Australia

1
The opinion piece in The Age.

In today’s Fairfax press, Sydney woman Mary Ticinovic advances a number of reasons as to why she believes that assisted dying is not merciful. The by-line identifies her as a “clinical psychologist”. But her arguments are not founded on the basic tenets of psychology. How so?

Read Mary’s opinion piece in The Age

All life is precious

Mary argues that to support assisted dying is to go “against the principle that all life is precious.” She offers no substantive explanation, invoking the notion of ‘human worth’, stating that it exists regardless of the health state or suffering of the person, and complaining that assisted dying promotes the idea that “your life is no longer worth living”.

These are not psychological arguments. We can agree that life is precious. But reluctantly deciding to hasten one’s death in the face of intolerable and unrelievable terminal suffering doesn’t negate that preciousness. Indeed, to some people, choosing assisted dying can evidence the preciousness of one’s very capacities and values as a human.

Whose standards?

Mary further muses over “by whose standards would we judge if life is not worthwhile any more”, as though this is only some vague theoretical argument amongst philosophers or doctors. This is not a psychological argument, either. Under assisted dying law reform, it is only the dying individual’s world-view and circumstances that determine whether he or she feels life is worth living: not anyone else. General philosophical theory doesn’t come into it.

She further argues that assisted dying “promotes a utilitarian view of humanity”. This is not a psychological argument, either. Nor is it valid. Indeed, legalised assisted dying respects the very nature of the diversity of humanity by enabling the world-views many people hold most dear: that of making rational choices consistent with their own beliefs, values and circumstances. Some patients, for example in Oregon, are deeply religious and believe that their God is compassionate and understands and respects their choice to avoid intolerable suffering. That’s not utilitarian at all.

Harm and the Hippocratic Oath

Mary invokes the Hippocratic Oath said by her medical friends to oblige doctors to “do no harm” and that the medical role is “in healing and helping the patient to be restored to health.” This is simplistic nonsense, not a psychological argument.

Firstly, doctors do harm all the time: think of surgical procedures or chemotherapy. Many medical interventions do harm, but we accept the harm because we expect there to be a commensurately greater good as a result.

Secondly, medical practice cannot always “restore the patient to health” as Mary exclusively puts it. What then? The dying patient may judge that the unrelievable suffering they will experience along the path to death is a greater harm than dying a little earlier. And, doctors also have a primary duty to relieve suffering, which Mary doesn’t mention. What is under review is whether a doctor may participate in the relief of intolerable and unrelievable suffering— by hastening death—if the patient believes this is the lesser harm.

Thirdly, the Hippocratic Oath is around 2,300 years old. It requires doctors to swear allegiance to ancient Greek gods. It forbids women from becoming doctors. It requires current doctors to train the next generation free of charge, and it forbids surgery. Contemporary doctors don’t take it, and it’s certainly not “part of training” as Mary mistakenly states.

None of these are psychology arguments.

'Sucker’s choice'

Mary then argues that requiring dying patients to endure until the end promotes—and that assisted dying prevents—“fostering gratitude”, “reconciling hurts or differences with family members or friends” and “showing them strategies or different ways to approach their pain and suffering”.

But, in jurisdictions where assisted dying is legal, for example in Oregon in the USA, these are precisely things that are encouraged under assisted dying. Doctors are required to inform applicants of available medical and palliative interventions. Family gathers on notice of an anticipated death, music and poetry is shared, and expressions of love, devotion and gratitude are exchanged.

If a dying patient has no intention of reconciling with family or reflecting on approaches to dealing with their pain and suffering under an assisted dying law, precisely the same intention applies to the current regime that requires the patient to endure until the end. To assume a difference is a false dichotomy.

Obligatory compassion

Mary also argues that assisted dying ought to remain outlawed because “nursing a sick loved one is a way to give back”. This is yet another specious non-psychology argument. It promotes the ‘right’ of the ‘nurse’ to express love and devotion through ‘caring interventions’ at the expense of the dying patient’s own world view and deeply-held wish for a hastened death. Now who’s being utilitarian?

