Legislative reform

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Branka van der Linden on the "HOPE" website.

HOPE’s Director, Branka van der Linden, is at it again, foisting more misleading information about voluntary assisted dying (VAD) on unwilling members of Parliament. I expose the rot and provide some background on Mrs van der Linden.

Van der Linden’s latest email to all WA MPs states:

Subject: WA Report relies on troubling Belgian study

 
[MP Salutation] --

Did you know that a study showing that one person in Belgium is euthanised every three days without their explicit consent also found that:

  • in more than 77 per cent of cases, the decision was not discussed with the patient;
  • in more than half of cases, the patient had never expressed a desire for their life to be ended; and
  • in more than half of the cases, the reason given was because killing the patient was the wish of the family?

 
Did you know that the WA majority report cited this study as evidence of assisted suicide and euthanasia reducing the incidence of unlawful activity?

Warm regards,

Branka van der Linden
Director, HOPE

 
Van der Linden’s method is to create an impression of calumny against VAD law reform. She uses a nice PR formula of three bullet points per communication. With repetition. It’s a method I expressly warned the WA Parliament to watch out for in my submission to its inquiry. The growing list of emails is now starting to look like ‘harassment’.

So let’s look at van der Linden’s claims — again. She’s talking about non-voluntary euthanasia (NVE) — again.

In her email to MPs, she complains that the WA majority report on end-of-life choices cited the study as evidence of the NVE rate reducing when VAD is legalised.

Well, the WA majority report formed that correct conclusion because that’s precisely what the cited study reported: drops in the NVE rates in both the Netherlands and Belgium after their euthanasia Acts came into effect in 2002.

While concerns ought to be expressed about the deliberate hastening of death without an explicit request from the patient with a view to improving knowledge and practices, it’s not caused by VAD laws as van der Linden desperately tries to imply.

Here are highly relevant things the cited study’s authors had to say, but van der Linden astonishingly ignores:

“The use of life-ending drugs without explicit patient request are not confined to countries where physician-assisted death is legal.”; and

“[NVE’s] occurrence has not risen since the legalisation of euthanasia in Belgium. On the contrary, the rate dropped from 3.2% in 1998 to 1.8% in 2007. In the Netherlands, the rate dropped slightly after legalization, from 0.7% to 0.4%” [The Belgian rate was 1.7% in a more recent replication of the research.]; and

The NVE cases found in the study “in reality resembles more intensified pain alleviation with a ‘double effect’, and death in many cases was not hastened.”

But let’s not let the facts get in the way of a good story. Van der Linden’s recent emails about VAD to MPs reveal astonishing ignorance and a willingness to overlook critical evidence contrary to her position, contained in the very source she cites.

The superficiality of her cherry-picking is kind of embarrassing: she holds an arts/law degree from Australian National University, so you’d expect more intelligent engagement.

It begs the question: who is Branka van der Linden? The “HOPE” website reveals little if anything.
 

Who is Branka van der Linden?

Branka Van der Linden is the current Director of anti-VAD website “HOPE (Preventing euthanasia and assisted suicide)”. HOPE is an initiative of the Australian Family Association, a Catholic lobby group established by Australia’s most famous lay Catholic, B. A. Santamaria.

HOPE’s founding Director and van der Linden’s predecessor, was Mr Paul Russell, the former Senior Officer for Family and Life at the Catholic Archdiocese of Adelaide.

It turns out that Branka van der Linden (née Seselja) is a sister of Catholic ACT Senator Zed Seselja who voted against David Leyonhjelm's recent Restoring Territory Rights (to legislate on VAD) Bill. But there’s more. Far more.

Branka, who attended Catholic St Clair’s College primary school and Padua Catholic High School, both in the ACT, is a “senior lawyer” at the Truth Justice and Healing Council, which provides services to the Australian Catholic Bishop’s Conference and Catholic Religious Australia in relation to the Catholic Church’s response to the Royal Commission into Institutional Responses to Child Sexual Abuse.

She’s advisory legal counsel for the lay Catholic St Vincent de Paul Society Canberra/Goulburn Territory Council. (And good on her for supporting this philanthropic work.)

She and her husband Shawn represent (or at least represented) the Australian Catholic Marriage and Family Council, and were representatives of the Catholic Archdiocese of Canberra & Goulburn on the National Family Pilgrimage to the (Catholic) World Meeting of Families in Philadelphia in 2015.

Husband Shawn has been described by the church as a “loyal Catholic servant” for nine years of service as the director of CatholicLIFE at the Catholic Archdiocese of Canberra and Goulburn.

