The man who chose death with dignity
A version of this article was first published: The Sydney Morning Herald - 23 September 2009
Christian Rossiter died with dignity. In saying this, I do not refer to the physical manner of his passing. Rather, my claim rests entirely on the fact that Rossiter died knowing that he had achieved recognition of his right to decide whether or not to accept ongoing medical treatment.
In one sense, the decision of the Supreme Court of Western Australia, to affirm Mr Rossiter’s right to make such a decision, was unremarkable. The court was merely giving legal effect to the principle of ‘respect for persons’ – a recognition of the essential dignity of each individual and their associated right, if competent, to make decisions concerning their own welfare. It is this principle that underpins the idea of informed consent – without which any physical intervention risks being classed as assault. The decision of the court was also uncontroversial. The decision did not, in fact, confer on Rossiter a right to die. It merely confirmed his right not to continue with treatment – even if the predictable consequence of this decision would be Rossiter’s own death.
It is important to note the nature of the treatment that Rossiter wished to decline. It is not that he was being asked to cope with the inconvenience of minor procedures. Rather, he was burdened with a tracheostomy, to assist his breathing, and a PEG tube – inserted through an incision in his body and into his stomach; to allow for hydration and feeding (without swallowing). The introduction and maintenance of a PEG tube has long been recognised as a medical treatment. In recognising Mr Rossiter’s right to refuse this treatment the court needed only to be certain that Mr Rossiter was truly able to make a free and informed decision.
Some might wonder how it could be ethical for the court to allow Mr Rossiter to refuse treatment in circumstances where it was clear that he intended to hasten his own death. It is important to distinguish between the right to refuse treatment and the likely outcome of such a refusal. This kind of distinction is routinely drawn in the field of medical ethics and involves the application of the principle of ‘double effect’. In essence, this principle says that it is allowable for a person to act with a noble intention and in pursuit of a good outcome even if in doing so they might reasonably expect to cause a second (double) effect that is bad. The principle importantly requires that the thing done (and intended) not be intrinsically evil. For example, the principle of ‘double effect’ is routinely used to justify the practice of administering increasing doses of opiates (morphine, etc) in order to prevent or ease pain – even though it is believed that this will most likely cause death through respiratory failure. In this common case, the intention is to alleviate suffering, not to cause death. The means employed are not intrinsically evil and the death (if it should occur and be caused by the opiate) is an unintended ‘double effect’.
It is easy to see how the principle of ‘double effect’ might apply in the case of Mr Rossiter. The ‘good’ to be secured was recognition of the fundamental right of Mr Rossiter to refuse treatment – a moral right enjoyed by Mr Rossiter as a person. The recognition of this right was not intrinsically evil. The withdrawal of treatment was not a deliberate act intended, by the court or his carers, to cause Mr Rossiter’s death. That Christian Rossiter did die – of infection – may have been an outcome desired by Mr Rossiter. However, from the point of view of the court, his carers, etc., Mr Rossiter’s death was an unintended, ‘double effect’ flowing from their proper decision to respect his autonomy.
It is important to note that the existence of a legal right to refuse treatment (at least in WA) need not have any impact on the number of people refusing treatment. The mere fact that we can refuse treatment does not mean that we should do so. Many might welcome the right to make such a choice, but not exercise it – perhaps because of religious beliefs, perhaps for altogether different reasons. However, whatever one decides about Christian Rossiter’s final choice, I hope that there is universal assent that it was for him to decide what should or should not be done to or with his living body. It is the recognition of that right and the underlying principle on which it is founded, that allows me to say that Christian Rossiter died with dignity.