Victoria

Dr Marion Harris is an experienced Melbourne-based oncologist. Having practiced for some twenty years, she’s co-authored research papers published in the peer-reviewed medical literature regarding the assessment of treatments for particular kinds of cancer.

You’d think that such experience and attention to evidence and proper deduction would give rise to a moderate and thoughtful approach towards legal VAD (even if opposed) and on other more general matters. But she offers quite strident nonsensical arguments.

Inane logical flaw

The lead reason that Dr Harris advances against VAD is that people will feel coerced to take the option. She cites three cases of people who decided to pursue intensive medical treatment for cancer instead of pursuing VAD, and who she states would all have been eligible for VAD. This means she says that they would have been expected to die within six months. She then notes they’re all alive and doing well — relatively speaking, with significant medical conditions — more than a year later, due to pursuing intensive medical interventions.

I emailed Dr Harris and she confirmed that these were indeed Victorian medical cases personally known to her.

With the chosen cases outlined, she claims that “the option of VAD ignores these possibilities [of further treatment]”. That is, in the state of Victoria where she works and where VAD is legal as she acknowledged in her article, she opines that VAD would stymie such medical interventions.

So, Dr Harris argues, using three cases of patients pursuing further treatment in a state with lawful VAD, that patients will not pursue further treatment if VAD were to be made lawful. (Her op-ed is clearly aimed at NSW MPs who are currently considering VAD legislation.)

It’s as whacky as the theory that the reason you never see elephants hiding in treetops is because they’re good at it.

And it flies in the face of clear documentary evidence of careful practice published by Victoria’s own Voluntary Assisted Dying Review Board, which Dr Harris doesn’t mention. We can only wonder why not.

Dr Harris inanely argues that people won't pursue medical treatment if VAD is legal, by describing three cases in which they did while VAD was legal.

Hubris?

A possible explanation for Dr Harris’ claim that people will be vulnerable to VAD when it is legal is that while she refuses to participate, doctors who do participate would not offer any and all available medical interventions that might help. But this this would be a shabby accusation against other doctors. Indeed, VAD law mandates that the patient be fully informed about treatment options as one of the qualification criteria should they apply.

Such an opinion about medical colleagues might also suggest a certain level of hubris and harsh attitudes about others. So perhaps this is not what she means, though other explanations for her conclusion are more elusive. We can only wonder, because Dr Harris has publicly stated in writing:

• “People are free to suicide but no-one has the right to expecct [sic] their govt to kill them on request.”
• “Boo hoo Ita … cry us a river … get over yourself” in response to ABC Chair Ita Buttrose saying she felt disrespected by Communications Minister Paul Fletcher.
• “Ha ha – nailed it” in response to a post “@JoeBiden ankle injury update ….. cause was falling over a box of @realDonaldTrump ballots in his basement.”
• “Very true” in response to a post stating that if Victoria’s Chief Medical Officer Professor Brett Sutton were put “in charge of climate emergencies he’d issue matches to every pyromaniac in Victoria, punch holes in the fire hoses at every CFA, then stand back and giggle while the state burned.”
   

She’s also retweeted comments that Donald Trump is the only person who can save the world from the Chinese Communist Party, and that the 2020 USA presidential election was “stolen” by election fraud.

Misrepresenting palliative care

In her article, Dr Harris argues again that palliative care is “the answer” despite both Palliative Care Australia and the Australian and New Zealand Society for Palliative Medicine clearly stating that palliative care can’t help everyone, and that a small minority suffer badly leading up to death.

While a small but meaningful minority, such cases of suffering in extremis are not “very rare” as Dr Harris wrongly states.

Dr Harris wrongly states that palliative care eliminates the need for VAD legislation. The peak bodies for palliative care in Australia state that while palliative care helps many people, it can't help everyone. Nor should we expect palliative care to be the only medical discipline to be infallible. That would be cherry-picked, confected nonsense.

A bright spot

In her favour, Dr Harris does at least acknowledge in her article that people can have “genuinely chosen a VAD pathway for themselves”.

The Catholic Communicators’ Guild

I’ve written before about the Catholic Church and its network of anti-VAD communicators, many of whom don’t reveal their religious ideology. One can only wonder, given Archbishop Anthony Fisher’s active call to find willing “spokespeople” for the Church, if it has directly recruited Dr Harris to its anti-VAD campaign — or whether she’s merely a privately motivated individual.

Either way, there’s no shortage of evidence of Dr Harris’ very, very deep Catholic roots indeed. On Twitter, she follows, for example:

• Pope Francis.
• Vatican News.
• Catholic Bishop Tim Harris, the church’s spokesperson against VAD.
• Catholic Archbishop Anthony Fisher (Sydney).
• Catholic Bishop Richard (‘Down’) Unders (also Opus Dei: Sydney).
• Catholic Archbishop Peter Commensoli (Melbourne).
• Catholic Archbishop Mark Coleridge (Brisbane).
• Jeremy Stuparich, Public Policy Director, Australian Catholic Bishops Conference.
• Xavier Symonds, Research Fellow, Plunkett (Catholic) Centre for Ethics.
• National Catholic Register.
• Catholic News Agency.
• Catholic Arena (Catholic news and opinion).
• The Catholic Leader.
• Father Andrew McDonald (Canadian Catholic priest).
• The Society of St Sebastian (Catholic and Orthodox).
   

She warmly retweets posts from Catholic sources. Her posts are also consistent with the Catholic Church’s stances on sexuality and abortion, though her attitudes in denial of global warming are inconsistent with the Vatican’s, which supports efforts to combat it.

Indeed, in June 2021 she co-authored a similar op-ed also in The Australian, again replete with Catholic talking points. The other author was Emeritus Professor of Medicine Haydn Walters. What The Australian failed to declare is that Dr Walters is a board member of the innocuously named “Christopher Dawson Centre for Cultural Studies”. The stated aim of this organisation, nestled directly within the Catholic Archdiocese of Hobart (it shares the church's head office address), is chillingly arrogant: “to promote awareness of the Catholic Intellectual Tradition and Cultural Patrimony as essential components of human civilization”.

