Thursday, 12 October 2017
The High Court of Justice in England has decisively rejected the argument for legalising assisted suicide based on autonomy.
The High Court found that it would not be possible to legalise assisted suicide without leaving vulnerable people at risk of being wrongly helped to commit suicide.
This decision is of profound relevance as you consider the Voluntary Assisted Dying Bill 2017.
Although it is claimed that this Bill has more safeguards than any other assisted suicide law proposed anywhere in the world, this is simply not true.
The latest Assisted Dying Bill introduced into the House of Lords on 9 Jun 2016 required that, before a person could be given assistance to end his or her life, the High Court must have confirmed that “it is satisfied that the person has a voluntary, clear, settled and informed wish to end his or her own life”.
Victoria’s assisted suicide Bill leaves this assessment entirely in the hands of two doctors, neither of which may have ever met the person before receiving a request for assisted suicide.
The High Court stated (para 100):
The involvement of the High Court to check capacity and absence of pressure or duress does not meet the real gravamen of the case regarding protection of the weak and vulnerable. Persons with serious debilitating terminal illnesses may be prone to feelings of despair and low self-esteem and consider themselves a burden to others, which make them wish for death. They may be isolated and lonely, particularly if they are old, and that may reinforce such feelings and undermine their resilience. All this may be true while they retain full legal capacity and are not subjected to improper pressure by others.
Proponents of the assisted suicide Bill have been far too ready to dismiss the concern that vulnerable people will be at risk.
The High Court astutely identifies that the risk to the vulnerable cannot be avoided simply by a decision making capacity test. Nor is it enough to rule out the more obvious forms of overt coercion. The real concern is that by making assisted suicide an option the lonely, frail, elderly, disabled or depressed may choose death because they feel like a burden on others.
The Court cited the data from Oregon as evidence that its concern about people choosing assisted suicide because they felt like a burden was not fanciful but a real danger:
Data from surveys in Oregon of people seeking physician assisted suicide showed that of those responding 48.9% cited “Burden on family, friends/caregivers” as one reason for their decision. The risk that individuals will feel such pressures is clearly a real one. (para 104)
The Court also was alert to the danger of pressure being applied later in the process, perhaps after the lethal medication was made available, on a person to proceed despite doubts or a more positive outlook:
Also, the court would look at the position at a particular point in time and would not pick up cases where the individual concerned had doubts or their mood changed later on, but might come under pressure to proceed despite this. (para 104)
Under the VAD Bill, once the lethal substance is provided there is no subsequent check on a person’s decision making capacity or freedom from coercion or undue influence. There is a very real danger that a person who wants to change their mind about taking the lethal substance may feel pressure from others to go ahead anyway.
Supporters of assisted suicide can list any number of alleged safeguards in the Bill. None of these address the central issue identified by the High Court as a good public policy reason to maintain a comprehensive ban on assisted suicide.
As British neurosurgeon and advocate for assisted suicide Henry Marsh has argued, it does not matter “if a few grannies get bullied into [assisted suicide], isn't that the price worth paying for all the people who could die with dignity?”
Do you think it is a price worth paying?
The High Court of Justice has decided it is too high a price to pay.
I hope you will too.
Tuesday, 10 October 2017
It is extraordinary that Andrew Denton can keep a straight face when he claims that the Netherlands is a model of transparency in euthanasia practice that can be confidently taken as evidence that legalising euthanasia or assisted suicide can be done safely – but then he is a comedian by profession.
I found nothing ‘slippery’ or underhanded about what they were doing. The systems in Belgium and the Netherlands are based on full and transparent disclosure – where every case is reported and reviewed by peer committees, aligned with the coroner’s office, and with the power to report doctors to state prosecutors for any breaches.
The latest detailed data published by Statistics Netherlands shows that nearly 1 in 4 (23.96%) of cases of explicit killing by euthanasia or assisted suicide are not reported, although reporting is legally required.
Legalising euthanasia and assisted suicide empowers doctors to kill their patients.
In 2015, in the Netherlands some 431 patients were killed by doctors without there being any explicit request from the patient and no legal basis for their deadly action. None of these cases has been investigated.
Altogether in 2015 there were 7,254 deaths caused intentionally by lethal medication – 6,672 deaths by euthanasia with a request; 431 deaths by euthanasia with no explicit request; and 150 deaths by assisted suicide.
This represents nearly one in twenty (4.93%) of all deaths in the Netherlands.
Most tellingly, more than one in ten (10.5%) of all deaths (other than sudden and expected deaths) of 17-65 year olds in the Netherlands are caused intentionally by euthanasia or assisted suicide.
