MP Updates: Victoria

Thursday, 16 November 2017

The term “aged care” appears only once in the Voluntary Assisted Dying Bill 2017.

This in itself is a significant indicator that the Andrews government has failed to consider the likely impact of this Bill on the 60,000 or so Victorians with complex care needs due to a high burden of chronic disease who are living in residential aged care facilities.

There is currently a lack of palliative care services for people in residential aged care. Palliative Care Victoria has called for an investment of $13 million per year to provide for one specialist palliative care team per 33 residential aged care facilities. The team would provide proactive and responsive specialist clinical support for aged care staff and GPs caring for residents with complex needs.

Neither the $140 million extra funding for Palliative Care Victoria pledged by the Liberals and Nationals on 21 August 2017 nor the $55.65 million announced in a door stop by the Attorney General Martin Pakula and the Minister for regional Development Jaala Pulford cover this specific funding shortfall identified by Palliative Care Victoria.

The Bill’s one mention of “aged care” is in fact quite alarming. It is in Clause 124 of the bill which would amend Section 36E of the Drugs, Poisons and Controlled Substances Act 1981 to exempt a “voluntary assisted dying substance” – the lethal poison to be supplied under the Bill for self-administration – from the provision in that act requiring managers of residential aged care facilities to ensure that drugs of dependence and poisons are managed by a registered nurse.

The Bill only authorises the person to whom the lethal poisons are provided for the purpose of suicide to have possession of the poison. So if a resident in aged care facility is given the poison he or she must keep it in their room, perhaps under the bed, in a locked box.

Recently, national attention has been drawn to the tragic reality that up to 40 per cent of people in aged care homes never get visitors.

Palliative Care Victoria has estimated that up to 6,000 Victorians living in residential aged care may be eligible under the Bill for access to assisted suicide or euthanasia.

Legalising assisted suicide poses a particular threat to older Victorians who are living with loneliness in an aged care facility. Is the solution to this loneliness to give the older person a poison in a locked box for company?

The Bill does nothing to ensure that a lonely person in an aged care facility who has been supplied with a suicide poison doesn’t take that poison one day without telling anyone else. Perhaps because a relative has failed to come to visit or a staff member was rude or their favourite TV program was cancelled.

We can and must do better than this.

The Voluntary Assisted Dying Bill 2017 is ill-thought out. It has ignored the day to day reality of many Victorians living in aged care facilities without adequate palliative care and without visitors. It poses an unacceptable risk to these older Victorians and should be rejected.

Tuesday, 14 November 2017

The Legislative Council debate on the Voluntary Assisted Dying Bill 2017 will begin today with Clause 1 of the Bill likely to be subject to close scrutiny.

Clause 1 sets out the main purposes of the Bill and gives as the first of these "to provide for and regulate access to voluntary assisted dying". Only later in Clause 3 is it made clear that "voluntary assisted dying" means the administration of a "poison or controlled substance or drug of dependence... for the purpose of causing a person's death".

Any pretence that the Bill is not about "causing a person's death" can only be maintained by ignoring the definitions of the key term in the Bill.

Two key questions then to be considered are:

If the Bill passes, which Victorians will have their deaths caused under its provisions?
If the Bill passes, how will these Victorians die?

Supporters of the Bill maintain that only those who are certainly dying soon anyway and who freely choose to use the provisions in the Bill will be given the deadly poison either for self-administration (assisted suicide) or administration by a medical practitioner (euthanasia).

However, despite the extensive debate in the Legislative Assembly, serious questions remain about this claim:

If there is any error rate in the diagnosis of terminal illnesses such as cancer then some Victorians misdiagnosed as terminally ill will die unnecessarily by poison. (Error rate in cancer diagnosis is 1.4%).
If there is any error rate in a prognosis of 12 months to live then some Victorians will die prematurely who could have lived much longer. Jeanette Hall was told she had six months to live and had decided on assisted suicide under Oregon's law in 2000. Dr Stevens offered her treatment instead and she is still alive today, 17 years later. One study found that more than one in ten people given a prognosis of 12 months to live may live for 2 years or more.
If there is any failure to identify depression or other mental illness that is affecting a request for assisted suicide then some Victorians who could have had their depression successfully treated will unnecessarily die by poison. A study in Oregon found that one in six requesting assisted suicide were depressed but only one in 25 were referred to a psychiatrist.
If there is any discrimination or prejudice against people living with a disability in the community, including the health professions, then some Victorians with a disability will be considered a burden and better off dead by those around them. They may ask for assisted suicide because of these discriminatory attitudes and a lack of equal access to health care.
If there is any failure to identify coercion or undue influence then some elderly Victorians may be coerced, bullied or subtly influenced to request assisted suicide or euthanasia. The Bill allows a family member who expects to inherit to be the sole witness to an administration request for euthanasia, which is immediately followed by the person being lethally injected by a doctor. Elder abuse is a real issue and is not adequately addressed in the Bill.
If there is such a thing as suicide contagion then some Victorians, including young people, may commit suicide because of the promotion of assisted suicide under this Bill. In those US states where assisted suicide is legal the overall suicide rate has increased by 6.3% more than other states and the suicide rate for over 65 year olds by 14.5%.

