Australia

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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Back in 1998, non-voluntary euthanasia  — or NVE — was carefully studied by Belgian scholars. It’s a problematic practice, even though often the medication doctors administered didn’t actually hasten death. They found it occured in 3.2% of all deaths.

In 2002, the Belgium parliament legalised voluntary assisted dying — or VAD.

In 2007, the Belgian scholars repeated their study and found that NVE had dropped by nearly HALF, to 1.8% of all deaths. Again in 2013, it was found to remain at a lower level, 1.7% (Figure 1).

Figure 1: Belgium's NVE rate has dropped dramatically since VAD was legalised

Thus, the State shining a bright light on end-of-life practices, including VAD, has resulted in improvements.

NVE has also been found to occur in every jurisdiction that’s been studied, VAD law or not, including Australia and New Zealand (Figure 2).

Figure 2: NVE has been found in every jurisdiction that's been studied

But the Catholic church would have you believe otherwise.

In a recent video, the Catholic Archdiocese of Sydney grotesquely misrepresented a single statistic from the Belgian studies. Using cold colours and the sound of a flatlining heartbeat, the Catholic video claims Belgium’s VAD law has caused its NVE. It’s a chilling confection of innuendo that thumbs its nose at the facts.

The Belgian study the church relies on expressly points out the significant NVE drop, so it’s not like they wouldn’t know.

 
Figure 3: The study expressly points out the significant drop

It's no wonder that lead scholar of the Belgian research, Assistant Professor Kenneth Chambaere, called the Church’s video “cherry-picked", “a blatant misrepresentation”, “scaremongering” and “appalling”. Professor Chambaere's full response appears below.

Despite the unambiguous evidence, multiple Catholic lobbyists have used cherry-picked NVE rates in a similar way, like:

• Catholic Professor Margaret Somerville;
• Catholic politician Daniel Mulino, whose claim is hosted by the Catholic Archdiocese of Melbourne; and
• Catholic lobbyist Branka van der Linden.

 
I’ve directly corrected their misleading claims before. Yet here we go again with the same unconscionable nonsense.

Interestingly, at a 2011 Catholic conference, Archbishop Anthony Fisher said:

“the man or woman in the street … may well be open to persuasion that permissive laws … cannot be effectively narrowed to such practices”

and

“we need to research and propose new messages”

Note that the Archbishop proposed... new messages. In his address he didn't propose to examine if his assumed calamities were valid or not.

The Church is entitled to opinions, but promoting misinformation doesn’t seem to be very Christian. The Church should withdraw its grotesque propaganda and apologise.

In conclusion, repeating fake news doesn’t make it true. The fact remains that Belgium’s NVE practice was considerably higher before it legalised VAD, and dropped significantly after.

---

Prof. Kenneth Chambaere's response in full

On viewing the Catholic Archdiocese of Sydney's video on Belgian NVE, which cites Prof. Chambaere's 2007 study, Prof. Chambaere made the following statement:

13th July 2019
 
Recently, a Vimeo video of the Archdiocese of Sydney on 'Debate on Euthanasia Laws' was brought to my attention: https://vimeo.com/339920133.

As lead author of the cited research, I was appalled at the video's blatant misrepresentation of the robust and honest research that we have been conducting in Belgium. It is quite frankly an insult to us as researchers who day in day out work to generate reliable and trustworthy insights into end-of-life practice in Belgium.
 
It is clear to me that the video has cherry-picked results from our studies to the effect of scaremongering among the public. As researchers, we fully grasp the emotional, ethical and societal gravity of the euthanasia practice and therefore also euthanasia research, and we never take it lightly. We believe we are always as objective and impartial as possible, as is to be expected of independent and free research. This only adds to my duty as a scientist to respond to the video in question and correct its mistakes. The general public and politicians must have access to reliable and correct evidence.
 
First of all, the figures shown in the video do not concern euthanasia practices at all. Euthanasia is by definition always at the explicit request of the patient. What the figures do refer to are physician acts to hasten a dying patient's death without their explicit request, a separate type of end-of-life practice altogether (see further).
 