Dr Harris even directly defends the Church. For example, in response to a post criticising the Church as incoherent for saying it would never abandon people who choose assisted dying, yet says it is likely to deny last rites and pastoral care for those who do, Dr Harris wrote:

• “Well the church is actually correct - the person is about to have an elective assisted suicide which is very different to a natural death so it does seem reasonable to question giving last rites - it’s the persons choice to select VAD and choices have consequences…”

Dr Harris provides ample evidence that she is a devout and traditional Catholic. That is her right. Curiously, though, she never mentions personal religious foundations for her views on VAD which align so strongly with Catholic Church talking points.

Conclusion

Dr Marion Harris’ anti-VAD tirades follow the same talking points as the Catholic Church and its network of communicators. In the current op-ed alone, she’s crafted an inane failure of logic, and employed misinformation about palliative care, to curry fear of responsible VAD law reform.

The invective apparent in some of her musings does her reputation no favours. While her personal view to never participate in VAD is deserving of respect, I argue that denying others their own choice of conscience, especially on the basis of misinformation and dumb logical falsehood, is not.

 

-----

For the record

For those wanting to run the "religious persecution" flag up the pole, this article is not for you. I wholeheartedly endorse Dr Harris's right to both her religion and her personal rejection of VAD. This article does not claim that Dr Harris's arguments are wrong because they are Catholic. It is to say, with appropriate reasoning (which Dr Harris failed to employ) and evidence that the claims she makes about VAD in her op-ed are illogical and poorly informed. They are an offence to acknowledging and protecting the different and deeply held ethical views of others.

The link I make to Catholicism is to point out how much of the nonsense promoted against VAD law reform is a malodorous vapour emanating from a seeming (and not infrequently actual) coordinated effort of a Catholic Church intent on imposing its views on all Australians, Catholic or not. Most Australians are not Catholic. And most lay Australian Catholics support VAD.

As I explain in a separate research series about Religiosity in Australia, the Church's intransigent attempts to trample the consciences of its own flock (let alone all Australians) is one of the reasons citizens have been abandoning the pews in droves in recent times.

 

Keywords: 

Fearmonger | Flapdoodle | Fudge | Faith | Assisted dying (AD) | Voluntary euthanasia (VE) | Australia | Victoria | Catholic | Rhetoric: The 'vulnerable'

• Read more about Dr Marion Harris' Catholic ideology on full display
• Log in or register to post comments

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

Australian Care Alliance gets the basics wrong

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

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

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

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

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

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

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

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

 
All these assumptions are patently false.

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

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

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

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

Cherry-picked overseas data, too

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

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

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

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

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

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

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

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

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

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

Enough of that.

Branka van der Linden cherry-picks, too

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

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

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

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

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

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

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

The actual numbers

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

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

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

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

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

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

Interpreting suicide data correctly

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

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

Figure 5: Victorian suicides per 100k population by year

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

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

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

Getting all the numbers right

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

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

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

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

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

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

Don't get carried away

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

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

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

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

Conclusion

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

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

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

 

Keywords: 

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

• Read more about Anti-VAD suicide gaffes a major embarrassment
• Log in or register to post comments

I've exposed Prof. Boer's cherry-picked nonsense before. Astonishingly, he even ignores data from the Dutch Euthanasia Commission, despite the fact he used to serve on one of its five Regional Review Committees.

What he doesn't mention is that amongst the five Regions, the Region with by far the highest rate of assisted deaths had the second-lowest rate of general suicide, and the Region with the lowest assisted death rate had by far the highest general suicide rate (Figure 1) in 2014,¹ the year Boer left his Committee and began bad-mouthing the Dutch law. Quite the opposite of "suicide contagion".

Figure 1: Dutch assisted death and general suicide rates by region, 2014

From multiple safeguards to just one

The Dutch euthanasia Act has a number of safeguards that stipulate who may qualify to access assisted dying in the Netherlands, and how qualification is assessed, implemented and reported to the authorities.

But there's another country that permits assisted dying with just one provision: Switzerland.

In effect since 1942, an exception in the Criminal Code permits assisted suicide, provided assistance is rendered for non-selfish motives. That's it. There's no legislated (or even government-regulated) requirements for age, illness or condition, decisional capacity, cooling off periods, or anything else.

In the 1980s, two assisted dying associations were formed to make assisted dying generally possible: Exit Deutsche Schweiz for German-speaking Swiss residents, and Exit A.D.M.D. for French-speaking residents.

Since then, several other smaller associations have been formed, including in 1998 Dignitas, which provides assistance to foreigners. (The main societies assist only Swiss residents.) The current membership of the societies, combined, is well in excess of 150,000 people, in a population of just 8.5 million. Assisted dying is often discussed openly in the media.

If "contagion" anywhere, in Switzerland, right?

Given that Switzerland has an abundance of the ingredients that religious opponents of assisted dying claim lead to "suicide contagion", you'd think they'd be shouting about Swiss "suicide contagion" from the rooftops.

But they don't mention Switzerland.

There's a powerful reason why: the data is not only unhelpful to their "contagion" theory, but actively hostile to it.

Latest official government data

I've written about Switzerland before, but, given the ongoing "suicide contagion" misinformation, I thought an update warranted. On request, my contact in the Swiss Federal Statistical Office (FSO) promptly re-supplied all publicly-available statistics of assisted deaths and general suicides, with the data now running up to 2017.

It makes for interesting reading. Figure 2 shows Switzerland's (CH) long-term general (non-assisted) suicide rate, along with the domestic (Swiss resident) and Dignitas (foreigner) assisted death rates. All the official (Australian Bureau of Statistics) longitudinal data I could find for Australia's (AU) general suicide rate is also included.

