WEBVTT 1 00:00:00.000 --> 00:00:02.340 Thank you for coming out on this wintry day. 2 00:00:02.680 --> 00:00:06.860 I'm Charlotte De Crepney, and I'm going to be chairing this afternoon's session, 3 00:00:07.040 --> 00:00:08.880 which will finish at 4.30. 4 00:00:09.380 --> 00:00:11.380 It's wonderful to see so many people here, 5 00:00:11.920 --> 00:00:14.240 and to welcome our guests, 6 00:00:14.500 --> 00:00:19.140 who are going to challenge us and give us their ideas about a healthy public. 7 00:00:22.120 --> 00:00:26.040 Each of our speakers will speak for 10 minutes, between 8 and 10 minutes. 8 00:00:26.040 --> 00:00:30.140 If you have a question along the way, please hold it in your mind, 9 00:00:30.820 --> 00:00:34.000 or jot it down, because we won't be having questions 10 00:00:34.000 --> 00:00:36.200 until each of the four speakers have finished. 11 00:00:37.080 --> 00:00:41.200 And then, it's a free-for-all, and I'll try and manage you all. 12 00:00:42.380 --> 00:00:45.600 I'd like to introduce the speakers to you in order, 13 00:00:46.280 --> 00:00:47.380 starting with Graeme Hugo. 14 00:00:48.220 --> 00:00:51.940 Graeme is Professor of the Department of Geographical and Environmental Studies, 15 00:00:52.200 --> 00:00:55.800 and Director of the National Centre of Social Application of Geographical... 16 00:00:55.800 --> 00:00:58.920 Information Systems at the University of Adelaide. 17 00:00:59.040 --> 00:01:00.180 One of our own here. 18 00:01:00.660 --> 00:01:04.100 Graeme is widely respected and has published widely in his field. 19 00:01:04.380 --> 00:01:07.980 He was elected a Fellow of the Academy of Social Sciences in Australia, 20 00:01:08.220 --> 00:01:12.940 and is currently on the International Union for the Scientific Study of Population Committee, 21 00:01:13.920 --> 00:01:15.300 on that committee on urbanisation. 22 00:01:16.320 --> 00:01:17.420 Very topical. 23 00:01:17.680 --> 00:01:25.400 In 2002, Graeme secured a $1.125 million Australian Research Council Federation Fellowship, 24 00:01:25.800 --> 00:01:28.620 to undertake a five year project called 25 00:01:28.620 --> 00:01:31.840 The New Paradigm of International Migration to and from Australia, 26 00:01:32.540 --> 00:01:34.680 Dimensions, Causes and Implications. 27 00:01:35.240 --> 00:01:39.720 And we greatly look forward, with keen interest, to Graeme's unique ideas about our topic today, 28 00:01:39.980 --> 00:01:41.000 A Healthy Public. 29 00:01:42.340 --> 00:01:47.020 Second, we have Nari Nafin, who is Professor of Law at the University of Adelaide. 30 00:01:47.440 --> 00:01:54.760 Nari has published extensively in the areas of Criminology, Criminal Law, Feminist Legal Theory, and Medical Ethics. 31 00:01:55.020 --> 00:01:55.780 She is a professor of Law at the University of Adelaide, and she is also a professor of Law at the University of Adelaide. 32 00:01:55.780 --> 00:01:59.700 barrister with the High Court of Australia and is a former police officer with the South 33 00:01:59.700 --> 00:02:04.620 Australian Police Department and former legal officer with the South Australian Premier's 34 00:02:04.620 --> 00:02:10.080 Department where she prepared reports on rape law and domestic violence. She's been a visiting 35 00:02:10.080 --> 00:02:14.360 international scholar at the Faculty of Law of Birkbeck College, University of London, 36 00:02:15.060 --> 00:02:19.780 visiting scholar at the European University Institute in Florence, Italy and has been 37 00:02:19.780 --> 00:02:23.940 the Baker Hostetia Professor of Law at the Cleveland Marshall College of Law, 38 00:02:23.940 --> 00:02:32.880 Cleveland State University USA. Clearly Nari brings her unique expertise and ideas to this 39 00:02:32.880 --> 00:02:40.040 debate. We look forward to that Nari. And John, John Murray is an Adelaidean where he studied 40 00:02:40.040 --> 00:02:47.000 medicine and completed a Master's in Public Health from Johns Hopkins University. In 1992 he joined 41 00:02:47.000 --> 00:02:52.760 the Epidemic Intelligence Service of the Centre for Disease Control and Prevention specialising 42 00:02:52.760 --> 00:02:53.920 in epidemics in disability and health. He's been a member of the Centre for Disease Control and 43 00:02:53.940 --> 00:02:59.540 Prevention for over a century in cholera in Africa and Asia. Since 1995 he's been working full-time 44 00:02:59.540 --> 00:03:05.960 on child health programs in developing countries, most recently Ethiopia, Ghana and Bangladesh. 