And as if this weren’t clear enough, a sample of Branka’s Facebook Likes is equally informative:

A sample of Branka van der Linden’s Facebook Likes

  • Archbishop Anthony Fisher (Catholic)
  • Archbishop Samuel J. Aquila (Catholic)
  • Archbishop Mark Coleridge (Catholic)
  • Bishop Robert Barron (Catholic)
  • Marist College Canberra Faith Formation (Catholic)
  • St Thomas the Apostle Kambah (Catholic)
  • Campion College (Catholic)
  • Teaching Catholic Kids
  • Ascension (Catholic Church)
  • CathFamily
  • St Therese of Lixieux (Catholic)
  • Dominican Sisters of Saint Cecilia in Australia (Catholic)
  • Fusion Youth Group (Catholic)
  • St Clare’s College (Catholic)
  • Marist Canberra Football Club (Catholic)
  • Light To The Nations (Catholic)
  • Catholic Voices USA
  • Centre for Faith Enrichment (Catholic)
  • World Meeting of Families 2015 (Catholic)
  • Quidenham Carmelite Monastery (Catholic)
  • Denver Catholic
  • Catholic Mission – Canberra & Goulburn
  • XT3 (Catholic youth association)
  • Missionaries of God’s Love Darwin (Catholic)
  • Marist College Canberra (Catholic)
  • Life, Marriage & Family Office (Catholic)
  • Infant Jesus Parish, Morley (Catholic)
  • MGL Priests and Brothers (Catholic)
  • Catholic Mission – Sydney, Broken Bay, Parramatta
  • Youth Mission Team Australia (Catholic)
  • Summer School of Evangelisation – Bathurst (Catholic)
  • Missionaries of God’s Live Sisters (Catholic)
  • Sisterhood National Catholic Women’s Movement
  • My Family My Faith (Catholic)
  • Catholic Talk
  • The Catholic Weekly
  • The Catholic Leader
  • Mercatornet (Catholic blog site)
  • BioEdge (Catholic blog site)

It’s clear that Branka van der Linden, like her predecessor Paul Russell, is very deeply invested in Catholic tradition. I will be the first to say I firmly believe that is entirely her right.

Yet how curious it is that while repeatedly advancing (secular) misinformation about VAD, Branka van der Linden doesn’t mention her profound religious convictions. It's surprisingly similar to the approach evidenced by Catholic Professor of Ethics, Margaret Somerville; and Catholic (then) Victorian MP Daniel Mulino; and Catholic Editor of The Australian, Paul Kelly (who warmly quotes Mulino); and Catholic director of the Euthanasia Prevention Coalition, Alex Schadenberg...

You get the idea: perhaps there's a pattern?

One possible source of pattern

What was it that the Catholic Archbishop of Sydney, Anthony Fisher, said at the 2011 Catholic Bioethics Conference in relation to opposing the legalisation of VAD?

"The most effective messengers may also vary: bishops, for instance, are not always the best public spokespeople for the Church on such matters."; and

"...the man or woman in the street ... may well be open to persuasion that permissive laws and practices cannot be effectively narrowed to such circumstances"; and

"We need to research and propose new messages also and carefully consider who should deliver them, where and how."

Nowhere in his address does Fisher propose actually testing whether his calamitous assumptions about VAD are true.

Gosh, another coincidence.

Epilogue

I want to be absolutely clear that I am not using a person’s religious conviction as a reason to dismiss their ideas. That’s called an ad hominem attack: an attack against the person rather than the substance of the argument (even assuming it has any substance to assess).

What I have done here and elsewhere, and I will continue to do, is to expose arguments that are false, misleading, illogical or otherwise unmeritorious on the basis of empirical evidence and reasoning.

It just turns out that organised misinformation against VAD law reform comes from deeply religious circles, and those religious circles often avoid mentioning their religiosity while spreading such nonsense under a ‘veneer of secularism’.

It’s in the public’s interest to understand where most organised misinformation against VAD comes from.


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'HOPE' is pedalling assisted dying misinformation to politicians again.

The Catholic-backed anti-assisted-dying ginger group, HOPE, was represented for years by Paul Russell. He's retired and Branka van der Linden is now at the helm. But its penchant for pedaling egregious misinformation hasn't changed. Van der Linden recently sent an email to all WA members of parliament, containing three points.

Van der Linden's email reads:

 

Dear [MP salutation],

Did you know that the WA majority report that recommended assisted suicide for WA either dismissed or failed to report on the following statistics?

  • In the Netherlands in 2015, 431 people were euthanised without their explicit consent.
  • In Belgium, 8 per cent of all deaths were without explicit consent from the patient.
  • In Oregon in 2017, the ingestion status of 44 (out of 218) patients was ‘unknown’, making it impossible to ascertain if these 44 patients ended their lives voluntarily and without coercion.

Yours faithfully,

Branka van der Linden

Director, HOPE

 

The trouble is, all three claims by van der Linden are either directly false or egregiously misleading. Here are the actual facts:

FACT: Peer-reviewed scientific research shows that the non-voluntary euthanasia rate of both the Netherlands and Belgium has dropped significantly since their assisted dying Acts came into effect in 2002, consistent with more careful end-of-life decision making across the board.

Fiction 1: van der Linden improperly cherry-picked a single year’s statistic for each country (and, incoherently, a raw count for one but a percentage for the other), implying that lawful voluntary euthanasia increases non-voluntary euthanasia, when the opposite is true.

Fiction 2: van der Linden claimed Belgium’s non-voluntary euthanasia rate is 8%. It has never been anywhere near that figure: the most recent figure is 1.7% and it was 3.2% before Belgium’s euthanasia law.