Secondly, yes, this problematic practice does exist in Belgium. But so does it exist in every other country where anyone has had the audacity to conduct research into it, euthanasia law or no euthanasia law.
 
Thirdly, the incidence of such practices has halved since the euthanasia law was enacted in Belgium.
 
Conclusion: acts of hastening death without explicit request are not a by-product of euthanasia legislation, and if anything, euthanasia legislation seems to decrease the occurrence of these practices. This conclusion features prominently in the paper cited in the video.
 
This practice even exist in Australia, and in significant numbers, according to one (potentially outdated) study. While this study was not identical to ours in Belgium, it still provides clear evidence of its occurrence in Australian end-of-life practice. The authors of the video ask whether Victoria will become like Belgium? If it means diminishing rates of these questionable practices, then surely becoming more like Belgium is a good thing!
 
Lastly, a 2014 detailed analysis in CMAJ Open clarified much about what these cases of hastening death without explicit request entail. I quote our conclusion here: "Most of the cases we studied did not fit the label of "nonvoluntary life-ending" for at least one of the following reasons: the drugs were administered with a focus on symptom control; a hastened death was highly unlikely; or the act was taken in accordance with the patient's previously expressed wishes. Thus, we recommend a more nuanced view of life-ending acts without explicit patient request in the debate on physician-assisted dying."
 
This is not to condone or excuse physicians who engage in such practices, but it is important to know and be clear about what we are focusing our societal discussions on.
 
The question then is, why did the authors of the video overlook these clear conclusions during their extensive review of the evidence? It is very difficult to see how our research could be misrepresented in the way it has been in the video. The research is very clear and it does not support the claims made in the video. I urge anyone relying on the large body of peer-reviewed evidence to analyse it carefully, and if necessary consult with the authors, before communicating to the general public.

Assistant Professor Kenneth Chambaere
End of Life Care Research Group
Vrije Universiteit Brussel
Belgium

 

Keywords: 

Fearmonger | Fudge | Faith | Assisted dying (AD) | Non-voluntary euthanasia (NVE) | Australia | Belgium | Catholic | Claim response | Rhetoric: Slippery slope

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The Act contains what is arguably the world's most detailed and carefully laid out safeguards.

Key aspects of the provisions are:

• The person must be 18 years or over; and
• Be ordinarily resident in Victoria and an Australian citizen or permanent resident; and
• Have decision-making capacity in relation to voluntary assisted dying; and
• Be diagnosed with an incurable disease, illness or medical condition that:
  • is advanced, progressive and will cause death; and
  • is expected to cause death within 12 months; and
  • is causing suffering that cannot be relieved in a manner the person deems tolerable; and
• Doctors and other healthcare workers are not permitted to raise assisted dying — only to respond to formal patient requests.
• The person must make three formal requests, the second of which must be written and witnessed by two independent people.
• The person must make the request themselves. Nobody else is authorised to make the request, and the request cannot be made via an advance care directive.
• Ordinarily, the minimum timeframe between first request and opportunity to take the medication is ten days.
• The person must maintain decisional capacity at all three requests.
• Two doctors must reach independent assessments that the person qualifies.
• Only doctors who have completed specialist training for voluntary assisted dying may participate.
• Any healthcare worker may decline to participate for any reason, without penalty.
• A prescription dispensed for the purpose of voluntary assisted dying must be kept in a locked box and any unused portion returned to the pharmacy after death.
• The person must self-administer the medication; except if the person is unable to, a doctor may administer. An independent witness is required if the doctor administers.
• Establishment of an authority to receive assisted dying reports, to assess reports, and to refer unacceptable cases to disciplinary or prosecutorial authorities.
• For Parliament to review summary reports; twice in the first two years and annually thereafter; a formal review at five years.
   

More information about the Act and how to access voluntary assisted dying are available from Health Victoria.