The upshot

I ran Mary’s opinion piece past an experienced psychologist, who described it as little to do with psychology. Note that neither of us has experience of or is commenting on Mary’s expertise as a clinical psychologist: she may indeed be a very good one.

My associate wondered out loud if Mary’s arguments were based more on underlying religious views than anything else. I agreed: they seemed to me remarkably consistent with the arguments advanced by religious opponents, even though they avoided directly religious words. So I did a little research.

It turns out that Mary is a committed and active Sydney Catholic.* Evidence abounds of her devotion to the Catholic tradition, and I commend her for her conscientious reflective practice and participation in it.

However, I argue that neither the stated psychological qualification nor the unstated religious affiliation make the offered arguments valid.

-----

* By way of fairness, I place on the record that I am agnostic.


Share This Post:
Victoria's VAD Bill has passed both Houses and is now an Act.

Update 7th December 2017

At 4:10pm on Wednesday 22nd November, the Voluntary Assisted Dying Bill passed both Houses of the Victorian Parliament. The Victorian Governor has signed the Bill into an Act, so it is now law in Victoria, though not yet in effect. The Act will come into effect in June 2019, given Victorian residents facing intolerable suffering from an incurable illness, and who meet a number of hurdles, to lawfully request and obtain a peaceful death assisted by their doctor.


Update 20th October 2017

Victorians are a step closer to having the choice of assisted dying in the face of a terminal illness. After a marathon all-nighter sitting, the Legislative Assembly (lower house) this morning passed the Voluntary Assisted Dying Bill 2017. The Bill will now be sent to the Legislative Council (upper house).

The vote was won convincingly at 47:37, despite heroic efforts of opponents to create FUD (fear, uncertainty and doubt) through extensive misinformation, and filibustering the Bill's progress by putting up amendements to numerous clauses.

The Legislative Council is expected to debate the Bill next month.


Update 21st September 2017

In great news for Victorians, yesterday (20th September 2017), the Government tabled its Voluntary Assisted Dying Bill into the lower house of the legislature. The Bill is comprehensive, offering Victorians a further end-of-life choice, with numerous safeguards, and the stiffest pentalties worldwide for breaking the rules.

  • Read the Bill's explanatory memorandum (PDF, 273Kb).
  • Read the whole Bill (PDF, 945Kb).
     

Parliamentary debate on the Bill is likely to commence mid October, so now is the time to contact your own members of the Victorian parliament and let them know you support the Bill. If you don't know which electorate you live in or who your members are, or don't have their contact details, then:

  • Visit the Victorian Electoral Commission website and enter your home address, at the top of the page, to find out. It will show you your upper and lower house electorates. Make a note of the lower house electorate (District, in purple).
  • Then go to the Victorian Parliament website and enter your lower house electorate name in the Electorate field (the last one) and click Search, to find your lower house member. Note down your Member's contact details.
  • Then, also click the [Electorate] button on the Member's page (on the right) and then click the Region link on the target page. This also gives you the names and details of your five upper house parliamentarians.
  • Take down their contact details and let them all know you're asking them to support the Bill.

The Standing Committee on Legal and Social Issues (Legislation and References) of the Parliament of Victoria, Australia, has recommended that the Government introduce leglislation to allow assisted dying in restricted circumstances.

Update 9th June 2016

In excellent news for Victorians, the LSIC has recommended that the Government legislate to allow assisted dying in restricted circumstances.

 

"Recommendation 49: The Government should introduce legislation to allow adults with decision making capacity, suffering from a serious and incurable condition who are at the end of life to be provided assistance to die in certain circumstances."

The recommendations include:

  • Eligibility: A mentally competent adult experiencing intolerable and unrelievable suffering, with weeks or months to live. Must be ordinarily resident in Victoria and an Australian citizen or permanent resident.
  • A process by which requests may be made (and rescinded).
  • Checks and tests to ensure that relevant critieria have been met.
  • Establishment of an authority to receive reports of assisted dying and present reports to Parliament.
  • That conscientious objection (to not participate) is protected.
  • That in the case that a patient cannot self-administer lethal medication, a doctor may do so at the patient's request.

 
You can read the full report here.

 

Important!

