Fact file by Neil FrancisPosted on Saturday 16th June 2018 at 1:51am
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).
Blog by Neil FrancisPosted on Thursday 17th May 2018 at 1:27am
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.
Blog by Neil FrancisPosted on Tuesday 13th February 2018 at 9:37pm
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.
Fact file by Neil FrancisPosted on Monday 12th February 2018 at 11:03pm
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.
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
The F filesPosted on Saturday 18th November 2017 at 11:27pm
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.
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.
Blog by Neil FrancisPosted on Monday 30th October 2017 at 11:20pm
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).
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.
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.
Blog by Neil FrancisPosted on Wednesday 18th October 2017 at 9:41pm
The Victorian parliament is debating the Government's Voluntary Assisted Dying Bill
Former Australian Prime Minister Paul Keating once famously branded the Senate “unrepresentative swill” for obstructing his legislative agenda. Today, the question of how representative our political masters are remains moot.
Major community support for VAD
Take voluntary assisted dying (VAD) for example. Poll after poll demonstrates that the overwhelming majority of Australians want this additional choice for people in extremis at the end of life. The impeccable Australian Election Survey (AES) conducted by Australian National University scholars last year confirmed that 77% of Australians want VAD reform, with 13% undecided and just 10% opposed.
Strong support (43%) is ten times greater than strong opposition (4%), and support is high across the political spectrum: amongst minor/independent (69%), Coalition (77%), Labor (80%) and Greens (87%) voters. Public support has been in the majority for more than four decades.
Political support missing in action
But since the Northern Territory Rights of the Terminally Ill Act in 1996, none of the many VAD Bills before various state parliaments has passed. And the Northern Territory’s Act was torn down by the federal parliament just eight months after coming into effect.
A 2008 university study of federal MP voting opportunities found 100% of Greens, 55% of Labor, and a paltry 17% of Coalition MPs voting in favour of VAD.
New analysis
Now, a new analysis of the ten state VAD Bills since 2000 where final divisions were called, offers further insights. It found 100% of Greens MP voting opportunities were in favour, along with 51% of Labor, 29% of minor party and independent, and a similarly paltry 17% of Coalition MPs. Excluding South Australia, whose parliament has debated the greatest number of VAD Bills, the Coalition support rate was just 9%.
Overall, while state Labor MP votes fell 29% short of Labor voter attitudes, Coalition MP votes fell an astonishing 60% short of Coalition voter attitudes. At the state level, Coalition MPs had the most voting opportunities — nearly half (48%). No wonder passing VAD Bills is challenging.
It begs the question, how is it that our legislative representatives fail to reflect clear public majority views on matters of conscience for so long?
Hidden reasons behind MP opposition
Obviously, lobbying on both sides of the conversation in part informs MPs’ views, but there are several more persuasive factors.
For a start, there’s a “truism” held by many MPs that their vote in favour of a VAD Bill would lose them more votes at a general election than would a vote against the Bill. However, the opposite has been demonstrated in multiplestudies.
Further, I’ve shown before that opposition to VAD is largely religious. A university study has also found that those who are more religious and who are politically engaged tend to hold very conservative views. So while there are religious MPs on both sides of politics, Coalition MPs are naturally more inclined to hold much more conservative views.
But that doesn’t fully explain the massive 60% representation gap on the Coalition side, either.
In good conscience?
A key factor lies in the seemingly reassuring principle of the “conscience vote.” The major parties have announced that their members are accorded a conscience vote (also known as a “free vote”) on the VAD Bill. That simply means that there’s no official published party policy on the matter and party members may vote freely on the basis of their own conscience.
There are two significant issues with this state of affairs.
The first is that the member may refer exclusively to their own conscience. But what if the MP’s conscience is at odds with the electorate’s? For my home state of Victoria, the 2016 AES study found 79% of the community in favour of VAD. There are 88 members of the Victorian parliament lower house, and just 40 members in the upper house. Therefore, it’s possible for as few as just 20 Victorian MPs to vote “no” in order to extinguish the will of 3.2 million Victorians (79% of 4.05 million Victorian voters).
If that weren’t enough, the second issue is that the right to ‘conscience’ is granted only in respect of the Bill itself, not on procedural matters about the Bill. It can make a huge difference.
