happens safely and painlessly, and solely in the interest of the patient and no-one else.

Thank you for your time.

About the Author

Daniella Kimel is a Sydney based writer, specializing in Public Communication and script editing. Her services are available internationally, and can be contacted at ifemme@gmail.com.