FACT: Oregon’s health department actively matches death certificates with prescriptions issued for assisted dying. At any time some prescriptions have not been taken and the person may still be alive, and for the deceased, death certificates are still being processed. This naturally means that some prescription/death statuses will temporarily be ‘unknown’ to authorities, even though they will be later determined.

Fiction 3: van der Linden comically implies that this proper process is sinister.

It's curious how 'HOPE' likes to repeatedly demonstrate how HOPElessly uninformed it is about the actual facts and that its methods include cherry-picking data which it thinks supports its anti-assisted dying case, but which don't.

Western Australians deserve better than HOPE's silly propaganda campaign.


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Victoria has shown what happens at the ballot box to candidates who oppose VAD

Many news outlets are reporting that Victoria's voluntary assisted dying (VAD) Act comes into effect mid-year, and how other Parliaments around the country are likely to implement similar reforms. Moves are afoot in Western Australia, Queensland, NSW and Tasmania, with other jurisdictions to follow. Marshall Perron, former Chief Minister of the Northern Territory and architect of the first VAD law in Australia, has penned a media release to highlight how VAD influenced the Victorian election. The result wasn't pretty for opponents of VAD law reform.

Media release - Marshall Perron

Parliamentarians traditionally shy away from supporting voluntary assisted dying (VAD), believing it is politically toxic to do so. Victoria, under the Andrews government, has changed all that by showing the opposite to be true.

After legislating VAD – Victoria is the first Australian state to do so – Andrews won a thumping victory at the 2018 Victoria State election.

Former NT Chief Minister Marshall Perron said there is a common perception that the political class has not been listening to its constituents. VAD is a classic example.

There were multiple reasons for Victoria’s election result, and VAD was clearly one of them. With unprecedented 80-85% public support, it should be no surprise that Victorian candidates who supported VAD polled more strongly.

In the previous parliament, almost all Liberal members voted against the VAD legislation. The party suffered an average 6.04% swing against it in the State election.

In addition, two of the staunchest Liberal opponents of the VAD bill lost their seats. In the lower house, Robert Clark was tossed out as the Member for Box Hill, a seat he’d comfortably held for a quarter century. In the upper house, Inga Peulich was rejected by voters in South Eastern Metropolitan, a Region she’d represented for three terms.

Dying With Dignity Victoria and Andrew Denton ran targeted campaigns focusing on four electorates – Burwood, Albert Park, Bentleigh and Prahran.  They used Robo calls, advertising, social media and face to face meetings to inform voters about where their candidates stood on VAD.

The Liberal candidates (one a sitting member) in these four electorates all opposed VAD. They suffered an average 10.1% drop in primary votes compared with the average drop in the Liberal vote overall of 6.04%.

The Liberal sitting member lost his seat. In the other three seats the sitting Labor and Greens members, who all supported VAD, were returned with significantly increased votes. The results for these four electorates were, compared to the 2014 election:

  • In Burwood, Liberal member Grahame Watt lost his seat with a 6.47% swing against. Labor candidate and VAD supporter Will Fowles was elected.
  • In Albert Park, Labor member and VAD supporter Martin Foley was returned with a massive 10.17% increase (two party preferred). The Liberal primary vote dropped 10.24%.
  • In Bentleigh, Labor member and VAD supporter Nick Staikos was returned with a massive 11.27% increase. The Liberal primary vote dropped 12.59%.
  • In Prahran, Greens member and VAD supporter Sam Hibbens was returned with a 7.0% increase. The Liberal vote dropped 10.29%.
     

Mr Perron, who introduced the world’s first successful VAD legislation in the Northern Territory in 1995 said candidates can increasingly expect to lose support when they ignore the wishes of the voters they seek to represent.

In a contest tighter than the Victorian election turned out to be, a handful of seats retained or lost on VAD could determine the outcome.

Marshall Perron


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Plenty of misinformation will be advanced to oppose Senator David Leyonhjelm's Restoring Territory Rights Bill.

In 1996 the Northern Territory Rights of the Terminally Ill Act (ROTI) came into effect. Just four people had used the Act when seven months later an Act of the Federal Parliament extinguished the NT law, by cancelling the Territories’ authority to enact it.

This week, the Senate [federal parliament] debates the Restoring Territory Rights (Assisted Suicide Legislation) Bill, sponsored by libertarian Senator David Leyonhjelm. If the Bill passes both houses, the Territories will again have the authority to legislate the matter of assisted dying.

Opponents of lawful assisted dying have been sharpening their knives to ensure that Senator Leyonhjelm’s Bill fails and that Territorians remain second-class citizens. In this post I expose one of the desperate and disgraceful pieces of misinformation opponents use to try and curry fear about law reform.

Opponent signals

There are signals from many quarters that assisted dying opponents are dragging out the tired old argument that indigenous Australians are too fearful of assisted dying to allow reinstatement of the Territories’ legislative authority.

The signals are clear, though so far mostly behind the scenes. Nevertheless, they predict a full onslaught of invalid “fear” claims in the parliamentary debate this week.

