Statistics

Using authoritative and robust data, I indicated that the ongoing rise in both countries' VAD rates would level out at rates that were culturally bound. This despite persistent hyperventilations of VAD opponents that most of us would eventually be "knocked off" by not-so-voluntary euthanasia. Generally, the adoption of behaviours at the societal level tends to follow a sigmoidal (stretched S-shaped) curve, and the then VAD data was consistent with this phenomenon.

The above chart is data I presented in 2016, with third order polynomial fits. A few things worth noting:

1. Both countries' VAD legislation came into effect in 2002.
2. Their legislation is quite similar, with only small differences.
3. Belgium provides a microcosm of cultural analysis because the national legislation applies to both the Dutch-predominant north (Flanders) and the French-predominant south (Wallonia).
4. The Dutch data starts well above zero because it had permitted VAD by regulation (not legislation) for some two decades prior to the legislation.
5. The late drop in the Dutch trend line is not so much a prediction, but a mathematical curiosity of third order polynomials. I did not predict a drop after leveling off.
6. The separate data for Flanders and Wallonia is measured by the proxy indicator, language (VAD reports filed in Dutch versus French). This is not perfect, particularly since Brussels, counted by the Belgians as a third official and separate region, speaks mostly French but is situated in Flanders. Nevertheless, it provides a powerful indicator of cultural differences in practice under the same laws.

 
In March last year the Belgian euthanasia commission published its 2020 report card. I re-analysed the data and wrote that the Netherlands' natural VAD rate seemed to be around 4.3%, and Belgium's (nationally) around 2.4%.

In April last year, the Dutch euthanasia commission published its 2020 report card. I analysed the data again and wrote that due to increased total deaths in 2020 due to Covid-19, the seeming drop in the VAD rates was an aberration and the rates would likely be slightly higher for 2021. This proved to be correct.

The very latest data

The other day, the Belgium euthanasia commission published a brief report of the statistics for 2021, and the Dutch euthanasia commission had also published its 2021 report card. So I thought this was an excellent opportunity to update our knowledge about culture and VAD rates.

And here's the same chart as above, updated with all data up to 2021.

Dutch and Belgian VAD rate analysis as at 2022

The Dutch VAD rate indeed has levelled out at around 4.3%, and the Belgian rate at around 2.4%. The Dutch rate is quite close to the prediction of 2016, while the Belgian rate is actually a bit lower than the 2016 prediction.

And the cultural difference between Dutch and French-speaking Belgians continues, with the Belgian Dutch VAD rate higher and closer to the Netherlands (of course, Dutch) rate. And the French-speaking rate seems not to have quite reached its resting place yet. That might well take another five or more years.

So, here's another general prediction. There will be further rises in the VAD rate, but they will be small, and long-term. This is because a majority of VAD occurs in relation to cancer, and cancer, statistically speaking, makes an appearance in the 50s age bracket, and peaks in the 60s and 70s. And populations in these countries, as around the world, are ageing.

But at no stage was hyperventilation warranted that significant numbers of people would be pressured into VAD, because there was a period of cultural "settling" in regard to both a personal preference for VAD in response to extreme and unrelievable suffering, and accessibility of VAD.

 

Keywords: 

Assisted dying (AD) | Belgium | Netherlands | Analysis | Statistics

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The report shows that the number of cases rose around 9% over the 2019 year. However, the number of total deaths was also up, resulting in a continuation of relatively level rate in recent years (Figure 1).

Figure 1: The assisted dying rate in the Netherlands and Belgium

With Covid-19 deaths having contributed towards a modest net increase in total deaths last year, the assisted dying rate is likely to be modestly higher in the coming year.

 

Keywords: 

Assisted dying (AD) | Belgium | Netherlands | Regulation | Statistics

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The reason the statistics are being discussed is because in 2017, Victoria's parliament legalised voluntary assisted dying (VAD) for the terminally ill. The law came into effect halfway through 2019, and 2020 was the first full year of its operation.

Australian Care Alliance gets the basics wrong

Here's the Australian Care Alliance's (ACA) splashy page trumpeting that Victoria's suicide rate has jumped 21.2% from 694 in 2017 to 842 in 2020.

Figure 1: ACA's splashy page trumpeting a 21.2% increase in Victorian suicides

That's... interesting. According to the Victorian coroner's official figures, there were indeed 694 suicides in Victoria in 2017. However, in 2020 the coroner's figure is actually 698, not 842 as claimed by the ACA. According to the ACA, Victoria's suicide count data looks like this (Figure 2).