Figure 2: Swiss death rates 1969–2017; Australian suicide rates 1990–2017

Immediately obvious is that the Swiss general suicide rate has dropped massively and consistently since the two main assistance societies were formed in the early 1980s. And it's continued to drop even as the rate of assistance, and public discussion, has increased over the most recent three decades.

I also asked the FSO how many cases on record were of minors (persons under the age of majority or 18 years). The answer? None. I double-checked. Zero. Zip. No minors receiving assisted dying in Switzerland. Indeed, cases under the age of 35 years old are uncommon.

Consistent with best practice

Indeed, the data is consistent with suicide prevention. The societies help people get the medical care they need and consider assisted death only when other avenues have failed to provide acceptable relief. Every assisted death is reported as such by the association to the authorities — otherwise the unexpected death would result in a coronial inquiry.

Each association has clearly-defined processes and oversight by ethics specialists. Clients requesting access are assessed carefully by doctors. (In fact, the lethal medication can only be lawfully obtained by medical prescription.) The associations take their responsibilities very seriously.

The data is also consistent with substitution: that what would have been some violent and lonely suicides as a result of unrelievable suffering from intractable conditions, are now peaceful assisted deaths.

And for the record, despite the Swiss law being in effect since 1942 versus Dutch regulation from only 1984; and Swiss law having only one provision versus Dutch regulation/legislation with many; in 2017 the Swiss assisted dying rate, including Dignitas cases, as a percent of all deaths, was less than half that of the Netherlands' rate.

Reasons for requesting an assisted death

Exit Deutsche Schweiz, by far the largest of the Swiss associations, has published statistics of its cases (Figure 3).

Figure 3: Reasons for pursuing assisted dying, Exit Deutsch Schweiz 2015

In 2015, like other jurisdictions, cancer was by far the most common reason (40.8%) for requesting an assisted death. Polymorbidities (22.4%) was next, followed by refractory pain at 8.6%, lung diseases at 5.0% and Parkinsons at 4.3%.

Despite no government-regulated access requirements, assistance for mental illness was very low at 1.7% (Dutch 1.2% in 2015) and cases of dementia at 1.4% (Dutch 2.0%; Belgian combined mental/dementia 3.1% in 2015).

And compared to Australia?

In the 1990s, the Swiss general suicide rate, although falling, was significantly higher than Australia's (Figure 2) until 2010, when the rates were the same. Since 2010, the Swiss suicide rate (with no legislated procedures for its permitted assisted dying) has continued to drop, while Australia's (at that time with no assisted dying law at all), began to rise.

This difference highlights the clear anchoring bias exhibited by religious opponents who cherry-pick their data to try and claim the rise in the Dutch general suicide rate must be the result of "suicide contagion" from assisted dying, when Australia's rate also increased over the same time period, but in the complete absence of an assisted dying law. (Victoria's assisted dying legislation didn't come into effect until mid-2019.)

Further, the Swiss rate has continued to drop even with a significant increase in assisted dying.

Conclusion

Of course, general suicide is a serious issue. It has numerous well-known risk factors (e.g. mental health, substance abuse, unemployment, relationship breakdown, opportunity) and protective factors (e.g. hotlines, funding mental health programs, unemployment benefits, removing opportunity), none of which assisted dying opponents mention while cherry-picking their statistics.

Meanwhile, as legislators contemplate the specific safeguards contained in Bills before their legislatures, it's important to strike an appropriate balance between sufficient safeguards, and inappropriately requiring those considering an assisted death to climb Mount Everest with one hand tied behind their backs.

Switzerland shows that even in a jurisdiction without legislated practices, access to assisted dying is modest, with assistance groups establishing their own stringent ethical and procedural standards.

And it amply demonstrates even under those conditions, an absence of supposed "suicide contagion".

-----

¹ Official Euthanasia Commission data and official Dutch government suicide statistics by region.

 

Keywords: 

Fearmonger | Fudge | Fiction | Faith | Assisted dying (AD) | Australia | Victoria | Belgium | Netherlands | Switzerland | Theo Boer | Margaret Somerville

• Read more about Why assisted dying opponents don't mention Switzerland
• 2 comments
• Log in or register to post comments

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

Key aspects of the provisions are:

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

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

 

-----

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

Access

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

Request

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

Assessment

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

Medication management

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

Administration

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

Practitioner protections

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

Mandatory reporting

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

Offences

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

Oversight

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

 

Keywords: 

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

• Read more about Voluntary assisted dying is now lawful in Victoria
• Log in or register to post comments

The Catholic Healthcare brick wall

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

This arbitrarily limits access to lawful choice by citizens.

Confected ‘institutional conscience’

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

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

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

Disgraceful framing in headline

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

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

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

Medical-coloured glasses

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

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

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

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

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

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

They’re very heavily medical-coloured glasses indeed.

Three faux ‘threats’

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

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

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

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

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

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

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

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

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

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

Doctor, heal thyself (and thine own systems).

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

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

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

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

Own failure in palliative care principles

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

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

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

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

Conclusion

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

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

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

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

In many places, there won’t be.

 

Keywords: 

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

• Read more about The shocking arrogance of Catholic Healthcare
• Log in or register to post comments

Media release - Marshall Perron

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

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

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

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

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

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

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

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

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

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

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

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

Marshall Perron

 

Keywords: 

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

• Read more about How voluntary assisted dying influenced the Victorian election
• Log in or register to post comments

How ironic it was that the very day after I quoted Keating’s slight against his then-hostile Senate, Keating himself, a conservative Catholic, would come out against voluntary assisted dying (VAD) reform.

Hansard record makes compelling reading

But, more importantly, the Hansard record of votes on the Victorian Bill in the lower house make for compelling reading.

Figure 1 shows Victorian voter support for VAD (from ANU Australian Election Study 2016 data) by political preference, and MP votes in support of the Victorian Bill (lower house, 2017).