How the parry works
Here’s what happened in 2008 when Victorian Greens MP Colleen Hartland’s VAD Bill was before the Legislative Council. MPs were afforded a conscience vote, and many of them had said they were supportive of VAD in general, but couldn’t support Hartland’s Bill in its current form. (That’s also a common ruse of MPs who in reality oppose the reform in principle but wish to appear ‘open minded’.)
When the final vote on Hartland’s Bill was lost, then Greens MP Greg Barber immediately moved a motion to refer the Bill to a parliamentary committee so that it could be improved to MPs’ satisfaction. Neither Labor nor Coalition parties afforded their members a conscience vote on this procedural matter, instead directing MPs to vote against such motions. The referral, which may have resulted in Victorians having wider end-of-life choices years ago, was cynically buried.
Most voters remain unaware of the shenanigans played in the corridors of power to achieve such results.
Australia’s special political conservatism
They’re not the only shenanigans, though. Another university study comparing federal MP conscience voting patterns in the UK, New Zealand and Australia found Australia to be different, accounting for why the UK and NZ have legalised marriage equality, while Australia hasn’t.
Firstly, the centre-left in Australia has a larger proportion of Catholic members than in the UK and NZ, accounting for some of the shortfall in Labor representation of progressive views.
Secondly, those amongst Coalition ranks, but with more liberal social consciences, had been lashed by Coalition party whips to vote against progressive reform. So while there was a public display of fairness and neutrality, the reality was quite different.
Borne out in state parliaments
These findings are replicated in Australian state parliament votes too, with Coalition MPs rarely if ever voting in favour of progressive social reform. Coalition MP votes on VAD including and since Hartland’s legislative attempt in 2008 are telling: in Victoria 2008 10:5 against, in Tasmania 2009 6:0 against; in Western Australia 2010 19:1 against; in NSW 2013 10:0 against; in South Australia 2016 14:7 against and in Tasmania 2017 13:1 against.
Rather than reflect 77% Coalition voter support for VAD, Coalition MP voting patterns reflect the highly negative stance of party leaders, whipped through the parliamentary party membership. For example, then WA Premier Mr Colin Barnett made it clear he thought assisted dying was “government-sanctioned killing”. Tasmanian coalition leader Mr Will Hodgman said that “protection for [vulnerable] people cannot be guaranteed.” Then-NSW Premier Mr Barry O’Farrell declared himself “strongly opposed”.
Back to Victoria’s Bill under debate
The situation in Victoria is looking somewhat more positive, with Premier Mr Daniel Andrews and many in his Cabinet publicly supporting reform. A lengthy, detailed, professional and well-resourced process has informed the crafting of the Bill.
However, opposition leader and would-be Premier Mr Matthew Guy has stated his resolute opposition to it and that he intends to vote “no”. That would mean he is quite comfortable for his own personal view to extinguish the contrary views also held in good conscience by 34,626 of the 43,831 voters in his own electorate of Bulleen, and 3.20 million of Victoria’s 4.05 million voters. (Electorate numbers as at 10 October 2017.)
An obvious solution
There’s an obvious solution for MPs whose own consciences disallow them from reflecting the overwhelming majority conscience of the electorate.
They could consider abstaining — simply absenting themselves from the chamber during the division. That would keep their own consciences intact while allowing the electorate’s conscience to be reflected.
I’m a constituent of Mr Guy’s. Over a period of months I made six robust attempts to meet with him to discuss these matters, especially the covert whip arrangements and the consideration of abstention. I can be persuasive in obtaining appointments, but my best efforts proved wholly unfruitful.
As I said to Mr Guy’s private assistant after the last failed attempt, voters could be forgiven for believing he’s more interested in meeting allegedly shady characters in fancy Brighton restaurants, than meeting with his own constituents.
Victorians are watching the parliamentary VAD debate. We’re taking notes that will inform our votes at the state election late next year.
Indications are at present there’s a good chance that Victorian MPs won’t be “unrepresentative swill”.
Blog by Neil FrancisPosted on Tuesday 10th October 2017 at 7:58am
The Parliament of Victoria is currently debating an assisted dying Bill.
As the Parliament of Victoria prepares to debate an assisted dying Bill, South Australian Catholic anti-assisted-dying lobbyist Mr Paul Russell is at it again. This time he's sent a missive to Victorian politicians shouting about, amongst other things, a crisis of assisted dying numbers in Washington state. He’s conveniently cherry-picked his arguments again.
