Blog by Neil FrancisPosted on Sunday 30th August 2020 at 9:13pm
St Mary's Cathedral, Hobart, Tasmania
Hobart Catholic Archbishop Julian Porteous makes a number of incorrect representations about voluntary assisted dying (VAD) in his recent Talking Points article (Hobart Mercury 23rd Aug). And, most of his own flock disagree with his opposed stance.
Let's take a look at the facts, and the Archbishop's 'alternatives'.
NOTE: While The Hobart Mercury published Archbishop Porteous' arguments, they declined to publish this rebuttal.
Key points
Archbishop Porteous wrongly equates VAD with general suicide and insinuates they are lonely deaths when they aren't.
He claims that palliative care can always help, when palliative care peak bodies clearly state that it can't.
He insensitively co-opts Covid-19 victims and their families into his arguments, despite them having nothing to do with VAD.
He doesn't represent his own flock: three quarters (74%) of Australian Catholics support VAD, including near half (48%) who strongly support VAD. A tiny 15% are opposed.
In just twelve years (2007─19), the Australian Catholic church has lost a quarter (26%) of its flock. Of those remaining, an increasing proportion, now half (50%), never or almost never attend services.
Diocese Director of Life, Marriage and Family, Mr Ben Smith, encourages Catholics to write to their politicians using the same talking points as Porteous, and with express instructions "DO NOT use religious arguments".
Assisted deaths completely different from general suicide
One particularly egregious aspect of Archbishop Porteous' rhetoric is the innuendo he employs to equate VAD with general suicide, including liberally sprinkling the word "suicide" through his narrative.
But there are profound differences between general suicide and VAD. Most Australians understand that, and research shows that most Australian doctors agree.
Assisted deaths are not lonely
The Archbishop, with astonishing misjudgement, also co-opts the Covid-19 deceased into his story arc: people whose funeral can't be attended by loved ones because of government-imposed lockdown. He obliquely infers that VAD users are or will be naturally unattended by loved ones — even without imposed lockdown.
He further slathers on observations about family reconciliations during the natural dying process, with the implicit meaning that's the only dying context in which families might reconcile.
His presumptions skirt extensive evidence that one of the most treasured factors amongst both VAD law users and their loved ones is the opportunity to express love and caring, and the ability to gather and say goodbye.
Further, multiple scholarly studies show that loved ones recover from bereavement after an assisted death at least as well as those bereaved from natural death, and in some cases, better.
Contrary to Archbishop Porteous' sinister insinuations, VAD deaths can prompt families to gather, express love, say goodbye, and grieve well.
Palliative care can't always help
Archbishop Porteous also argues that palliative care "is able to manage pain and suffering" such that nobody should experience a bad death. He ought to know better: more than half of all palliative care services in Australia are delivered via Catholic institutions.
Palliative Care Australia has clearly stated that "complete relief of all suffering is not always possible, even with optimal palliative care". Even Catholic Doctor's Association palliative care specialist Dr Odette Spruyt, a past President of the Australian and New Zealand Society of Palliative Medicine, has said "it is simplistic to argue that palliative care can remove all suffering at the end of life."
Both of Australia's peak palliative care bodies acknowledge that even the best care can't relieve all terrible suffering at the end of life.
Less treatment but more treatment
Then there's the incoherence of the Archbishop’s argument acknowledging that people want to avoid more medical intervention, while arguing at the same time that more medical intervention (palliative care) is always the only answer to end-of-life suffering.
What about the devout religious?
He adds an odour of hubris to this unctuous spread by noting with disapproval that "family members of those who have had difficult deaths" are the most vocal supporters of law reform. Indeed. These are real people with real experiences of when even the best palliative care can't help.
For balance, it's worth pointing out that numerous research studies show that it's the most religious who are the most vocal opponents of VAD law reform.
Numerous scholarly studies show that it's the most religious who are the most vocal opponents of VAD law reform.
But don't mention religion
It's curious then that the Archbishop — a senior cleric — invokes not a single religious statement or reference in his narrative. Perhaps he's coordinated well with his diocesan Director of Life, Marriage and Family Office, Mr Ben Smith, who advises in an anti-VAD letter-writing guide handed out at Tasmanian masses last week, "DO NOT use religious arguments".
Unsurpisingly, Mr Smith also recommends other language demonstrated in the Archbishop's opinion piece: imply that people will be vulnerable, say that palliative care is the answer, bring up the Covid-19 pandemic, and refer to assisted suicide rather than assisted dying.
Director of Hobart's Catholic Life, Marriage and Family Office, Mr Ben Smith, urges Catholics to write to their politicians to oppose VAD, but directing them “DO NOT use religious arguments”.
Far from representing the 'everyman'
Rather than use any religious references, Archbishop Porteous carefully crafts his grave implications in 'everyman' language as though the points he makes are naturally agreeable to everyone.
But he doesn't represent the great majority of Australians, four out of five (80%) of whom support VAD, according to the most recent (2019) impeccable national study from Australian National University.
Far from representing Australian Catholics
Nor does Archbishop Porteous represent the views of most Australian Catholics. The ANU study also found that three quarters (74%) of them support VAD, with only a tiny minority (15%) opposed. A staggering near-half (48%) of Australian Catholics now strongly support VAD, up from around a third (36%) just three years earlier in 2016.
Three quarters of Australian Catholics support VAD law reform, almost half of them strongly.