 

-----

Full list of safeguards in Victoria's voluntary assisted dying framework

Access

1. Voluntary
2. Limited to 18 years and over
3. Residency requirement [Victorian resident and Australian citizen or permanent resident]
4. Limited to those with decision-making capacity
5. Must be diagnosed with condition that meets restrictive set of criteria [advanced, progressive and will cause death]
6. End of life is clearly defined [death expected within weeks or months, not more than 12 months]
7. End of life condition combined with requirement for suffering
8. All of the eligibility criteria must be met
9. Mental illness alone does not satisfy the eligibility criteria
10. Disability alone does not satisfy the eligibility criteria

Request

11. Must be initiated by the person themselves
12. No substitute decision makers allowed
13. Cannot be included as part of an advance directive
14. Health practitioner prohibited from raising voluntary assisted dying
15. Person must make three separate requests
16. Must have written request [witnessed in the presence of a medical practitioner]
17. Two independent witnesses to request [exclusions for family members, beneficiaries, paid providers]
18. Specified time must elapse between requests [first and third requests must be at least 10 days apart with exception when death imminent]
19. Additional time required to elapse between steps of completing process [second assessment and third request must be at least one day apart
20. Must use independent accredited interpreter [if an interpreter is required]
21. No obligation to proceed, may withdraw at any time

Assessment

22. Eligibility and voluntariness assessed by medical practitioners
23. Must be two separate and independent assessments by medical practitioners
24. Assessing medical practitioners must have high level of training/experience
25. Assessing medical practitioners must have undertaken prescribed training [to identify capacity and abuse issues]
26. Requirement to properly inform person of diagnosis, prognosis and treatment options, palliative care, etc, [by both assessing medical practitioners]
27. Referral for further independent assessment if there is doubt about decision-making capacity
28. Coordinating medical practitioner must confirm in writing that they are satisfied that all of the requirements have been met

Medication management

29. Person required to appoint contact person who will return medication if unused
30. Medical practitioner must obtain a permit to prescribe the medication to the person
31. Medication must be labelled for use, safe handling, storage and disposal
32. Pharmacist also required to inform the person about administration and obligations
33. Medication must be stored in a locked box

Administration

34. Medication must be self-administered [except in exceptional circumstances]
35. If physical incapacity, medical practitioner may administer
36. Additional certification required if administered by medical practitioner
37. Witness present if medical practitioner administers

Practitioner protections

38. Health practitioner may conscientiously object to participating
39. Explicit protection for health practitioners who are present at time of person self-administering
40. Explicit protection for health practitioners acting in good faith without negligence within the legislation
41. Mandatory notification by any health practitioner if another health practitioner acting outside legislation
42. Voluntary notification by a member of the public of a health practitioner acting outside legislation

Mandatory reporting

43. Reporting forms set out in legislation
44. Reporting mandated at a range of points and from a range of participants to support accuracy
45. First assessment reported [to Board]
46. Second assessment reported [to Board]
47. Final certification for authorisation reported [to Board, incorporates written declaration and contact person nomination]
48. Additional form reported [to Board] if medication administered by medical practitioner
49. Prescription authorisation reported by DHHS [to Board]
50. Dispensing of medication reported [to Board]
51. Return of unused medication to pharmacist reported [to Board]
52. Death notification data reported [to BDM and collected by Board]

Offences

53. New offence to induce a person, through dishonesty or undue influence, to request voluntary assisted dying
54. New offence to induce a person, through dishonesty or undue influence, to self-administer the lethal dose of medication
55. New offence to falsify records related to voluntary assisted dying
56. New offence of failing to report on voluntary assisted dying
57. Existing criminal offences for the crimes of murder and aiding and abetting suicide continue to apply to those who act outside the legislation

Oversight

58. Guiding principles included in legislation
59. Board is an independent statutory body
60. Board functions described in legislation
61. Board reviews compliance
62. Board reviews all cases of [and each attempt to access] voluntary assisted dying
63. Board has referral powers for breaches
64. Board also has quality assurance and improvement functions
65. Board has expanded multidisciplinary membership
66. Board reports to publicly [to Parliament every six months for first two years, thereafter annually
67. Five year review of the legislation
68. Guidelines to be developed for supporting implementation

 

Keywords: 

Assisted dying (AD) | Australia | Victoria | Legislative reform

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The Catholic Healthcare brick wall

More than half of all palliative care services in Australia are delivered through Catholic institutions, of which Cabrini Health is one arm. These institutions have determined that VAD will not be available in any of their facilities or via any of their services, even if the individual patient and doctor are supportive.