Mr Russell wrote that in Washington state:
“deaths from lethal drugs prescribed under the Act have nearly quadrupled (376%) from 51 in 2010 to 192 in 2016.”
His latest claim extends his misinformation crown title.
Don’t get me wrong. He cites the correct raw data figures for Washington. But he packages them up handily with FUD (Fear, Uncertainty and Doubt) wrapping, all tied up with the most sinister bow he can muster.
I’ve criticised the use of uncontextualized raw data before, and I do so again.
The relevant facts
Washington state legalised assisted dying by ballot in 2008. The following year the law was put into practice, and 2010 was the first full year of its operation.
Here’s the rate of assisted deaths as a proportion of all deaths in Washington state for all the years on record. As you can see, the rate hasn’t even reached one half of one percent of all deaths in 2016.
2009
2010
2011
2012
2013
2014
2015
2016
0.07%
0.11%
0.14%
0.17%
0.23%
0.24%
0.30%
0.35%
Never ones to miss out on an opportunity to spread FUD, if it were just one case last year and two this year, assisted dying opponents would be shouting from the rooftops: “Crisis!! 100% increase!!”. But in reality, only a small minority use the law, yet thousands of patients and their families are given comfort by the option being avaialble even if they don't use it. That message was made loud and clear by Oregon Senator Ginny Burdick. Washington's Death With Dignity Act is modelled on Oregon's, and Oregon's Act has been in effect for twenty years.
A Catholic trifecta
Of course in his missive, Mr Russell, like his fellow Catholic whom I’ve also called out for misinformation, Prof. Margaret Somerville, avoids referring to Swiss data. And their fellow Catholic Mr Daniel Mulino, who furnished a minority report to the Victorian Parliament’s recommendations on end of life choices, a report I’ve also called out for stunning misinformation, fudges his numbers about Switzerland, referring to data from 1998 without further context.
Why do these lobbyists avoid or selectively refer to the Swiss situation? Because the actual data is an inconvenient truth to their FUD story-telling.
An inconvenient truth
Switzerland’s assisted dying law came into effect seventy-four years ago, in 1942. If just one person had used the law in 1942, using Mr Mulino’s favourite annual increase figure of 17.5%, that would equate to 110,338 people pursuing an assisted death in Switzerland in 2014.
I say 2014 because that’s the most recent year for which official Swiss Government assisted dying figures are available. And what was the actual figure in 2014? There were 742 cases of assisted dying amongst Swiss residents, and Dignitas reports that it assisted 198 foreign nationals. That’s a total of 940 assisted deaths.
Let’s add another 60 foreign-national assisted death cases from the much smaller Swiss society that provides accompaniment for foreigners. That makes around 1,000 cases in 2014, including all those who came from all over the world. And it’s less than one hundredth of the minimum rate the doomsayers predict by cherry-picking one statistic that suits their argument.
Swiss law has the fewest safeguards
The Swiss assisted dying law has none of the safeguards of the Washington law. By Mr Russell and Co’s reckoning, you’d think that the Swiss (and those who visit) would be dropping off like flies.
By way of further comparison, the doomsayer number of assisted deaths for 2014 (a minimum of 110,338 cases) is substantially greater than the total number of deaths in Switzerland that year: 63,938. It’s an obvious impossibility.
In 2014, the Swiss rate of assisted deaths including all the foreign nationals who came to use its law, was 1.5% of all deaths; and 1.2% for resident-only cases.
And the rate of assisted deaths in Luxembourg in 2014 (legalised in 2009), whose laws are much more liberal than Washington’s though stricter than Switzerland’s, was 0.17% of all deaths. It’s odd how the doomsayers don’t report Luxembourg data, either.
And what are these cases?
These are cases of people in extremis with no realistic prospect of relief or improvement, choosing a peaceful assisted death as a better option than being forced to prolong their torture, according to their own deeply-held beliefs, values and examined consciences.
Mr Russell believes they should be required to endure their torture. There is a point to it, he says: because it joins them “in some mysterious way to the sufferings of Christ”... whether others believe in Christ, or at least Mr Russell’s version of him, or not.
You won't find this degree of candour on his anti-assisted dying website, but you can find it at NewsWeekly, which is run by the National Civic Council (NCC), itself established by Australia's most famous and conservative lay Catholic, B. A. Santamaria. Mr Russell has been President of the NCC South Australian chapter.
