Some of the issues that no law can contain, correct or manage.

For those pushing the assisted suicide and euthanasia agenda there’s clearly a sales pitch involved to support their ultimate goal of legislative change. Fair enough.

But I can’t help but think that the public and politicians alike therefore tend towards seeing actions as killing a patient or helping them to suicide as occurring in some sort of utopian manner; there’s pain and suffering; the person qualifies; so on we go.

Putting aside the reality that we know from places like Oregon that pain or fear of pain is a lower order concern; trumped as it is by issues relating more to loss of autonomy or fear of being somehow becoming disabled, there’s still a whole lot more to the process that needs exploring lest, in the rush to act, we overlook some critical considerations.

One such consideration is how the conversation between the doctor and the patient takes place. Who initiates it and when.

Professor Margaret Somerville wrote once that, when providing a person with a poor diagnosis, a doctor is likely to be legally obliged to set out all legal options for the person which, if the Victorian Bill passes, would include explaining the ‘option’ of death by suicide or euthanasia. The issue is, of course, creating for the person the ability to make a fully informed consent.

Yet most euthanasia and assisted suicide bills I have seen include a provision that, somehow, the conversation needs to be initiated by the person themselves and not the doctor. It might be observed that such an assertion may really be about some sort of formal request, but that’s likely not to be the first time that the issue is raised. Moreover, unless a doctor chooses to make a file note, no one will ever know how the conversation got started.

The Ministerial Advisory Panel recommendations to the Victorian Premier, Daniel Andrews, attempted to cover this issue:

“To make properly informed decisions, people need access to appropriate information. The provision of information about voluntary assisted dying may, however, be taken as a suggestion by a health practitioner that their patient should request and access voluntary assisted dying… This is why the Panel is recommending that a health practitioner should not be allowed to initiate a conversation about voluntary assisted dying with their patient.”

This is at best an aspirational statement with no force in law.

It was perhaps honoured in the breach recently in a matter raised on Victorian 3AW Radio by presenter, Neil Mitchell in a short segment entitled: GP reportedly handing out voluntary euthanasia consent forms.

Mitchell, a well-known supporter of euthanasia was gobsmacked by the story of a 103 year old woman who was given an Advance Care Directives form by her doctor for her to consider. The form included the phrase: ‘… should it be legal to do so at that time. I request that my death be hastened by a doctor providing or administering a fatal dose to allow me to die with dignity.’

The interview explained that the Advance Care Directives form was produced by none other than Dignity with Dying Victoria, the principle pro-euthanasia lobby in that state. As Mitchell explained, you cannot access the forms on their website without some sort of log in, but that clearly did not preclude the doctor in question from printing off multiple copies for his surgery.

This raises some very serious questions.

Apart from The Netherlands, Advance Care Directives that stipulate the person being made dead by euthanasia or by assisted suicide are not acceptable. This stands to reason given the serious nature of the request and the need for a contemporaneous consent that the doctor can verify for themselves. Was the person fully aware of their options when they completed the form? Did they have a diagnosis at the time? Was there some form of coercion or ‘inheritance impatience’ going on?

This brings into question the entire raison d’etre of the pro-euthanasia lobby. They would know full well that any law brought to open up any Australian state to euthanasia or assisted suicide would never consider consent-in-advance by way of a directive as a valid consideration – not initially at least. So, why create false hope in a person who says they desire euthanasia by suggesting they ‘tick a box’ on a form?

Why would any doctor choose to promote/provide an Advance Care Directive Form from a lobby group that includes such an ‘option’ when the government provides a comprehensive guide and forms of their own on various government web portals? (see for example: https://www.betterhealth.vic.gov.au/health/servicesandsupport/advance-care-plans ) Moreover, simply handing a person a form to take home and consider when online guides are available to assist the process smacks of utility and abandonment; as Neil Mitchell observed:

Well, I think it's wrong. Even if it's legal, I think the doctor shouldn't be doing that. It's like touting for business. It's saying, "Oh look, you're old, even though you're healthy." And I would want to live alone at 103, which is quite an achievement. "Even though you're old, and I want to live alone, maybe you should be signing up something for euthanasia."

But this is not the only example I know of where what we could call, ‘rogue elements’ act in ways that the proposed laws do not necessarily envisage.

Dr. Peter Goodwin, the former Medical Director of Oregon’s pro-assisted suicide Compassion and Choices, said that about 75 percent of those who died using Oregon’s assisted suicide law through the end of 2002 did so with the organization’s assistance. In one example year, during 2003, the organization was involved in 79 percent of reported assisted suicide deaths. According to Dr. Elizabeth Goy of Oregon Health and Science University, Compassion in Dying (former name) sees “almost 90 percent of requesting Oregonians…” “In 2008 the proportion of reported C&C PAS deaths significantly increased to 88 percent (53/60) of all reported deaths.” And in 2009, 57 of the 59 reported assisted suicide deaths were Compassion & Choices clients.

We also know that end-of-life clinics operating in both Belgium and The Netherlands often see the ‘hard cases’ at the edge of the law that other doctors simply won’t take on.

There’s an old saying: In the first year of a new law, proponents will look for ways to comply with the directives; in the second year, they look to see how to get around them.

It is not scaremongering to suggest that the local pro-euthanasia lobby will look to move more firmly into ‘advocacy’ if ever a law is passed in Australia. It’s common sense. But what that ‘advocacy’ might entail is an open question.

There are so many questions that need to be asked about how things will work under the proposed and yet-to-be-seen Victorian regime. To simply assume that it’s all ‘sweetness and light’ as proponents suggest, is as naïve as it is dangerous.