Paul Russell

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Home of the bible society in Launceston, from where the ACL's latest media release was launched

"Bullshit!"

That was the reaction of Dutch Senator Erik Jurgens when I asked him about a Dutch euthanasia anecdote spread by Mr Paul Russell, then head of the Australian anti-VAD Catholic front organisation "HOPE". In 2011, Mr Russell had been spreading the story:

"I often use the story of the death of a 26 year old ballerina in Holland [sic]. She had contracted a form of arthritis at this young age and her dancing career and dreams were dashed. An American oncologist who spoke later to the killing doctor reported the Dutch medico as saying something like 'One doesn't like doing it, but it was her choice.'" — Paul Russell, "HOPE" [my emphasis]

(Note: "Holland" comprises just the two north-west provinces of the Netherlands. "Holland" and "the Netherlands" are not correctly substitutable terms. The Dutch euthansia Act applies to the whole of the Netherlands, not to just two provinces.)

Checking with authoritative sources

In 2012, I travelled across the Netherlands with camera in tow, interviewing key stakeholders in the nation's assisted dying law about its operation. Nobody had heard of the supposed ballerina case, including long-serving politicians, the Royal Dutch Medical Association, nor even Professor Theo Boer or the Dutch Patient Rights Association who actively oppose the law.

robinbernhoffoncamera.jpgUSA doctor Dr Robin Bernhoft muses about a Dutch ballerina nobody in the Netherlands has heard of

It turns out that the meme was a bit of unverified nonsense put about by USA Catholic radio- and televangelist Dr Robin Bernhoft in an early 1990s polemic anti-VAD video, "False Light", narrated by staunch Catholic actor Joseph Campanella. Dr Bernhoft has castigated believers in evolution as "sexually immoral, abortion supporters, racists and violators of each of the Commandments".

In the video, Dr Bernhoft often gazes nonchalantly into the distance, or at his hands, as he narrates his stories. It's all very third-hand and mysterious, conspicuously devoid of even the faintest whiff of evidence. But Dr Bernhoft doesn't claim to have actually spoken to the doctor, as Mr Russell states. Perhaps the confidently stated direct-contact idea is a signal of confirmation bias.

Those little Dutch cards

Confidence was also common amongst VAD opponents, like Oregon Nurse Donna Howell also featured in "False Light", spreading the nonsense that the Dutch wander around carrying little cards pleading for protection from being killed.

"It's gotten so bad in Holland [sic] that people have in their wallets little cards that say 'Do not euthanise me without my permission'." — Nurse Donna Howell

donnahowelloncamera.jpgUSA Nurse Donna Howell confidently says the Dutch carry little cards saying 'do not euthanise me'

Just like the supposed ballerina, nobody I interviewed across the Netherlands, including the anti-VAD Patient Rights Association which would be the natural source of "little cards" for patients, had ever heard of the little cards, either.
 

Update 13-Oct-2020

A colleague reminds me of an event that's important and very revealing in this context. On 23rd February 2012, the President of the Royal Dutch Medical Association (KNMG) wrote to the President of the American Medical Association in response to "inadequacies" in Republican Presidential candidate Rick Santorum's statements about assisted dying practice and its supposed consequences in the Netherlands.

Mr Santorum, amongst other things, claimed that the Dutch wear bracelets saying "do not euthanise me". Notice how there can be random small, yet conspicuous, mutations in misinformational anecdotes.

The KNMG was unequivocal in its professional advice: "'Do not euthanise me' bracelets do not exist." The KNMG President closed with the observation that:

"Interpretations about the practice of euthanasia in other countries should not be biased by personal opinions whether or not euthanasia is justificed in situations of unbearable suffering without prospect of improvement."

The architect of the Dutch euthanasia law, Dr Els Borst, arguably the most informed stakeholder of the era, responded to the "little cards" claim in plainer language:

"That is an absolute lie." — Els Borst

A diet of evidence-less anecdotes

Anecdotes — devoid of verifiable evidence — about supposed dangers are a favourite diet of VAD opponents, like the nonsense put about by the Vatican, and Catholic Professor Margaret Somerville, that Dutch elderly are streaming into Germany for hospital treatment for fear of being euthanised in the Netherlands; that Els Borst supposedly regretted her law reform; or that there's some kind of slippery slope from VAD to non-voluntary euthanasia — which Rick Santorum handily mutated into involuntary euthanasia.

The anecdote is a favourite snack of opponents for dishing out when they've run out of other confectionery.

Back to now

One's being served up again in Tasmania right now, and it smacks of desperation. In its most recent media release, the Australian Christian Lobby, from the home of the Bible Society in St John Street, Launceston, launched its latest shrill warning with the claim that:

"In a conversation with a member of the British Parliament, one Dutch doctor explained what it was like when euthanasia laws first came to the Netherlands. He said, 'We agonised over our first case of euthanasia all day, but the second case was much easier and the third was a piece of cake.'"

So let's reflect: on some unspecified date ("when euthanasia laws first came to the Netherlands": but that would be the mid 1980s) some unnamed British MP once said that an unnamed Dutch doctor once told him or her… that their third euthanasia case "was a piece of cake".

Who what now?

One only has to glance at readily-available records to see what a load of, um, how shall we put this?... bollocks, the claim is. The Australian Christian Lobby is not referring to a recent, documented, verfied fragment of evidence. Rather, the ACL has jauntily appropriated a statement from May 1998, by Lord McColl of Dulwich in the British parliament. Straight from the Hansard's mouth:

"The Dutch doctors told us: 'We agonised over our first case of euthanasia all day, but the second case was much easier and the third was a piece of cake.'" — Lord McColl

"Dutch doctors": plural. However, the statement is not of the kind that would be said by a broad collective of doctors as Lord McColl story relates.

Indeed, in 2006 his Hansard story mutated to "when a Dutch doctor was asked...". Suddenly from multiple doctors to just one; from direct, personal receipt of the claim, to the claim being made to an unspecified audience, stated in the tell-tale passive voice. If it were really said to you and you wanted to punch home a key point in a spirited on-the-record debate, you wouldn't forget, and you'd make a point that it was said to you, wouldn't you?

Piling up the anecdotes

What else has Lord McColl had to say about the Holland [sic] experience on the Hansard record in 2006? Ah, the "little cards" anecdote, still doing the rounds more than a decade after its invention:

"Many elderly people in Holland [sic] are so fearful of euthanasia that they carry cards around with them saying that they do not want it." — Lord McColl

An anecdotal claim without at least one independent, verifiable source isn't really evidence at all. It's just a myth. A handy but hollow sound bite. It reveals little about the subject... but rather a more about the claimant.

The "piece of cake" anecdote, like those before and since, are just myths conjured up to curry fear, uncertainty and doubt. Piling them up doesn't make them any more true.

Conclusion

As I put one anecdotal claim after another to each of my interviewees across the Netherlands, including VAD opponents, they'd roll their eyes and give courteous replies to the effect that, as one interviewee generously put it, "nobody in the Netherlands takes such commentary seriously."

But I think I prefer Senator Erik Jurgens' parsimony: Bullshit.

And if history is any guide it won't be long before the next re-moistened cowpat is heaved at the political reform fan in the hope that some of it sticks.


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Branka van der Linden on the "HOPE" website.

HOPE’s Director, Branka van der Linden, is at it again, foisting more misleading information about voluntary assisted dying (VAD) on unwilling members of Parliament. I expose the rot and provide some background on Mrs van der Linden.

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

Subject: WA Report relies on troubling Belgian study

 
[MP Salutation] --

Did you know that a study showing that one person in Belgium is euthanised every three days without their explicit consent also found that:

  • in more than 77 per cent of cases, the decision was not discussed with the patient;
  • in more than half of cases, the patient had never expressed a desire for their life to be ended; and
  • in more than half of the cases, the reason given was because killing the patient was the wish of the family?

 
Did you know that the WA majority report cited this study as evidence of assisted suicide and euthanasia reducing the incidence of unlawful activity?