It’s not the numbers, it’s the circumstances
To be clear, in no jurisdiction has its legislature enacted access to assisted dying on the basis of a numeric ceiling. They’ve enacted access on the basis of intolerable and unrelievable suffering. And to this day, those are the folks who may be granted access to an assisted death.
Conclusion
Again, Mr Russell (and colleagues) do themselves no favours by conspicuously cherry-picking the data they want to use, and wrapping it up in threatening garb to create FUD amongst politicians.
Blog by Neil FrancisPosted on Thursday 14th September 2017 at 10:20pm
Another Catholic 'academic' spreads more misinformation. Photo: donaldytong
It’s very disappointing that Catholic theologian Dr Joel Hodge’s recent editorial in Fairfax media about assisted dying law reform contained misinformation: the same old tired and discredited story trotted out as though it's true. Dr Hodge also repeated an old and curiously one-sided (Catholic) examination of the hypothetical slippery slope.
Unhappily, the kind of misinformation that Dr Hodge advances muddies the waters and cruelly stands in the way of legislative action, which most Australians want.
An impeccable national survey conducted by scholars at Australian National University last year found 77% of Australians in favour of assisted dying law reform. Strong support (43%) outweighed strong opposition (4%) by more than ten to one. In the two states whose Parliaments are currently considering reform, NSW and Victoria, support stands at 75% and 79% respectively.
Non-religious support is 91%, and it’s high amongst Catholics (74%) and Anglicans (79%) as well. Bishops are jarringly out of step with the views of their flocks. And across the political spectrum, 87% of Greens, 80% of Labor, 77% of Coalition and 69% of minor party voters also want reform.
The electorate’s desires couldn’t be clearer. But politicians — who have little time to fact-check what they’re told — are fed the kind of misinformation Dr Hodge advances.
The false 'non-voluntary euthanasia slippery slope' argument
He quotes details from a medical journal article by Dr José Pereira, a Canadian Catholic physician. Like others who cite this article, Dr Hodge fails to mention that it was thoroughly debunked in a surgical deconstruction by expert scholars. They found Pereira’s claims variously unsupported by any evidence, unsupported by the sources he cited, or false, concluding that the article was “smoke and mirrors.”
Like other Catholics, Dr Hodge relies heavily on a thoroughly debunked journal article by Catholic Canadian doctor, José Pereira.A significant source of smoke, which Dr Hodge fans from this debunked article, is the claim regarding “900 Dutch deaths hastened without explicit request”: that is, non-voluntary euthanasia or NVE. Such figures are cited as ‘proof’ of the hypothetical slippery slope from legalised voluntary euthanasia to NVE.
Other opponents of assisted dying variously put the figure at 500 or 1,000. For the sake of argument, let’s say the 900 figure is equivalent to 1,000. Both the 500 and 1,000 figures, also repeatedly promoted by Catholic ethicist Professor Margaret Somerville and others, have been true. But here’s the thing.
What they don’t mention is that the 1,000 rate is from the 1990s when Dutch assisted dying was conducted under a general regulatory framework. In 2002 the Dutch euthanasia Act came into effect. Amongst the Act's many details was the establishment of a Commission which examines every reported case of assistance.
Since then, the Dutch NVE rate has dropped to 500, and even further. It has stayed low and is now similar to the NVE rate in the United Kingdom, the world’s gold standard for palliative care, and where assisted dying remains illegal.
There was a significant drop in the NVE rate in Belgium, too, after its euthanasia Act came into effect, also in 2002.
It is absolutely unconscionable that yet another Catholic commentator has trotted out the same old lie as though it's true. Dr Hodge is an academic and it is incumbent on him to check the facts before sounding off.By cherry-picking a single figure, opponents argue the opposite of the facts, implying or even directly claiming that NVE rates are caused by or have risen as a result of legalised assisted dying. I’ve comprehensively exposed this nonsense before, yet it comes up repeatedly.
It’s similar to other lines of Catholic argument against assisted dying, like the claim that Dutch elderly supposedly travel to Germany for healthcare because they fear being euthanised by their Dutch doctors — an outrageous falsehood. There’s also the faintly desperate claim that Dr Els Borst, the architect of the Dutch euthanasia Act, later regretted her reform — a fake claim she’s firmly corrected.