Figure 2: The ACA polemically claims that Victoria's suicide count has increased 21.2%

So, how did the ACA reach a count of 842? Well, their argument is to shamefully and humiliatingly disrespect Victoria's terminally ill who died peacefully under its VAD law in 2020 — 144 of them according to the official 2020 reports of Victoria's Voluntary Assisted Dying Review Board — and add them to the coronial count of 698 suicides.

The ACA points out that VAD supporters have said that legalising VAD should decrease Victoria's general suicides by about 50 cases a year, but say the count's gone up substantially instead. See how they craftily deploy logical fallacy to fabricate a crisis?

Arguing that VAD law must reduce the suicide count by 50 cases a year (but seemingly didn't) and at the same time adding VAD cases to the suicide count to complain that it's gone up, requires at least three assumptions:

1. that all terminally ill violent suiciders now automatically qualify for and easily gain access to VAD; and
2. that nobody else with a terminal illness who would not have chosen violent suicide, should or would use the law; and
3. that no other factors make a significant difference to trends in general suicides.

 
All these assumptions are patently false.

Obviously, some people will not legally qualify for VAD; for example, amongst its restrictions it requires death to be expected with 6 months; 12 months for a small set of specific illnesses.

Obviously, some who would not have suicided but instead would suffer intolerably and against their wishes until death, will now choose to pursue VAD.

And obviously, well-known factors such as rates of mental illness, substance abuse, intimate relationship troubles, bullying, financial or legal difficulties, and other factors are major influencers of general suicide rates. But to the ACA, the only factor that supposedly has any effect is the one they are ideologically opposed to: VAD.

It's worrisome that this nonsense is sold to the public by ACA's supposed experts: “health professionals and lawyers”.

Cherry-picked overseas data, too

The ACA's ideological bias is further revealed by their website page about the “social contagion of suicide”. In it, they cite as authoritative, the 2015 Jones and Paton (both firm Catholics) article purporting to show 6.3% suicide contagion from VAD to the general population. I've comprehensively exposed that article as an ideologically-driven mathematical farce fuelled by no fewer than ten major scientific offenses. It's interesting that the ACAs methodology is just like Jones' and Patons': reporting VAD supporter statements that legalisation should decrease the general suicide rate, and then adding VAD deaths to conclude the opposite.

They also commit one of Jones' and Patons' other offences: selectively quoting data from other studies that might be seen to support their theory, but excluding critical alternative information from the same study that runs counter to the theory.

The ACA cites a Swiss study to breathlessly report that 6.5% of those who witnessed an assisted death in that country experienced sub-threshold PTSD, and 13% full PTSD. The ACA expressly states:

“Like any other suicide, assisted suicide can profoundly affect surviving family members and friends.” — The Australian Care Alliance

There you have it: the ACA draws a direct equivalence between peaceful VAD deaths in the face of terminal illness and with loved ones present, and lonely, violent deaths by general suicide.

The ACA cites no other relevant material from the Swiss article. That's revealing, because the article clearly reported that the PTSD rates were higher than in the general population. There's what the ACA left out: the PTSD rates were higher than for almost everyone else who hadn't just suffered the loss of a loved one.

To draw valid and meaningful interpretations, it is necessary to compare the bereavement challenges of VAD family versus families of general deaths, deaths in the face of extreme suffering without hastened death, and cases of violent suicide. As I've published before from peer-reviewed studies, bereavement symptoms of VAD family are at least as good as, and can be better than those where the deceased has suffered in extremis at the end of life, and certainly relative to violent suicides.

The ACA also doesn't mention that the Swiss study found a "prevalence of complicated grief ... comparable to that reported for the general Swiss population". It's not like the information was hard to find. It's right there in the Abstract on the front page of the article.

That the ACA cherry-picked a couple of Swiss data points while omitting key “unhelpful” information, and argued, by linking the selected cherries with the above quote, that said Swiss data established something it clearly did not (that VAD deaths supposedly cause similar family trauma as violent suicides), suggests an astonishing degree of ignorance.

The ACA's cherry-picking of data, while omitting key unhelpful information, suggests an astonishing degree of ignorance.

Enough of that.

Branka van der Linden cherry-picks, too

I've crossed pens (or is that keyboards?) with Ms van der Linden several times before in regard to misinformation. She misinforms on this matter, too.

Curiously, like the ACA and also without explanation, she cherry-picks just the 2017 and 2020 suicide counts from the Victorian coroner's report (Figure 3). You'd think this was the only data in the report, but no, it isn't.