Warm regards,

Branka van der Linden
Director, HOPE

 
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:

A sample of Branka van der Linden’s Facebook Likes

  • Archbishop Anthony Fisher (Catholic)
  • Archbishop Samuel J. Aquila (Catholic)
  • Archbishop Mark Coleridge (Catholic)
  • Bishop Robert Barron (Catholic)
  • Marist College Canberra Faith Formation (Catholic)
  • St Thomas the Apostle Kambah (Catholic)
  • Campion College (Catholic)
  • Teaching Catholic Kids
  • Ascension (Catholic Church)
  • CathFamily
  • St Therese of Lixieux (Catholic)
  • Dominican Sisters of Saint Cecilia in Australia (Catholic)
  • Fusion Youth Group (Catholic)
  • St Clare’s College (Catholic)
  • Marist Canberra Football Club (Catholic)
  • Light To The Nations (Catholic)
  • Catholic Voices USA
  • Centre for Faith Enrichment (Catholic)
  • World Meeting of Families 2015 (Catholic)
  • Quidenham Carmelite Monastery (Catholic)
  • Denver Catholic
  • Catholic Mission – Canberra & Goulburn
  • XT3 (Catholic youth association)
  • Missionaries of God’s Love Darwin (Catholic)
  • Marist College Canberra (Catholic)
  • Life, Marriage & Family Office (Catholic)
  • Infant Jesus Parish, Morley (Catholic)
  • MGL Priests and Brothers (Catholic)
  • Catholic Mission – Sydney, Broken Bay, Parramatta
  • Youth Mission Team Australia (Catholic)
  • Summer School of Evangelisation – Bathurst (Catholic)
  • Missionaries of God’s Live Sisters (Catholic)
  • Sisterhood National Catholic Women’s Movement
  • My Family My Faith (Catholic)
  • Catholic Talk
  • The Catholic Weekly
  • The Catholic Leader
  • Mercatornet (Catholic blog site)
  • BioEdge (Catholic blog site)

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.


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The Parliament of Victoria is currently debating an assisted dying Bill.

As the Parliament of Victoria prepares to debate an assisted dying Bill, South Australian Catholic anti-assisted-dying lobbyist Mr Paul Russell is at it again. This time he's sent a missive to Victorian politicians shouting about, amongst other things, a crisis of assisted dying numbers in Washington state. He’s conveniently cherry-picked his arguments again.

Mr Russell wrote that in Washington state:

“deaths from lethal drugs prescribed under the Act have nearly quadrupled (376%) from 51 in 2010 to 192 in 2016.”

Now I’ve called Mr Russell out before for misinformation, for example his laughable ‘secret’ opinion poll, promoting a misrepresentation of a Council of Europe determination, complaining at the same time that people will die too early but yet live too long, and spreading despicable misinformation about Dutch neonatal euthanasia.

His latest claim extends his misinformation crown title.

Don’t get me wrong. He cites the correct raw data figures for Washington. But he packages them up handily with FUD (Fear, Uncertainty and Doubt) wrapping, all tied up with the most sinister bow he can muster.

I’ve criticised the use of uncontextualized raw data before, and I do so again.

The relevant facts

Washington state legalised assisted dying by ballot in 2008. The following year the law was put into practice, and 2010 was the first full year of its operation.

Here’s the rate of assisted deaths as a proportion of all deaths in Washington state for all the years on record. As you can see, the rate hasn’t even reached one half of one percent of all deaths in 2016.

 2009 

 2010 

 2011 

 2012 

 2013 

 2014 

 2015 

 2016 

 0.07% 

 0.11% 

 0.14% 

 0.17% 

 0.23% 

 0.24% 

 0.30% 

 0.35% 

 

Never ones to miss out on an opportunity to spread FUD, if it were just one case last year and two this year, assisted dying opponents would be shouting from the rooftops: “Crisis!! 100% increase!!”. But in reality, only a small minority use the law, yet thousands of patients and their families are given comfort by the option being avaialble even if they don't use it. That message was made loud and clear by Oregon Senator Ginny Burdick. Washington's Death With Dignity Act is modelled on Oregon's, and Oregon's Act has been in effect for twenty years.

A Catholic trifecta

Of course in his missive, Mr Russell, like his fellow Catholic whom I’ve also called out for misinformation, Prof. Margaret Somerville, avoids referring to Swiss data. And their fellow Catholic Mr Daniel Mulino, who furnished a minority report to the Victorian Parliament’s recommendations on end of life choices, a report I’ve also called out for stunning misinformation, fudges his numbers about Switzerland, referring to data from 1998 without further context.

Why do these lobbyists avoid or selectively refer to the Swiss situation? Because the actual data is an inconvenient truth to their FUD story-telling.

An inconvenient truth

Switzerland’s assisted dying law came into effect seventy-four years ago, in 1942. If just one person had used the law in 1942, using Mr Mulino’s favourite annual increase figure of 17.5%, that would equate to 110,338 people pursuing an assisted death in Switzerland in 2014.

I say 2014 because that’s the most recent year for which official Swiss Government assisted dying figures are available. And what was the actual figure in 2014? There were 742 cases of assisted dying amongst Swiss residents, and Dignitas reports that it assisted 198 foreign nationals. That’s a total of 940 assisted deaths.

Let’s add another 60 foreign-national assisted death cases from the much smaller Swiss society that provides accompaniment for foreigners. That makes around 1,000 cases in 2014, including all those who came from all over the world. And it’s less than one hundredth of the minimum rate the doomsayers predict by cherry-picking one statistic that suits their argument.

Swiss law has the fewest safeguards

The Swiss assisted dying law has none of the safeguards of the Washington law. By Mr Russell and Co’s reckoning, you’d think that the Swiss (and those who visit) would be dropping off like flies.

By way of further comparison, the doomsayer number of assisted deaths for 2014 (a minimum of 110,338 cases) is substantially greater than the total number of deaths in Switzerland that year: 63,938. It’s an obvious impossibility.

In 2014, the Swiss rate of assisted deaths including all the foreign nationals who came to use its law, was 1.5% of all deaths; and 1.2% for resident-only cases.

And the rate of assisted deaths in Luxembourg in 2014 (legalised in 2009), whose laws are much more liberal than Washington’s though stricter than Switzerland’s, was 0.17% of all deaths. It’s odd how the doomsayers don’t report Luxembourg data, either.

And what are these cases?

These are cases of people in extremis with no realistic prospect of relief or improvement, choosing a peaceful assisted death as a better option than being forced to prolong their torture, according to their own deeply-held beliefs, values and examined consciences.

Mr Russell believes they should be required to endure their torture. There is a point to it, he says: because it joins them “in some mysterious way to the sufferings of Christ”... whether others believe in Christ, or at least Mr Russell’s version of him, or not.

You won't find this degree of candour on his anti-assisted dying website, but you can find it at NewsWeekly, which is run by the National Civic Council (NCC), itself established by Australia's most famous and conservative lay Catholic, B. A. Santamaria. Mr Russell has been President of the NCC South Australian chapter.

It’s not the numbers, it’s the circumstances

To be clear, in no jurisdiction has its legislature enacted access to assisted dying on the basis of a numeric ceiling. They’ve enacted access on the basis of intolerable and unrelievable suffering. And to this day, those are the folks who may be granted access to an assisted death.

Conclusion

Again, Mr Russell (and colleagues) do themselves no favours by conspicuously cherry-picking the data they want to use, and wrapping it up in threatening garb to create FUD amongst politicians.

Wiser heads will prevail in Victoria.


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Victorian MP Daniel Mulino's minority report contains multiple serious errors and misinformation.

Last year, the Victorian Parliament's Legal and Social Issues Committee concluded an extensive investigation into end of life choices, publishing a report of over 400 pages recommending improvements to palliative care and for assisted dying. Catholic-backed Shop, Distributive and Allied Employees' Association (‘shoppies’ union) Labor member of the Victorian Parliament Mr Daniel Mulino furnished his own minority report, opposing the majority recommendation for assisted dying law reform. That’s entirely his right. However, his report contains multiple, serious cases of misinformation. He must withdraw his report.

Daniel Mulino, Labor parliamentary member for the Victorian Region of Eastern Victoria,1 and a member of the Catholic-backed ‘shoppies’ union,2 was a member of the Legal and Social Issues Committee that thoroughly investigated end of life decision making and produced a 400+ page report in 2016 making recommendations for law reform and regulation.