Figure 1: Victorian electorate support and MP vote support for VAD (lower house, 2017)
Sources: AES 2016; Hansard

It’s quite obvious that Greens MPs (100% v 91%) , Labor MPs (86% v 84%) and minor/independent MPs (67% v 76%) approximately represented the proportion of voter support. (It’s unsurprising that all Greens MPs vote in favour of VAD Bills: it’s Greens policy; while it’s a ‘conscience’ matter for other parties.)

The yawning Coalition chasm

But the yawning chasm of Coalition MPs not representing their own voters (14% v 73%) is even more stark. That’s a gap of nearly sixty percentage points. Surely that would be enough to raise the eyebrow of any conservative voter?

Aside from a handful of Coalition MPs who voted in support of the VAD Bill, it’s clear that there’s generally no real ‘conscience’ vote across the Coalition benches.

The corridors have been buzzing with stories of threats to Coalition promotions and preselections, and threats to preference deals for the state election next year, though of course there’s nothing public and on the record. Just the serene statement that “our members have a conscience vote.” The discrepancy amongst Australian Coalition ranks has been formally uncovered before in university research.

It’s a national story

However, it’s not like this is confined to Victoria. Here’s the same chart (Figure 2) for all state VAD bills across Australia since 2000 which have had a division on the vote — so we know who voted which way.

Figure 2: Australian electorate support and state MP vote support for VAD (all state Bills since 2000)
Sources: AES 2106; Hansards

Again, the largest and most striking gap between voter desire for reform and MPs opposing their voters’ wishes is amongst the Coalition ranks, at a full sixty percentage points short of proper representation.

It’s a similar picture to that published by university researchers in 2008, who found just 17% Coalition voting support in favour of VAD in the federal parliament, too.

As I’ve explained before, the Party leader’s public statements can be ‘persuasive,’ and Mr Matthew Guy, leader of the Victorian Parliamentary Coalition, has made his entrenched opposition to this reform loud and clear.

Inform your own voting

As debate in Victoria’s upper house commences tomorrow, we’ll be watching who’s in favour and who’s against. And we’ll report the voting record to help inform how you cast your own vote at Victoria’s state election in November next year.

In the meantime, here’s the full record of the Victorian Legislative Assembly votes.

Full voting record – Victorian Legislative Assembly 2017 VAD Bill

Ayes	47		Noes	37
Allan, Jacinta	Labor		Angus, Neil	Liberal
Andrews, Daniel	Labor		Battin, Brad	Liberal
Britnell, Roma	Liberal		Blackwood, Gary	Liberal
Bull, Josh	Labor		Blandthorn, Lizzie	Labor
Carroll, Ben	Labor		Bull, Tim	Nationals
Couzens, Chris	Labor		Burgess, Neale	Liberal
D'Ambrosio, Lily	Labor		Carbines, Anthony	Labor
Dimopoulos, Steve	Labor		Clark, Robert	Liberal
Donnellan, Luke	Labor		Crisp, Peter	Nationals
Edbrooke, Paul	Labor		Dixon, Martin	Liberal
Edwards, Maree	Labor		Fyffe, Christine	Liberal
Eren, John	Labor		Gidley, Michael	Liberal
Foley, Foley	Labor		Guy, Matthew	Liberal
Garrett, Jane	Labor		Hodgett, David	Liberal
Graley, Judith	Labor		Kairouz, Marlene	Labor
Green, Danielle	Labor		Katos, Andrew	Liberal
Halfpenny, Bronwyn	Labor		McCurdy, Tim	Nationals
Hennessy, Jill	Labor		McLeish, Cindy	Liberal
Hibbins, Sam	Greens		Merlino, James	Labor
Howard, Geoff	Labor		Northe, Russell	Ind.
Hutchins, Natalie	Labor		O'Brien, Danny	Nationals
Kealy, Emma	Nationals		O'Brien, Michael	Liberal
Kilkenny, Sonya	Labor		Pesutto, John	Liberal
Knight, Sharon	Labor		Richardson, Tim	Labor
Languiller, Telmo	Labor		Riordan, Richard	Liberal
Lim, Hong	Labor		Ryall, Dee	Liberal
McGuire, Frank	Labor		Ryan, Steph	Nationals
Morris, David	Liberal		Smith, Ryan	LIberal
Nardella, Don	Ind.		Smith, Tim	Liberal
Neville, Lisa	Labor		Southwick, David	Liberal
Noonan, Wade	Labor		Suleyman, Natalie	Labor
Pakula, Martin	Labor		Thompson, Murray	Liberal
Pallas, Tim	Labor		Tilley, Bill	Liberal
Paynter, Brian	Liberal		Wakeling, Nick	Liberal
Pearson, Danny	Labor		Walsh, Peter	Nationals
Perera, Jude	Labor		Watt, Graham	Liberal
Sandell, Ellen	Greens		Wells, Kim	Liberal
Scott, Robin	Labor
Sheed, Suzanna	Ind.
Spence, Ros	Labor
Staikos, Nick	Labor
Staley, Louise	Liberal
Thomas, Mary-Anne	Labor
Thomson, Marsha	Labor
Ward, Vicki	Labor
Williams, Gabrielle	Labor
Wynne, Richard	Labor
TOTAL AYES			TOTAL NOES
Labor	38		Labor	6
Greens	2		Greens	0
Liberal	4		Liberal	24
National	1		National	6
Other	2		Other	1
TOTAL	47		TOTAL	37
Abstained	2
Asher, Louise	Liberal
Victoria, Heidi	Liberal
Did not vote	1
Brooks, Colin	(Speaker, Labor)

Note: The vote represents 87 of 88 seats. The seat of Northcote was vacant owing to the untimely death of its representative, Fiona Richardson, from cancer.