Consider too a Catholic bishop’s claim, without reservation and in formal evidence before an official Parliamentary inquiry, that Oregon’s general suicide rate was very low prior to its assisted dying Act but very high afterwards — contrary to the facts. Or a report cherry-picking just half a sentence from a journal paper to claim that a significant proportion of assisted-death patients in Oregon had symptoms of depression, when the other half of the verysame sentence clearly stated that none of them had.
As Professors Griffiths, Weyers and Adams wrote in 2008, “imprecision, exaggeration, suggestion and innuendo, misinterpretation and misrepresentation [and worse] took the place of careful analysis.” Sadly, the same still seems true today.
Major Catholic flip-flop on choosing death
Now let’s turn our attention to the core of Dr Hodge’s thesis. His plea for “the vulnerable” leads his argument and is heavily egged throughout the polemical pudding.
A comparison is moot: Australians have the right to refuse any unwanted medical treatment, even if it’s life-saving.
In my home state of Victoria, this right to refuse is enshrined in statute. The statute contains just three ‘safeguards’ for checking a refusal, and those only apply if the refusal is formally documented in writing but not if it’s only oral.
As I’ve explained in detail before, the consequence is that a person can refuse life-saving medical treatment with few if any checks and balances. In theory, just as Dr Hodge argues in regard to assisted dying, the person might feel pressured by greedy relatives, resource-poor doctors or others, to so refuse.
In this case, where is the Catholic call for protections? Where is the moral outrage on behalf of ‘vulnerable patients’? There is none. In fact, the Catholic Church’s call is quite the opposite. In a directive to all Catholic healthcare institutions in the USA, the Conference of Catholic Bishops make the Church’s position abundantly clear. They direct that there is no obligation for patients to use “disproportionate means of preserving life.”
The Catholic church's rhetoric against assisted dying is a major flip-flop when compared to its cosy attitude towards refusal of life-saving medical treatment: both might result in hypothetical pressure to choose death, yet only assisted dying has adequate safeguards.They define disproportionate means as “…those that in the patient’s judgement do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community.”
So, under two identical hypothetical possibilities of inappropriate persuasion to choose death, Dr Hodge’s argument bristles against an assisted dying reform containing — as he acknowledges — no fewer than 68 safeguards, while his Church argues that patients may refuse life-saving medical treatment if the patient feels it’s “hopeless,” entails “excessive burden” or imposes “excessive expense” on others, with hardly any, or no statutory safeguards at all.
The incoherence, and repetition of misinformation, is indefensible. Civil debate on such an important matter deserves better.
Blog by Neil FrancisPosted on Wednesday 23rd August 2017 at 7:35pm
The WA Parliament has established a Committee to investigate end-of-life choices
After months of public remarks about end-of-life choices by the WA Premier Mark McGowan, the WA Parliament has just passed a resolution to establish a Joint Select Committee to investigate end-of-life choices for Western Australians.
Similar to the Victorian Parliamentary inquiry in 2015/16, the move is a strong step forward in assessing current practice and recommending improvements to both legislative and regulatory oversight of end-of-life for Australians in the west.
The Joint Committee is comprised of eight members, four from the Legislative Assembly (Reece Whitby, Labor, Baldivis; Amber-Jade Sanderson, Labor, Morley; Simon Millman, Labor, Mount Lawley; John McGrath, Liberal, South Perth) and four from the Legislative Council (Robin Chapple, Greens, Mining and Pastoral; Nick Goiran, Liberal, South Metropolitan; Colin Holt, Nationals, South West; Sally Talbot, Labor, South West).
Its terms of reference are:
That the Committee inquire into and report on the need for laws in Western Australia to allow citizens to make informed decisions regarding their own end of life choices and, in particular, the Committee should—
assess the practices currently being utilised within the medical community to assist a person to exercise their preferences for the way they want to manage their end of life when experiencing chronic and/or terminal illnesses, including the role of palliative care;
review the current framework of legislation, proposed legislation and other relevant reports and materials in other Australian States and Territories and overseas jurisdictions;
consider what type of legislative change may be required, including an examination of any federal laws that may impact such legislation; and
examine the role of Advanced Health Directives, Enduring Power of Attorney and Enduring Power of Guardianship laws and the implications for individuals covered by these instruments in any proposed legislation.
The Committee will soon meet for the first time to elect a Chair and Deputy Chair. It will have up to twelve months to report back to both Houses.