Figure 3: Branca van der Linden's version of Victorian suicide counts by year

She uses these two figures to argue that said drop of 50 cases per year hasn't happened. This employs the same fallacies as the ACA: suggesting that two single data points strongly support a hypothesis, and assuming that the thing one is ideologically opposed to, VAD, is the only thing to alter the rate of general suicides over time.

Like the ACA, she also suggests adding the VAD figures to the coroner's general suicide data to say that in that case, suicides have increased significantly.

Both the Australian Care Alliance and Branca van der Linden cherry-pick just two data points from more full and robust longitudinal data to try and argue their case against VAD.

So what does the coroner's full data set look like?

The actual numbers

The Victorian coroner's 2021 report into suicides contains data for all years 2016 to 2020 inclusive. And it looks like this (Figure 4).

Figure 4: The complete set of data from the Victorian coroner's report on suicide counts per year

Now we're beginning to see a possible reason as to why the ACA and Ms van der Linden chose just two data points. Remember that VAD was legalised by the Victorian parliament in 2017. The law was not in effect for 2017, 2018, or the first half of 2019.

Well, the data clearly suggests an increasing suicide count trend up to 2018. The upward trend stops in 2019, when VAD was in operation for the second half of the year. And in 2020, the first full operational year of VAD, the upward trend has been interrupted by a downward result. Neither the ACL nor Ms van der Linden mention this.

Neither the Australian Care Alliance nor Branca van der Linden mention the fuller, longitudinal data that doesn't support, and indeed appears hostile to, their hypothesis.

But even the raw suicide count statistics are a bit misleading.

Interpreting suicide data correctly

Using raw counts to compare suicide statistics (e.g. year to year or place to place) is lazy and wrong. All other things being equal, if you had twice the population, you'd expect twice the suicide count. To make valid comparisons, you have to compare rates, not raw counts. This is relevant because populations obviously change over time, and Victoria between 2016 and 2020 was no exception.

I've retrieved the official Victorian population figures by year and computed the standard official suicide rate statistic: suicides per 100,000 population. The Victorian suicide rates look like this (Figure 5):

Figure 5: Victorian suicides per 100k population by year

The data shows a rising suicide rate from 2016 to 2018, a levelling off in 2019 in which VAD was operational for half the year, and a fall back to the 2016 rate in 2020, the first full operational year of VAD.

Computing from the rate drop between 2018 (11.4 with no VAD law) and 2020 (10.8, first full year of VAD law), the equivalent count of suicide decrease in 2020 was 38 persons. And that's without assuming the general suicide rate would have continued its rising trend.

The equivalent suicide decrease from 2018 to 2020 was 38 persons.

Getting all the numbers right

The ACA correctly cites then Minister for Health, Ms Jill Hennessy, as stating in 2017 that "Evidence from the coroner indicated that one terminally ill Victorian was taking their life each week." That would be 52 cases a year, which the ACA rounds out to 50 a year. The headline figure from the coroner's report actually calculates to 48. No biggie, just round numbers.

But the figure is quite wrong. You have to read the coroner's special 2017 report to the Victorian parliament regarding suicides in cases of illness, to calculate the correct numbers.

The coroner's report didn't just include suicide data for terminally ill people. It also included cases of advanced incurable but not terminal illness, and cases of severe suffering resulting from injuries. So the terminal illness data (to which the VAD law is relevant) is a fraction of the total. We can calculate from the Tables in the report that 23% of the cases were in respect of injuries, so that leaves 77% for terminal and other advanced illnesses.

Of the illnesses listed, the relevant one as a proxy measure for terminal illness is “cancer”, and that comprises 50% of the illness cases. So, 50% of 77% of 48 cases a year = 19 cases a year in respect of terminal illness.

So that's an actual likely decrease of 19 suicide cases a year, compared with an equivalent drop in the actual data of 38 persons in the first full year.

The actual annual count of general suicides in respect of terminal illness, as reported to the Victorian parliament by the state coroner in 2017, was 19 persons a year, and not 50 as widely stated.

Don't get carried away

It's imporant to note that citing this interesting numeric analysis as “proof” of the law's effectiveness in respect of reducing Victoria's suicide rate, would, at present, be an overconfident claim. While far more firmly based in proper forms of evidence than the vapid nonsense promoted by the ACA and Ms van der Linden, this is a correlation. Correlation does not equal causation: the ACA and Ms van der Linden should remember that. For example, 2020 was a very unusual, Covid-19-dominated annus horribilis, which may have affected suicide rates in unexpected ways.

While the coroner's fuller data set so far is consistent with reasoned expectations of suicide substitution, it is premature to conclude the data proves the principle. More years' data, and more detailed, causative analysis involving the control of confounding factors, is necessary before reaching greater certainty in the association.