 

Keywords: 

Assisted dying (AD) | Australia | Victoria | Analysis | Legislative reform | Poll / survey | Statistics

• Read more about Coalition the 'unrepresentative swill' on VAD
• Log in or register to post comments

Major community support for VAD

Take voluntary assisted dying (VAD) for example. Poll after poll demonstrates that the overwhelming majority of Australians want this additional choice for people in extremis at the end of life. The impeccable Australian Election Survey (AES) conducted by Australian National University scholars last year confirmed that 77% of Australians want VAD reform, with 13% undecided and just 10% opposed.

Strong support (43%) is ten times greater than strong opposition (4%), and support is high across the political spectrum: amongst minor/independent (69%), Coalition (77%), Labor (80%) and Greens (87%) voters. Public support has been in the majority for more than four decades.

Political support missing in action

But since the Northern Territory Rights of the Terminally Ill Act in 1996, none of the many VAD Bills before various state parliaments has passed. And the Northern Territory’s Act was torn down by the federal parliament just eight months after coming into effect.

A 2008 university study of federal MP voting opportunities found 100% of Greens, 55% of Labor, and a paltry 17% of Coalition MPs voting in favour of VAD.

New analysis

Now, a new analysis of the ten state VAD Bills since 2000 where final divisions were called, offers further insights. It found 100% of Greens MP voting opportunities were in favour, along with 51% of Labor, 29% of minor party and independent, and a similarly paltry 17% of Coalition MPs. Excluding South Australia, whose parliament has debated the greatest number of VAD Bills, the Coalition support rate was just 9%.

Overall, while state Labor MP votes fell 29% short of Labor voter attitudes, Coalition MP votes fell an astonishing 60% short of Coalition voter attitudes. At the state level, Coalition MPs had the most voting opportunities — nearly half (48%). No wonder passing VAD Bills is challenging.

It begs the question, how is it that our legislative representatives fail to reflect clear public majority views on matters of conscience for so long?

Hidden reasons behind MP opposition

Obviously, lobbying on both sides of the conversation in part informs MPs’ views, but there are several more persuasive factors.

For a start, there’s a “truism” held by many MPs that their vote in favour of a VAD Bill would lose them more votes at a general election than would a vote against the Bill. However, the opposite has been demonstrated in multiple studies.

Further, I’ve shown before that opposition to VAD is largely religious.  A university study has also found that those who are more religious and who are politically engaged tend to hold very conservative views. So while there are religious MPs on both sides of politics, Coalition MPs are naturally more inclined to hold much more conservative views.

But that doesn’t fully explain the massive 60% representation gap on the Coalition side, either.

In good conscience?

A key factor lies in the seemingly reassuring principle of the “conscience vote.” The major parties have announced that their members are accorded a conscience vote (also known as a “free vote”) on the VAD Bill. That simply means that there’s no official published party policy on the matter and party members may vote freely on the basis of their own conscience.

There are two significant issues with this state of affairs.

The first is that the member may refer exclusively to their own conscience. But what if the MP’s conscience is at odds with the electorate’s? For my home state of Victoria, the 2016 AES study found 79% of the community in favour of VAD. There are 88 members of the Victorian parliament lower house, and just 40 members in the upper house. Therefore, it’s possible for as few as just 20 Victorian MPs to vote “no” in order to extinguish the will of 3.2 million Victorians (79% of 4.05 million Victorian voters).

If that weren’t enough, the second issue is that the right to ‘conscience’ is granted only in respect of the Bill itself, not on procedural matters about the Bill. It can make a huge difference.

How the parry works

Here’s what happened in 2008 when Victorian Greens MP Colleen Hartland’s VAD Bill was before the Legislative Council. MPs were afforded a conscience vote, and many of them had said they were supportive of VAD in general, but couldn’t support Hartland’s Bill in its current form. (That’s also a common ruse of MPs who in reality oppose the reform in principle but wish to appear ‘open minded’.)

When the final vote on Hartland’s Bill was lost, then Greens MP Greg Barber immediately moved a motion to refer the Bill to a parliamentary committee so that it could be improved to MPs’ satisfaction. Neither Labor nor Coalition parties afforded their members a conscience vote on this procedural matter, instead directing MPs to vote against such motions. The referral, which may have resulted in Victorians having wider end-of-life choices years ago, was cynically buried.

Most voters remain unaware of the shenanigans played in the corridors of power to achieve such results.

Australia’s special political conservatism

They’re not the only shenanigans, though. Another university study comparing federal MP conscience voting patterns in the UK, New Zealand and Australia found Australia to be different, accounting for why the UK and NZ have legalised marriage equality, while Australia hasn’t.

Firstly, the centre-left in Australia has a larger proportion of Catholic members than in the UK and NZ, accounting for some of the shortfall in Labor representation of progressive views.

Secondly, those amongst Coalition ranks, but with more liberal social consciences, had been lashed by Coalition party whips to vote against progressive reform. So while there was a public display of fairness and neutrality, the reality was quite different.

Borne out in state parliaments

These findings are replicated in Australian state parliament votes too, with Coalition MPs rarely if ever voting in favour of progressive social reform. Coalition MP votes on VAD including and since Hartland’s legislative attempt in 2008 are telling: in Victoria 2008 10:5 against, in Tasmania 2009 6:0 against; in Western Australia 2010 19:1 against; in NSW 2013 10:0 against; in South Australia 2016 14:7 against and in Tasmania 2017 13:1 against.

Rather than reflect 77% Coalition voter support for VAD, Coalition MP voting patterns reflect the highly negative stance of party leaders, whipped through the parliamentary party membership. For example, then WA Premier Mr Colin Barnett made it clear he thought assisted dying was “government-sanctioned killing”. Tasmanian coalition leader Mr Will Hodgman said that “protection for [vulnerable] people cannot be guaranteed.” Then-NSW Premier Mr Barry O’Farrell declared himself “strongly opposed”.

Back to Victoria’s Bill under debate

The situation in Victoria is looking somewhat more positive, with Premier Mr Daniel Andrews and many in his Cabinet publicly supporting reform. A lengthy, detailed, professional and well-resourced process has informed the crafting of the Bill.