45 00:03:06.840 --> 00:03:10.920 John is a marvellous writer who's received positive acclaim for his work from example 46 00:03:10.920 --> 00:03:18.500 the New York Times, Boston Globe, Toronto Globe and Mail, London Sunday Times and the Bulletin 47 00:03:18.500 --> 00:03:22.740 and Financial Review in Australia. His story collection, which I can't wait to get, 48 00:03:22.940 --> 00:03:23.920 a few short stories from his work, is a collection of his work. He's been a member of the Centre for 49 00:03:23.920 --> 00:03:23.940 Disease Control and Prevention for over a century in Ethiopia and Africa. He's been a member of the Centre for Disease Control and Prevention. 50 00:03:23.940 --> 00:03:30.080 A few short notes on tropical butterflies will soon be published in 10 languages with the title story 51 00:03:30.080 --> 00:03:37.260 being selected by the Joyce Carol Oates for the Best New American Voices in 2003. Clearly we'll be 52 00:03:37.260 --> 00:03:44.040 well informed and challenged by his ideas today. And last and certainly not least is Professor Peter 53 00:03:44.040 --> 00:03:49.320 Doherty who is widely published and much sought after as a speaker at public fora such as this 54 00:03:49.320 --> 00:03:53.800 one today. He commutes between St Jude's Children's Research Hospital in Memphis, 55 00:03:53.920 --> 00:03:59.260 USA and the Department of Microbiology and Immunology at the University of Melbourne. 56 00:03:59.680 --> 00:04:06.060 In 1997 Peter was Australian of the Year and having in the previous year shared the Nobel Prize in 57 00:04:06.060 --> 00:04:11.860 Physiology of Medicine with his Swiss colleague Rolf Zinchenagel for their discovery of how the 58 00:04:11.860 --> 00:04:18.280 immune system recognises virus infected cells. A major achievement that clearly has relevance to 59 00:04:18.280 --> 00:04:23.380 worldwide public health. Interestingly he was the first person with a veterinarian qualification 60 00:04:23.920 --> 00:04:28.880 to win a Nobel Prize and we look forward to his unique ideas about today's challenge, 61 00:04:29.200 --> 00:04:40.080 a healthy public. So welcome to you all. And firstly we will hear from Graeme. 62 00:04:40.600 --> 00:04:46.700 Thank you very much and thanks for the chance to speak to you. I'm a demographer. I study 63 00:04:46.700 --> 00:04:53.620 population as an aggregate. We look at the way in which populations change, the dynamics and the 64 00:04:53.920 --> 00:05:00.220 impacts of that change. So my perspective on this very, very important topic I guess is that very 65 00:05:00.220 --> 00:05:07.960 much from the perspective of demography. I want to talk about four issues which I think are very, 66 00:05:08.020 --> 00:05:15.340 very significant when we look at the whole issue of a healthy public. Before I start though I'd 67 00:05:15.340 --> 00:05:22.220 like to say that I think one of the major dimensions of a healthy public is one which is a fair public, 68 00:05:22.360 --> 00:05:23.900 one in which there is a healthy public. And I think that's one of the major dimensions of a healthy public. 69 00:05:23.900 --> 00:05:32.460 People have an equal opportunity to access to basic services in health, in education and to develop 70 00:05:32.460 --> 00:05:40.860 their talents. And I think that equity issue of access to health services is a really crucial one 71 00:05:40.860 --> 00:05:46.400 and I think it will get to be more crucial in the future if there is pressure placed on our health 72 00:05:46.400 --> 00:05:52.980 system which means that these services are rationed. And it concerns me greatly as a person 73 00:05:52.980 --> 00:05:53.880 who's been lucky enough to be able to do that. I think it's a really important issue. And I think 74 00:05:56.900 --> 00:05:58.500 it's a really important issue. And I think it's a really important issue. And I think it's a really 75 00:05:58.500 --> 00:06:02.620 important issue. And I think it's a really important issue. And I think it's a really important issue. 