Mr Mulino furnished a “minority report” as an addendum to the main report in order to oppose the Committee’s recommendation that assisted dying be legalised.3

Promoted by Catholics to Catholics

Mr Paul Russell, South Australian publisher of the Catholic anti-euthanasia website ‘HOPE,’§ says this of Mr Mulino’s minority report in the Catholic lawyer association’s blog:4

Daniel Mulino MLC's analysis should be read first, before the Majority Report. It forms not only a sound academic and rigorous approach but also, by implication, is damning of the narrow, outcome focus of the Majority Report.”

How sweet of Mr Russell to so generously plug Mr Mulino’s report. But, in gushing about the ‘sound academic and rigorous approach’ he claims to be in it, shows that he doesn't understand what constitutes proper and sound evidence, and that he's easily impressed by charts and lots of ‘literature’ citations.

Numerous fundamental faults

The reality is very different.

Rather than bore you with a mind-numbing blow-by-blow dissertation on the numerous fundamental faults in Mr Mulino’s report, I’ll demonstrate how the report cherry-picks, misquotes and misunderstands its way through the evidence, via four revealing examples.

Example 1. Cherry-picking ‘helpful’ data

Mr Mulino’s minority report illustrates the rise in number of assisted deaths in the Netherlands and Belgium, and produces some statistics (Figures 1 & 2 are directly from his minority report).

mulinocharts1and2.gifFigures 1 and 2 (of Mr Mulino’s minority report): Assisted deaths in Belgium and the Netherlands

Note that Belgian data is for the years 2003–15, but the Netherlands only for the years 2008–15. That’s odd, because the euthanasia Acts for both countries came into effect in 2002, and so 2003 was the first full year for both.

Mr Mulino doesn’t point out that his report treats the two countries differentially, and provides no explanation as to why. We might notice, however, that the dicrepancy has the consequence of making his claims look 'better.'

Using Mr Mulino’s presentation style, Figure 3 illustrates all the relevant data for the Netherlands.

netherlandsfullfig2.gifFigure 3: The full Netherlands data
Source: Official Euthanasia Commission reports

As you can see, there is a virtual flatline between 2003 and 2007. Indeed, there is even a tiny drop in numbers between 2005–06. This is an inconvenient truth to Mr Mulino’s thesis that there has been a consistent massive rise in numbers. It also substantially reduces the compound annual growth rate he wrongly quotes for just 2008–15.

He’s also cherry-picked only raw data. In fact, the only valid way to compare year to year, and jurisdiction to jurisdiction, is to use the rate for each year: that is, the number of assisted deaths as a proportion of total deaths in the same year and jurisdiction, so that you’re comparing apples with apples. It's necessary because the total deaths count goes down and (mostly) up a bit each year. The official government statistics for total deaths by year for both countries are readily available online, so there’s no excuse for not using them.

When you calculate the rates, you get validly-comparable results, as I illustrate in Figure 4.

dutchbelgianratesto2015.gifFigure 4: Rate of assisted dying as a percent off all deaths in the Netherlands and Belgium 2003–2015
Sources: Official government statistics; Euthanasia Commission reports

As I explain in my detailed research whitepaper on Benelux assisted dying,5 these are sigmoid (stretched-S) shaped curves which are typical of human behaviour change. And there is a drop in the rate in both countries in 2015, which Mr Mulino doesn’t report.

My Benelux whitepaper also reports the data from Luxembourg (Figure 5), which Mr Mulino fails to mention, even though it has legislation, since 2009, almost identical to the Netherlands and Belgium, and the Luxembourg government's data is freely available online.

dutchbelgianluxratesto2015.gifFigure 5: Rate of assisted dying in the three lawful Benelux countries
Sources: Official government statistics; Euthanasia Commission reports

Luxembourg’s data (yellow in Figure 5; no data available yet for 2015), is also an inconvenient truth to the case Mr Mulino attempts to prosecute. There’s no substantial rise.

Example 2. Comparing apples with oranges: mis-matching data

Mr Mulino again fails to compare apples with apples. Take, for example, his vocal claim that the annual total death counts for the Netherlands decreased at the same time as the total counts for assisted dying increased.

When you look at the data he’s used (the citation for the negative total deaths trend he quotes in his Table 2), you find that he’s used total death data for 2000­–10, which is falling, while his assisted dying data is for 2008­–15, which is rising.

This just isn’t on: it’s completely invalid to compare data like this from one period with data from another period to claim or imply a causal relationship. Of what possible relevance is the total death data for 2000–02, while his total deaths data for 2011–15 is missing? I illustrate the full story in Figure 6.

 

mulinomismatcheddata.gifFigure 6: Netherlands total and assisted deaths for different periods
Sources: Official government statistics; Euthanasia Commission reports

The solid blue and orange lines are data Mr Mulino used and reported, and their dotted ends are data that he omitted. It’s easy to see that the total deaths data his report inappropriately relies upon has a negative (downwards) slope (left-hand blue dashes), while the matching total deaths data he should have used has a positive (upwards) slope (right-hand blue dashes). Valid comparison gives lie to his claim.

Example 3. White is the new black: Misquoting the opposite

Mr Mulino’s report also argues that there’s ample evidence that a significant proportion of people with depression are gaining access to assisted dying:

“Ganzini et al, in a broad ranging review of instances of assisted dying in Oregon, found that twenty percent of the patients had symptoms of depression.” [Italics mine]

This assertion is nonchalantly plucked from the review6 without reading it properly, seemingly to support his thesis. In fact, the source does the exact opposite. Figure 7 is an image of the Abstract, where it says in large print, right up front:

Twenty percent of the patients had symptoms of depression; none of these patients received a prescription for a lethal medication.” [Emphasis is mine]

ganziniabstract2000.gifFigure 7: The paper Abstract articulates exactly the opposite of Mr Mulino’s claim
Source: Ganzini et al 20006

Had Mr Mulino bothered to read either the abstract or the methodology of this study properly, he would have realised that the doctor sample was of those eligible to prescribe under Oregon’s Death With Dignity Act, not just those who had, and that none of the study's patients who were assessed with possible depression had accessed an assisted death.

It's not like the information was hard to find — his report cites literally half a sentence to support his claim, when the full sentence says the opposite.

Example 4. Any port in a storm: Cherry-picking, misunderstanding and misrepresenting out-of-date data

In attempting to establish a 'slippery slope' from voluntary, to non-voluntary euthanasia (NVE) — a practice where doctors may hasten death (e.g. by administering increasing doses of opioids) when the patient hasn’t explicitly requested it — Mr Mulino states in his minority report:

“Two countries with the highest rates of this type of end-of-life (Belgium at 1.5% and the Netherlands at 0.60%) allowed the practice of euthanasia and assisted dying.”

Oh dear, Mr Mulino's report cherry-picks again. Just look at his source.7 The study, published in 2003, contains Table 2, with the relevant data in it (Figure 8).

vanderheide2003table2.gifFigure 8: Table 2 from the 2003 study Mr Mulino cites
Source: van der Heide et al 20037

There are no fewer than five major offences Mr Mulino commits here.

Firstly, look at the table. I’ve highlighted the line in yellow from which Mr Mulino draws his figures of 1.5% for Belgium and 0.60% for the Netherlands. You can immediately and easily see that Denmark’s rate of 0.67% is higher than the Netherlands' of 0.60%.

So, Mr Mulino’s statement mentioning only Belgium and the Netherlands with “highest NVE rates” is misleading. He failed to either report or explain why Denmark’s rate is higher than the Netherlands, while Denmark doesn’t have an assisted dying law; the opposite of his thesis.

Secondly, he also fails to mention Switzerland’s NVE rate of 0.42%, or to explain that it’s lower than the Netherlands and Belgium. That’s highly relevant, because Switzerland has the world’s oldest assisted dying law — in effect since 1942 — and its statute contains none of the safeguards in the Belgian and Dutch Acts. This too is at odds with Mr Mulino’s thesis.

Thirdly, if Mr Mulino had read the study properly instead of just cherry-picking convenient figures from it, he would have noticed in the methodology section that the fieldwork (doctors filling in questionnaires) was completed in 2001 and early 2002, that is, before either the Netherlands or Belgian Acts came into effect later in 2002 (the Netherlands in April and Belgium in September).

Thus, the Dutch and Belgian data points Mr Mulino advances as ‘evidence’ of an NVE ‘slippery slope’ from legislated assisted dying have nothing whatever to do with assisted deaths under their Euthanasia Acts, because neither Act existed at the time the study was conducted.