But as I've published in detailed and extensive analyses based on robust official data, so far all the longitudinal data on suicide rates in jurisdictions where VAD is lawful is consistent with suicide substitution, not suicide contagion. Some VAD opponents just cherry-pick their way through tidbits to try and argue the opposite.

To date, all the robust, longitudinal data on suicides in jurisdictions where VAD is lawful is consistent with suicide substitution, not suicide contagion.

Conclusion

The Australian Care Alliance and Ms van der Linden disgracefully cherry-pick and misrepresent Victoria's recent suicide data in a manner consistent with their own theories, while proper and appropriate analysis of the full data available shows results inconsistent with their hypothesis, and currently consistent with the opposite.

To paraphrase Ms van der Linden's own statement: “It is unfortunate that the deaths of terminally ill Victorians were politicised so shamelessly by [anti-]euthanasia activists for their own ends.”

These continued cherry-picked data gaffes are an embarrassment to their promoters.

 

Keywords: 

Bull | Fudge | Fiction | Faith | Assisted dying (AD) | Australia | Victoria | Branka van der Linden | Religion | Catholic | Statistics | Rhetoric | Rhetoric: Suicide | Rhetoric: Suicide 'contagion'

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Each federal election, the AES gathers extensive demographic and attitudinal data from a substantial sample of Australians. That means we have comparable snapshots from each election in recent times, including 2019, 2016, 2013, 2010 and 2007 (though attitudes toward VAD have been asked only since 2016).

First up, given the well-documented strong connection between higher religiosity and less favourable attitudes towards VAD, let’s take a quick look at Australia’s changing religious landscape.

Abandoning religion: from trickle to torrent

Since federation, periodic census data collected by the Australian Bureau of Statistics (ABS) confirms a long-term decline in religious affiliation (Figure 1).

Figure 1: Religious affiliation in Australia by census year (ABS data)
NOTE: Figures are nett of typically 10% non-response

Even this data generally overstates actual religious affiliation, compared with repeated good-quality polls. Census data has pegged religious affiliation typically 4-8% higher than do most polls.

That’s because until the most recent census (2016), collections had primarily or exclusively used a single, massive booklet for household completion. Mr Jones was unlikely to upset Mrs Jones by ticking the “No religion” box when he thinks she’s sure the family is Anglican, and she can see his answers. In contrast, relatives are not looking over the shoulder of an opinion poll respondent, which allows them to be more frank.

Additionally, a formal booklet is more likely to prompt respondents to answer in terms of historical household identity (a lagging indicator), while ad hoc surveys are more likely to prompt answers in terms of recent, pragmatic attitudes and practices (current indicator).

Abandoning religious identity

AES data clearly shows that for major denominations, Australians are leaving institutionalised religion in droves (Figure 2).

Figure 2: Religious affiliation by federal election year (AES data)

Over just 12 years Catholic affiliation has dropped from 28% to 21% (a drop of 26% of its flock); Anglican from 21% to 15% (-29%); and Uniting/Methodist from 8% to 4% (-52%). In total, minor Christian denominations have remained around the same, while non-Christian denominations have experienced a small increase, mostly from immigration.

But by far the most dramatic change over the 12 years is that No Religion has soared from 26% to 41% of the population, an increase of 61%. The largest increase was between 2016 and 2019, most likely a result of Australians’ dismay at the 2017 reports of the royal commission into institutional responses to the sexual abuse of children. It found that most offenses occurred in religious institutions, more than half of them in the Catholic church alone.

Abandoning religious practice

Not only have Australians been abandoning religious identity, but for the most part increasingly abandoning religious practice (Figure 3).

Figure 3: Almost never/never attend religious services (AES data)

At the same time as many Australians have abandoned religious identity, those still identifying with Catholic, Uniting, and non-Christians faiths are attending services less than before.

Overall, service attendance has remained about the same amongst minor Christian denominations, and there has been an increase amongst Anglicans (actually because far more Notionals — people who identify with a denomination but never attend religious services — have “left” the Anglican church).

Indeed, in 2019, fewer than half of Australians (47%) ever attend religious services, just a third (32%) attend more often than once in a blue moon, and a mere 16% are consistent attenders.

Clerics might still be talking, but fewer Australians than ever want to listen.

Abandonment to continue

Australians will continue to abandon religion given that most younger Australians reject religion at the same time that older, more religious Australians pass away (Figure 4).