These figures are relevant for Victoria because the Voluntary Assisted Dying Bill 2017 includes provision for euthanasia, which is the direct administration by a doctor of a lethal poison, controlled substance or drug of dependence, in some cases.
The only requirement to opt for euthanasia over self-administration (suicide) is for the administering doctor to certify that he or she is satisfied that a person “is physically incapable of the self-administration or digestion of the” lethal poison.
This condition is not subject to any confirmation or investigation by a third party before a VADPAP – a voluntary assisted dying practitioner administration permit is issued.
Physically incapable of self-administration could include having a shaky hand or poor eyesight.
Physically incapable of digesting may include a dry mouth making swallowing difficult or a tendency to regurgitate (a common complication of assisted suicide.)
Both assisted suicide and euthanasia are available in the Netherlands. In 2015 some 97.8 % of people opted for euthanasia over assisted suicide.
If the VADPAP becomes more popular in Victoria than the VADSAP – the voluntary assisted dying self-administration permit – then the numbers choosing nice, safe doctor administered death may over time creep closer to those in the Netherlands.
Even if the VADSAP were to be more common there are still many dangers associated with assisted suicide as demonstrated in the latest data from the State of Washington, released last month.
This latest data confirms that once assisted suicide is legalised use of it increases from year to year, seemingly without limit.
Deaths from lethal drugs prescribed under the Act have nearly quadrupled (376%) from 51 in 2010 to 192 in 2016, increasing by 13.6% from 2015 to 2016 alone.
Some 59% of those for whom a prescription for lethal drugs was provided did not cite any concern about pain control as a reason for asking for the prescription.
However, 87% cited concerns about loss of autonomy and 51% cited concerns about being a burden on family, friends or caregivers.
Significantly, 8% cited concerns about the financial implications of treatment.
Only 5% of those given a lethal prescription were referred to a psychiatrist or psychological for evaluation.
In some cases, the prescribing doctor knew the patient for less than a week before writing the prescription, and in more than half the cases (53%) the doctor knew the patient for less than 25 weeks.
In 2016, one person took 11 hours to lose consciousness after ingesting the lethal dose and one person took 22 hours to die after ingesting the lethal dose.
In 2016 in some 4% of cases, the lethal dose was regurgitated, double the rate in the previous year.
This may be related to the use of new experimental cocktails of lethal drugs being used since the price of the previously used drugs, secobarbital and pentobarbital (Nembutal), escalated.
The first of the new cocktails is a mix of phenobarbital, chloral hydrate and morphine sulfate. It was used in 88 cases in 2015, and 44 cases in 2016.
The second experimental cocktail includes morphine sulfate, propranolol, diazepam, digoxin and a buffer suspension. It has been used in 2 cases in 2015 and 22 cases in 2016.
It appears that similar experimental lethal cocktails will be authorised for use by Department of Health and Human Services public servants charged with issuing VADSAPs.
As in the VAD Bill, there is no requirement under the Washington Act for a physician or any other person to be present when the lethal dose is ingested.
Since 2009, there have been 200 cases where no health-care provider was present when the lethal dose was ingested and a further 104 cases where it is not known if a health-care provider was present.
In other words, in some 304 cases people have died ingesting a dose of lethal medication, legally prescribed under Washington law, and nobody knows whether the person freely ingested the lethal dose or they were cajoled, coerced or forced to do so by another person.
I encourage you to carefully consider the implications for vulnerable Victorians before taking the community down this dangerous path.
Thursday, 5 October 2017
On 19 September 2017, just two days before the assisted suicide bill (euphemistically called the Voluntary Assisted Dying Bill 2017) was introduced respectively into the Legislative Assembly, the American College of Physicians published its updated position paper on Ethics and the Legalization of Physician-Assisted Suicide in its prestigious Annals of Internal Medicine.
The American College of Physicians is the largest medical specialty organization in the United States, with members in more than 145 countries worldwide. ACP membership includes 152,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness.
Its position on assisted suicide is therefore of great interest, not just in the United States, but here in Victoria.
The Position Paper considers – but rejects - the argument for assisted suicide based on patient autonomy:
Some have advocated strongly, on the basis of autonomy, that physician-assisted suicide should be a legal option at the end of life. As a proponent of patient-centered care, the American College of Physicians (ACP) is attentive to all voices, including those who speak of the desire to control when and how life will end. However, the ACP believes that the ethical arguments against legalizing physician-assisted suicide remain the most compelling. On the basis of substantive ethics, clinical practice, policy, and other concerns articulated in this position paper, the ACP does not support legalization of physician-assisted suicide. It is problematic given the nature of the patient– physician relationship, affects trust in the relationship and in the profession, and fundamentally alters the medical profession's role in society.