However, opposition leader and would-be Premier Mr Matthew Guy has stated his resolute opposition to it and that he intends to vote “no”. That would mean he is quite comfortable for his own personal view to extinguish the contrary views also held in good conscience by 34,626 of the 43,831 voters in his own electorate of Bulleen, and 3.20 million of Victoria’s 4.05 million voters. (Electorate numbers as at 10 October 2017.)

An obvious solution

There’s an obvious solution for MPs whose own consciences disallow them from reflecting the overwhelming majority conscience of the electorate.

They could consider abstaining — simply absenting themselves from the chamber during the division. That would keep their own consciences intact while allowing the electorate’s conscience to be reflected.

I’m a constituent of Mr Guy’s. Over a period of months I made six robust attempts to meet with him to discuss these matters, especially the covert whip arrangements and the consideration of abstention. I can be persuasive in obtaining appointments, but my best efforts proved wholly unfruitful.

As I said to Mr Guy’s private assistant after the last failed attempt, voters could be forgiven for believing he’s more interested in meeting allegedly shady characters in fancy Brighton restaurants, than meeting with his own constituents.

Victorians are watching the parliamentary VAD debate. We’re taking notes that will inform our votes at the state election late next year.

Indications are at present there’s a good chance that Victorian MPs won’t be “unrepresentative swill”.

 

Keywords: 

Filibuster | Fudge | Assisted dying (AD) | Australia | Victoria | Analysis | Legislative reform | Statistics

• Read more about Assisted dying - are our political masters "unrepresentative swill"?
• Log in or register to post comments

Many Australian clerics are trying their hardest to foil Parliamentary attempts to drag Australia into the 21^st century on social policy. They seem to care little for the ongoing demise of their own constituencies.

Religion declining since the 1960s

Religious affiliation in Australia has been declining consistently since the 1960s, consecutive Australian Bureau of Statistics (ABS) census figures show (Figure 1). At the 2016 census, somewhat more than half (60%) of all Australians claimed a religion. More Australians than ever before identified as ‘no religion’ — for the first time ever a larger group than any single religious denomination.

Figure 1: Australian religious affiliation by census year
Source: ABS

Weak religious commitment

Not only has religious affiliation been dropping, but the nature of the affiliation is weak (Figure 2). Amongst the two largest religious denominations, a quarter of Catholics (26%) and nearly half of Anglicans (47%) are Notionals: that is, they identify with the denomination but never attend religious services. More than half of Catholics (52%), and four in ten Anglicans (41%), attend religious services only occasionally (Occasionals: several times a year or less often).

Figure 2: Australian denominations and Australian religious identity (ARI-6)
Source: Australian Election Study (AES) 2016

Just 22% of Catholics and a mere 12% of Anglicans demonstrate commitment to their denomination through dedicated service attendance (Regular = monthly or more often, and Devout = weekly or more often).

The picture is particularly grim for the Anglican church, dominant in Australia from Federation until the 1960s. With both a deeply impoverished affiliation rate in 2016 (13.3%), and just 12% of the flock dedicated to service attendance, a miniscule 1.6% of Australians are committed Anglicans.

The picture is only slightly better for the Catholic church. With 22.6% affiliation in 2016, and 22% of those committed to service attendance, it's a slightly larger but still damningly small 5.0% of Australians who are committed Catholics. Further, the Catholic church’s affiliation may be significantly lower at the next (2021) census, as Australians vent their dismay and disgust at how badly it’s handled the scourge of child sexual abuse that’s occurred under its ‘pastoral umbrella.’

Hollow ‘leadership’

Across all religious denominations, just 16% of Australians are committed to their denomination — Regular or Devout religious service attenders — while 30.1% Reject religion altogether.

And yet those at the head of their ships of faith still demand that we listen to and comply with their moral dictates, assuming that they have an automatic right to steer our morality in their own chosen direction. If they think they’re ‘leading,’ most Australians aren't following.

The indications are that they're going the way of Kodak, now a small, wan shadow of its former dominant self. If the Anglican and Catholic churches were companies with voting shareholders (or even not-for-profits with voting members), the Boards and executives (archbishops and bishops) would have been, for overseeing such profound and continuing erosion of their brand franchises, replaced long ago.

Entrenched rather than learning

You’d think all this would be a warning message to archbishops and bishops to seek to understand their flocks and build bridges for mutual understanding and engagement; to demonstrate a bit of flexibility in recognising alternative and equally respectable moral codes that were not established in ancient and very different times. But no.

Their recent performances on both voluntary assisted dying and marriage equality law reform suggest otherwise.

The fact is that to rebuild their franchises, the churches need to reach out to their Occasionals and to their Notionals — those who identify with the denomination but rarely if ever attend services. But the bishops have been pleasing only (some of) their Regulars and Devouts. It's a classic and literal case of “preaching to the converted.”

Voluntary assisted dying

In the matter of voluntary assisted dying (VAD) law reform, there are presently VAD Bills before both the NSW and Victorian parliaments. Figure 3 shows Australian attitudes toward VAD by religious affiliation.

Figure 3: Australian religious affiliation and attitudes toward VAD
Source: AES 2016

Opposition to VAD amongst most denominations is very small, and really only makes an appearance amongst minor Christian and non-Christian denominations. Just 10% of Catholics and 7% of Anglicans oppose VAD, 5% and 3% of them strongly.

Figure 4 shows the real story. Opposition to VAD amongst Rejecters, Socialisers, Notionals and Occasionals is almost non-existent, and support is in a huge majority (85% of Socialisers, 89% of Notionals and 78% of Occasionals). Opposition to VAD amongst religion Rejecters is less than 2%. That is, opposition to VAD is almost entirely religious, although religious opposers pretend their opposition is nothing to do with faith.