Figure 4: Religion by age cohort 2019 (AES data)

This picture is even more dire for clerics than it was just three years earlier in 2016 (Figure 5).

Figure 5: Religion by age cohort 2016 (AES data)

Over the next 25 years the Catholic church and minor Christian denominations will struggle, while the Anglican and Uniting churches will almost cease to exist if current trends continue.

An integrated measure of religion

For further analysis, we’ll use the Australian Religious Identity 6-Factor (ARI6) model. It segments on the combined basis of religious attitudes and behaviour across a spectrum from Rejecters to Devouts.

Unsurprisingly over the past decade, Devouts have remained firmly entrenched in their faith (Figure 6), while there has been a small downward trend amongst Regulars.

Figure 6: Australian Religious Identity 6-Factor (ARI6) by year (AES data)

Most of the abandonment of religion in recent years has been amongst Occasionals, those who identify with a religious denomination but rarely attend services. This begs the question as to whether clerics were right to assume that they spoke for many in their flocks in the first place.

Attitudes toward VAD — Overall

Between 2016 and 2019 there was a small but statistically non-significant increase in total support for VAD, while there was no change in total opposition (Figure 7).

Figure 7: Australian adult attitudes toward VAD by year (AES data)

What is readily apparent, though, is a substantial increase in the number of Australians strongly in support of VAD (from 43% to 53%), while total opposition has remained tiny at fewer than one in ten Australians (9%).

Attitudes toward VAD — Religious affiliation

Amongst Australians who still count themselves as religiously affiliated in 2019, a majority of all religions except minor Christian denominations clearly favour VAD (Figure 8), including three quarters (74%) of Catholics, four in five Anglicans (78%) and Uniting/Methodists (81%), and almost all non-Christian religious (96%) and non-religious (92%).

Even amongst the minor Christian denominations with nearly half (49%) in support, just one in five (20%) were opposed to VAD, the rest being neutral.

Figure 8: Attitudes toward VAD by religious affiliation 2019 (AES data)

Strong support amongst Catholics increased massively from 36% in 2016 to 48% (close to half in strong support) in 2019, highlighting the irony of Catholic clergy continuing to actively oppose VAD law reform.

Given the tiny minorities opposed across the religious spectrum, those clerics who continue to vocally oppose the legalisation of VAD — including some employing serious misinformation — in no way are speaking for the majority of their flocks.

Attitudes toward VAD — Religiosity

Unsurprisingly, given the vast body of existing scholarly research evidence, opposition to VAD is largely religious (Figure 9).

Figure 9: Attitudes toward VAD by ARI6 2019 (AES data)

Nearly half of all opposition to VAD (44%) is of Devouts, with an additional quarter (26%) amongst Regulars and Occasionals, and a smaller proportion (17%) from Notionals.

Tellingly, even amongst the most religious, opposition to VAD has dropped significantly in just three years since 2016 (Figure 10). Opposition to VAD amongst Devouts dropped from nearly half (46%) to just over a third (35%), and amongst Regulars from 25% to just 15%.

Figure 10: Attitudes toward VAD by ARI6 2016 (AES data)

For 2019, proportions of the most opposed religious segment, Devouts, are almost evenly split amongst supporters, neutrals and opposers.

Amongst the next most religious, Regulars, supporters outnumber opponents by three to one, and in all the other segments supporters outnumber opponents by more than ten to one.

The evidence is clear: even amongst the most religious Australians, opposition to VAD is melting away.

The lowdown for politicians

What does this mean for legislators, who the community is asking to legalise VAD with responsible safeguards? Figure 11 shows VAD attitudes of Australians by the political party they identify with.

Figure 11: Attitudes toward VAD by political party identity 2019 (AES data)

It’s obvious why VAD Bills have been sponsored by Greens members and/or facilitated by Labor governments.

In contrast, Australian Coalition parliamentary parties (with notable exceptions of a handful of Coalition members) have steadfastly obstructed consideration and passage of VAD Bills. This is not because the party machinery is representing the broader Coalition voter, whose overall support stands at 74% versus a tiny 13% opposed. Rather, it’s because of the (widely reported) takeover of the party machinery by the religious right.

The natural home of VAD opponents is minor right parties, comprising overall a slight majority (53%) opposed to VAD. [Addendum: those identifying with minor right parties comprise just 3.1% of the adult Australian population.]

Given that minor right party voters are most likely to give their major party preference flow to the Coalition, the real concern for Coalition election strategists is to minimise first preferences going to a minor right party in the one or two electorates (if any) in which such a minor party win might even be on the cards.