The Paper stresses that the real, practicable and ethical alternative to assisted suicide is to properly address the needs of patients at the end of life and their families.
Society's focus at the end of life should be on efforts to address suffering and the needs of patients and families, including improving access to effective hospice and palliative care.
Access to state-of-the-art symptom control remains limited for all dying patients. Of particular concern, evidence of ethnic and racial disparities in access, outcomes, and communication is increasing. Many patients fear they will not receive appropriate end-of-life care when they need it. Others are concerned about being a financial, physical, or other burden on their family, losing autonomy or control, or being placed in a long-term care facility. Some are alone or lonely; loneliness has a mortality risk similar to that of cigarette smoking, yet its health implications are underappreciated. Many persons approaching death are clinically depressed or have other psychiatric comorbid conditions, and some contemplate suicide. According to Wilson and colleagues, “the expression of a desire for death by a terminally ill patient should raise a suspicion about mental health problems; by itself, however, it is not definitively diagnostic of one”. This desire fluctuates over time and may be related to inadequate symptom management. Medicine can and should ameliorate many of these problems; some, however, are outside the scope or goals of medicine and should be addressed in other ways.
The Paper also highlights social justice issues connected with assisted suicide.
Legalization of physician-assisted suicide also raises social justice issues. Society and the medical profession have duties to safeguard the patient–physician relationship and human dignity. These duties apply especially to the most vulnerable members of society: the sick, the elderly, children, the disabled, the poor, minorities, and others.
Some individuals might view themselves as unproductive or burdensome and, on that basis, as candidates for assisted suicide, especially if a physician raises it or validates a request.
This is a very valid concern as the data from Oregon shows that in 2016 nearly one out of two (48.87%) people who died after taking prescribed lethal medication cited concerns about being a “Burden on family, friends/caregivers” as a reason for the request.
Does the concern about being a burden originate solely from the person or is it generated by subtle (or not so subtle) messages from family, friends and caregivers - including physicians - who find the person to be a burden or a nuisance or just taking too long to die?
Elder Law expert Margaret Dore has commented:
In both Washington and Oregon, the official reporting forms include a check-the-box question with seven possible "concerns" that contributed to the lethal dose request. These concerns include the patient's feeling that he was a "burden." The prescribing doctor is instructed: "Please check 'yes,' 'no,' or 'don't know' depending on whether or not you believe that a concern contributed to the request." In other states, a person being described as a "burden" is a warning sign of abuse. For example, Sarah Scott of Idaho Adult Protection Services describes the following "warning sign": "Suspect behaviour by the caregiver . . . [d]escribes the vulnerable adult as a burden or nuisance." The recommendation is that when such "warning signs" exist, a report should be made to law enforcement and/or to the local adult protective services provider. Washington and Oregon, by contrast, instruct its doctors to check a "burden" box. Washington and Oregon promote the idea that its citizens are burdens, which justifies the prescription of lethal drugs to kill them. Washington's and Oregon's Acts do not promote patient "control," but officially sanctioned abuse of vulnerable adults.
The ACP Position Paper also refers to the link between legalizing assisted suicide and an overall increase in the suicide rate, especially among the elderly:
Physician-assisted suicide laws have been associated with a 6% increase in total suicides (15% in those older than 65 years) in the states where physician-assisted suicide is legal, controlling for state-specific time trends.
The American College of Physicians acknowledges the valid concerns from disability groups.
Vulnerable communities and individuals raise strong concerns that legalization leads to attitudinal changes, subtle biases about quality of life, and judgments that some lives are not worth living. National disability groups are opposed to physician-assisted suicide.
Rather than just rejecting assisted suicide as incompatible with the proper goals of medicine as well as the common good, the ACP’s Position Paper sets out a very helpful 12 step program for caring for patients at the end-of-life who may at some stage request assisted suicide:
Regardless of jurisdiction, physicians may encounter patients who request physician-assisted suicide (or express fear of suffering with death). Patient concerns and reasons for the request should be discussed thoroughly. As for all patients nearing the end of life, the physician should:
Be present, listening to the patient and keeping dialogue open, exploring the reasons for the request, trying to understand its meaning and seeking alternative solutions where possible.
Affirm that he or she will care for and not abandon the patient, accompanying and advising the patient through the journey of end-of-life care (studies suggest “the desire to hasten death is future focused and appears to be related to fear of distress and not coping, rather than with current levels of distress or coping ability”.
Discuss patient goals of care and the nature of curative and comfort care, explaining a both/and approach to disease-oriented and palliative care as well as an either/or approach and asking, for example, how do you hope I can help you?
Facilitate advance care planning and an understanding of surrogate decision making, as desired by the patient.
Ensure that the patient is fully informed of the right to refuse treatments and what that entails.