76 00:06:02.620 --> 00:06:09.600 South Australian, which I think is an incredible achievement. And it's my fear that with the 77 00:06:09.600 --> 00:06:15.600 rationing which is likely to occur in the future that these sorts of achievements will not be as 78 00:06:16.120 --> 00:06:23.880 great in the future. The four issues which I want to talk about are firstly the whole issue of 79 00:06:23.900 --> 00:06:33.140 children. In South Australia presently as in Australia, the proportion of children who live in 80 00:06:33.140 --> 00:06:42.680 poverty is twice the proportion of adults. This to me is a major concern across a number of areas, 81 00:06:42.860 --> 00:06:48.520 education and so on, but particularly in the area of health. And I think it is an area where we do 82 00:06:48.520 --> 00:06:53.880 have to focus particularly on the needs, the specific needs of children. And I think that's a really 83 00:07:00.460 --> 00:07:10.160 important issue to talk about, to talk to the highest 84 00:07:17.940 --> 00:07:19.320 in the last 12 years or so. 85 00:07:19.540 --> 00:07:21.920 And I think we have to come up with innovative solutions 86 00:07:21.920 --> 00:07:25.600 to overcoming this issue, 87 00:07:25.700 --> 00:07:28.060 whether it be through nutrition, through exercise, 88 00:07:28.420 --> 00:07:31.540 through education and so on. 89 00:07:32.400 --> 00:07:35.860 The second area which I want to mention briefly 90 00:07:36.500 --> 00:07:38.440 is that of Indigenous people. 91 00:07:39.540 --> 00:07:43.760 There has been enormous strides in Indigenous health made 92 00:07:43.760 --> 00:07:45.540 over the last 20 or 30 years, 93 00:07:45.540 --> 00:07:48.220 particularly in the areas of maternal health 94 00:07:48.220 --> 00:07:50.760 and reducing infant mortality. 95 00:07:51.820 --> 00:07:56.180 But to me, it is still totally unacceptable in our society 96 00:07:56.180 --> 00:07:59.140 that a young Aboriginal man 97 00:07:59.140 --> 00:08:03.980 has four times the chance of dying in their 20s and 30s 98 00:08:03.980 --> 00:08:05.380 than a non-Aboriginal man. 99 00:08:05.920 --> 00:08:09.160 To me, these issues go beyond health. 100 00:08:09.220 --> 00:08:11.500 They go to the whole of society. 101 00:08:11.940 --> 00:08:14.340 But health is one of the dimensions 102 00:08:14.340 --> 00:08:15.420 that has to be addressed. 103 00:08:15.540 --> 00:08:16.120 It is one of the things that we have to be focused on 104 00:08:16.120 --> 00:08:17.460 in tackling them. 105 00:08:17.700 --> 00:08:19.320 So along with children, 106 00:08:19.500 --> 00:08:23.020 I believe the whole area of Indigenous health 107 00:08:23.020 --> 00:08:27.140 is one which we have to embrace to a greater extent. 108 00:08:29.040 --> 00:08:34.060 The third area that I would like to talk about is ageing. 109 00:08:35.500 --> 00:08:38.140 Now, this is very demographic, of course, 110 00:08:38.160 --> 00:08:42.700 but we can be absolutely certain in South Australia 111 00:08:42.700 --> 00:08:45.520 that our population aged up to 20 years old, 112 00:08:45.540 --> 00:08:46.140 over 65, 113 00:08:46.500 --> 00:08:49.180 is going to double in the next 20 years. 114 00:08:49.480 --> 00:08:51.120 It is absolutely certain. 115 00:08:51.240 --> 00:08:53.120 Those people are already here. 116 00:08:53.220 --> 00:08:54.280 They're just not old yet. 117 00:08:54.420 --> 00:08:58.860 We just have to wait for them to move into those older age groups. 118 00:08:59.380 --> 00:09:01.580 Now, we have to plan for that. 119 00:09:01.940 --> 00:09:04.540 The reality is that it is going to put 120 00:09:04.540 --> 00:09:07.980 a great deal of pressure on our health system. 