The lowdown for election candidates

It’s been a firm belief among the political class for a long time that candidates openly supporting VAD would be punished at the polls on election day, with little to no downside for candidates opposed to VAD. That, however, is fake news.

A 2012 Newspoll survey asked voters if, all other things being equal, they would change their vote if their otherwise preferred election candidate’s stance was the opposite of their own (support vs opposition). (Full disclosure: as CEO of YourLastRight.com I commissioned the survey.)

VAD-supporting voters stated they would punish their preferred candidate (opposing VAD) at three times the net rate that VAD-opposing voters would punish a supporting candidate. I’ve subsequently published various other observations that are consistent with this finding.

Now that strong support for VAD amongst the Australian public is significantly higher than it was in 2016 (let alone 2012), it would be foolhardy for any supportive politician to hide their light under a bushel, or for an opposed candidate to effectively thumb their nose at the majority of voters.

I’m reminded of a favourite remark of Sir Humphrey Appleby (Nigel Hawthorn) in the 1980s British political comedy series Yes Minister, who would gently point out his Minister’s policy folly (Jim Hacker played by Paul Eddington) with the light remark, “that would be very courageous, Minister!”

It’s now a very courageous candidate indeed who believes their personal opposition to VAD ought to trump the support of the vast majority of their constituency. And, given the ongoing abandonment of religion in Australia, such candidates will soon find themselves on the wrong side of history.

The lowdown for campaigners and voters

Given that most Australians — increasingly including the religious — are in favour of responsible VAD law reform, and with a growing proportion strongly in support, it’s more important than ever to determine election candidates’ real attitudes toward VAD.

Some candidates provide prompt and candid responses to help voters decide. But many candidates obfuscate, either failing to respond at all or responding with non-answers such as they haven’t seen specific legislation yet so cannot answer, or cynically stating only the obvious such as “opinions vary” and it can be “an emotive issue”.

The key action with obfuscators is to get a real answer to the question “could there be any version of a VAD Bill that could enjoy your support?” And assume those who still obfuscate would have said “no”, had they been candid.

 

Keywords: 

Assisted dying (AD) | Australia | Religion | Non-religious | Christian | Anglican/Church of England/Episcopal | Catholic | Analysis | Legislative reform | Poll / survey | Statistics

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

 
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:

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.

 

Keywords: 

Fearmonger | Flapdoodle | Faith | Australia | Anthony Fisher | Paul Kelly | Paul Russell | Alex Schadenberg | Margaret Somerville | Branka van der Linden | Religion | Catholic | Claim response | Legislative reform | Lobbying: Opponents | Statistics | Rhetoric: The 'vulnerable'

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Van der Linden's email reads:

 

 

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.

 

Keywords: 

Fearmonger | Flapdoodle | Fudge | Fiction | Faith | Belgium | Netherlands | Oregon | Branka van der Linden | Claim response | Legislative reform | Statistics | Rhetoric: Slippery slope | Rhetoric: The 'vulnerable'

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Multiple fatal flaws

In the ‘analysis’ outlined in his article, Boer commits a number of fatal scientific no-noes, including failing to analyse the variable he actually surmised might cause suicide contagion, cherry-picking data that supported his conclusion while ignoring or offhandedly dismissing data at odds with his conclusion, and wrongly forming a causative conclusion from a simple correlation while failing to control for any confounding variables of which there are many.

A litany of scientific offences

In addition to the fatal flaws, Boer’s article contains numerous other scientific and academic offences. My forensic analysis concludes:

“In summary, Boer’s article contains a litany of scientific and scholarly failures. Its speculations are ill-informed, poorly-assembled, incoherent in places and mostly uncited, the data cherry-picked and invalidly interpreted, and the laissez faire methodology incapable of validly supporting its conclusion.
 

Boer conjures up mere smoke and mirrors to argue suicide contagion from VAD in the Netherlands. The article should be retracted.”

The article also reflects badly on the journal that published this smoke and mirrors: the Journal of Ethics in Mental Health. Neither peer review nor editorial effort identified or attempted to correct any of the nonsense in the article.

What was he thinking?

Professor Boer is an expert in Reformist Protestant theology. As a religious ethicist, it’s astonishing that he considered himself suited to conducting and publishing a ‘causative’ scientific study.

In his article, Boer proposed VAD as the only factor to contribute to changes in the Netherlands’ general suicide rate (and dismissed the Belgian data which contradicted his theory).

In reality, numerous risk and protective factors affect the suicide rate, and in the Netherlands as I’ve established using their official government data, just one factor — unemployment — explains 80% of the variance in the Dutch suicide rate since 1960. Boer casually dismisses this without providing the faintest fume of an empirical analysis himself.