Discontinue or do not start medications and interventions that interfere with the patient's values, goals, and preferences.
Assess and treat the patient's pain and other distressing physical and psychological symptoms.
Assess and optimize patient function through a whole-patient focus.
Coordinate, as desired by the patient, the efforts of other members of the health care team, and use community-based resources to address financial, emotional, and spiritual burdens on the patient and family.
Prepare the patient and family for what they can expect as illness progresses, addressing uncertainty together and ensuring that the patient and family have informed expectations, including, for example, an understanding that advanced illness often entails a natural loss of appetite and thirst.
Regularly assess the patient's status and decision-making capacity.
Arrange hospice care at home if that is the patient's preference, being cognizant that palliative and hospice care expertise should be used as early as is indicated. Many patients in the United States receive such care too late or not at all.
None of the processes that would be set up under the Voluntary Assisted Dying Bill 2017 would help facilitate such a thorough, thoughtful, helpful approach to end of life care. Instead the Bill would put in place a tick a box, form filling, one way process that ends with a person, possibly alone, ingesting an experimental cocktail of lethal drugs or being injected by a doctor with a deadly poison.
Victorians deserve better. The ACP’s twelve step program points the way.
Tuesday, 3 October 2017
In an unusual display of bipartisanship, five Democrats and five Republicans have cosponsored a resolution in the United States House of Representatives warning that “assisted suicide (sometimes referred to as death with dignity, end-of-life options, aid-in-dying, or similar phrases) puts everyone, including those most vulnerable, at risk of deadly harm and undermines the integrity of the health care system.”
The resolution recites in its twenty-two preambular paragraphs a series of substantial reasons for opposing the legalisation of assisted suicide, regardless of the particular euphemism used to describe its harsh reality.
The first reason given is that, while “society has a longstanding policy of supporting suicide prevention” introducing “a public policy of assisted suicide” directly undermines this.
The so-called Voluntary Assisted Dying Bill 2017 would adopt as public policy in Victoria the availability of State approved assisted suicide for some members of the community, directly undermining Victoria’s Suicide Prevention Framework.
The Bill is particularly egregious insofar as it proposes a formal permit to be issued by the Secretary of the Department of Health and Human Services or any public servant to whom the Secretary delegates the power. This permit is to be called by the Orwellian title of “a voluntary assisted dying self-administration permit” (VADSAP). It will specify the person who is thereby authorized by the State to commit suicide and the particular poison to be used.
It is difficult to think of anything a State could do that more directly contravenes the fundamental message of all suicide prevention programs – that everyone’s life is of value and that there is always hope.
World Suicide Prevention Day 2017 was observed on 10 September with the theme “Take a minute, change a life”.
In Victoria, if Parliament votes for the assisted suicide bill, public servants will take a minute to issue a suicide permit to end a life.
The bipartisan resolution goes on to identify the groups most at risk from assisted suicide: people who are elderly, experience depression, have a disability, or are subject to emotional or financial pressure to end their lives.
None of the so-called safeguards in the Bill provides effective protection for these groups of people.
The resolution cites the very telling data from Oregon that proponents of assisted suicide never cite because it undermines the narrative on which they are marketing assisted suicide, namely that it is ONLY for a very small group of people who have unrelieved pain or other severe physical symptoms that cannot be helped by palliative care.
The Oregon Health Authority’s annual reports reveal that pain or the fear of pain is listed second to last (25 percent) among the reasons cited by all patients seeking lethal drugs since 1998, while the top five reasons cited are psychological and social concerns: “losing autonomy” (92 percent), “less able to engage in activities that make life enjoyable” (90 percent), “loss of dignity” (79 percent), “losing control of bodily functions” (48 percent), and “burden on family friends/caregivers” (41 percent).
The Bill would facilitate assisted suicide on the basis of “suffering” which “cannot be relieved in a manner that the person considers tolerable” (Clause 9 (1) (d) (iv)). This subjective approach to suffering is broad enough to encompass all the reasons given by Oregonians for requesting assisted suicide, including feeling like a burden on family.
The resolution also points to the flaws in the process set up in Oregon and the handful of other US States that have copied that model, including:
no requirement to “receive psychological screening or treatment, though studies show that the overwhelming majority of patients contemplating suicide experience depression”
The Bill does not provide for screening for depression but only suggests optional referral for decision-making capacity, that is the ability to understand basic information about the person’s condition and about assisted suicide. Most people committing suicide have full decision-making capacity but need help overcoming depression and other drivers of suicidal ideation. The Bill does nothing to facilitate such help.
no requirement for a medical attendant to be present at the time the lethal dose is taken, used, ingested, or administered to intervene in the event of medical complications
The Bill does not provide for a health professional to be present at the time of suicide by poison. See information on medical complications in Oregon here.
no requirement that a qualified monitor be present to assure that the patient is knowingly and voluntarily taking, using, ingesting, or administering the lethal dose
The Bill does not provide for a monitor to be present at the time the poison is taken, nor even require that the person have decision-making capacity at that time, which may be months or even years after the poison was provided.