Populist beginning of the misinformation

Since the NT ROTI Act there have been ongoing claims that indigenous (Aboriginal and Torres Strait Islander) Australians are wholly and deeply fearful of assisted dying law. A chief flag-waver of this proposition is Jesuit Priest Father Frank Brennan. He’s not only argued this line repeatedly in public, but promoted it to at least one parliamentary inquiry.

Fr Brennan likes to frame this argument to suggest that it’s uniquely substantive and persuasive, while other highly relevant information is merely “suggestion”.

“There was a suggestion these fears were whipped up by the churches and other conservative groups.” — Fr Brank Brennan

The “indigenous fears” opinion has been widely disseminated by other Catholics, including now-disgraced Fr John Fleming in a paper on behalf of the Catholic Southern Cross Bioethics Institute, and by Mr Paul Russell, Director of “HOPE”, a ginger group established by the Catholic Australian Family Association.

Classic cherry-picking

I’ve called out Mr Russell and others before for cherry-picking information to suit their arguments. And here we are again. In this blog, Mr Russell correctly reports that indigenous NT parliamentarian Mr Wes Lanhupuy voted in favour of the ROTI Act, but dismisses his vote as the result of “pressure”.

What Mr Russell disgracefully omits from his plug is that Mr Lanhupuy was directly involved in the consultation of indigenous communities, and said this in his parliamentary speech:

“The church has been a major voice. … I heard in the community that some of the churches were telling people that they should not support the bill basically because of their religious beliefs. No information whatsoever was given as a reason for that. No information was given whereby people could determine their own beliefs. That was disappointing.” — NT indigenous parliamentarian Mr Wes Lanhupuy (Hansard)

Disgraceful religious prejudice

But there’s more. At the time the federal parliament was debating its Bill to overturn the ROTI Act in 1997, the Senate Legal and Constitutional Legislation Committee conducted a formal investigation and published a Senate report, Consideration of legislation referred to the Committee: Euthanasia Laws Bill 1996. Its 204 pages make interesting reading.

For example, Mr Creed Lovegrove, a former senior Northern Territory public servant leading the Native Affairs Office, reported to the Senate Committee:

“I express my concern, not at the right of certain ideologists to have their say, but at the misrepresentations some were making to people over whom they have an emotional hold. Where this group happens to be Aboriginal, I believe some of the frightening lies they were told about the subject were a psychological and emotional exploitation of them, as blatant as any that has ever occurred in the Territory.” — p 44

…and reported to him by a group of senior and influential Aboriginals:

“They reckon the government is going to round up all the real sick people and those with V.D. and things like that and finish them off.” — p 45

…and on page 44 of the report, the Northern Territory government noted that at least one Aboriginal community wanted to hear the full story about euthanasia, not just the Church story.

Fake news — avoiding healthcare

There were also widespread claims that indigenous Northern Territorians were avoiding presenting to medical centres for healthcare for fear of being euthanased. However, the Senate report noted (p 52) that the claim was controversial, and that the Northern Territory government had provided statistics to show no significant decrease in presentations for treatment.

In a classic opponent manoeuvre when the data yet again didn’t fit the story, it was then claimed (p 52) that future data could show a decrease in presentations.

Morally bankrupt argument

But that’s a morally bankrupt argument. You don’t deny Jack the right to drive a car because Jill has an ill-informed phobia that Jack’s right is likely to contribute to her own death. Rather, the ethical approach is to provide Jack with his right and to provide Jill with education.

And that’s precisely what the NT government did. In today’s money, it stumped up $500k for education programs, and those programs were beginning to take effect. In testimony to the Committee, Reverend Dr Djiniyini Gondarra (opposed to the legislation) conceded that the education efforts had been somewhat effective in overcoming fears about the ROTI Act (p 52).

Ironic reverse discrimination

Perhaps one of the most ironic aspects of church-led fear of the ROTI Act was the Act’s “reverse discrimination” itself. The Act required, if the doctor and patient did not share the same first language, that a qualified and authorised translator be engaged before the patient might qualify for an assisted death.

Given the rarity of qualified and authorised translators, especially in remote communities, indigenous Northern Territorians would have had significantly less access to use the law than their white, city-based fellow citizens.

Putting it into perspective

Setting aside the dreadfully misinformed fear of assisted dying law and its stoking by churches, the question arises as to the prevalence of indigenous residents in the Territories: both Northern Territory and Australian Capital Territory. I’ve retrieved Australian Bureau of Statistics data from the 2016 census to answer that question (Figure 1).

 

indigenousterritorians.gifFigure 1: Australian Territory indigenous populations
Source: Australian Bureau of Statistics, 2016 census

Indigenous peoples represent a quarter of the population in the NT (25.5%), and a tiny minority (1.6%) in the ACT. Across the two Territories, that’s 10.3% of the population. Even if all the indigenous citizens opposed assisted dying law reform (which is clearly not the case), their impact on overall attitude would be minor.

By way of comparison, most national polls find around 12% of Australians opposed to assisted dying law reform. And, as I’ve factually demonstrated, almost all of that is faith-based. Such ‘fears’ are not a valid reason to prohibit others from pursuing a choice they deeply feel is moral and justified.