This arbitrarily limits access to lawful choice by citizens.

Confected ‘institutional conscience’

I say ‘arbitrarily’ because ‘institutional conscience’ is a confection: it doesn’t really exist. Only real persons have conscience. The fabricated dictates of any institution — presented as ‘moral rules’ — extinguish the actual real conscience of those who exist within it: at least, those whose conscience differs.

The upshot is that a specific cohort of religious, celibate men in Rome dictate whether Australian citizens can or can’t obtain lawful healthcare services from half the service providers.

So let’s examine what the institutional ‘conscience’ has to say.

Disgraceful framing in headline

“We can’t let voluntary assisted dying negate our commitment to the ill”, Michael’s article headline screams.

Firstly, VAD is not available to the “ill”. It’s available only to those with terminal illness and intolerable suffering, according to 68 criteria.

Secondly, Michael invokes a false dichotomy of “negating a commitment”. VAD does not “negate a commitment”. Indeed, to fail to hear and respect a persistent, fully informed and tested request for VAD that meets all the criteria is to negate palliative care’s commitment to honour the patient’s deeply held values, beliefs and decisions.

Medical-coloured glasses

“The introduction of voluntary assisted dying legislation in Victoria on June 19 will remind us of the occasional failure of medicine,” Michael says.

That’s it. The patient’s death is a failure of medicine, as though a person’s death is a medical event rather than a deeply human and private one of personhood.

It also flags the common but immature medical assumption that “death = failure”. Death is inevitable, not a “failure”. The key question about death for people with terminal illness is “how”, and Michael presumes to prescribe the “how”: being receptacles for interventions that she and her colleagues provide.

Let’s be clear. Many people are helped enormously by palliative care. That’s a great credit to the discipline’s specialists.

However, as Palliative Care Australia acknowledges, even the best palliative care can’t relieve all excruciating, debilitating and humiliating refractory symptoms.

Michael’s answer to this sometimes “failure” of medical interventions? Deliver more interventions, whether the patient considers them consistent with his own values, beliefs and circumstances or not.

They’re very heavily medical-coloured glasses indeed.

Three faux ‘threats’

Michael then invokes three faux ‘threats’ supposedly caused by lawful VAD in Victoria.

Faux threat 1: “Validating suicide as an acceptable choice”.

Michael exposes her own bias here: that all self-hastening of deaths are the same — that there is no meaningful difference between a dying person who is fully informed and whose rational choice for a peaceful assisted death has been extensively tested, with the violent and impulsive action of a person suffering a temporary, resolvable personal crisis, be it mental illness, substance abuse, intimate relationship breakdown or other circumstance.

Michael is pretty much on her own here. Most Australian doctors make a clear distinction between these very different contexts.

Faux threat 2: “accepting substandard medical care by supporting the lack of rigour in defining [VAD] eligibility”.

Michael overlooks that there is a major lack of rigour in existing, lawful end-of-life choices.

There are no statutory requirements for a patient to refuse medical treatment, even if the treatment would be life-saving.

There are no statutory requirements for the voluntary refusal of food and fluids in order to die, either.

More critically, despite terminal sedation being a common end-of-life medical practice but ethically problematic (including that it may hasten death and may not alleviate intractable symptoms), not only is there no statutory requirement for its practice, but neither the Australian Medical Association nor Palliative Care Australia have official guidelines on its practice.

Thus, in railing against the staggering 68 standards of practice prescribed in Victoria’s VAD law — vastly more than any other in the world — as a “lack of rigour”, Michael makes no mention of three other major life-end choices that have no such standards, including her own discipline’s terminal sedation.