The last Victorian to die with the formal approval of the State of Victoria was Ronald Ryan on 3 February 1967. In 1975 the Parliament of Victoria abolished the death penalty.

The same public policy considerations — especially the danger of even a single wrongful death — should lead the Legislative Council to reject the Voluntary Assisted Dying Bill 2017, which has a main purpose of introducing a scheme to cause the death of Victorians by the administration of a poison.

Friday, 10 November 2017

In an important article outlining inequalities in access to palliative care in regional Victoria compared to Melbourne, the Minister for Health Jill Hennessy is reported as having “rejected suggestions that patients suffering from poor access to palliative care were more likely to opt for voluntary assisted dying.”

If the Minister has been correctly reported, this reckless and heartless dismissal of a genuine concern is appalling.

The article was based on data released on 25 October 2017 by Palliative Care Victoria in a document entitled “Regional Inequalities in Access To Palliative Care Across Victoria”.

The data in this document demonstrates:

Lack of genuine choice for Victorians with life limiting illness in relation to access to palliative care.
Supply constraints on palliative care impeding access by Victorians who would benefit from palliative care prior to their death.
Significant regional inequalities in access to palliative care, when and where it is needed.

Funding of palliative care for admitted inpatients in the Hume Region for 2016/17 was a massive 57% less than the Victorian average per death.

In both the Barwon SW and Gippsland regions funding for palliative in the community, that is at home where many Victorians prefer to die, was 39% less than the Victorian average per death.

And total palliative care funding in Loddon Mallee was 22% less than the Victorian average per death.

Another area of serious shortfall in palliative care funding is in relation to elderly Victorians in residential age care.

In 2014/15, the latest year for which data is available, nearly 14,000 Victorians died in residential aged care. Only 1,740 of these Victorians received palliative care. About 8,750 were likely to have needed palliative care but did not receive it. This represents a shortfall of 82%. That is to say that more than four out of every five Victorians who die each year in aged care and who could have had their pain, suffering and discomfort relieved by palliative care cannot access that care.

The Liberal/ National pledge of $140 million for extra palliative care funding will go some way to meet these shortfalls.

It is possible that, in a cynical move to meet the concerns raised by several MLCs who supported the Voluntary Assisted Dying Bill at its second reading vote, the Andrews government might suddenly find the money and the will to match the Coalition pledge.

However, those who are genuinely concerned to ensure that every Victorian has equitable access to gold standard, world’s best practice palliative care – regardless of whether they live in regional or metropolitan Victoria, or die as an inpatient, a home, or in aged care – will understand that any such funding will take several years to produce such equitable access.

Victorians deserve better from the Minister for Health than a choice between no access to palliative care and facilitated access to the administration of a substance “for the purpose of causing the death of a person” as Ms Hennessy’s Bill puts it.

Thursday, 9 November 2017

If the Minister has been correctly reported, this reckless and heartless dismissal of a genuine concern is appalling.

The article was based on data released on 25 October 2017 by Palliative Care Victoria in a document entitled “Regional Inequalities in Access To Palliative Care Across Victoria”.

The data in this document demonstrates:

Lack of genuine choice for Victorians with life limiting illness in relation to access to palliative care.
Supply constraints on palliative care impeding access by Victorians who would benefit from palliative care prior to their death.
Significant regional inequalities in access to palliative care, when and where it is needed.

Funding of palliative care for admitted inpatients in the Hume Region for 2016/17 was a massive 57% less than the Victorian average per death.

In both the Barwon SW and Gippsland regions funding for palliative in the community, that is at home where many Victorians prefer to die, was 39% less than the Victorian average per death.

And total palliative care funding in Loddon Mallee was 22% less than the Victorian average per death.

Another area of serious shortfall in palliative care funding is in relation to elderly Victorians in residential age care.