Fourthly, he is resorting here to a single point-in-time study, which has little to no scientific power to establish ‘causation’. To really establish causation, as a minimum you have to assess longitudinal data, which I show in Figure 9. It demonstrates the precise opposite of Mr Mulino's ‘slippery slope’ thesis that voluntary euthanasia causes NVE, which if true would lead to a significant increase in the NVE rate in both countries after statutory legalisation.

dutchbelgianuknverates.gifFigure 9: Longitudinal NVE rates in the Netherlands, Belgium and the UK
Sources: Netherlands8; Belgium9; UK10

Both the Dutch and Belgian NVE rates have dropped with high statistical significance since their euthanasia Acts came into effect. Indeed, the NVE rate in the Netherlands is now similar to the rate in the UK, which is acknowledged as the world’s gold standard in palliative care and which has never had an assisted dying law. This is consistent with assisted dying law reform shining a bright light on all end of life practices.

It’s not like he simply didn’t know

Fifthly, it’s particularly disappointing that Mr Mulino’s report only cherry-picked outdated data in an attempt to ‘prove’ his case when I had already directly furnished the current relevant evidence to his Committee as a properly-researched formal submission: Figure 9 above is Figure 19 in my submission, and I provided the peer-reviewed research citations for the data.11

Not only that, but the official transcript of my appearance as an expert witness before the parliamentary Committee confirms that Mr Mulino specifically quizzed me on that Figure 19 and I pointed out the sources of its data:12

Mr MULINO — Figure 19, for example.

Mr FRANCIS — The reference should be in the text. The last sentence on the previous page gives you the citations for that data.

Mr MULINO — Okay.”

Even further, when fellow-Committee-member and Catholic assisted dying opponent Mrs Inga Peulich asked about the same thing (with Mr Mulino present) — “1,000 of those who have been accidentally euthanased in the Netherlands” — I literally put the chart up on the projection screen and explained it in full to the Committee until they had no more questions. The “1000” figure is the approximate rate prior to the Dutch Euthanasia Act, while the rate has dropped significantly since.

The evidence is irrefutable: it’s not like Mr Mulino was merely blissfully unaware of the relevant data contradicting his NVE ‘slippery slope’ claim. His minority report expressly overlooks this robust evidence and instead refers inapproriately to selective and outdated data that seemed to, but didn’t, support his argument.

Five major offences in a single citation: surely Mr Mulino’s report — far from ‘academic and rigorous’ — sets a new record?

A common religious thread?

The NVE ‘slippery slope’ claim is also popular amongst and spread by the Catholic Archdioceses of Melbourne,13 Sydney14 and Brisbane,15 as well as by other Catholic anti-assisted dying lobbyists such as Alex Schadenberg,16 Paul Russell,17 and Professor of Ethics at the Catholic University of Notre Dame Australia, Margaret Somerville.18

Indeed, Mr Mulino’s minority report appears amongst 11 Catholic responses against assisted dying law reform published by the Catholic Archdiocese of Melbourne (Figure 10).

cam-mulino-report.jpgFigure 10: Daniel Mulino’s minority report appears amongst Catholic responses on the Catholic Archdiocese of Melbourne’s website19

Indeed, Mr Mulino’s linked document doesn’t seem to emanate from his parliamentary office or from wider parliamentary services: the PDF file's metadata reveals that it was authored, electronically at least, by “mmacdonald”.

Calls to both Mr Mulino's electorate office and to the Parliament of Victoria confirm there is no "M Macdonald" at either. I did, however, find online one Matthew Macdonald, researcher and Executive Officer of the Catholic Archdiocese of Melbourne’s (CAM) Office for Life, Marriage and Family — in other words, the same organisation that published the list in Figure 10 containing the link to Mr Mulino’s minority report.

Mr Macdonald is also listed as the CAM's official contact person in its submission (#705) opposing assisted dying to the Victorian Parliament's inquiry into end of life choices.20 Both the CAM and Mulino reports also refer to a journal paper by Catholic doctor José Pereira,21 and neither report mentions the subsequent evidential rebuttal outlining why Pereira's claims were merely "smoke and mirrors".22 Even more curiously, the Pereira paper is included in Mr Merlino's minority report bibliography, though his report doesn't actually cite it as the CAM submission does.

The CAM parliamentary submission was authorised and signed by Episcopal Vicars Anthony Ireland and Anthony Kerin, who also appeared as witnesses before the parliamentary Committee, during which they told, as I've explained, a whopping great falsehood about Oregon.23

Conclusion

Contrary to Paul Russell’s enthusiastic claim that Daniel Mulino’s minority report provides a ‘rigorous’ case against assisted dying law reform, the report merely serves as further evidence of how those implacably opposed to assisted dying can cherry-pick, misunderstand and rather desperately clutch their way through their ‘evidence.’

Mr Russell is not an academic expert and one can understand his limited capacity to judge whether work is ‘scholarly.’ However, Mr Mulino holds a PhD in economics from Yale,* so it’s quite astonishing that he published a ‘researched’ report containing multiple major flaws, including outdated and cherry-picked data contrary to more recent, direct and relevant evidence of which he was specifically aware, actively inquired into and had explained and cited to him in full.

These anomolies beg the question: did Matthew McDonald or someone else at the Catholic Archdiocese of Melbourne write Mr Mulino’s report for him? Mr Mulino needs to explain himself, since regardless of who authoried it, he signed it off in his own name and is therefore ultimately responsible for it.

Given the multiple fundamental errors, the honourable course for Mr Mulino to pursue is to withdraw his minority report.

The question is: will he rise to the occasion?

 

Addendum: A missed opportunity for primary research

Mr Mulino — as well as Mrs Peulich who also wrote a minority report against assisted dying — declined to join other members of the parliamentary Committee on an official overseas fact-finding tour to jurisdictions where assisted dying is lawful. This was a critical opportunity for Committee members to directly quiz proponents, opponents, researchers, regulators, legislators and others with direct experience. It would have given them invaluable opportunities to directly examine and test  assumptions, hypotheses and performance. How curious then that these two non-participataing Committee members each furnished a minority report opposing the majority recommendation to legalise assisted dying in Victoria.

 

---------------

§    The HOPE website is an initiative of the Australian Family Association (AFA), a faith-based organisation founded by Australia’s most famous Catholic, B. A. Santamaria. Mr Russell is a former Vice President of the AFA, and a former Senior Officer for Family and Life at the Catholic Archdiocese of Adelaide.

*    While Mr Mulino holds a PhD and would be entitled to be addressed as “Dr”, his Parliamentary title is “Mr”.