The recommendation has yet to translate into a Bill and a majority vote of both Houses of the Victorian Parliament. Some parliamentarians are intractably opposed to this reform and it's important that policitians hear from you to know that you want them to support the reform.

Sign the petition to go to all Victorian parliamentarians now, and spread the word!

 


 

 

Submissions were invited from interested individuals and organisations into end-of-life decision-making in Victoria, including:

  • current practices including palliative care;
  • whether current legislation satisfactorily encompasses contemporary community standards, aspirations and views;
  • a review of legislation and practices in other jurisdictions, both within Australia and overseas; and
  • what types of legislative change may be required.

Submissions to the inquiry, which have not been requested to remain confidential, are published on the Parliamentary website here.

Despite the Terms of Reference for the inquiry  (below) do not mention assisted dying, almost all submissions to the inquiry have been made either to support or oppose the legalisation of voluntary euthanasia or physician-assisted dying. Clearly, the community is strongly engaged with the issue.

More information is available on the Victorian Parliament Inquiry's website.

 

Submissions have now closed.

 

Terms of Reference   

 

STANDING COMMITTEE ON LEGAL AND
SOCIAL ISSUES
(Legislation and References)

 

Terms of Reference

58th Parliament

 

Inquiry into End of Life Choices

 

On 7 May 2015 the Legislative Council agreed to the following motion:

That pursuant to Sessional Order 6 this House requires the Legal and Social Issues Committee to inquire into, consider and report, no later than 31 May 2016, on the need for laws in Victoria to allow citizens to make informed decisions regarding their own end of life choices and, in particular, the Committee should —

  1. assess the practices currently being utilised within the medical community to assist a person to exercise their preferences for the way they want to manage their end of life, including the role of palliative care;
  2. review the current framework of legislation, proposed legislation and other relevant reports and materials in other Australian states and territories and overseas jurisdictions; and
  3. consider what type of legislative change may be required, including an examination of any federal laws that may impact such legislation.

 

Share This Page:
0

Last weekend in Adelaide, Australia, delegates from around the world congregated at a conference convened by Paul Russell's group, "HOPE". The conference's purpose was to share information in opposition to assisted dying law reform. It was held in Adelaide partly because it is described as the 'virtual epicenter' of moves to legalise voluntary euthanasia. That's a great credit to Frances Coombe and her team at the South Australian Voluntary Euthanasia Society, who work tirelessly towards reform that the overwhelming majority of citizens want.

But here's the rub. Despite being an international conference with a public website advertising its value and program, it was open only to "anyone who opposes euthanasia and assisted suicide."

How curious.

When I chaired the global World Federation of Right To Die Societies conference in Melbourne, Australia in 2010, of course we had closed sessions for our people. That's natural and proper.

But we also had a full day of sessions open to the public. Plenty of opponents attended.

Not only that, but I also ensured that a range of voices were heard in the official program, too. Father Bill Uren, naturally opposed from the viewpoint of the Catholic tradition, was gracious enough to participate in a panel discussion. There was of course lively debate, and, I am pleased to say, all conducted with courtesy despite the differences of perspective.

All good, open and healthy stuff.

So the question is, why did the anti-euthanasia delegates in Adelaide feel it necessary to conduct their entire conference in secret? Were they scared of a range of views? Might there have been misinformation that could be challenged? Some other reason?

I guess time will tell.


Share This Post:
0

The Royal Australian College of Physicians (RACP) invited reasoned and measured assisted-dying doctor, Dr Rodney Syme, to address its annual conference in Cairns, and then unceremoniously pulled the plug. Cowardice? Flip-flop? You bet.

In February this year, Dr Syme says he was approached by a member of the the RACP 2015 Congress committe to attend and deliver a paper to the annual conference, in Cairns 24-27 May. The title of his paper was "Caring for those at the end of their journey." Dr Syme accepted the invitation and spent considerable time and effort preparing and polishing his paper. He was quite clear that a polemic on assisted dying was not suitable for this occasion, and wrote a paper discussing the gap between the rhetoric and the reality of palliative care: in other words, as is well-established, that despite the excellent quality of pallaitive care in Australia, it simply can't relieve the intolerable suffering of all dying patients. In any case, it would be unrealistic to expect palliative care to be perfect: we live in an imperfect world.