Figure 4: Australian religious identity (ARI-6) and attitudes toward VAD
Source: AES 2016

Only amongst Regulars and Devouts does opposition to VAD make a real appearance. Yet even amongst Devouts, with the strongest opposition, it’s in the minority (47%).

And what have the bishops been doing? They’ve campaigned strongly against VAD, spreading misinformation. Take for example the Catholic Church’s latest version of its anti-euthanasia polemic ‘brochure’ (Figure 5).

Figure 5: The Catholic Church’s latest polemic brochure against VAD
Source: Catholic diocese of Byron Bay

This amateur production reveals a superficial understanding of the issues and a penchant for hyperbole. Worse, it employs significant misinformation in order to create FUD (fear, uncertainty and doubt), as does an advertisement taken out by a number of bishops from various denominations, in Melbourne’s major daily newspaper (Figure 6).

Figure 6: The June 2017 bishops' anti-VAD print advertisement
Source: Herald Sun

The bishops’ manoeuvres will only alienate their congregation’s least committed members, the Notionals and Occasionals — the very people they should be wooing back to the pews, and who are strongly supportive of VAD as a valid and respectable response to intolerable and unrelievable suffering at end of life.

Perhaps the bishops would find this suggestion unpalatable, too much like a sales pitch. If that’s the case, one can only point out that selling the claim of saving of souls is the very task of evangelism. One could ask, “is your God likely to approve heartily of the continued withering of Australian faith?”

Marriage equality

The second contemporary example is marriage equality (ME). Figure 7 shows Australian attitudes to ME by religious denomination.

Figure 7: Australian religious affiliation and attitudes toward ME
Source: AES 2016. Note: There was no ‘neither/nor’ option in this survey question

A clear majority of Australians in all groups except minor Christian denominations support marriage equality. That includes 74% of Catholics, 63% of Anglicans and 60% of Uniting Church members.

Figure 8 shows attitudes toward marriage equality by religious identity.

Figure 8: Australian religious identity (ARI-6) and attitudes toward ME
Source: AES 2016

Support of marriage equality is in a clear majority amongst Rejecters (88%), Socialisers (82%), Notionals (73%) and Occasionals (71%). Around half (49%) of Regulars also support marriage equality.

Only amongst Devouts is support for marriage equality in the minority, with a quarter (25%) supporting and three quarters (75%) opposing it.

And what have the bishops been doing? They’ve run a massive campaign against marriage equality law reform. Indeed, the Anglican Archbishop of Sydney, Glenn Davies, announced that the diocese had donated, from precious church funds, $1 million to the ‘No’ campaign.

The public was even more dismayed to discover the diocese had granted just $5,000 to dealing with entrenched domestic violence in its ranks, at the same time as allocating the $1 million to preventing the equal expression of love.¹

Given that marriage equality is almost certain to be legalised in Australia either directly after this voter ‘poll’ or in the term of the next Parliament, that’s an extraordinary squandering of a vast charitable sum for no net result. Calls have been made for the diocese’s tax-exempt status to be reviewed.

Substitute movements

In fact, so refractory has been the stance of many bishops, that Australians of faith have resorted to establishing their own networks outside the churches, for example Christians Supporting Choice for Voluntary Euthanasia, Australian Christians for Marriage Equality, and Australian Catholics for Equality.

Conclusion

The evidence is incontestable: opposition to VAD is almost completely religious, and opposition to ME is largely religious, despite protestations to the contrary.

Bishops’ conduct in relation to these reforms, which most Australians want, have been unhelpful by resisting Australia’s move into the 21^st century — on the basis of ancient interpretations of scripture to which only a small minority of Australians subscribe.

The bishops' conduct has run strongly counter to the compassion and understanding they could have shown in order to engage the Notionals and Occasionals amongst their flocks; to halt the erosion of their religious capital, and to rebuild it.

These bishops most certainly don't represent the general views and beliefs of most Australians on VAD or ME. Rather, they give the appearance of administrators who are determined to preside over smaller and smaller congregations: a kind of “slow euthanasia.”

---

1. Gleeson, H 2017, Sydney Anglican church confesses to domestic abuse in its ranks, plans to reform with new policy, ABC News, viewed 10 Oct 2017, <https://www.abc.net.au/news/2017-10-10/sydney-anglican-church-to-unveil-domestic-abuse-policy/9033426>.

 

Keywords: 

Fearmonger | Faith | Assisted dying (AD) | Australia | New South Wales | Victoria | Catholic Church | Religion | Christian | Anglican/Church of England/Episcopal

• Read more about Religious ‘leaders’ determined to alienate their flocks
• Log in or register to post comments

They’re at it again. This time it’s the religious right’s latest ‘think tank’ front group, the impressively-named Institute for Civil Society. Sounds grand, doesn’t it?

But if you look into their lot in life, it’s to protect ‘religious freedoms.’ By that, they mean the right to lawfully discriminate against others of whom they disapprove, while at the same time arguing that they not be discriminated against.

Mark Sneddon and Sharon Rodrick of the ‘Institute’ published an opinion piece in Fairfax Media today.

In it, they slam the Victorian Government’s Voluntary Assisted Dying Bill, which was introduced into the Parliament recently.

They criticize the Bill for inadequate safeguards. (There are no fewer than 68 of them.)

The logical fallacy

They level several criticisms at the Bill to say it's not 'safe'. But they could have advanced any criticism of the Bill to claim, as they do, that “the vulnerable will be at risk” — a logical fallacy as I’ve pointed out before. The "vulnerable will be at risk", by circular definition, if the Bill is printed in black ink (as it is) instead of purple, but they didn't complain about the colour of the ink.

The flip-flop

The point is, they flip-flop because they’re remarkably inconsistent in their position. At the same time as pointing out supposed flaws in the Voluntary Assisted Dying Bill, demanding a much higher standard of proof about a number of things, they completely fail in their opinion piece to even mention — let alone demand the same level of safeguards for — an already-legal and equivalent hypothetical risk for the “vulnerable.”