121 00:09:09.020 --> 00:09:10.620 It's a bit counterintuitive, 122 00:09:10.620 --> 00:09:12.920 but the older population today 123 00:09:12.920 --> 00:09:15.280 are less healthy than the older population, 124 00:09:15.540 --> 00:09:16.920 the population of 20 years ago. 125 00:09:17.340 --> 00:09:19.620 And the reason for that is that we, 126 00:09:19.740 --> 00:09:20.660 our health system, 127 00:09:20.700 --> 00:09:22.240 has rescued people from death. 128 00:09:22.580 --> 00:09:25.360 People who otherwise would have died have survived, 129 00:09:25.580 --> 00:09:27.840 but they've not survived as fully healthy people. 130 00:09:28.360 --> 00:09:33.680 So despite the improvements overall in health, 131 00:09:34.920 --> 00:09:38.820 we can't accept that, 132 00:09:38.900 --> 00:09:41.200 we have to accept that there will be extra pressure 133 00:09:41.200 --> 00:09:43.920 placed by the growing numbers of older people 134 00:09:44.680 --> 00:09:45.520 on people with disabilities, 135 00:09:45.520 --> 00:09:46.140 and that's a big part of the reason 136 00:09:46.140 --> 00:09:48.420 why we have to continue to work on our age care system. 137 00:09:49.780 --> 00:09:52.820 The final area that I want to briefly mention 138 00:09:52.820 --> 00:09:55.320 is that of mental health. 139 00:09:55.560 --> 00:09:59.280 To me, this is the area of health which is pushed to one side 140 00:09:59.280 --> 00:10:01.660 and is often not considered 141 00:10:01.660 --> 00:10:04.760 when we look at the whole issue of health. 142 00:10:05.320 --> 00:10:07.400 I've been privileged enough to serve 143 00:10:07.400 --> 00:10:09.840 on the State Social Inclusion Board, 144 00:10:10.080 --> 00:10:13.480 and it seems to me that so many of the issues 145 00:10:13.480 --> 00:10:14.700 which we deal with, 146 00:10:14.720 --> 00:10:15.500 are not considered. 147 00:10:15.500 --> 00:10:16.320 And so I think that the issues on that board, 148 00:10:16.440 --> 00:10:19.740 dealing with highly disadvantaged groups, 149 00:10:19.960 --> 00:10:22.420 have a very important mental health dimension. 150 00:10:23.000 --> 00:10:26.840 And it does seem to me that we have not been effective 151 00:10:26.840 --> 00:10:32.960 in tackling the big issues of mental health. 152 00:10:33.760 --> 00:10:35.440 So what's to be done? 153 00:10:35.900 --> 00:10:39.380 The theme of this whole festival of ideas. 154 00:10:39.900 --> 00:10:42.200 I believe we have to think differently. 155 00:10:42.420 --> 00:10:45.260 We can't go on doing things the way they've been done 156 00:10:45.500 --> 00:10:45.640 in the past. 157 00:10:46.040 --> 00:10:50.820 We have to rethink of the way in which we tackle health. 158 00:10:52.120 --> 00:10:54.600 Medicine is a very important part of health 159 00:10:54.600 --> 00:10:56.340 and has to be considered. 160 00:10:56.600 --> 00:10:59.280 But there are a whole range of other aspects of society 161 00:10:59.280 --> 00:11:00.960 which do impinge upon health, 162 00:11:01.120 --> 00:11:03.740 and we have to consider it in that holistic way. 163 00:11:04.240 --> 00:11:07.640 We have to look at different ways of providing services. 164 00:11:08.320 --> 00:11:11.560 The medical model is a very, very important part 165 00:11:11.560 --> 00:11:12.860 of providing health services, 166 00:11:13.100 --> 00:11:15.160 but many of our illnesses, 167 00:11:15.160 --> 00:11:17.180 chronic illnesses and so on, 168 00:11:17.280 --> 00:11:20.100 need to be dealt with in different ways, 169 00:11:20.280 --> 00:11:22.980 different community-based, paramedical, 170 00:11:23.160 --> 00:11:26.500 a whole range of ways in which they need to be tackled. 171 00:11:26.720 --> 00:11:31.240 There is no reason why the increased pressure 172 00:11:31.240 --> 00:11:33.480 on our health system in the future 173 00:11:34.240 --> 00:11:38.540 should result in a lessening of the wellbeing of people 174 00:11:38.540 --> 00:11:42.180 if we prepare for it early enough 175 00:11:42.180 --> 00:11:45.040 and we are prepared to use ideas 176 00:11:45.040 --> 00:11:48.340 beyond the traditional ways in which we've dealt with them. 177 00:11:48.520 --> 00:11:49.400 Thank you very much. 178 00:11:57.260 --> 00:11:58.220 Thank you, Graeme. 179 00:11:59.040 --> 00:12:00.520 Now we're going to hear from Nari. 180 00:12:07.940 --> 00:12:10.360 Thank you for coming out on this cold afternoon. 