References

  1. Parliament of Victoria 2017, Daniel Mulino, viewed 20 Mar 2017, https://www.parliament.vic.gov.au/members/details/1764-daniel-mulino.
  2. Tomazin, F 2016, Explainer: The push towards a dying-with-dignity policy in Victoria, Fairfax Media, viewed 3 Dec 2016, https://www.theage.com.au/national/victoria/explainer-the-push-towards-a-dyingwithdignity-policy-in-victoria-20161203-gt3bso.html.
  3. Legal and Social Issues Committee 2016, Inquiry into end of life choices. Final report, Parliament of Victoria, Melbourne, pp. 444.
  4. Russell, P 2016, End-of-life choices report: A sugar coated poison pill for Victoria, Melbourne Catholic Lawyers Association, viewed 14 Jun 2016, https://www.catholiclawyers.com.au/latest-news/853-end-of-life-choices-report-a-sugar-coated-poison-pill-for-victoria.
  5. Francis, N 2016, Assisted dying practice in Benelux: Whitepaper 1, DyingForChoice.com, viewed 13 Nov 2016, /resources/fact-files/assisted-dying-benelux-whitepaper-1.
  6. Ganzini, L, Nelson, HD, Schmidt, TA, Kraemer, DF, Delorit, MA & Lee, MA 2000, 'Physicians' experiences with the Oregon Death with Dignity Act', New England Journal of Medicine, 342(8), pp. 557-563.
  7. van der Heide, A, Deliens, L, Faisst, K, Nilstun, T, Norup, M, Paci, E, van der Wal, G & van der Maas, PJ 2003, 'End-of-life decision-making in six European countries: descriptive study', The Lancet, 362(9381), pp. 345-350.
  8. Onwuteaka-Philipsen, BD, Brinkman-Stoppelenburg, A, Penning, C, de Jong-Krul, GJF, van Delden, JJM & van der Heide, A 2012, 'Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey', The Lancet, 380(9845), pp. 908-915.
  9. Bilsen, J, Cohen, J, Chambaere, K, Pousset, G, Onwuteaka-Philipsen, BD, Mortier, F & Deliens, L 2009, 'Medical end-of-life practices under the euthanasia law in Belgium', New England Journal of Medicine, 361(11), pp. 1119-1121.
  10. Seale, C 2009, 'End-of-life decisions in the UK involving medical practitioners', Palliat Med, 23(3), pp. 198-204.
  11. Francis, N 2015, Submission to the Parliament of Victoria Standing Committee on Legal and Social Issues on the Inquiry into End of Life Choices, DyingForChoice.com, Melbourne, pp. 51.
  12. Parliament of Victoria 2015, Standing Committee on Legal and Social Issues inquiry into end-of-life choices: Witness-Mr Neil Francis, DyingForChoice.com, Melbourne, pp. 10.
  13. The Catholic Leader 2010, No to euthanasia – Yes to genuine care, Catholic Archdiocese of Brisbane, viewed 15 Dec 2010, https://catholicleader.com.au/features/no-to-euthanasia-yes-to-genuine-care_70380/.
  14. Catholic Archdiocese of Sydney 2017, Experts warn against following overseas experience with euthanasia, viewed 12 Mar 2017, https://catholicweekly.com.au/2017/2017120_1449.shtml.
  15. Catholic Archdiocese of Brisbane 2010, No to euthanasia - yes to genuine care, The Catholic Leader, viewed 25 Feb 2012, https://catholicleader.com.au/features/no-to-euthanasia-yes-to-genuine-care_70380/.
  16. Schadenberg, A 2013, Exposing vulnerable people to euthanasia and assisted suicide, Ross Lattner, London ON.
  17. Russell, P 2015, Submission 926: Submission to the Victorian Legal and Social Issues Committee inquiry into end of life choices, HOPE, Melbourne, pp. 56.
  18. Francis, N 2017, Margaret Somerville misleading claim - 'Non-voluntary euthanasia slippery slope', DyingForChoice.com, viewed 19 Apr 2017, /resources/videos/margaret-somerville-misleading-claim-non-voluntary-euthanasia-slippery-slope.
  19. Catholic Archdiocese of Melbourne 2017, Why now in Victoria?, viewed 3 Aug 2017, https://www.cam1.org.au/euthanasia/Be-Informed/Why-now-in-Victoria.
  20. Catholic Archdiocese of Melbourne 2015, Submission to the Legal & Social Issues Committee: Inquiry into end of life choices, Submission 705, Melbourne, pp. 16.
  21. Pereira, J 2011, 'Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls', Current Oncology, vol. 18, no. 2, pp. e38-48.
  22. Downie, J, Chambaere, K & Bernheim, JL 2012, 'Pereira's attack on legalizing euthanasia or assisted suicide: smoke and mirrors', Current Oncology, vol. 19, no. 3, Jun, pp. 133-8.
  23. Francis, N 2015, Catholic Church misinforms Parliamentary inquiry, DyingForChoice.com, viewed 25 Nov 2015, http://www.dyingforchoice.com/blogs/catholic-church-misinforms-parliamentary-inquiry.

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Research results must be judged in relation to the study's methodology.

In his latest blog, titled “Who are you going to trust?”, anti-assisted dying lobbyist Mr Paul Russell says:

“Polling noted today in the Australian shows a significant level of distrust in our political classes to get the issue of euthanasia and assisted dying right.”

He then goes on to quote some select statistics from said poll. In his blog, he mentions nothing about the sponsorship or conduct of the poll. After some searching, I found no other reference to said poll on his ‘HOPE’ website.

This is rather curious, because The Australian article he quotes, points out that the ‘poll’ was commissioned by him (his website is called ‘HOPE’).

Thus, Mr Russell tries to add credibility to his ‘poll results’ in his blog by citing only that it has been reported in a national newspaper. This ‘quote-someone-else-so-it-must-be-authoritative’ rhetorical strategy has been used before by opponents of assisted dying (see Box at end).

But as Mr Russell has himself promoted — happily republishing the opinion of the CEO of Christian Medical Fellowship (UK) — “opinion polls add up to very little.” That’s quite true… when they’re poorly designed and run, including the big no-no, ‘push-polling’, in which the researcher attempts to get the answer they want by crafting questions more likely to get it.

I searched hard for any reference to the methodology of said ‘poll’, but was unable to identify any despite a diligent search. Therefore, we don’t know what approach Mr Russell took: robust or otherwise.

Let’s assume for the sake of argument (and the absence of public evidence) that a poll of some kind was actually conducted. If it were a truly legitimate poll, you’d think that Mr Russell would be shouting about the study from his own rooftop (the ‘HOPE’ website). But so far, he hasn’t.

Mr Russell, while quoting statistics, has said absolutely nothing about the methodology — that I can find via a quite diligent search.

Results can only be interpreted in light of how the research was actually conducted, so quoting a 'study' while failing to publish its methodology in full is an absolute no-no. It only invites derision.

Rebecca Urban, for The Australian, quotes a number of ‘statistics’ from the ‘poll’ seemingly without question. But she’s hardly to blame: she’s skilled at journalism, not primary research.

So, for the benefit of Paul Russell, Rebecca Urban and all journalists reporting claimed statistics, here’s your minimum standard of conduct if the public are not to guffaw at the claims. All reported results must be in relation to properly disclosed methodology:

  • Who commissioned the research? (✔ Ms Urban reports who)
  • Who conducted — actually carried out — the research (e.g. a reputable research company)?
  • What precise population were respondents drawn from, how were they recruited, and screened in or out? What were the counts and percentage participation (approached/participated)?
  • What were the dates of the fieldwork?
  • What procedures were used to establish and maintain the authenticity of who was sampled (e.g. if an online poll, could people from anywhere technically participate in this Victorian poll)?
  • How was the questionnaire administered (e.g. paper self-complete, online, CATI)?
  • What was the script of stimuli administered to respondents? In other words, what prompts were given and what questions were asked: exact order and wording?
  • What results were obtained for each question (i.e. full rather than selective crosstabs)?
     

Until Mr Russell publishes in full how his ‘poll’ was conducted, the only honourable course of action for him to pursue is to withdraw the claimed results.

Until then, we can only see them as untrustworthy and a bit of a joke.

 

Rhetorical tactic — “Not” quoting yourself

This rhetorical tactic is also used by Mr Russell’s fellow Catholic, Prof. Margaret Somerville. For example, in her 2015 book Bird on an Ethics Wire, in relation to the supposed (but fanciful) fear of being euthanized in the Netherlands if adequate pain management is accepted, Somerville says in Chapter 4:

It has been alleged that Dutch physicians have interpreted patients’ consent to pain management as consent to euthanasia.38

If you’re like most people, you’d assume, given the effort of a citation (38), that an independent source had made the statement based on some evidence. Indeed, if you look at reference 38 you’ll see that the author is Lauren Vogel, and the source article is in the Canadian Medical Association Journal. All sounds like solid, legit stuff, doesn’t it?

However, Ms Vogel is a journalist, not a Dutch medic or a researcher, and what she reports in relation to Somerville’s claim is merely a quote of what someone said. And who is that someone? Why, it’s Margaret Somerville — what a coincidence!

Somerville could have just said “I’ve argued this before…”, but instead gives a seemingly robust reference to a source that has the appearance of independence and scholarship. Yet obviously she knows that the source is merely herself saying so.

Let’s be clear: something is not true just because someone alleges it. Even if they allege it twice or more. And happen cite themselves via someone else in the process.


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The Catholic Church flip-flops on 'the vulnerable'. Photo: Donaldytong

The Catholic Church in Australia is reeling from revelations at the Royal Commission into Institutional Responses to Child Sexual Abuse, of a shocking number of cases that have occurred under its ‘pastoral umbrella.’ Yet it presumes to tell the rest of us about the hypothetical moral dangers of assisted dying laws for ‘the vulnerable.’

To add insult to injury, it flip-flops on its stance.