The resolution concludes:
That it is the sense of the Congress that the Federal Government should ensure that every person facing the end of their life has access to the best quality and comprehensive medical care, including palliative, in-home, or hospice care, tailored to their needs and that the Federal Government should not adopt or endorse policies or practices that support, encourage, or facilitate suicide or assisted suicide, whether by physicians or others.
Victoria would do well to adopt this wise and thoughtful approach to end-of-life care rather than facilitating the suicide of its citizens.
Thursday, 28 September 2017
In her second reading speech introducing the Voluntary Assisted Dying Bill 2017, Victorian Minister for Health, Jill Hennessy, opened with a declaration that “Far too many Victorians have suffered too much and for too long at the end of their lives”.
She made much of the evidence from the Coroner to the End of Life Choices Inquiry, falsely claiming that “the Coroner indicated that one terminally-ill Victorian was taking their life each week”. However, a careful scrutiny of the actual evidence from the Coroner’s Court shows that this claim is significantly exaggerated as at least half of those in the cohort studied were definitely NOT terminally ill and so would not be legible for access to assisted suicide under the Bill.
Nor was it the case that nothing else could have been done for these people as Dr Jeremy Dwyer the Manager of the Coroners Prevention Unit which conducted the study acknowledged.
Minister Hennessy proposes in effect that the only thing that will be offered to Victorians distressed by deteriorating physical health to prevent them dying horrible deaths alone by suicide is for the State of Victoria to issue them with an assisted suicide permit so they can pick up a bottle of lethal drugs to take home - and still die a lonely death by suicide, perhaps with horrible complications.
The Minister for Health’s new suicide framework for Victoria is apparently "Suicide Prevention for (some) Victorians — Suicide Permits for Other Victorians."
The Minister for Health chooses to ignore the expert evidence from Palliative Care Victoria, the warnings from three former Victorian AMA Presidents, the letter from 101 oncologists and many others that the proper response to evidence that some Victorians are suffering unacceptably at the end of life is to provide funding to close the identified gaps in the equitable provision of palliative care across all sectors in Victoria.
The detailed processes proposed by the Bill do nothing to ensure that assisted suicide or euthanasia does not become a “go to” option instead of ensuring every Victorian is readily able to access gold standard palliative care.
Despite it being well known that many doctors, who have not undergone specialist training in palliative care, are quite ignorant of what modern palliative care can do the Bill simply requires the two doctors assessing a person’s request for assisted suicide or euthanasia to “inform the person about palliative care options and the likely outcomes of that care”. There is NO requirement that either doctor have the necessary training, experience or knowledge to ensure that the person is properly informed about modern palliative care.
It is surely irresponsible not to actually refer a person, who under the Bill’s requirements is supposedly experiencing suffering “that cannot be relieved”, to a palliative care specialist for a full and thorough palliative care assessment.
The Bill simply adopts a checklist, tick a box approach. Somehow the Minister is imagining that merely requiring assessing doctors to mention palliative care is sufficient to ensure that people “will never turn to” assisted suicide or euthanasia because they have not been provided with palliative care.
The Minister also suggests that for some people simply being prescribed the lethal drugs and having them to hand will be sufficient to give them a “greater sense of control”. This alleged placebo affect raises serious doubts about the major premise of the Bill — that assisted suicide or euthanasia is necessary to end the suffering of some Victorians. Apparently a sugar tablet labelled POISON might work just as well.
Tuesday, 26 September 2017
The Voluntary Assisted Dying Bill 2017 was tabled in the Victorian Legislative Assembly on Thursday 21 September 2017. The Bill, it has been repeatedly claimed by Premier Daniel Andrews, would set up a system that was the “most conservative, careful, and safest in the world”.
Some simple fact checking shows this to be a big fat lie.
Victoria’s scheme has an eligibility catchment twice that of Oregon’s: 12 months to live rather than 6 months. Errors in prognosis and diagnosis mean many Victorians with years to live could be assisted to suicide and die unnecessarily.
Victoria’s scheme does not allow the assessing doctors to question whether the person’s suffering is genuinely unrelievable; the Netherlands scheme requires two doctors to hold the conviction, after due care, that the person’s suffering is lasting and unbearable. Under the Victorian scheme persons whose suffering is purely existential or that is able to be relieved by good palliative care could still be assisted to suicide.