At the same time, the ANU study reveals that the Catholic Church represents fewer and fewer Australians. In just the twelve years between 2007 and 2019, the Catholic Church lost a quarter (26%) of its flock. Australians with no religion (41%) now outnumber Catholics by two to one (21%).
In addition, of the fewer still identifying as Catholic, there's been an increase of more than one in five — now comprising half (50%) — who never, or almost never, attend services.
It's worth emphasising that even amongst those who haven't abandoned the Catholic church altogether — the more entrenched — strong support for VAD law reform has soared.
The Australian Catholic church has lost a quarter of its flock in 12 years, and half of those remaining never or almost never attend services.
Not the best spokesperson
Amid shrinking flocks, withering attendance and a weighty jump in strong Catholic support for VAD, it's curious that the Archbishop continues to vocally push entrenched opposition. Perhaps Sydney's Catholic Archbishop Anthony Fisher was right when he said in 2011, "Bishops, for instance, are not always the best public spokespeople for the Church on such matters." Indeed.
As politicians are only too keenly aware, they're elected by the people, not appointed by religious officials.
Australians unambiguously show a determined and increasing appetite for lawful VAD. It would be a courageous politician indeed who resolved to trudge the road now so obviously on the wrong side of history.
The F filesPosted on Wednesday 5th October 2016 at 10:21pm
Palliative Care Australia's position statement on assisted dying.
I’ve written previously about palliative care specialists trying to filibuster assisted dying law reform. In this F file, I reveal how Australia’s peak body for palliative care (PC), Palliative Care Australia (PCA), segues from a state of ignorance to its own filibuster that would stall assisted dying choice.
First up, let me say that I hold deep admiration for the generally excellent services PC specialists provide at the bedside. I believe that PC deserves strong support and good funding. The peak body’s leadership in regard to its stance on assisted dying, however, is of a dramatically lower calibre.
Revised policy statement
In PCA’s latest incarnation of its Position Statement on ‘Euthanasia and physician assisted suicide’,1 the organisation says that:
“Public discussion and policy development on issues related to euthanasia and physician assisted suicide should be informed by research. There is insufficient research into euthanasia and physician assisted suicide.” — Palliative Care Australia, Position Statement
One can only agree wholeheartedly with the first sentence. Of course public discussion and policy development should be informed by research wherever possible.
The filibuster
And there follows the filibuster rub — PCA unequivocally claims that there is insufficient research. The logical consequence of PCA's juxtaposition is that we ought to muzzle public discussion and policy development because, PCA alleges, there is insufficient research to inform it.
Certainly in terms of Australia there are only a handful of published studies into attitudes and practices. But assisted dying is illegal in Australia. There are very substantial ethical and legal issues when it comes to conducting research.
Who is PCA to claim "insufficient research"?
PCA is the peak body for PC, a specific discipline within medicine that represents (well-paid) doctors. It runs a staffed office in Fyshwick ACT, and is overseen by a Board and Executive. It has a key purpose of lobbying in the halls of power in the Federal Parliament, and, presumably on the basis of the statement above, has a goal of ensuring that government PC policy (and funding) is informed by research. You'd think it might have some resources and connections to go looking for some research evidence.
A revealing comparison
In comparison, I conduct my assisted dying law reform work on a completely pro-bono basis, as a single individual, in my spare time. I have a formal literature collection on end-of-life decision making, including assisted dying, of currently over six thousand articles. I’m not talking about mere opinion published in the media: I’m talking about articles published in professional journals and in official government and agency reports.
I just ran a quick check across my database, looking for items specifically in respect of assisted dying (not medical or palliative care in general) in the Netherlands, Belgium and Oregon, where assisted dying has been legal for some time. Here’s what I found.
In respect of assisted dying the Netherlands I hold 366 journal articles and 25 official reports. For Belgium, I hold 152 journal articles and 11 official reports. And for Oregon I hold 144 journal articles and 32 official reports.
That’s a total of 662 journal articles and 68 official reports in respect of three lawful assisted dying jurisdictions. And that doesn’t count any holdings of book chapters, conference papers and the like. The journal article count will be somewhat overstated because a minority of journal papers are about more than one lawful jurisdiction (e.g. the Netherlands and Belgium). So let’s estimate that downwards to, say, a mere 400 journal articles.
That’s an abundance of evidence from and review about jurisdictions where assisted dying is legal. Could we always know more about assisted dying? Sure.
Double standards when it comes to evidence
We could also know a lot more about PC. I recently asked PCA for a simple but critical headline statistic — one you’d think was necessary to inform policy about PC resources and funding: “what proportion of Australians who experience a non-sudden death (i.e. deaths where PC might be relevant) actually receive PC?”
PCA kindly responded, but the answer in a nutshell was “we don’t know.”
But I wouldn't suggest for a moment that we muzzle “public discussion and policy development on issues related to PC” because the peak body hasn't done enough research to calculate (or even estimate) a fundamental policy-informing statistic.
Conclusion
The Australian community would be better served if PCA acquainted itself with the extensive available literature on assisted dying in lawful jurisdictions (as well as headline PC statistics), and dropped its inappropriate filibuster.
References
Palliative Care Australia 2016, Euthanasia and physician assisted suicide: Position statement, viewed 1 Sep 2016, <http://palliativecare.org.au/download/2448/>.