Equivalent hypothetical risk in operation for nearly 30 years

In Victoria, patients have an inalienable right to refuse any and all medical treatment. No reason need be given, even if the treatment is life-saving. The Medical Treatment Act 1998, currently in force, has several safeguards to protect against coercion or undue influence. In Section 5(1), one doctor and “another person” (who can be anybody) must be satisfied that:

• “the patient has clearly expressed or indicated a decision”; and
• “the patient’s decision is made voluntarily and without inducement or compulsion”; and
• “the patient has been informed” about their condition and “has appeared to understand that information”; and
• “the patient is of sound mind and has attained the age of 18 years.”
   

They’re all the legislated safeguards for the refusal of life-saving medical treatment.

And how many cases of undue influence have been prosecuted in Victoria over the nearly 30 years the Medical Treatment Act 1998 has been in effect? Precisely none. Not one.

So much for Messrs Sneddon and Rodrick’s avaricious relatives lurking at every bedside.

A new, equivalent hypothetical risk

The Medical Treatment Planning and Decisions Act 2016, which will come into force in March next year and which extinguishes the Medical Treatment Act 1998 at that time, also contains several similar safeguards for the refusal of life-saving medical treatment.

In witnessing an Advance Care Directive (Section 17), the two signatories, only one of whom must be a medical doctor, must certify that:

• the person “appeared to have decision-making capacity” in relation to the documented decisions; and
• the person “appeared to understand the nature and effect of each statement”; and
• “the person appeared to freely and voluntarily sign the document”; and
• “the person signed the document in the presence of the two witnesses”; and
• “the witness is not an appointed medical treatment decision maker for the person.”*
   

In Section 52 of the Act, a health practitioner is forbidden to administer medical treatment if they are aware the patient has refused it, however (lawfully) refused.

This Act was passed in the term of the current Parliament: that is, by the same State MPs who are now considering the Voluntary Assisted Dying Bill.

There was no great fracas over the sensible safeguards spelled out in the new Medical Treatment Planning and Decisions Act. There was no onslaught of “crisis!” op-ed screeds published in newspapers. There were no countless hours of talking heads tut-tutting and painting doomsday scenarios.

It was passed by the Parliament and accepted by the people as striking the right balance.

No safeguards at all in many cases

And that’s it: the sum-total of safeguards to refuse life-saving medical treatment in Victoria. However, if the patient refuses medical treatment verbally, there are no mandated safeguards at all in either old or new Act, because the statutory safeguards apply only to refusal given in writing.

Yet despite all this, Messrs Sneddon and Rodrick rail against safeguards against coercion and elder abuse only in regard to the Voluntary Assisted Dying Bill, in which the safeguards are of a significantly higher calibre, with, for example, mandatory multiple doctor opinions, documentation trail, multiple requests, no go-ahead until approval by an external authority, notifications of numerous kinds, oversight by a specially-established panel, and so on.

It’s obvious what a flip-flop Messrs Sneddon and Rodrick’s demands are in respect of decisions that will foreseably result in death.

Another embarrassing flip-flop

Messrs Sneddon and Rodrick particularly also complain at length at the supposedly ‘lax’ definition of decision-making capacity in the Voluntary Assisted Dying Bill.

That’s a major and embarrassing flip-flop. Here’s why.

The section of the Voluntary Assisted Dying Bill that stipulates those requirements (Section 4) is the same section number 4 that governs the right to refuse of life-saving medical treatment in the Medical Treatment Planning and Decisions Act 2016. Only a few words have been changed to alter the context from refusal of treatment to consideration of assisted dying. Otherwise, the Sections are identical.

Messrs Sneddon and Rodrick don't point this out in their opinion piece. Indeed, I was unable to find online any evidence that they had published any complaint about the provisions when the Medical Treatment Planning and Decisions Act was in debate, nor since. If they have, I’d be happy for them to point it out.

Is it all a strategic ruse, anyhow?

It’s pertinent to ask if the objections are a ruse anyhow, because, as Andrew Denton has rightly pointed out, a key opponent strategy is not to give an outright “no” to assisted dying Bills, but to say only “not this Bill” and create an atmosphere of FUD (fear, uncertainty and doubt) so that it is defeated.

A typical ruse example

By way of example, I’ve published an account of how Victorian MP Daniel Mulino published outrageous misinformation about assisted dying. As a result, we had an extended conversation, during which he acknowledged that he had indeed published misinformation. At the end of the conversation I asked if he could support the Government’s Voluntary Assisted Dying Bill. (He’s a member of said Government.)

No, it’s too liberal, he said, pointing to Oregon’s Death With Dignity Act, now in force for nearly 20 years, as a more conservative approach. So I asked him if he would support a Bill like Oregon’s.

No, he said, there were still concerns about it.

By now you’ve spotted the merely incremental withdrawal of supposed possible support. So I asked him outright if there was any form of assisted dying Bill he could support.

The relevant word within a long discourse: No.

And there’s the answer that belies the political strategy. It doesn’t matter one whit what provisions are included in an assisted dying Bill, just criticize a bunch of provisions and create FUD to defeat it.

 

----

* Section 62 of the Act also requires a doctor to notify the Public Advocate if “significant treatment” is refused — but only if it is refused by a substitute decision maker on behalf of the patient: not by the patient herself. And “significant treatment” is defined as treatments (not non-treatments) which are likely to have a serious impact on the patient (bodily intrusion, risk to life, side effects or distress). “Significant treatment” in the Act does not mean treatment whose refusal may result in death.

 

Keywords: 

Fearmonger | Flapdoodle | Filibuster | Flip-flop | Fudge | Faith | Physician-assisted dying (PAD) | Australia | Victoria | Religion | Rhetoric: Killing | Rhetoric: The 'vulnerable'

• Read more about Religious 'think tank' flip-flops
• Log in or register to post comments