Playing the race card

Indeed, if opponents were intent on justifying the denial of a parliament to legislate for assisted dying on the basis of supposed indigenous attitude — playing the race card — then they must also by corollary campaign for the denial of State parliaments to legislate. That's because there are nearly four times as many indigenous Australians in NSW (216,170) and three times as many in Queensland (186,483) as there are in the Northern Territory (58,246) [2016 census data].

To argue one and not the other is to flip-flop.

Contact your Senators now

Church-whipped fear about assisted dying law amongst indigenous Australians is appalling and to be condemned, as is spreading false claims about a supposed reduction in presentations for medical care.

Senators will be inundated with false claims as they contemplate the Leyonhjelm Bill — including that indigenous Territorians are terrified of assisted dying law. (Lyeonhjelm’s Bill doesn’t legalise assisted dying: it only restores Territory parliament rights to consider the reform.)

It’s critical that Senators also hear from supporters of Territory rights — that Territorians not be treated as second-class citizens compared to State-based citizens.

To that end YOU can do something right now! Use the Go Gentle Australia submission page to send a message of support to your State or Territory Senators now. Go Gentle make it so easy, by showing you who your Senators are by merely entering your address.

Don’t delay! Here’s the link again.

 

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Disclaimer: I do not claim, suggest, imply or impute that any individuals named in this article were personally or individually responsible for, or were involved in, any misinformation being provided to indigenous Australians about assisted dying law.


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Physician consultation and end of life decision quality improves under VAD law

Two DyingForChoice.com reports to the Western Australia Parliament committee inquiry into end of life choices furnish clear evidence from multiple peer-reviewed research papers that the quality of a broad range of end-of-life decision types have improved in jurisdictions with voluntary assisted dying (VAD) laws.

Training and decision making has improved under VAD

In the first report, studies show that the quality of palliative care education and the quality of decision making has improved when VAD is legalised: (PDF 0.6Mb).

Where decision making is best and worst

In the second report, studies show that clearly inappropriate doctor decisions (unilaterally making end of life decisions about a patient without involving the patient or her family) are lowest in the Netherlands with its extensive experience in VAD, and highest in Italy with its strong opposition to VAD: (PDF 0.2Mb).

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Which doctors 'play God' most with patient end of life decisions might surprise you

In two supplementary submissions to the Parliament of Western Australia, I report empirical evidence about the standards of end-of-life medical decision making in jurisdictions with and without voluntary assisted dying (VAD) laws. The evidence clearly contradicts the assumption of assisted dying opponents that legalised VAD will lead to worse end-of-life decision making by physicians. In fact, the evidence clearly shows which physicians are 'playing God' with their patients, and it's not the Dutch.

When I appeared as an expert witness before the Parliament of Western Australia's Joint Select Committee on end of life choices, the Hon. Nick Goiran, a staunch Christian opponent of VAD, asked me for evidence of bringing end of life decision making out of the 'dark shadows' and into the light in jurisdictions in which VAD is lawful.

Existing evidence

Of course, there's the clear evidence from both the Netherlands and Belgium that the rate of non-voluntary euthanasia (NVE) has dropped significantly and stayed lower after their Euthanasia Acts each came into effect in 2002. There's also the clear evidence that the rate of nurse administration of possible life-ending drugs has dropped significantly in Belgium with a VAD law, over a similar time period in which it had increased significantly in New Zealand, where there is no VAD law. These forms of evidence were already documented in the comprehensive submission (PDF 5.4Mb) I'd made to the Committee.

Training and decision making has improved (Supplementary 1)

Mr Goiran opined that any improvements in palliative care were not relevant to his question. In my first supplementary submission to the Committe (PDF 0.6Mb) to further inform it of the empirical evidence, I disagree. As I point out, VAD decisions are not made in a vacuum: they are made after other interventions have been considered and declined, or tried and failed to provide sufficient relief. Palliative care options are central to these considerations. Therefore, whether palliative care improves or deteriorates after VAD laws are introduced is crucial.

Adding to the body of knowledge about the quality of palliative care, in this first supplementary submission I report that Dutch and Belgian physicians attended palliative care professional training at vastly higher rates than most other countries in the several years after VAD was legislated.

I also report the research evidence showing increases in desirable end of life decision rates, and decreases in undesirable decision rates in both the Netherlands and Belgium.

Where decision making is best and worst (Supplementary 2)

In my second supplementary submission (PDF 0.2Mb), I report data from two careful scientific studies into end of life decision making by doctors across multiple countries, including the Netherlands, Belgium, Switzerland, Italy and Australia.

The results are striking: for clearly inappropriate decisions such as withholding chemotherapy or administering terminal sedation without consulting their mentally competent patient, the Netherlands was clearly the best performer with the lowest rates of these kinds of decisions amongst physicians. And who was the overall worst? Italy.

Yes, that jurisdiction that harbours the head office of the world's most actively VAD-opposing organisation, the Catholic church, and where 82% of physicians are Catholic, were by far the most likely overall to make medical end of life decisions about their mentally-competent patients without consulting either the patient or her family. Italian physicians were, respectively, more than five times, three times, and twice as likely as those from the Netherlands, Beligum or Switzerland, to make unilateral end of life decisions without consulting either the patient or her family.