The Liberal/ National pledge of $140 million for extra palliative care funding will go some way to meet these shortfalls.

Tuesday, 7 November 2017

The Voluntary Assisted Dying Bill 2017 passed its second reading in the Legislative Council on 3 November 2017 by a narrow margin of just 2 votes.

In the Legislative Assembly the Minister for Health and Attorney General knocked back every proposed amendment, essentially asserting that the Bill, as drafted, is perfect and cannot be usefully improved.

It remains to be seen whether this view on the perfection of the Bill will be abandoned by Minister Jennings in the Legislative Council in order to secure the necessary votes at third reading.

Serious concerns about the Bill as its stands were raised by at least four speakers who supported the Bill at second reading.

These concerns included:

Inequalities in access to palliative care in regional Victoria

Data released on 25 October 2017 by Palliative Care Victoria shows the extent of these inequalities:

Victorians in the Hume, Gippsland and Loddon Mallee regions have the worst access to palliative care with the average palliative care funding per death in 2016-2017 in those regions between 22% and 29% less than the average for all Victorians. None of the rural regions received palliative care funding per death equivalent to that provided in metropolitan areas.

Victorians in the Barwon SW and Gippsland regions face significant inequalities of access to community palliative care. The palliative care funding per death in those regions is 39% lower compared to the state average.
Doctor shopping

The Bill as it stands allows all assessments of a person’s decision making capacity and freedom of coercion to be made in a single visit to each of two doctors who may have never met the person before and never see the person with their family. There is no role mandated for a person’s regular treating doctor.

In fact the Bill positively facilitates doctor shopping by requiring a co-ordinating medical practitioner to keep searching for a second doctor to agree that the person is eligible if one or more consulting medical practitioners assess the person as ineligible.
Depression and mental illness

In a series of non-answers to questions about depression and its effect on decision-making capacity the Minister for Health steadfastly refused to admit that any further safeguards were needed in the Bill to protect people from deciding to access assisted suicide or euthanasia while depressed.

The New South Wales Voluntary Assisted Dying Bill 2017 currently before its Legislative Council requires a compulsory assessment of decision-making capacity by a psychiatrist or psychologist.

The Northern Territory’s Right of the Terminally Ill Act had a similar provision. But a review of the deaths under that Act found that, despite this requirement, at least two of the four people who were euthanased had depressive symptoms that were being inadequately treated, and that all four suffered from demoralisation that could have been better addressed.

So even a compulsory brief assessment by a psychiatrist will not guarantee protection for those suffering depression and demoralisation.
Elder abuse, including in aged care facilities

An article by Therese Alloui in the Herald Sun, 8 February 2017, was titled “Vulnerable elderly Victorians easy prey for abuse in nursing homes”. In that article it reports:

A spokeswoman for the Victorian Office of the Public Advocate said 60 per cent of cases brought to its attention involved financial abuse.

"We also see significant numbers of cases where vulnerable older people have been physically, verbally, emotionally or sexually abused,” the spokeswoman said. “Usually the abuser is a relative — often a child or their spouse — but residents of aged care facilities are particularly vulnerable to abuse by the people who are supposed to care for them".

“We have to ensure that residents of aged care facilities have the same rights and protections as others,” she said.

In addition to these concerns we still do not know anything about which of the poisons and drugs of dependence that meet the definition of a voluntary assisted dying substance will be used to cause the death of Victorians if the Bill passes a third reading.

I urge you, regardless of whether you support the idea of assisted suicide and euthanasia in principle, to carefully scrutinise each clause of this Bill before deciding to support it at the third reading.

Thursday, 2 November 2017

The key to the Voluntary Assisted Dying Bill 2017 is the voluntary assisted dying substance, defined in Clause 3 of the Bill to mean “a poison or controlled substance or a drug of dependence specified in a voluntary assisted dying permit for the purpose of causing a person's death”.

During the debate on the Bill in the Legislative Assembly the Minister for Health admitted that the Andrews government still had no idea which poisons would be used to cause the death of Victorians if the Bill was passed.

She said:

“on the issue of the assisted dying substance, the panel recommended and the government has accepted that, during the implementation period, research be done and that a university pharmacy compounding research body develop particular compounds that may be appropriate for assisted dying.

Obviously pharmaceuticals and the pharmaceutical industry are very rapidly evolving and there are very large amounts of research overseas.

[The] university pharmacy department [will] be retained for the purposes of looking at current research on this issue and what current compounds are used internationally.”