Boer’s article did little but amply demonstrate his underlying anchoring and confirmation bias on the subject, his unfamiliarity with the complexity of suicide, and ignorance of proper scientific principles.

For good measure, he casually threw in a comment about “suicide contagion” or copycat suicides, without understanding that in suicide, copying is the method of causing death. But by definition, general suiciders don’t follow the provisions of the euthanasia Act.

His endeavour made as little sense as me writing a conclusive article about Reformist Protestant theology, about which I know very little.

A copycat analysis?

Coincidentally, the structure of the storyline, the litany of scientific offences committed, and the conclusions reached in Boer’s article were surprisingly similar to those in an ‘analysis’ of Oregon’s suicide rate in another paper by Jones and Paton. Like Boer, Jones and Paton start out by surmising that assisted dying ought to lower the general suicide rate, and conclude the opposite.

Boer approvingly cites the Jones and Paton article, even though a forensic analysis found no fewer than ten major scientific flaws in it and provided multiple sources of empirical evidence at odds with the article’s conclusions.

But Boer manages to cock even the citation up, referring to the article’s authors as Holmes and Paton.

Will the real Theo Boer please stand up?

Boer notes that he’s always been a euthanasia sceptic. Nevertheless, as a Reformist Protestant, he had long accepted assisted dying in “emergency” situations, of which intolerable and otherwise unrelievable suffering is a ‘qualifying’ criterion, and which is the substance of the Dutch euthanasia law (it’s regarded in legal circles as a law of “necessity”). He also opined that the Dutch model was a decent one that other jurisdictions could emulate.

Boer served as the ethicist member of one of the five Dutch euthanasia review commissions, examining every case reported to it between 2005 and 2014.

In 2014 he publicly quit his post on the review committee, slamming the Dutch assisted dying system. He’s been badmouthing it to anyone who will listen, since.

In preparation for this analysis, I asked Boer if his vocal opposition to the Dutch assisted dying model was now based on an in-principle opposition to assisted dying, or only in regard to more recent practice under the Dutch euthanasia Act. Despite a couple of iterations, I didn’t get a specific answer.

The law hasn’t changed

Here’s the point. While Boer repeatedly opines that things changed radically in the Netherlands around 2007, the country’s euthanasia Act hasn’t changed since it was passed in 2001 (and came into effect in 2002). Not. One. Word.

In addition, the Dutch Supreme Court determined in 1994 that individuals with mental (in the absence of concomitant physical) illness could qualify under the then regulatory euthanasia framework, and it was found that cases occurred every year.

And the 2001 Act formalised in statute the regulatory framework that had existed since at least 1984, when the Dutch medical association first published guidelines for euthanasia.

Thus, the Act reflects very long-standing practice, and it hasn’t changed since it was enacted, in contrast to Boer’s claim that things have radically changed.

Flimsy and incoherent ‘ethics’ part 1

This brings us to the first fatal incoherence of Boer’s “ethics”: that he now opposes the law because people with psychiatric illness and other conditions are, in slightly increasing numbers, availing themselves of the euthanasia law. It is these cases against which Boer rails, despite having previously said the Dutch model is a good example for the world, and having actively participated in the system.

Boer’s flip flop is to argue that a law that permits assisted dying under a range of medical conditions (and has done so for decades) is a good law, provided some of those who might qualify (like psychiatric cases) never use it.

Try and explain the ethics behind that position.

Flimsy and incoherent ‘ethics’ part 2

The second fatal incoherence of Boer’s ‘ethics’ is his repeated complaint that until around 2007, the numbers of euthanasia cases was “somewhat steady”, but increased after that. Never mind that the majority of the increase was still in relation to terminal cancer: Boer simply railed at the increased numbers as a major problem.

But, try and explain using ethical principles, why it is appropriate for 2,000 people a year to avail themselves of the euthanasia law, but inappropriate for 4,000 (who all qualify)?

Indeed, the Dutch euthanasia Act makes no mention of numbers: there is no legislated limit on the count of people who might choose to use the law. Rather, it is based on due care criteria, outlining the circumstances of who may qualify, and the process by which they may.

The legislature’s intent remains unchanged and is still being adhered to, though more people, the majority of whom have terminal cancer, are using the law.

It’s astonishing that a Professor of Ethics fails to reflect on the fatal incoherence of his own ‘ethical’ arguments.

What happened?

Boer, who had supported and promoted the Dutch euthanasia model suddenly and incoherently changed his position to vocally opposed in 2014. What happened?