So much for high moral standards under a more religiously-driven and VAD-opposing regime.

I also illustrate from another study how VAD decision making in the Flemish north of Belgium, where the rate of VAD deaths is higher, is significantly higher in quality than in the Walloon south.

Conclusion

The peer-reviewed research data currently available consistently and directly demonstrate improvements in end of life care education and decision making in jurisdictions with VAD compared with those that don't. In contradiction to VAD opponents' assumptions, it's Italian physicians — who largely oppose VAD — who tend to 'play God' most with their patients.

The evidence comprehensively supports the view that legalisation of VAD brings a wide range of end of life decision making out of the shadows and into the light, where critical and open appraisal results in significant improvements.


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A DyingForChoice.com editorial appears in the Jan/Feb 2018 edition of LivingNow

A DyingForChoice.com editorial in the Jan/Feb 2018 issue of lifestyle magazine, LivingNow, explains why assisted dying law reform in Australia has taken so long, and why it will accelerate from here.

Download the editorial (PDF 3.5Mb)

Visit LivingNow


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The Parliament of Western Australia is investigating end-of-life choices including VAD. Photo: WA Parliament

DyingForChoice.com's major submission to the Parliament of Western Australia on end-of-life choices, including assisted dying, has now been published and is available online. It contains recent updates to research data about assisted dying.

Download a full copy of the submission PDF.

Table of Contents

Terms of reference. p5

Definitions. 6

Statement of Barbara Roberts, former Governor of Orergon. 7

Part A: Introduction. 8
  A critical principle. 8
  Decision-making biases to be avoided. 8
  Potential bias 1: Strong emotional language diminishes critical faculties. 8
  Potential bias 2: Repetition doesn’t make a falsehood true. 8
  Potential bias 3: Use of ‘authorities’ as undeserved ‘evidence’ cues. 8
  Assisted dying law reform is necessary. 9
  Consequences of denying lawful assisted dying choice. 10
  Overmedicalisation and institutionalisation of death. 12
  Choice to die can be rational 13
  Regulation of existing underground practice. 14

Part B: Overwhelming support. 16
  Australian voter attitudes by demographic. 16
  Assisted dying a major issue for voters. 20
  More supporters than opponents think reform important. 20
  Voters will punish opposing MPs more. 20
  Not just a silver-hair issue. 21
  Summary of Australian public attitudes. 22
  Australian health professional opinion.. 23
  AMA opposed stance indefensible. 23
  RACGP supportive stance. 23
  Nurses & Midwives’ Federation supportive stance. 23
  Australian Psychological Society supportive stance. 24

Part C: Opposing arguments critiqued. 25
  Time to name up filibustering for what it is. 25
  Hippocratic Oath fictions. 25
  ‘First do no harm’ fails in the real world. 26
  Assisted dying is not about ‘saving money’. 27
  Assisted dying is consistent with the right to life. 28
  Palliative care availability improves. 28
  Trust in doctors remains high. 28
  Ample evidence against ‘slippery slope’ theories. 30
  Failure 1: Rhetorical sham. 30
  Failure 2: Unsupported by overseas evidence. 32
  Failure 3: Unsupported by domestic evidence. 33
  Opposing world views can be concurrently accommodated. 35

Part D: Correcting misinformation about lawful jurisdictions. 37
  Dr Els Borst remains proud of euthanasia law reform. 37
  Dutch elderly happy with nursing homes. 38
  Non-voluntary euthanasia rates fall, not rise. 39
  No suicide contagion. 42
  Not in Oregon. 42
  Not in Switzerland. 45
  Not in the Netherlands. 46
  Not in Belgium. 48
  Belgian nurses are like anywhere else. 49
  Dutch happy to go to hospital 51
  Groningen Protocol a wise policy. 52
  Theo Boer always an assisted dying law sceptic. 52
  Women are not vulnerable to voluntary euthanasia laws. 53
  Victorian MP publishes extensive misinformation..\ 54
  Opponents admit no slippery slope ‘cause and effect’. 54

Part E: Potential models of assisted dying law reform. 56
  Oregon/Washington model. 56
  Benelux model. 56
  Swiss model. 57
  Options for Western Australia. 58

Conclusion. 59

Statement of Ginny Burdick, Acting Senate President, Parliament of Oregon. 60

Summary of recommendations. 61

References. 62

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Jones, Paton and Kheriaty's articles demonstrate poor science and multiple, egregious instances of bias.

In 2015, Dr David Jones and Prof. David Paton published an article titled “How does legalization of physician-assisted suicide affect rates of suicide?” in the Southern Medical Journal. The article purported to establish suicide contagion from Oregon and Washington Death With Dignity Act (DWDA) deaths to “total suicides.”  It also purported to establish no decrease in general suicide rates, which Jones & Paton argued should occur by substitution of assisted death for some general suicides. (Notice how these two ‘expected’ results — an anticipated rise and an anticipated fall in suicide rates — are at odds in principle.)