Never mind that the argument is contradicted by evidence

The Church’s favourite argument — already contradicted by scholarly analysis that curiously seems to be of no interest to the Church — is this: if people are given the choice of assisted dying, they will feel compelled to choose it, coerced by doctors, greedy relatives or others; subtly or otherwise.

No matter that health care workers routinely report that relatives usually try and persuade their dying loved one to endure yet another invasive and burdensome treatment; not dissuade them from it.

The flip-flop

If the Catholic Church were indeed genuinely concerned about coercion of ‘the vulnerable,’ then it would equally oppose the right to refuse medical treatment, particularly if the treatment were life-prolonging. But it doesn’t.

If granny might die as a result of refusing a particular medical intervention, then a doctor might persuade her to refuse in order to conserve medical resources. Or greedy relatives might persuade her so that they are relieved of the burden and expense of looking after her and gain earlier access to her estate.

As eminent legal scholar Gerald Dworkin has argued,1 if there’s a theoretical ‘slippery slope’ for assisted dying, it’s the same for the refusal of life-preserving medical treatment.

To hold different positions under the same risks is to flip-flop. That’s especially so when there are numerous safeguards built into assisted dying statutes, but currently few or none for the right to refuse life-preserving medical treatment.

Parallel theoretical risks: refusal of life-saving medical treatment, and assisted dyingThe Catholic Church approves of the theoretical risk of the left-hand course (refusal of life-saving medical treatment), but not of the theoretical risk of the right-hand course (assisted dying) which is lower in practice by virtue of considerably more statutory safeguards.

Local experience confirms risk is theoretical

In my home state of Victoria, where the right to refuse any unwanted medical treatment has been enshrined in statute for nearly three decades (the Medical Treatment Act 1988), how many prosecutions have there been under the Act’s provisions against inappropriate persuasion?

Precisely none. Not a single case. So much for the theory.

It all serves to highlight that the Catholic Church’s only real argument is that it believes that it’s morally wrong to deliberately hasten death. However, it avoids this argument because as a religious tenet, it doesn’t appeal to the masses.

Catholic directives

The Church’s flip-flop about ‘the vulnerable’ is not a one-off accident. Take for example the ‘Ethical and Religious Directives for Catholic Health Care Services’ published by the United States Conference of Catholic Bishops.2

The Bishops ‘direct’ that there is no obligation on patients to use disproportionate means of preserving life. They state that disproportionate means are:

“…those that in the patient’s judgement do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community.”

The Bishops further ‘direct’ that:

“The free and informed judgment made by a competent adult patient concerning the use or withdrawal of life-sustaining procedures should always be respected and normally complied with, unless it is contrary to Catholic moral teaching.”

Setting aside the Church’s hubris of dishonouring the patient’s choice if the Church disagrees, it would be theoretically easy for someone to persuade the patient that hope was not reasonable, that the burden would be too great, or that the cost to the family or society would be too high.

Suffering for our God’s (your own) good

On the next page, the Bishops expressly ‘direct’ that:

“Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering.”

That’s unqualified. So, if you’re atheist, agnostic, Jewish, Hindu, Muslim or even a Christian who believes assisted dying can be appropriate, as a patient in their institutions you are to be persuaded that suffering against your beliefs and wishes is ‘redemptive’ in the eyes of the Vatican’s version of a God.

In Australia in 2009, for the Office for Family and Life in the Catholic archdiocese of Adelaide, Mr Paul Russell argued in News Weekly that “there is a point to suffering” because:

“It’s about the profound connection that each and every life has to the incarnate God … We know that the sufferings we endure well are joined in some mysterious way to the sufferings of Christ.”

Pity any poor soul who doesn’t share Mr Russell’s views. Curiously, there is no mention of this underpinning belief in his anti-assisted dying blog, “HOPE.”

Invalid argument in any case

The Church’s argument that ‘the vulnerable’ will be ‘at risk’ from assisted dying laws — for example in the Victorian Bishops’ recent pastoral letter to the Catholics of Victoria opposing the upcoming assisted dying parliamentary Bill — is itself fundamentally invalid.

That’s because, as I’ve previously explained, it’s a circular argument: a logical fallacy.

Ban yellow socks on Wednesdays
A circular argument: We must ban yellow socks on Wednesdays or the 'vulnerable' will be 'at risk'.
‘The vulnerable,’ by definition are those ‘at risk,’ and will still be so if we wear yellow socks on Wednesdays. Therefore, we should ban such bright footwear midweek — and anything else we happen to oppose — on the same basis.

Might anyone suggest that “we should ban religion because the vulnerable will be at risk of succumbing to extreme religious views”?

Will the Church change its mind?

The Catholic Church does change its mind from time to time, though its reforms are glacially slow.

Take, for example, its theory of limbo, a place on the doorstep of hell where, the Church claimed, babies go if they die before they’re baptised: that they’d be prevented from entering heaven. It would be hard to imagine a crueller worry to put into the heads of uneducated new parents.

But in 2007, after centuries of confidently promoting the theory, the Catholic Church decided that it was wrong and buried it.

Will it change its mind on assisted dying? Maybe, but don’t hold your breath.

Conclusion

The Catholic Church, reeling from its extensive failure to protect our most vulnerable — children — and notwithstanding some good individuals within, still presumes to morally lecture the rest of us with the logical fallacy of how ‘risky’ assisted dying legislation is supposed to be to ‘the vulnerable,’ while flip-flopping in support of refusing life-saving medical treatment under the same theoretical risk.

The Bishops’ rhetoric amply exposes their confected crisis against assisted dying as nothing but religious doctrine draped in faux secular garb… in reality a sheep in wolves’ clothing.

 

References

  1. Dworkin, G, Frey, RG & Bok, S 1998, Euthanasia and physician-assisted suicide, Cambridge University Press, Cambridge, New York. pp.66ff
  2. United States Conference of Catholic Bishops 2009, Ethical and religious directives for Catholic health care services, United States Conference of Catholic Bishops, Washington DC, pp. 43, https://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf.

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The Age reports a 'gloves off' campaign of misinformation

Both the Herald Sun and The Age reported last week that religious anti-assisted dying crusaders are running a 'gloves off' campaign in Victoria.

Religious forces are gathering once again to attempt to thwart the views of the great majority of Victorians in favour of assisted dying law reform.

Matt Johnston in the Herald Sun quoted Paul Russell, a long-term figure in Catholic circles, and Greek Orthodox Bishop Ezekiel, in statements against assisted dying.

Farrah Thomazin in The Age quoted religious stalwarts Margaret Tighe of Right To Life, and the Australian Christian Lobby, in further statements against assisted dying.

The crux of the story is that 'pollsters' claim to have run a survey in Victoria. They refuse to be identified. They refuse to publish their methodology. And they refuse to publish all their results. Enough said.

They cherry-pick an item from their supposed poll to claim that 33% of Victorians who oppose assisted dying will change their vote against a supporting politician at the next election. They neglect to mention that only a tiny minority of Victorians actually oppose assisted dying. Their analysis is astonishingly superficial, even assuming they ran a proper, robust poll and didn't manufacture the numbers themselves.

They then use this tidbit of 'data' to put the fear of electoral defeat into politicians who will soon to face an assisted dying Bill in the Victorian Parliament.

What rubbish. Assisted dying (AD) opponents seem to be utterly shameless in misrepresenting and distorting cherry-picked data to push their religious agenda — which they pretend isn't religious.

The real situation in respect of AD is the exact opposite of their claims as I show in a proper, robust analysis of legitimate data, demonstrating that:

  • A massive 78.9% of Victorians support AD, with only a tiny 8.1% opposed. Strong supporters outnumber strong opponents by more than ten to one.
  • Significantly more supporters of AD believe that law reform is personally important, than opponents believe the status quo (no law) is personally important.
  • At a general election, far more Victorian voters will punish Members who oppose the AD Bill than will punish Members who support it (3.5 to 1 overall, 2.4 to 1 for the Liberal/National Coalition and 6.6 to 1 for Labor).
  • The co-sponsors of Victoria’s 2008 AD Bill were returned with greatly increased majorities (including relative to their party’s overall performance) despite campaigns against them by anti-AD crusaders.

 

You can read the full analysis here.

So that Victorian politicians are not misled, I have forwarded my report to the Victorian Government's Cabinet and other selected members of Parliament.