So the pressure is on for the university pharmacy department to deliver the perfect lethal cocktail by 19 June 2019 so the first Victorians can die by suicide on the Andrews government’s schedule.

This will not be the first time the pressure has been on to develop lethal poisons for human use.

In 1939 psychiatrist Paul Nitsche, head of the asylums in Saxony, developed the so-called “Saxon special path”, which pioneered the use of luminal to kill psychiatric patients by injection. It was found (by research!) that starving the patients first meant that a lower dose of luminal was required.

Luminal, under its better known name phenobarbital, was used, mostly in a cocktail with other drugs, in 107 (44.6%) of suicides carried out in 2016 under Washington State’s Death With Dignity Act and in 39 (29.3%) of suicides carried out in 2016 under Oregon’s Death With Dignity Act.

This lethal cocktail used in Washington and Oregon was made up of phenobarbital, chloral hydrate and morphine sulphate.

Kaiser Health News reported in December 2016 on problems with this experimental cocktail:

“But the combination turned out to be too harsh, said Dr. Robert Wood, a volunteer medical adviser for End of Life Washington.

“The chloral hydrate mixture was too caustic for some folks and our volunteers didn’t like using it,” because some patients became distressed, Wood said.

Most doses of lethal medication are bitter, often requiring patients to take anti-nausea drugs. But the new mixture was not only bitter but also caused a burning sensation in the mouths of some patients, said Glennon. “There was some profound burning,” she said. “We didn’t like working with it. As a volunteer, you want to reassure people. We’re about a peaceful, dignified death.”

So back to the experiments!

The next cocktail used by suicide doctors was a three drug mixture that includes diazepam, digoxin, and morphine.

However, a new problem emerged, as reported in the Seattle Times in March 2017:

“[Twenty percent] of the cases were three hours or more before death, which we think is too long,” said Robert Wood, a retired HIV/AIDS researcher who volunteers with the advocacy group End of Life Washington, in an email. “The longest was 31 hours, the next longest 29 hours, the third longest 16 hours and some eight hours in length.”

Patients and families are told to expect sleep within 10 minutes and death within four hours. When it takes far longer, family members get worried, even distressed, said Dr. Carol Parrot, a retired anesthesiologist who has prescribed drugs for dozens of aid-in-dying patients in Washington.

Suicide doctors are now experimenting with a four drug cocktail including diazepam, digoxin, morphine and propranolol.

This experimentation with lethal cocktails of drugs on people in Washington and Oregon must be what the Minister for Health referred to during debate on the Bill as “very large amounts of research overseas”.

The Oregon data shows that in 2016, for those for whom information is available, some 11.1% of people ingesting lethal drugs regurgitated them. Some six people in Oregon have regained consciousness after initially going into a coma, one of them after 3 days and 16 hours.

The interval from ingestion of lethal drugs to unconsciousness has been as long as one hour while the interval from ingestion to death been as long as 4 days and 8 hours.

The Washington data shows that 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. Seven people regurgitated the lethal medication. In 2014 one person suffered seizures after ingesting the lethal medication.

The Voluntary Assisted Dying Bill 2017 is being marketed to MPs by the Minister for Health as providing Victorians with new choices for “a good end of life and death”.

Instead the Bill would abandon suicidal Victorians to be the living laboratory subjects of experiments with lethal cocktails.

The suicide/euthanasia Bill should be rejected and more funding and effort put in palliative care and suicide prevention for all Victorians.

Tuesday, 31 October 2017

Margaret Dore, an experienced attorney specialising in elder law in Washington State, where assisted suicide is legal, has urged Victorian MPs to “to reject the proposed bill seeking to legalize assisted suicide and euthanasia.”

Her analysis of the Voluntary Assisted Dying Bill 2017, which would legalise euthanasia as well as assisted suicide, can be read in full here.

Dore points out that in “Oregon and Washington State, most people who die under their [assisted suicide] laws are elders, aged 65 or older. This demographic is already an especially at risk group for abuse and financial exploitation. This is true in both the US and Australia.

Elder abuse and exploitation perpetrators are often family members. They typically start out with small crimes, such as stealing jewelry and blank checks, before moving on to larger items or to coercing victims to sign over deeds to their homes, to change their wills or to liquidate their assets. Amy Mix, an elder law attorney in the US, explains why older people are especially vulnerable:

The elderly are at an at-risk group for a lot of reasons, including, but not limited to diminished capacity, isolation from family and other caregivers, lack of sophistication when it comes to purchasing property, financing, or using computers. Defendants are family members, lots are friends, often people who befriend a senior through church.