In my thorough and empirically-backed response, I expose the disgraceful playbook of these authors as they shambolically commit no fewer than ten deadly sins against science in the pursuit of their opposition to lawful assisted dying.

Get the full report here

Executive Summary

In 2015, Dr David Jones & Prof. David Paton published an article in the Southern Medical Journal titled “How does legalization of physician-assisted suicide affect rates of suicide?” This study examines the article, as well as an enthusiastic editorial of it by Dr Aaron Kheriaty in the same journal issue, both of which portray “suicide contagion” from Oregon and Washington’s death with dignity acts (DWDA).

However, while contagion from general suicides is a well-established phenomenon, there are multiple sound reasons to reject contagion theory in relation to assisted deaths, including:

  • Most healthcare professionals readily acknowledge key differences in the characteristics of assisted deaths: for example, a fully informed, tested and rational decision with shared decision-making.
  • Those using Oregon and Washington’s DWDAs are, by qualifying for it, already actively dying. Thus, they are choosing between two ways of dying rather than between living and dying.
  • Most of those using the DWDA discuss it with their families (expected, peaceful death), whereas most general suicides occur in isolation and without discussion (unexpected, often violent death).
  • Multiple studies show that while families of general suicide experience complicated bereavement, families of assisted dying cope at least as well as, and in some cases better than, the general population or those who considered but did not pursue assisted death.

 
Even if “suicide contagion from assisted dying” theory were sound, direct evidence from official government sources shows that the number of potential suicides in Oregon in 2014 would have been fewer than 2 in 855 cases: undetectable by general modelling methods.

Jones & Paton’s article title conveys an air of skilled and scientific neutrality. However, close examination of the article, and Kheriaty’s editorialisation of it, reveals least ten serious flaws or ‘scientific sins.’

The authors demonstrated little understanding of the complex issues surrounding suicide, willingness to unjustifiably equate assisted dying with general suicide, contentment with failing to search for, consider or include contrary evidence including from sources they cite to argue their case, unreasonable trust in a model that couldn’t hope to legitimately resolve their premises, satisfaction with executing their model amateurishly, a disposition to overstate confidence of causation in the absence of meaningful statistical correlations, and an inclination for emphasising results in accordance with their theories while de-emphasising or ignoring others.

Any of these flaws was serious enough to invalidate Jones & Paton’s article and Kheriaty’s conclusions of it, yet there is not one deadly flaw: there are at least ten.

Their claim of a supposed 6.3% suicide contagion rate from assisted dying in Oregon and Washington is a conceptual and mathematical farce.

The Southern Medical Journal is a peer-reviewed journal. However, it is difficult to reconcile the rigorous standards and sound reputation that peer review is intended to maintain, with the numerous, egregious flaws in this study and its dissemination.

Rather than inform the ongoing conversation about lawful assisted dying, the Jones & Paton and Kheriaty articles misinform and inflame it.

Given the numerous egregious flaws, both articles ought to be retracted.

 

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With a handful of exceptions, the Coalition has demonstrated itself to be 'unrepresentative swill' on assisted dying law reform.

It was with tongue in cheek that I recently quoted former Prime Minister Paul Keating to wonder if politicians voting on assisted dying Bills were ‘unrepresentative swill.’ The now-obvious answer to this question has become more than just humorous, with the publication yesterday of the Hansard record of Victoria’s Legislative Assembly vote on the Voluntary Assisted Dying Bill 2017.

How ironic it was that the very day after I quoted Keating’s slight against his then-hostile Senate, Keating himself, a conservative Catholic, would come out against voluntary assisted dying (VAD) reform.

Hansard record makes compelling reading

But, more importantly, the Hansard record of votes on the Victorian Bill in the lower house make for compelling reading.

Figure 1 shows Victorian voter support for VAD (from ANU Australian Election Study 2016 data) by political preference, and MP votes in support of the Victorian Bill (lower house, 2017).

Chart: Victorian electorate support and MP vote support for VAD (lower house, 2017)Figure 1: Victorian electorate support and MP vote support for VAD (lower house, 2017)
Sources: AES 2016; Hansard

It’s quite obvious that Greens MPs (100% v 91%) , Labor MPs (86% v 84%) and minor/independent MPs (67% v 76%) approximately represented the proportion of voter support. (It’s unsurprising that all Greens MPs vote in favour of VAD Bills: it’s Greens policy; while it’s a ‘conscience’ matter for other parties.)

The yawning Coalition chasm

But the yawning chasm of Coalition MPs not representing their own voters (14% v 73%) is even more stark. That’s a gap of nearly sixty percentage points. Surely that would be enough to raise the eyebrow of any conservative voter?

Aside from a handful of Coalition MPs who voted in support of the VAD Bill, it’s clear that there’s generally no real ‘conscience’ vote across the Coalition benches.

The corridors have been buzzing with stories of threats to Coalition promotions and preselections, and threats to preference deals for the state election next year, though of course there’s nothing public and on the record. Just the serene statement that “our members have a conscience vote.” The discrepancy amongst Australian Coalition ranks has been formally uncovered before in university research.