One factor might shed some light. In 2014, Boer was appointed to the endowed professorship of Lindeboom Chair in Ethics in Healthcare at Kampen Theological University.

While Kampen Theological University is a Dutch Reformist Protestant institution and therefore may support assisted dying in “emergency” cases, the Lindeboom Institute, which endows Boer’s eponymous professorship, is less understanding.

The Lindeboom Institute was co-founded by several orthodox Christian institutions and cooperates with the Netherlands Evangelical University which studies science from an creationist Biblical perspective.

The Institute demands “biblically sound medical ethics” along with “Christian norms and values”. You’d be left wondering what that actually means, until you find on its website that the Board’s role is “the protection of people at all stages of life”.

In addition, participating organisations that fund the Lindeboom endowment, like the Dutch Patients Association, Pro Life Health Insurance and the Foundation for Christian Philosophy, are strongly opposed to assisted dying in any form.

It turns out that the authors of that other ‘analysis’ that commits numerous similar scientific offences which generate smoke and mirrors, Jones and Paton, are devout conservative Catholics.

Gosh. What a coincidence.

 

Keywords: 

Bull | Fearmonger | Flapdoodle | Flip-flop | Fudge | Fiction | Faith | Assisted dying (AD) | Euthanasia | Belgium | Netherlands | Article review | Claim response | Lobbying: Opponents | Statistics | Rhetoric: Suicide 'contagion'

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Belgium Euthanasia - Figures for the year 2018

By Jan Eyckmans
Posted on 28/02/2019

These figures relate to the registration documents for euthanasia carried out between 1 January 2018 and 31 December 2018 examined by the Commission. A more detailed analysis of euthanasia reported in 2018 will be made in the next biennial report of the Commission (gathering data for 2018 and 2019).

The number of reports received during this period was 2357. The majority were written in Dutch, concerned patients aged 60 to 89 years and slightly more women. Most often, euthanasia took place at home.

The main conditions causing the euthanasia claims were either cancers or a combination of several conditions (polypathologies) that were not likely to improve and that caused more and more serious disabilities up to organ failure. Death of patients was usually expected in the near future. Patients whose death is clearly not expected in the short term suffered mostly from polypathologies, while the death of cancer patients is rarely considered such.

Requests for euthanasia on the basis of mental disorders and behavior remain marginal (2.4% of all euthanasia). Like all euthanasia records, they comply with the legal requirements (patient capable, written request, medical situation without solution, constant suffering, intolerable and unbearable, caused by a serious and incurable condition, application and repeated request).

No euthanasia of unemancipated minors was recorded in 2018.

The Commission considered that all the declarations received met the essential conditions of the law and none were transmitted to the public prosecutor.

Detailed figures

The number of reports received in 2018 was 2357. The number of recorded euthanasia remained stable (only 1.8% increase).

The number of registration documents in French continues to increase (76% NL / 24% FR).

67.1% of the patients were older than 70 years and 41% were over 80 years old. Euthanasia in patients under 40 remains very limited (1.7%). It is mainly patients in the 60, 70, and 80 age groups who request euthanasia (75.8%). The largest group of patients is between 80 and 89 years old (29.9%).

In 2018, no statement regarding the euthanasia of minors was recorded.

The number of euthanasia in the home (46.8%) is still increasing, while those in the hospital are still decreasing (36.1%). The number of euthanasia in nursing homes and nursing homes continues to increase (14.3%). This corresponds to the patient's wish to end his life at home.

In the vast majority of cases (85.4%), the physician estimated that patient deaths were predictable in the near future.

For the majority of patients, several types of physical and psychological suffering (not to be confused with psychiatric conditions) were observed simultaneously (78.7%). These sufferings were always the consequence of one or more serious and incurable conditions.

Less than 1% of euthanasia involved unconscious patients who made an advance declaration.

The conditions causing the euthanasia were mostly tumours (cancers) (61.4%), polypathologies (18.6%), diseases of the nervous system (8.3%), circulatory system diseases. (3.8%), diseases of the respiratory system (2.4%) and mental and behavioural disorders (2.4%).

Press contacts

• Jacqueline Herremans, lawyer
+32 (0) 2 648 75 30
+32 (0) 475 74 40 92
jacqueline.herremans@lallemand-legros.be

• Michèle Morret-Rauïs, oncologist
+32 (0) 475 40 41 22
morret.rauis@gmail.com

Related documents:

• euthanasia__2018.docx (45.5Kb)

 

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The original document in French is available here.

 

Keywords: 

Assisted dying (AD) | Belgium | Regulation | Statistics

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