In some cases, elder abuse and financial exploitation are fatal. Consider People v. Stuart in which an adult child killed her mother with a pillow, allowing the child to inherit. The Court observed:

Financial considerations [are] an all too common motivation for killing someone.”

The Minister for Health claims that the Bill is safe because two doctors have to certify that they are satisfied that the person requesting assisted suicide or euthanasia is acting voluntarily and without coercion.

Dore rightly observes that this is not a real safeguard because:

In both Australia and the US, victims do not report abuse. For example, in Victoria, it is estimated that there are more than 20,000 unreported cases of abuse, neglect and exploitation each year and approximately 100,000 in Australia nationwide. Meanwhile, in the US, it’s estimated that only 1 in 14 cases ever comes to the attention of the authorities. Reasons for the lack of reporting include:

Many who suffer from abuse . . . don’t want to report their own child as an abuser.

Dore notes that as with the assisted suicide laws in Oregon and Washington State:

The bill allows a patient to administer the lethal dose in private, without a witness or doctor present. In addition, the drugs typically used are water and alcohol soluble, such that they can be injected into a sleeping or restrained person without consent. Alex Schadenberg, Executive Director for the Euthanasia Prevention Coalition, puts it this way:

With assisted suicide laws in Washington and Oregon [and with the proposed bill], perpetrators can . . . take a “legal” route, by getting an elder to sign a lethal dose request. Once the prescription is filled, there is no supervision over administration. Even if a patient struggled, who would know?”

I encourage you to read Margaret Dore’s full analysis and consider it carefully. She approaches the Bill with the eye of a lawyer who is experienced in helping elderly people who are being abused by family or financial predators. She demonstrates that the alleged safeguards in the Bill are illusory and the choice the Bill purports to give people is an illusion.

Elderly Victorians deserve a better deal than this assisted suicide and euthanasia Bill offers.

Thursday, 26 October 2017

Former prime minister Paul Keating has warned of the pressure legalising assisted suicide and euthanasia would put on people to choose to die prematurely to relieve their family of the burden of care:

[I]t is "commonplace" for patients to tell doctors in front of their loved ones that they have no wish to be a burden on families.

Once this bill is passed the expectations of patients and families will change. The culture of dying, despite certain and intense resistance, will gradually permeate into our medical, health, social and institutional arrangements. It stands for everything a truly civil society should stand against. A change of this kind will affect our entire community not just a small number of dying patients. It is fatuous to assert that patients will not feel under pressure once this bill becomes law to nominate themselves for termination.

Under the Voluntary Assisted Dying Bill 2017 elderly Victorians are likely to feel pressure from inheritance impatient children to first request and then to act on a VADSAP (voluntary assisted dying self-administration permit) or, if they are particularly frail and unable to personally open the locked box and drink the prescribed poison, a VADPAP (voluntary assisted dying practitioner administration permit).

The former prime minister dismissed as “bald utopianism” the claim that assisted suicide laws can have rigorous safeguards:

An alarming aspect of the debate is the claim that safeguards can be provided at every step to protect the vulnerable. This claim exposes the bald utopianism of the project – the advocates support a bill to authorise termination of life in the name of compassion, while at the same time claiming they can guarantee protection of the vulnerable, the depressed and the poor.

No law and no process can achieve that objective. This is the point. If there are doctors prepared to bend the rules now, there will be doctors prepared to bend the rules under the new system. Beyond that, once termination of life is authorised the threshold is crossed.

The “bald utopianism” identified by Mr Keating as a danger to the vulnerable was in full evidence in the Legislative Assembly debate as the Minister for Health rejected amendment after amendment out of hand.

In particular, the Minister declared that it was just fine for the single witness required under the Bill to a person’s final request for a doctor to administer poison to the person to be a knowing beneficiary of the will!

The Minister also rejected an amendment that would have ensured that if a person lost decision-making capacity the lethal poison was removed from that person.

The Bill requires the two assessing doctors to inform a person requesting assisted suicide or euthanasia about “palliative care options available to the person and the likely outcomes of that care”. However, neither of the two doctors is required to have any expertise or experience in palliative care. And the Minister for Health rejected an amendment that would simply have ensured that before offering assisted suicide or euthanasia to a person a doctor had actually undergone training on “current awareness of outcomes achievable by best practice palliative care”.

The Minister is apparently comfortable with doctors who are ignorant of the “outcomes achievable by best practice palliative care” to be offering their patients ill-informed information that may lead to the person committing suicide or being killed by a doctor when palliative care could have relieved the person’s suffering and fears.