181 00:12:13.220 --> 00:12:14.640 All this talk about obesity 182 00:12:14.640 --> 00:12:17.460 makes me think about the five outfits I tried on before this one. 183 00:12:19.420 --> 00:12:21.280 And now I'm going to be deadly serious. 184 00:12:22.720 --> 00:12:26.880 I write and I'm talking today really as a medical lawyer 185 00:12:26.880 --> 00:12:30.280 interested in the ethical dimensions of health. 186 00:12:31.780 --> 00:12:34.860 And the question I'm posing is, 187 00:12:34.960 --> 00:12:36.940 does law strike a healthy balance 188 00:12:37.640 --> 00:12:40.300 between the interests of the treatable living, 189 00:12:40.480 --> 00:12:44.240 those who can positively benefit from medical treatment, 190 00:12:44.640 --> 00:12:46.720 and the interests of the dying, 191 00:12:46.900 --> 00:12:48.060 the deceased, 192 00:12:48.940 --> 00:12:50.380 and the never to be born? 193 00:12:50.940 --> 00:12:55.720 Does law value and protect each cohort to the right degree? 194 00:12:55.820 --> 00:12:57.100 Does it get the balance right? 195 00:12:57.220 --> 00:12:58.540 So there's my problem. 196 00:12:59.420 --> 00:13:01.420 Starting with the case of Terri Schiavo, 197 00:13:01.560 --> 00:13:03.240 immensely publicised. 198 00:13:04.940 --> 00:13:10.420 Her case engaged evangelical Christians around America 199 00:13:10.420 --> 00:13:12.200 and perhaps around the world, 200 00:13:12.200 --> 00:13:14.160 and including the President himself. 201 00:13:15.200 --> 00:13:17.100 And they insisted that life, 202 00:13:17.300 --> 00:13:19.960 in virtually any state at all, 203 00:13:20.000 --> 00:13:20.820 is sacred. 204 00:13:21.380 --> 00:13:26.160 Life per se must be sustained at whatever economic cost 205 00:13:26.160 --> 00:13:29.600 and whatever the real benefit to the person. 206 00:13:29.780 --> 00:13:34.180 A very strong view broadly held among certain groups. 207 00:13:35.380 --> 00:13:40.040 Terri Schiavo had no mental life after deprivation of oxygen. 208 00:13:40.260 --> 00:13:41.440 And over a number of years, 209 00:13:41.440 --> 00:13:45.140 she was repeatedly diagnosed as persistently vegetative state, 210 00:13:45.340 --> 00:13:47.120 and her autopsy confirmed that. 211 00:13:48.000 --> 00:13:50.780 Yet the view pressed was that she should be kept alive 212 00:13:50.780 --> 00:13:53.280 and that any life at all was worth hanging onto. 213 00:13:54.540 --> 00:13:57.920 I say that these people believe that innocent life, 214 00:13:58.060 --> 00:13:59.620 in particular, deserved protection 215 00:13:59.620 --> 00:14:03.180 because the President himself is well known 216 00:14:03.180 --> 00:14:05.580 as a proponent of the death penalty 217 00:14:06.440 --> 00:14:09.960 and approved quite a large number of executions, 218 00:14:09.960 --> 00:14:11.480 while Governor of Texas. 219 00:14:13.140 --> 00:14:13.680 So, 220 00:14:15.480 --> 00:14:18.380 some of the paradoxes about the sanctity of life. 221 00:14:19.000 --> 00:14:20.100 As we also know, 222 00:14:20.140 --> 00:14:22.320 the American courts disagreed with the President 223 00:14:22.320 --> 00:14:24.120 and said that Terri could die. 224 00:14:24.340 --> 00:14:27.400 They accepted evidence that she wouldn't have wanted 225 00:14:27.400 --> 00:14:28.780 to live like this, 226 00:14:29.380 --> 00:14:31.100 views expressed by her husband, 227 00:14:31.300 --> 00:14:33.160 and said that she did not have to 228 00:14:33.160 --> 00:14:34.940 and her life support could be withdrawn, 229 00:14:35.160 --> 00:14:36.440 and it famously was. 230 00:14:36.660 --> 00:14:39.700 And she died about 12, 13 days afterwards. 231 00:14:40.940 --> 00:14:42.340 Here in Australia, 232 00:14:43.240 --> 00:14:47.320 it's fairly clear that doctors are not obliged 233 00:14:47.320 --> 00:14:49.980 to keep struggling to keep us alive, 234 00:14:50.320 --> 00:14:51.840 though it often looks like they're trying to. 235 00:14:52.960 --> 00:14:55.940 They're not obliged to treat us 236 00:14:55.940 --> 00:14:59.760 if they think our treatment is futile, 237 00:14:59.800 --> 00:15:01.060 it's medically futile. 