The only way in which this campaign could be called 'gloves-off' is that opponents, lurking around with their shadowy misinformation, don't want to get bullshit on their mittens. Hands seem to be much easier to wash. And hide.


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Alex Schadenberg's latest shrill and misleading article

Catholic Canadian anti-assisted-dying blogger Alex Schadenberg is at it again. This time he’s parading his ignorance and spreading bull about a potential change in Oregon’s assisted dying legislation.

The Bill

Mr Schadenberg correctly reproduced Section 3 of Oregon Senate Bill 893, which states:

SECTION 3. An expressly identified agent may collect medications dispensed under ORS 127.815 (1)(L)(B)(ii) and administer the medications to the patient in the manner prescribed by the attending physician if:

(1) The patient lawfully executed an advance directive in the manner provided by ORS127.505 to 127.660;

(2) The patient’s advance directive designates the expressly identified agent as the person who is authorized to perform the actions described in this section;

(3) The patient’s advance directive includes an instruction that, if the patient ceases to be capable after medication has been prescribed pursuant to ORS 127.800 to 127.897, the expressly identified agent is authorized to collect and to administer to the patient the prescribed medication;

(4) The medication was prescribed pursuant to ORS 127.800 to 127.897; and

(5) The patient ceases to be capable.

Mr Schadenberg fails to mention Section 2, which states:

SECTION 2. Section 3 of this 2017 Act is added to and made a part of ORS 127.800 to 127.897.

What is the ORS range?

And what precisely isORS 127.800 to 127.897’ (ORS = Oregon Revised Statutes)? Why, it’s the entirety of Oregon’s existing Death With Dignity Act!

In other words, a patient still has to be terminally ill, fully informed, made a formal request, the request assessed as genuine and free, waited the required cooling off period, made another formal request, been assessed as qualifying all the requirements by multiple doctors, has legally appointed an agent expressly for the purpose of administering lethal medication pursuant to the Death With Dignity Act, have their medication prescribed (immediately before which the attending physician must again verify that the patient is making an informed decision) and then the patient ceases to be capable, before the agent may then administer.

Mr Schadenberg exposes that at best he fundamentally doesn’t understand the Bill, nor took much if any effort to do so.

That’s hardly the free-for-all Mr Schadenberg posits in his shrill blog implying that ‘assisted suicide and euthanasia’ was being extended to ‘incompetent people’ without further qualification; falsely insinuating that any incompetent person could then obtain assistance for suicide or euthanasia.

No ‘defence’

If Mr Schadenberg were to claim that he really meant ‘only within the scope of the current Death With Dignity Act,’ and that he’s been taken out of context, that simply won’t wash. Bill 893 makes a provision only for someone else to administer the lethal dose (that is, what Mr Schadenberg refers to as ‘euthanasia’) if the patient ceases to be capable after already qualifying under the existing Act. The Bill does not permit patient self-administration: that is, using Mr Schadenberg’s own language, ‘assisted suicide’—which he expressly refers to in his article.

Parading a non-existent extension of ‘assisted suicide’ clearly exposes that at best he fundamentally doesn’t understand the Bill, nor took much if any effort to do so.

Wrong again…

He also got it completely wrong as to who may administer when the patient ceases to be capable:

“The bill enables the doctor to administer…” — Alex Schadenberg

However, if you read Section 3 of the Bill (above) that Mr Schadenberg himself reproduces, you’ll see clearly that the patient must expressly identify a particular person ('agent') to administer lethal medication should the patient cease to be capable. The patient may appoint his or her doctor, but can appoint in their Advance Care Directive anyone to be the agent; including a trusted and loved family member. The only particular requirement for the agent’s administration is that he or she must “administer in the manner prescribed by the attending physician.”

Conclusion

But let’s not the facts get in the way of a gratuitous reaction trumpeting shrill hyperbole and headline, shall we Mr Schadenberg?

And as usual, Catholic Australian anti-assisted-dying blogger Paul Russel has dutifully reproduced Mr Schadenberg’s farce.


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Back in 2013 the High Court of Ireland rejected a legal bid by multiple sclerosis sufferer Marie Fleming to achieve a lawfully-assisted peaceful death.

The Court naturally relied on expert testimony in reaching its judgement, yet its conclusions included a statement containing significant errors of fact.

The erroneous statement

In its judgement,1 the Court made the following statement:

Above all, the fact that the number of LAWER (“legally assisted deaths without explicit request”) cases remains strikingly high in jurisdictions which have liberalised their law on assisted suicide (Switzerland, Netherlands and Belgium) — ranging from 0.4% to over 1% of all deaths in these jurisdictions according to the latest figures — without any obvious official response speaks for itself as to the risks involved.” [My emphases in bold]

In fact, the Court's judgement is wrong on not one, not two, but three significant matters. But that hasn't stopped opponents of assisted dying law reform from quoting the judgement as though it were factual and persuasive, when it isn't: relying on it because it was made by a High Court—the 'authority bias.'

Consequences

Here are just a few examples of the Court's statement being wielded by assisted dying opponents as though it were conclusive evidence against law reform:

 
These examples illustrate the frequency of quoting the misinformation and how it feeds into and wrongly shapes public policy formation.

Three strikes

So what are the three counts on which the Court's judgement was seriously wrong?

Strike 1: Wrong concept

First, let’s get the concepts right. LAWER is not “legally assisted deaths without explicit request.”

Such nomenclature is an oxymoron. To ‘assist’ is to accommodate, serve or help someone accomplish something. But if there has been no request then one cannot be helping. You can’t ‘assist’ a little old lady across the road if she has expressed no interest in going there: you’d be forcing her across the road. Equally, you can’t ‘assist’ a death if there’s no proper ‘request.’

LAWER in fact stands for “Life-ending Acts Without Explicit Request” (of a competent patient).5 And with the exception of the possible ‘lawfulness’ of the doctrine of double effect, such acts are illegal.

Further, if such acts were legal as the Court’s statement posits, then there would be no need for an “obvious official response” as the Court then concludes. The statement lacks fundamental coherence.

Strike 2: Not ‘strikingly high’

The Court's judgement states unequivocally that LAWER (otherwise known as Non-Voluntary Euthanasia or NVE) rates in Switzerland, the Netherlands and Belgium are ‘strikingly high’, though no comparative yardstick is recorded in the judgement by which one might draw or justify that subjective judgement. Similar 'strikingly high' statements also appear in sections 102 and 104 of the judgement.

There is in fact a scientific study, published in The Lancet in 2003, that provides sound empirical evidence that could have properly informed the Court (Figure 1).6

Non-voluntary euthanasia in seven European countriesFigure 1: The non-voluntary euthanasia (NVE) rates of seven European countries in late 2001/early 2002

As revealed by this study, the NVE rates in Switzerland and the Netherlands were in fact lower than in Denmark, a country which has never had an assisted dying law.

The only country which did appear to have an NVE rate notably higher than the others was Belgium. The research study collected the data for analysis between June 2001 and February 2002. However, Belgium’s Euthanasia Act was not passed by its Parliament until 28th May 2002, well after data collection was complete. Thus, even in describing Belgium’s NVE rate as ‘strikingly high’ compared to a number of other European countries, it cannot be attributed to an assisted dying law because none existed at the time.

In fact, the NVE rate in Belgium had been found to be high back in 1998,7 well before the Bill for the country's Euthanasia Act was even tabled in Parliament.

Further, if assisted dying laws had such effects, it might be expected that the NVE rate would increase the longer that assisted dying laws were in place. In that case the NVE rates in Switzerland (statute since 1942) and the Netherlands (regulation since the early 1980s) would have NVE rates much higher than Belgium’s (statute since 2002). But the exact opposite is true.

Indeed, Rietjens and colleagues8 further concluded in their review of NVE in the Netherlands, Belgium, Denmark and Switzerland that “the use of drugs with the intention to hasten death without an explicit request of the patient is part of medical end-of-life practice in the studied countries, regardless of their legal framework, and it occurs in similar fashion.” The study, published in 2007, would also have been important evidence before the Court.