Dr Syme has been in the news recently in regard to providing medication and advice to Mr Ray Godbold, who is dying of advanced gatroesophageal cancer. The medication and advice gives Mr Godbold control over the end of his life.

Then, the RACP dropped a bombshell on 8th May. It unilaterally cancelled Dr Syme's invitation. It claimed to have done so in response to complaints by palliative care specialists.

Given that the RACP congress is titled "breaking boundaries, creating connections", and promises delegates a "diverse program" that facilitates "interaction and debate", this is an appalling development.

Dr Syme responded that:

  1. I personally feel deeply insulted.
  2. I regard the behaviour of those at the highest level of the college, an academic institution of high repute, as being less than expected of an academic body.
  3. For the college to surrender to “significant disquiet” from an unknown and undisclosed number of members in this way is cowardly.
  4. The Lead Fellow who invited me was incensed at the College’s reaction.
  5. The outcome is an act of academic censorship of the worst kind – they did not know the content of my address.
  6. It illustrates the extreme depths to which those opposed to open debate on an important medical and social issue will descend to stifle debate.”

I'm not surprised by that view. If palliative care specialists (and/or others) do not believe Dr Syme's points to be valid or defensible, then let him put them, and then rebut them. To reneg on the original invitation because someone might disagree is academic censorship.

That the RACP would stoop to such insulting flip-flop is not a great endorsement of their stature as an esteemed medical body.  It's time we had open and frank debate about end-of-life matters. Of course there will be disagreements—that is the point of debate.

The RACP owes a full explanation to both Dr Syme and to medical colleagues throughout Australia as to how many people demanded Dr Syme's invitation be withdrawn, and precisely on what basis, not merely that "they might not have liked what Dr Syme may  have to say."

Mr Marshall Perron, former Chief Minister of the Northern Territory, wrote the following to the RACP:

As a supposedly professional body the [RACP] organisation should encourage open and honest discussion on issues of great interest to our ageing citizens.  Instead you demonstrate a cowardly approach of which you should be ashamed.

 

 


Share This Post:
0

 

Dying Victorian man Peter Short, and his wife Elizabeth talk about coping with Peter's terminal illness, and make a plea to Australian Prime Minister Tony Abbott to meet with them to discuss responsible assisted dying law reform. Peter has since died.

Visit the YouTube page.

Share This Post:
0

 

The Hon. Bob Such's Ending Life With Dignity Bill 2013, before the South Australian Parliament, contains a strong compliment of safeguards, as Neil Francis explains in this video. The refusal of life-saving treatment, to which Australians are entitled but with the same direct and foreseeable consequence as doctor-assisted dying requests, have practically none of these safeguards, yet there has been NO avalanche of inappropriate persuasion to refuse life-saving medical treatment, as the so-called "slippery slope" hypothesis would have us believe.

This is the third of three videos sent to South Australian MPs in 2013.

Visit the YouTube page.

Share This Post:
0

 

Opponents of assisted dying law reform often invoke fictional slippery slopes as objections to law reform. In this video, Neil Francis gives three examples of supposed slippery slopes argued by opponents, explains why they are fictional, and shares the perspectives of several recognised experts from the USA state of Oregon about their Death With Dignity law which has been in effect since 1997. Three long-time Oregonian Death With Dignity Act opponents also admit there's no cause-and-effect relationship established between law reform and supposed slippery slopes.

This is the second of three videos sent to South Australian MPs in 2013.

Visit the YouTube page.

Share This Post:
0

 

While good palliative care can help many dying patients and their families, the clear worldwide evidence is that even the best palliative care possible simply can't help alleviate intolerable suffering for some. This is not a criticism of palliative care. In these cases, the overwhelming majority of the public want law reform to allow the patient to request and receive assistance from their doctor to peacefully hasten their death.

This is the first of three videos sent to South Australian MPs in 2013.

Visit the YouTube page.

Share This Post:

Pages

Subscribe to RSS - Australia