238 00:15:01.180 --> 00:15:02.260 That's the basic law. 239 00:15:03.520 --> 00:15:09.160 So, the law reflects the view that life at all costs 240 00:15:09.160 --> 00:15:09.940 does not exist. 241 00:15:09.940 --> 00:15:11.320 It does not have to be held onto. 242 00:15:12.260 --> 00:15:14.320 Quality of life does matter, 243 00:15:14.880 --> 00:15:18.540 and treatment which gives no real benefit to the patient, 244 00:15:18.740 --> 00:15:19.920 according to the medicos, 245 00:15:20.020 --> 00:15:20.960 need not be given. 246 00:15:22.180 --> 00:15:24.860 Patients and relatives cannot insist 247 00:15:24.860 --> 00:15:26.560 on endless medical measures, 248 00:15:26.840 --> 00:15:29.260 which in the view of the doctors is a waste of time. 249 00:15:29.540 --> 00:15:33.000 There's a medical limit to what can be done for someone, 250 00:15:33.120 --> 00:15:35.700 and there is a legal limit in that they're allowed to stop. 251 00:15:36.020 --> 00:15:38.060 This doesn't mean that they always want to stop. 252 00:15:38.280 --> 00:15:39.920 There seems to be a very strong medical expectation 253 00:15:39.940 --> 00:15:42.440 and ethical ethic of keep trying, keep trying. 254 00:15:43.500 --> 00:15:46.680 It's also lawful to withdraw a feeding tube 255 00:15:46.680 --> 00:15:49.740 from someone who will never again have a mental life. 256 00:15:50.100 --> 00:15:53.600 And the most important legal case on that comes from England, actually, 257 00:15:53.680 --> 00:15:55.280 the case of Tony Bland. 258 00:15:55.560 --> 00:15:59.020 Tony Bland was crushed at the fence 259 00:15:59.020 --> 00:16:01.400 at the Hillsborough Soccer Stadium. 260 00:16:02.040 --> 00:16:03.700 He was deprived of oxygen 261 00:16:03.700 --> 00:16:05.800 and went into a persistent vegetative state. 262 00:16:08.020 --> 00:16:09.920 His family wanted him to be 263 00:16:09.940 --> 00:16:14.360 and he wanted his supporting feeding and hydration tube withdrawn, 264 00:16:15.120 --> 00:16:18.860 and his case was appealed all the way up to the House of Lords, 265 00:16:19.100 --> 00:16:20.480 which was asked the question, 266 00:16:20.680 --> 00:16:23.320 would it be murder to take away his tubes? 267 00:16:23.580 --> 00:16:24.900 That was the medical question, 268 00:16:25.080 --> 00:16:26.540 the one that really worried the doctors. 269 00:16:27.140 --> 00:16:30.140 The House of Lords said it would not be murder 270 00:16:30.140 --> 00:16:32.360 to take away hydration and nutrition 271 00:16:32.940 --> 00:16:37.040 because there was no obligation to keep treatment going 272 00:16:37.040 --> 00:16:39.820 because there was no benefit he was deriving from it. 273 00:16:39.940 --> 00:16:43.360 There was not a life worth living in the case of Tony Bland. 274 00:16:43.580 --> 00:16:47.360 So the tube, as in the Schiavo case, was withdrawn 275 00:16:47.940 --> 00:16:49.980 and it was perfectly lawful to do so. 276 00:16:50.200 --> 00:16:53.500 We don't have a case in point just like this in Australia, 277 00:16:53.580 --> 00:16:56.880 but it looks like that would be pretty well the common law 278 00:16:56.880 --> 00:16:58.000 for Australia as well, 279 00:16:58.140 --> 00:17:01.940 and South Australia has legislated on this in a fairly similar manner. 280 00:17:03.960 --> 00:17:06.640 So even though someone is legally still alive, 281 00:17:07.480 --> 00:17:09.920 Tony Bland and Terry Schiavo had lower brains, 282 00:17:09.920 --> 00:17:10.220 they had a higher brain function, 283 00:17:10.520 --> 00:17:11.580 but not high brain function, 284 00:17:11.780 --> 00:17:13.000 so legally they were still alive, 285 00:17:13.600 --> 00:17:15.620 it was lawful to take away the tube. 286 00:17:16.040 --> 00:17:19.100 In America, because it was thought she wouldn't want it, 287 00:17:19.160 --> 00:17:21.120 in England and here in Australia, 288 00:17:21.360 --> 00:17:24.240 basically because it's thought to be futile. 289 00:17:24.380 --> 00:17:26.620 There is no interest worth preserving here. 290 00:17:27.420 --> 00:17:31.500 However, by contrast, it is murder to end the life with a toxin. 