Doctor, heal thyself (and thine own systems).

Faux threat 3: “introducing into the healthcare curriculum the intentional ending of life as acceptable medical treatment”

Michael creates a misleading impression here. By referring to ‘curriculum’ you might think that all medical students would have to undergo training on how to end lives, or be ‘indoctrinated’ to accept VAD. That is not true.

To be able to prescribe lethal medication under Victoria’s legislation, the doctor must undergo additional training in relation to that procedure. Doctors will only receive the training if they self-nominate for it: it’s not compulsory.

If, by ‘curriculum’ Michael means only “VAD might be discussed” in medical school, then she would have to articulate why termination of pregnancy (to which the Catholic church objects) should not be discussed, either. Nor the transfusion of blood, since many Jehovah’s Witnesses object to the procedure.

Own failure in palliative care principles

Nowhere in her opinion piece does Michael acknowledge that the patient may deeply hold values and beliefs that validly favour VAD. Thus, Michael offends the first principle of palliative care which is to make the patient the centre of care and to honour as much as possible the patient’s values, beliefs, attitudes and wishes.

Indeed, in her conclusion, Michael states that palliative care “remains committed to the ongoing accompaniment of our patients. Not abandoning them” and which is “the only plausible method of compassion and care.”

This surely is the most egregious and arrogant self-interest of all: patients must subject themselves to being accompanied by palliative care staff and their ‘interventions’ whether they want more or not.

On the contrary, to fail to hear and respect a genuine, informed and persistent request for a peaceful hastened death from a dying patient for whom this accords most firmly with his deeply held values and beliefs, is to abandon the patient.

Conclusion

Michael is of course entitled to her personal stance, and I celebrate her right to hold her views: for herself.

However, her ‘requirement’ that all Victorians be denied access to an option that four out of five believe to be moral — and instead subject themselves to interventions administered by Michael and her colleagues — reveals an unattractive arrogance.

It’s a shame that Catholic bioethics doesn’t teach more about reflection, especially as to whether one’s own beliefs ought to dictate and limit the choices of others with equally firmly held, though different, values.

In the meantime, Victorians are pawns to the tyranny of the Vatican as to whether there is a local healthcare facility that will hear and examine their request for a peaceful, assisted death in the face of terminal illness.

In many places, there won’t be.

 

Keywords: 

Fearmonger | Fudge | Assisted dying (AD) | Australia | Victoria | Catholic Church | Legislative reform | Lobbying: Opponents | Rhetoric: Killing | Rhetoric: Suicide

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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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Media release - Marshall Perron

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

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

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

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

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

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

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

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

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

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

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

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

Marshall Perron

 

Keywords: 

Assisted dying (AD) | Physician-assisted dying (PAD) | Australia | Victoria | Legislation | Legislative reform

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Opponent signals

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

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

Populist beginning of the misinformation

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

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

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

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

Classic cherry-picking

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

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

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

Disgraceful religious prejudice

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

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

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

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

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

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

Fake news — avoiding healthcare

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

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

Morally bankrupt argument

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

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

Ironic reverse discrimination

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

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

Putting it into perspective

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

 

Figure 1: Australian Territory indigenous populations
Source: Australian Bureau of Statistics, 2016 census

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

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

Playing the race card

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

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

Contact your Senators now

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

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

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

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

Don’t delay! Here’s the link again.

 

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

 

Keywords: 

Fearmonger | Filibuster | Fudge | Fiction | Faith | Australia | Australian Capital Territory | Northern Territory | Religion | Catholic | Legislative reform | Lobbying: Opponents | Statistics | Rhetoric

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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.

 

Keywords: 

Assisted dying (AD) | Australia | Western Australia | Catholic | Legislation | Legislative reform

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Download the editorial (PDF 3.5Mb)

Visit LivingNow

 

Keywords: 

Physician-assisted dying (PAD) | Voluntary euthanasia (VE) | Australia | Religion | Legislative reform | Rhetoric

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