Victoria’s scheme does not require assessing doctors to consider whether a person’s request for assisted suicide is affected by depression or other mental health disorders; Oregon’s scheme requires doctors who suspect this to refer a person to a psychiatrist or psychologist. Under Victoria’s scheme persons who are suicidal because of depression can still be assisted to suicide provided two doctors think the person understands what they are doing. Most people who commit suicide understand what they are doing but we still try to prevent it.
Victoria’s scheme offers both assisted suicide or for anyone who feels physically unable to self-administer the deadly drugs it offers euthanasia by the doctor; Oregon only allows assisted suicide. The far higher take up rate in the Netherlands and Belgium where both euthanasia and assisted suicide are on offer suggests the Andrews government estimate of 150 Victorians per year accessing assisted suicide or euthanasia is likely a significant underestimate.
Victoria’s scheme unlike Oregon’s does not require reporting on the nature of the suffering or the reasons for persons requesting assisted suicide. Victorians won’t know if, like in Oregon, twice as many people choose assisted suicide because they feel like a burden than out of concern for physical pain.
Thursday, 21 September 2017
British neurosurgeon and advocate for legalising assisted suicide Henry Marsh has argued that “Even if a few grannies get bullied into [assisted suicide], isn't that the price worth paying for all the people who could die with dignity?”
As you consider your position on the Voluntary Assisted Dying Bill 2017 one key question to ask is how sure can you be that the provisions of the Bill will only apply to a small, well-defined group of people, imminently dying and in otherwise unbelievable physical pain who freely and without any kind of pressure or coercion choose to request assisted suicide? (Assuming, contrary to the evidence from palliative care Victoria that there is pain that can’t be relieved.)
Many people hold the view that the death penalty may be justified in a particularly horrific case. However, such people may still reject the reintroduction of the death penalty because they are not convinced that any proposed regime would ensure that not even a single innocent person is put to death wrongly by the State. The same test should be required for any regime claiming a safe approach to assisting the suicide of certain Victorians.
Some of the categories of people who may be at risk from the Voluntary Assisted Dying Bill are:
People wrongly diagnosed with a terminal illness or with an inaccurate prognosis who may have years to live;
People without access to gold standard palliative care or deflected from seeking palliative care through the availability of assisted suicide who are suffering unnecessarily;
Elderly people who are overtly or subtly made to feel a burden by family members or carers with “inheritance impatience”
People with mental illness especially undiagnosed depression that could be treated;
People with disabilities who are often told by others that would “be better off dead”;
Suicidal young people who may not distinguish a message that suicide is a good, wise choice for some Victorians (the terminally ill) but not for them.
Think about these Victorians as you consider whether legalising assisted suicide would be good or bad public policy.
Tuesday, 19 September 2017
When discussing assisted suicide and euthanasia, details, scenarios, and opinions can seemingly complicate the matter.
But the question is simple: should we allow doctors to intentionally assist a person in suicide?
Everyone would want the very best of care at the end of life, and to receive the best pain and symptom management possible.
No one wants to prolong suffering – we want to provide the most relief and comfort possible. However, the issue really isn’t about pain; it’s about fear.
Do we give in to fears or learn to deal with them? Do we abandon people to such fears or do we help them to work through them?
These are tough questions, but there is another, grave question that must be answered: do we make public policy for the common good or do we make fundamental changes to our laws on homicide for the few?
These kinds of questions know no conventional political divide. Euthanasia and assisted suicide voting records really don’t line up with any other issue.
Ultimately, euthanasia and assisted suicide legislation blurs the line between killing out of compassion and killing out of fear.
Such an issue requires careful consideration and debate.
Thursday, 14 September 2017
At other times and in other places bills have been called, ‘dying with dignity’, ‘dignity with dying’, ‘rights of the terminally ill’, ‘end of life options’ etc., but they all really amount to much the same thing.
Why is it that we cannot simply call the ‘Voluntary Assisted Dying Bill’ the ‘Assisted Suicide and Euthanasia Bill’?
It wasn’t that long ago in Australia that we did just that. Why the change? Why the euphemism?
Words do matter and the use of proper terms matters – especially when we are talking ‘life or death’ situations and such a fundamental shift in public policy.
Tuesday, 12 September 2017
Up until the last few years, most bills presented in Australia’s Parliaments on this issue have focussed on euthanasia and not so much on assisted suicide.
Yet with the data and anecdotes from both Holland and Belgium increasingly showing significant problems in recent years and with the more recent Canadian experiment also developing problems, it is perhaps understandable that supporters of some form of legalised early death would turn to Oregon as a model.
But is Oregon a model worth following?