291 00:17:32.160 --> 00:17:36.120 Law maintains a distinction between taking treatment away, 292 00:17:36.260 --> 00:17:37.680 which is called an omission, 293 00:17:37.680 --> 00:17:40.680 and positively applying a toxin, 294 00:17:41.260 --> 00:17:42.240 and that's called murder. 295 00:17:42.520 --> 00:17:44.680 The practical effect of this is most unfortunate. 296 00:17:45.240 --> 00:17:46.500 When treatment is withdrawn, 297 00:17:46.840 --> 00:17:49.160 the person must be left to die slowly 298 00:17:49.160 --> 00:17:50.680 and it can take up to a fortnight. 299 00:17:50.860 --> 00:17:52.680 In the case of the PVS, 300 00:17:53.380 --> 00:17:55.260 the persistently vegetative state patient, 301 00:17:55.460 --> 00:17:56.700 they feel nothing, 302 00:17:56.820 --> 00:18:01.500 but they are seen by others to be dehydrating to death, 303 00:18:01.760 --> 00:18:03.600 which is a horrible thing to witness, no doubt. 304 00:18:04.180 --> 00:18:07.660 But far worse is the case of someone who does have a memory loss, 305 00:18:07.680 --> 00:18:08.080 who has a mental life, 306 00:18:08.360 --> 00:18:11.100 and who cannot be put out of their misery. 307 00:18:11.380 --> 00:18:14.920 The best that can be done is increase of palliative care, 308 00:18:15.040 --> 00:18:15.780 of pain relief, 309 00:18:16.080 --> 00:18:17.980 but not with the intention of killing, 310 00:18:18.080 --> 00:18:18.840 because that would be murder. 311 00:18:19.320 --> 00:18:21.760 And then they can slowly die, 312 00:18:22.040 --> 00:18:25.060 but they cannot be hurried along in any other way 313 00:18:25.060 --> 00:18:27.000 than increase of morphine. 314 00:18:27.080 --> 00:18:28.680 And as we know from many famous cases, 315 00:18:28.860 --> 00:18:32.040 this means undignified and painful deaths 316 00:18:32.680 --> 00:18:34.460 where palliative care doesn't work. 317 00:18:35.520 --> 00:18:36.040 So, 318 00:18:36.040 --> 00:18:38.700 the rights of the dying are not preserved. 319 00:18:40.040 --> 00:18:41.960 What our law does preserve, 320 00:18:42.020 --> 00:18:43.200 to a very surprising degree, 321 00:18:43.400 --> 00:18:44.500 is the rights of the dead, 322 00:18:44.660 --> 00:18:47.500 and at a considerable cost to the living. 323 00:18:48.420 --> 00:18:51.540 Although we can't ask someone to help us to die, 324 00:18:51.660 --> 00:18:54.680 we are permitted to hang onto our organs 325 00:18:54.680 --> 00:18:58.180 and to exercise legal control of our bodies after death, 326 00:18:58.420 --> 00:19:00.300 which I find a very peculiar idea. 327 00:19:01.780 --> 00:19:02.800 In this respect, 328 00:19:02.860 --> 00:19:04.900 the dead take priority over the living, 329 00:19:04.900 --> 00:19:06.960 the living who need their organs, basically. 330 00:19:07.560 --> 00:19:10.980 Faced with clear evidence that a person wants to hang onto their organs 331 00:19:10.980 --> 00:19:11.840 after they die, 332 00:19:11.980 --> 00:19:13.480 or their relatives don't want them to go, 333 00:19:13.720 --> 00:19:16.440 a doctor would be unwise to remove them. 334 00:19:16.800 --> 00:19:18.520 It will probably be an offence. 335 00:19:19.800 --> 00:19:20.860 As a consequence, 336 00:19:21.200 --> 00:19:24.500 because we don't have a good ethic in this country of organ donation, 337 00:19:24.720 --> 00:19:28.020 we have one of the lowest organ donation rates in the world. 338 00:19:29.380 --> 00:19:32.660 Organ donation is not extreme medicine necessarily, 339 00:19:32.660 --> 00:19:33.920 particularly if you look at, say, 340 00:19:33.920 --> 00:19:35.600 kidneys and kidney dialysis machines, 341 00:19:35.980 --> 00:19:37.980 the cost of people being on those machines. 342 00:19:39.020 --> 00:19:41.220 The removal and replacement of a kidney 343 00:19:41.220 --> 00:19:46.020 is major but relatively routine surgery and highly successful, 344 00:19:46.240 --> 00:19:47.900 and it gets people off expensive equipment 345 00:19:47.900 --> 00:19:50.580 and gives them a life and takes them away from a machine. 