It’s a national story

However, it’s not like this is confined to Victoria. Here’s the same chart (Figure 2) for all state VAD bills across Australia since 2000 which have had a division on the vote — so we know who voted which way.

Chart: Australian electorate support and state MP vote support for VAD (all state Bills since 2000)Figure 2: Australian electorate support and state MP vote support for VAD (all state Bills since 2000)
Sources: AES 2106; Hansards

Again, the largest and most striking gap between voter desire for reform and MPs opposing their voters’ wishes is amongst the Coalition ranks, at a full sixty percentage points short of proper representation.

It’s a similar picture to that published by university researchers in 2008, who found just 17% Coalition voting support in favour of VAD in the federal parliament, too.

As I’ve explained before, the Party leader’s public statements can be ‘persuasive,’ and Mr Matthew Guy, leader of the Victorian Parliamentary Coalition, has made his entrenched opposition to this reform loud and clear.

Inform your own voting

As debate in Victoria’s upper house commences tomorrow, we’ll be watching who’s in favour and who’s against. And we’ll report the voting record to help inform how you cast your own vote at Victoria’s state election in November next year.

In the meantime, here’s the full record of the Victorian Legislative Assembly votes.

Full voting record – Victorian Legislative Assembly 2017 VAD Bill

Ayes

47

  

Noes

37

Allan, Jacinta

Labor

 

Angus, Neil

Liberal

Andrews, Daniel

Labor

 

Battin, Brad

Liberal

Britnell, Roma

Liberal

 

Blackwood, Gary

Liberal

Bull, Josh

Labor

 

Blandthorn, Lizzie

Labor

Carroll, Ben

Labor

 

Bull, Tim

Nationals

Couzens, Chris

Labor

 

Burgess, Neale

Liberal

D'Ambrosio, Lily

Labor

 

Carbines, Anthony

Labor

Dimopoulos, Steve

Labor

 

Clark, Robert

Liberal

Donnellan, Luke

Labor

 

Crisp, Peter

Nationals

Edbrooke, Paul

Labor

 

Dixon, Martin

Liberal

Edwards, Maree

Labor

 

Fyffe, Christine

Liberal

Eren, John

Labor

 

Gidley, Michael

Liberal

Foley, Foley

Labor

 

Guy, Matthew

Liberal

Garrett, Jane

Labor

 

Hodgett, David

Liberal

Graley, Judith

Labor

 

Kairouz, Marlene

Labor

Green, Danielle

Labor

 

Katos, Andrew

Liberal

Halfpenny, Bronwyn

Labor

 

McCurdy, Tim

Nationals

Hennessy, Jill

Labor

 

McLeish, Cindy

Liberal

Hibbins, Sam

Greens

 

Merlino, James

Labor

Howard, Geoff

Labor

 

Northe, Russell

Ind.

Hutchins, Natalie

Labor

 

O'Brien, Danny

Nationals

Kealy, Emma

Nationals

 

O'Brien, Michael

Liberal

Kilkenny, Sonya

Labor

 

Pesutto, John

Liberal

Knight, Sharon

Labor

 

Richardson, Tim

Labor

Languiller, Telmo

Labor

 

Riordan, Richard

Liberal

Lim, Hong

Labor

 

Ryall, Dee

Liberal

McGuire, Frank

Labor

 

Ryan, Steph

Nationals

Morris, David

Liberal

 

Smith, Ryan

LIberal

Nardella, Don

Ind.

 

Smith, Tim

Liberal

Neville, Lisa

Labor

 

Southwick, David

Liberal

Noonan, Wade

Labor

 

Suleyman, Natalie

Labor

Pakula, Martin

Labor

 

Thompson, Murray

Liberal

Pallas, Tim

Labor

 

Tilley, Bill

Liberal

Paynter, Brian

Liberal

 

Wakeling, Nick

Liberal

Pearson, Danny

Labor

 

Walsh, Peter

Nationals

Perera, Jude

Labor

 

Watt, Graham

Liberal

Sandell, Ellen

Greens

 

Wells, Kim

Liberal

Scott, Robin

Labor

     

Sheed, Suzanna

Ind.

     

Spence, Ros

Labor

     

Staikos, Nick

Labor

     

Staley, Louise

Liberal

     

Thomas, Mary-Anne

Labor

     

Thomson, Marsha

Labor

     

Ward, Vicki

Labor

     

Williams, Gabrielle

Labor

     

Wynne, Richard

Labor

     

 

 

 

 

 

 TOTAL AYES

 

 

 TOTAL NOES

 

Labor

38

 

Labor

6

Greens

2

 

Greens

0

Liberal

4

 

Liberal

24

National

1

 

National

6

Other

2

 

Other

1

TOTAL

47

 

TOTAL

37

         

Abstained

2

     

Asher, Louise

Liberal

     

Victoria, Heidi

Liberal

     
         

Did not vote

1

     

Brooks, Colin

(Speaker, Labor)

 

Note: The vote represents 87 of 88 seats. The seat of Northcote was vacant owing to the untimely death of its representative, Fiona Richardson, from cancer.


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