Oregon’s website describes the data collection protocol for its annual reports, as follows:
“The identity of participating physicians is coded, but the identity of individual patients is not recorded in any manner. Approximately one year from the publication of the Annual Report, all source documentation is destroyed.”
Alicia Parkman, Mortality Research Analyst for the Oregon Health Authority, makes a similar representation as follows:
To ensure confidentiality, our office does not maintain source information on participants.
(See appendix at A4 in this deposition.)
The significance is that Oregon’s annual reports cannot be verified to source documentation.
Even so, research and the annual reports from Oregon do show some alarming concerns. Issues with administration, short or no pre-existing doctor/patient relationships, deaths that were far from ‘peaceful’, wrong prognoses, mental health concerns, etc. paint a very different picture.
Many of these risks cannot be adequately dealt with.
Please, don’t put the people of Victoria at risk!
Thursday, 7 September 2017
Doctors who know what they're talking about say it's hard enough to give a prognosis of six months to live. For 12 months, it's almost impossible!
What does '12 months or less to live' really mean? How accurate is a prognosis that far out?
The Ministerial Advisory Panel report suggested an upper limit for qualification for assisted suicide and/or euthanasia should be that a person “be diagnosed with an incurable disease, illness or medical condition that… is expected to cause death within weeks or months, but not longer than 12 months.”
If a week is a long time in politics, then can we expect prognostication as far out as 12 months to be accurate?
The answer from the research and from common sense really is, no. Not only is a prediction so far out really 'guess work,' but the diagnosis may be wrong and treatments may be successful.
Earlier last week we introduced you to Jeanette Hall — her remission has given her 17 more years of life and more to come!
And Jeanette is not the only person to have outlived her '6 months or less to live' prognosis in either Oregon or Washington state.
The further out from the expected death, the less accurate the prognosis becomes. Six months is not safe; 12 months is certainly even more unsafe!
You can learn more about the problems with prognosis by downloading our new FACT SHEET: Assisted suicide: “death expected in not longer than 12 months.”
Thursday, 31 August 2017
Australia’s population is aging at a growing rate. At the same time, economic pressures and rising house prices are making it increasingly difficult for younger Australians and Australian families to get established in property.
Into that mix we find the trend of Elder Abuse; often called ‘inheritance impatience’.
Apart from the abuse itself, it is largely characterised as a hidden epidemic: hard to detect and under reported.
Whether the sense of ‘being a burden’ is internal or external to the person – or both – it remains a significant public policy challenge to eradicate elder abuse and is a very real concern in regards to consent for assisted suicide and euthanasia. There will be circumstances where subtle coercion and abuse may go undetected.
As Dutch academic, Henk Reitsema points out:
“Before it becomes a legal option, caring for someone who needs care is just the human thing that you do. But once they have the option to 'choose' to let their lives be ended, their not doing so is to choose to burden their next of kin - and that's unfair!”
Our elders deserve better!
Tuesday, 29 August 2017
Meet Jeanette Hall. Jeanette has survived her cancer prognosis by 17 years and still loves life!
But if she had been referred to a different Oncologist in Oregon in 2000, it might have been different.
The Ministerial Advisory Panel’s final report cited the Hall case as proof that the law in Oregon works. Jeanette’s Oncologist, Dr Stevens responded:
Their conclusion [the MAP] is not the conclusion that Jeanette Hall or I would use. Jeanette was saved because she saw a doctor (myself) who did not believe in assisted suicide. She strongly believes that if she had been under the care of a doctor who believed in assisted suicide that she would now be dead. Instead she is alive 17 wonderful years later.
Friday, 25 August 2017
Polls released in Victorian newspapers last weekend suggest that between 66 and 86 per cent of Victorians support assisted suicide and euthanasia.
Are these polls an accurate reflection of Victorian sentiment on the issue?
Are these polls based upon people having a solid understanding of the subject?
70% becomes 51%
The Sexton Marketing Group poll from July this year in selected Victorian electorates returned a similar headline number; 70% support to be precise.
But the addition of one simple further question saw support drop to 51%. Providing information improves literacy on the subject and has been shown repeatedly to collapse support.
More information, precise language rather than euphemisms, and the explanation of alternatives to assisted suicide and/or euthanasia all change the polling outcomes.
You can’t ignore polling, but it is legitimate to question precisely what the poll really tells us.
Given the low level of public literacy on this subject across Australia, the only solid conclusion we can arrive at is to note that a significant proportion of the population is deeply concerned that people should not suffer at the end of their lives.
Wednesday, 23 August 2017
What is it with disability and assisted suicide and euthanasia?
Why do disability advocates across the globe hold such grave concerns?