346 00:19:52.680 --> 00:19:56.780 So I find it odd that there are such strong rights invested in the dead, 347 00:19:56.960 --> 00:20:02.180 and I find quite appealing the idea that we return to the biomass when we die. 348 00:20:02.560 --> 00:20:03.520 Just go back. 349 00:20:03.920 --> 00:20:06.380 And we can be used in any way at all. 350 00:20:08.080 --> 00:20:08.980 With dignity. 351 00:20:09.620 --> 00:20:14.080 One other area I find a paradox 352 00:20:14.920 --> 00:20:18.880 in terms of our investment in the idea of the sanctity of life, 353 00:20:19.140 --> 00:20:22.360 but not perhaps behaving in that way consistently, 354 00:20:22.660 --> 00:20:26.180 and also raising interesting questions about how we spend our money, 355 00:20:26.220 --> 00:20:27.100 our health dollars, 356 00:20:27.120 --> 00:20:31.280 is our very protective attitude to frozen embryos, 357 00:20:31.920 --> 00:20:33.340 excess frozen embryos. 358 00:20:33.920 --> 00:20:38.580 Which are in excess to the needs of the potential parents. 359 00:20:38.700 --> 00:20:42.380 The use of such embryos for research and therapeutic purposes 360 00:20:42.920 --> 00:20:44.080 is highly regulated. 361 00:20:44.660 --> 00:20:48.720 Indeed, there's been a three-year embargo on the use of excess embryos 362 00:20:48.720 --> 00:20:52.620 created after 5th of April 2002. 363 00:20:53.160 --> 00:20:58.060 And the sanctity of life is invoked in defence of these policies. 364 00:20:58.860 --> 00:21:00.620 So to sum up, 365 00:21:00.720 --> 00:21:03.900 I'd like to make four major points, 366 00:21:03.920 --> 00:21:07.540 about the balance struck between the interests of the dying, 367 00:21:07.740 --> 00:21:08.560 the dead, 368 00:21:09.400 --> 00:21:10.860 the yet to be born, 369 00:21:10.900 --> 00:21:11.920 and the never to be born, 370 00:21:12.080 --> 00:21:14.680 and those who are left here trying to live on a healthy life, 371 00:21:14.780 --> 00:21:15.720 perhaps looking for some organs. 372 00:21:16.560 --> 00:21:20.860 Firstly, there is a sensible legal pragmatism about medical treatment 373 00:21:20.860 --> 00:21:24.340 for those who can receive no real further benefit from it. 374 00:21:24.400 --> 00:21:27.140 Treatment can be legally stopped when it is useless. 375 00:21:27.700 --> 00:21:29.980 Heroic measures do not have to be undertaken. 376 00:21:30.640 --> 00:21:33.740 That doesn't mean that there isn't an ethic of wanting to undertake those 377 00:21:33.920 --> 00:21:34.700 heroic measures. 378 00:21:35.300 --> 00:21:39.300 Secondly, life may only be ended by withdrawal of treatment 379 00:21:39.920 --> 00:21:42.540 or by increased painkillers, such as morphine. 380 00:21:42.860 --> 00:21:46.020 In both cases, death occurs slowly, 381 00:21:46.880 --> 00:21:48.620 probably by dehydration, 382 00:21:48.720 --> 00:21:51.060 and I think this appears to be a cruel law 383 00:21:51.060 --> 00:21:55.020 in the case of the PVS patient. 384 00:21:55.600 --> 00:21:57.820 It's cruel to those who look on. 385 00:21:58.300 --> 00:22:01.580 And it's a cruel law to those who still have a mental life 386 00:22:01.580 --> 00:22:03.480 and who must die in this way. 387 00:22:06.120 --> 00:22:07.460 Thirdly, the dead, 388 00:22:07.600 --> 00:22:09.460 who have ceased to have any living interests, 389 00:22:09.680 --> 00:22:10.660 rule from the grave. 390 00:22:11.120 --> 00:22:13.520 The wishes of the deceased must be respected. 391 00:22:14.060 --> 00:22:18.060 I think laws about organ donation need to be reviewed. 392 00:22:18.220 --> 00:22:19.300 In fact, they are up for review. 393 00:22:19.660 --> 00:22:21.660 And I don't think this does strike the right balance 394 00:22:21.660 --> 00:22:23.440 between the treatable living and the dead. 395 00:22:24.700 --> 00:22:28.300 Finally, I think we can question the elaborate legal regulation 396 00:22:28.300 --> 00:22:31.560 of the use of embryos for therapeutic purposes, 397 00:22:31.920 --> 00:22:33.900 especially when the same organ donation 398 00:22:33.920 --> 00:22:36.860 and the same embryos are lawfully permitted to succumb, 399 00:22:36.920 --> 00:22:38.160 that means die, 400 00:22:40.180 --> 00:22:42.040 and will never have a life. 401 00:22:42.920 --> 00:22:45.960