Strike 3: Not ‘remaining’ high

The Court's judgement states unequivocally that the LAWER (NVE) rate of the three countries ‘remains’ strikingly high. No specific evidence was supplied in the judgement to support this statement. Indeed, the judgement notes:

  • In section 28 that Dutch NVE had been “consistently declining.”
  • In section 91 that “the number of LAWER deaths has significantly declined in both [Dutch and Belgian] jurisdictions.”
  • In section 94 that “the trend in [Dutch] LAWER cases are declining in numbers (from 1,000 in 1990 to 550 in 2005)” and that in Belgium “the number of LAWER cases has declined since legalisation of assisted death.”
  • In section 101 that the NVE rates of both the Netherlands and Belgium had dropped.

 
Despite this clear and repeated evidence, the Court summarises in section 96 that the evidence cannot be “regarded as encouraging or satisfactory.”

But what does empirical research tell us about the NVE trends? In both the Netherlands and Belgium, since assisted dying was enshrined in statute and became effective in 2002, the rate of NVE has decreased significantly (Figure 2).7,9-11 In fact, the rate in the Netherlands is now similar to that in the UK, a country which has never had an assisted dying law and which provides the world’s gold standard in palliative care practice.

Non-voluntary euthanasia rates have decreased in the Netherlands and BelgiumFigure 2: Empirical trends in NVE rates before and after legalisation of assisted dying

These are critical yardsticks by which to judge practice in jurisdictions that have assisted dying laws with jurisdictions that don't. The UK study was published in 2009 and was readily available prior to the High Court’s hearings, yet appears not to have been presented in evidence.

The final (2010) Dutch NVE statistic in Figure 2 may or may not have been available to the Court: it was published in 2012 around the time the Court was taking evidence. The final (2013) Belgian statistic would not have been available to the Court as it was published in 2015.

Conclusion

While the High Court worked diligently within the scope of evidence brought before it:

  • The Court’s definition of LAWER is incorrect and incoherent;
  • Its statement that the NVE rates of the Netherlands and Switzerland are ‘strikingly high’ are evidentially wrong when compared with other countries without assisted dying laws;
  • Its implication that the higher NVE rate in Belgium was caused by assisted dying law reform is evidentially wrong; and
  • Its statement that the rates remain high is evidentially wrong.

 
The High Court's judgement does not provide defensible evidence or argument against assisted dying law reform.

Many lobbyists have repeated these incorrect statements, significantly misleading media, policy makers and legislators.

Now that the facts are readily available it’s appropriate to avoid repeating evidentially wrong statements, regardless of the apparent 'authority' of their source.
 

Summary of facts

  1. LAWER stands for "Life-ending Acts Without Explicit Request". Its practice is similar in countries with and without assisted dying laws.
  2. The NVE rates in the Netherlands and Switzerland are lower than the rate in Denmark, a country which has never had an assisted dying law.
  3. The NVE rate in Belgium appears higher, but was so long before assisted dying law reform and so cannot have been caused by such a law.
  4. The NVE rates of the Netherlands and Belgium have both decreased significantly since their assisted dying statutes came into effect in 2002.

References

  1. High Court of Ireland 2013, Fleming v Ireland & Ors - Determination, [2013] IEHC 2, Dublin.
  2. Boudreau, JD, Somerville, MA & Biller-Andorno, N 2013, 'Physician-assisted suicide: should not be permitted/should be permitted', New England Journal of Medicine, 368(15), pp. 1450-1452.
  3. Somerville, M 2016, 'Killing as kindness: The problem of dealing with suffering and death in a secular society', The Newman Rambler, 12(1), pp. 1-26.
  4. Keown, J 2014, 'A right to voluntary euthanasia? Confusion in Canada in Carter', Notre Dame Journal of Law, Ethics & Public Policy, 28(1), pp. 1-45.
  5. Pijnenborg, L, van der Maas, PJ, van Delden, JJM & Looman, CW 1993, 'Life-terminating acts without explicit request of patient', Lancet, 341(8854), pp. 1196-1199.
  6. van der Heide, A, Deliens, L, Faisst, K, Nilstun, T, Norup, M, Paci, E, van der Wal, G & van der Maas, PJ 2003, 'End-of-life decision-making in six European countries: descriptive study', The Lancet, 362(9381), pp. 345-350.
  7. Bilsen, J, Cohen, J, Chambaere, K, Pousset, G, Onwuteaka-Philipsen, BD, Mortier, F & Deliens, L 2009, 'Medical end-of-life practices under the euthanasia law in Belgium', New England Journal of Medicine, 361(11), pp. 1119-1121.
  8. Rietjens, JA, Bilsen, J, Fischer, S, Van Der Heide, A, Van Der Maas, PJ, Miccinessi, G, Norup, M, Onwuteaka-Philipsen, BD, Vrakking, AM & Van Der Wal, G 2007, 'Using drugs to end life without an explicit request of the patient', Death Studies, 31(3), Mar, pp. 205-21.
  9. Seale, C 2009, 'End-of-life decisions in the UK involving medical practitioners', Palliat Med, 23(3), pp. 198-204.
  10. Onwuteaka-Philipsen, BD, Brinkman-Stoppelenburg, A, Penning, C, de Jong-Krul, GJF, van Delden, JJM & van der Heide, A 2012, 'Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey', The Lancet, 380(9845), pp. 908-915.
  11. Chambaere, K, Vander Stichele, R, Mortier, F, Cohen, J & Deliens, L 2015, 'Recent trends in euthanasia and other end-of-life practices in Belgium', N Engl J Med, 372(12), pp. 1179-1181.
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Mr Max Bromson (seated) at Parliament House Canberra in June 2014. He died not long afterwards.

Assisted dying critic Mr Paul Russell has done it again. I’m beginning to think that he’s a tremendous asset to the pro-assisted-dying movement. Why would I say that?

Well, this time his pronouncements appear in National Right To Life News, the online newspaper of the USA Catholic-founded National Right To Life Committee, and in which Mr Russell represents ‘HOPE,’ his anti-euthanasia lobby platform founded by the Australian Family Association—itself Catholic-founded and backed.

The complaint

In his opinion piece, Mr Russell complained that Mr Max Bromson of Adelaide, Australia, who ended his own life after a long period of serious suffering from advanced cancer, lived far longer than his doctors had estimated.1

That he outlived his diagnosis by more than four years confirms the observation that qualifying periods in euthanasia and assisted suicide about ‘six months to live’ or similar, are really meaningless.” — Paul Russell

The pro-assisted-dying message

Mr Russell, in a single sentence, unequivocally demolishes the foundation of his own arguments in opposition to legalising assisted dying. He is a huge fan of the ‘vulnerable’ argument: that once legalised, people will quickly be pressured into assisted dying.

If his ‘vulnerable’ argument held true (a hypothesis that peer-reviewed scientific research contradicts), those with the means to peacefully end their lives would do so. And they wouldn’t take four years to think about it.

By explicitly pointing out that Mr Bromson had survived for much longer than expected (as fellow assisted-dying critic Mr Wesley Smith pointed out in another case), Mr Russell directly disproves the rhetoric of his ‘vulnerable’ argument.

People will quickly end their own lives... but survive far longer than expected: It's a spectacular flip-flop.

Conclusion

Thanks, Mr Russell, for pointing out that people don’t want to die—that they live as long as they can possibly bear it—and disproving your own nonsense. Keep up the good work!

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Footnote: Blind ignorance?

I’m also curious as to whether Mr Russell advances misinformation in blind ignorance, or whether the situation is worse. Who can say?

I have on a number of occasions explained simply and clearly why the west-coast-USA state assisted dying laws require that for the patient to qualify for assisted dying, one of the conditions is that the patient’s doctor must assess that the patient is likely to die within six months.

The reason is not that those with five months to live are deserving of the choice, but those with ten months to live are not, as Mr Russell bizarrely assumes.

The very important outcome is that when the doctor makes that assessment, the patient then automatically qualifies for free hospice care. It takes monetary considerations out of the equation, which is important in the context of the expensive USA healthcare system.

So, Mr Russell demonstrates profound ignorance at best by opining that the prognosis of time remaining must be superbly accurate, when it can’t be except possibly in the last days.

It’s about quality of life, not quantity; framed by hospice care being readily and freely available.

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References

  1. Russell, P. 2016, No charges in suicide case in South Australia, including “Dr. Death,” Philip Nitschke, viewed 3-Aug-2016, https://www.nationalrighttolifenews.org/2016/08/no-charges-in-suicide-case-in-south-australia-including-dr-death-philip-nitschke/

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