Last week local and interstate disability advocates came to the Victorian Parliament to tell their story. As they said; they are the ‘small voices’ and ‘that’s why you [MPs] need to listen!’
“We can't have assisted dying when we don't have the resources to live and live well.”
“I'm really concerned that it frames disabled lives as inherently less than other lives, and when we live in a world that values us, in a myriad of ways, as being less than non-disabled people anyway, I really think it is opening up for a really dangerous and lethal space for people living with disabilities.”
— Jax Jacki Brown
Please take the time to learn more about why many people living with disability fear the outcome of this issue. Click here for the short videos and testimonies.
Coroner John Olle’s evidence presented to the End of Life Choices inquiry has had an instrumental role in the discussion on legalising assisted suicide in Victoria. Yet, careful examination of the evidence presented to the inquiry shows that a decision to legalise assisted suicide on that basis would be unfounded. Among the reasons are:
Many in this cohort would not qualify: Of the 240 suicide cases between 2009 and 2013 included in the study by the Coroners Prevention Unit, 54 (22.5%) had chronic health issues resulting from injuries. None in this group would appear to self-evidently qualify for eligibility under the Andrews government’s proposed criteria.
There are other options: The Coroner claims that no one in this cohort qualified for palliative care. However, this appears to be based on a very narrow concept that palliative care only applies to the last days of life.
Depression and suicidal ideation: Of the 5 case studies presented by the Coroners Court in its initial submission, 4 mention factors that could motive suicide independent of physical health issues.
Facts matter: a simple analysis shows that the Coroner’s words are no basis for assisted suicide. Read the full fact sheet here.
Tuesday, 8 August 2017
There are always people who suffer from the unintended consequences of the legalisation of assisted suicide in places where it is permitted.
Meet Stephanie Packer.
Stephanie Packer is a mother of three, living in California. Her chemotherapy treatment was approved by her insurer, and then subsequently – and abruptly – declined after the assisted suicide legislation was passed.
You allowing those patients to make that choice affects me negatively, and affects my fight and my ability to stay with my children. I want to carry on. I want to do everything I can to have one more second with my kids and as soon as this law was passed, and you see it where these laws are passed, patients fighting for a longer life will always be denied treatment because this will always be the cheapest option.
Friday, 4 August 2017
Today’s article in the The Australian says it all – marginal seats are in trouble over assisted suicide.
Here a just a few of the key numbers:
8% — is the number of Victorians whose primary voting intention have moved away from the major parties in marginal seats. These voters are indicating they will vote for independent and minor parties and make the outcomes of seats dependent on preferences.
26% — is the number of Victorians who change their view of assisted suicide laws once they hear that there is no consensus in medical opinion on this issue.
77% — is the number of Victorians who have serious underlying concerns about assisted suicide including the funding and availability of palliative care.
33% — is the number of Victorians against assisted suicide who will change their vote at the state election on the strength of this issue. And the numbers of faith based and multicultural voters are even higher. Read more: Victorian euthanasia laws: Right-to-die vote to play critical role in next state election – Herald Sun.
Thursday, 3 August 2017
The Ministerial Advisory Panel report provides for a period of 10 days between a person making an initial and final request for assisted suicide, upon which a person is then able to receive their prescription for lethal drugs.
This is shorter than:
the notice period required for a couple intending to marry;
the standard processing time for the issue of a death certificate at the Victorian Registry of Births, Deaths and Marriages;
the average time a public patient in Victoria needs to wait before receiving cardio-thoracic surgery;
the notice period required for the issue of a firearm in Victoria; and
the statutory time period given to respond to a notice from a neighbour of their intention to build a fence.
Tuesday, 1 August 2017
HOPE wants all Members of the Victorian State parliament to have the facts on assisted suicide and the impact it has on your electorates.
Here are three numbers from our recent polling that you need to be aware of:
59% — is the number of Victorians that said the lack of consensus amongst doctors and the medical associations like the AMA was the single biggest factor in informing their view on assisted suicide legislation. Read more: “Doctors warn Victoria against euthanasia move” — ABC.
61% — is the number of Victorians who want this whole process slowed down or stopped altogether. Read more: Voters 'wary of rushing euthanasia laws, don't trust MPs to get it right' — The Australian.
33% — is the number of Victorians against assisted suicide who will change their vote at the state election on the strength of this issue. And the numbers of faith based and multicultural voters are even higher. Read more: Victorian euthanasia laws: Right-to-die vote to play critical role in next state election — Herald Sun.
This poll was taken in May of this year across 1029 Victorians. Margin of error: ±3.2% at a 95% level of confidence. Representative of the Victorian adult population, by age, gender and geographic coverage. ISO-20252 standards and Australian Privacy Principles applied to this poll.