It is now up to the Legislative Council to truly act as a house of review and to reject this reckless social experiment that puts vulnerable Victorians at risk.

Tuesday 24, October 2017

After a marathon overnight debate, in which the Minister for Health dismissed out of hand each one of the well-thought out amendments proposed to make her Voluntary Assisted Dying Bill 2017 just a little bit safer for vulnerable Victorians, it passed the Legislative Assembly 47 votes to 37.

Congratulations to all those MPs who moved and supported amendments. Although each of these amendments was defeated, your hard work has exposed the stubborn, ideological position of the Minister for Health as caring more about her “perfect” Bill than the genuine well-being of Victorians.

As the assisted suicide and euthanasia Bill moves to the Legislative Council, it is now clearer than ever that there is nothing in Hennessy’s “perfect” Bill to:

protect people suffering with treatable depression from opting for assisted suicide while depressed;
prevent the establishment of death clinics where two doctors in the same clinic can openly advertise their willingness to facilitate assisted suicide or euthanasia within a few days for people they have never met before;
protect people from elder abuse and other forms of coercion;
ensure that lethal drugs are not left in the possession of people who lack decision-making capacity;
protect doctors and nurses who conscientiously object to participation in assisted suicide and euthanasia from losing their jobs;
stop people taking lethal drugs prescribed under the Bill out of Victoria;
stop people moving to Victoria to access assisted suicide or euthanasia within days of arriving here;
ensure data on the reasons for choosing assisted suicide is collected and published; or
empower the Coroner to investigate deaths following the prescription of lethal drugs under the Bill even if foul play is suspected.

Most significantly, the Minister for Health was unable to give any information about the lethal drugs to be used. All we know is that it is likely to be some experimental lethal cocktail compounded by pharmacists. Nothing will be known about how long between ingestion and loss of consciousness, or between ingestion and death, or about failure rates or complications because there is NO requirement for a health practitioner or even a witness to be present when this experimental lethal cocktail is ingested.

The Minister for Health is offering distressed and vulnerable Victorians a government permit to commit suicide alone at home with an experimental lethal cocktail of drugs instead of gold standard palliative care, equal access to health care for people with disability, protection from elder abuse by inheritance impatient heirs and suicide prevention for all, including depressed people with deteriorating physical health.

I urge members of the Legislative Council not to drink the Kool Aid. It will kill!

Thursday, 19 October 2017

In a disgraceful speech on his Voluntary Assisted Dying Bill 2017 Premier Daniel Andrews has betrayed his duty to serve the common good and well-being of all Victorians by endorsing a counsel of despair promoting suicide as the only possible choice for some Victorians.

He said:

Every year 50 people experiencing an irreversible deterioration in physical health are resorting to the ‘final cry of human desperation’. Fifty people a year are vanishing in lonely, desperate and unspeakable ways — 50 people who the coroner says have made an ‘absolute clear decision’ that no reasonable offer of support or relief could possibly temper.

Daniel Andrews’ misnamed Bill – it is an assisted suicide and euthanasia bill – would positively endorse suicide for some Victorians by empowering public servants appointed by the Secretary of the Department of Health and Human Services to issue permits authorising a named individual to be given a lethal poison to be taken by the person in order to cause the person’s death.

The Scrutiny of Acts and Regulations Committee in its report on the Bill has observed that “In relation to a permit from the Secretary of the Department of Health and Human Services, the Committee notes that neither the Northern Territory’s scheme, nor any existing one overseas, gives a public servant a role in deciding whether or not a person can access voluntary assisted dying.”

It appears that the poisons to be specified on the suicide permits are likely to be experimental lethal cocktails compounded by pharmacists.

The Bill does not require a medical practitioner or even a witness to be present when a person – authorised by a public servant to commit suicide – ingests the experimental lethal cocktail of poisons.

These Victorians may die alone with Daniel Andrews’ approval of their suicidal despair.

Graham Watt, Member for Burwood, in his speech on the Bill addressed the claim by Coroner John Olle, the Minister for Health and the Premier that suicide is the only choice for some Victorians. He pointed out that in many of the cases being cited “the person expressed suicidal ideation to family, neighbours or a doctor or had already attempted suicide. It is not clear that in any of these cases appropriate action was initiated to respond to this disclosure.

I personally find it distressing that the Minister for Health is using 240 tragic deaths by suicide between 2009 and 2013 of Victorians suffering deteriorating physical health to justify offering Victorians state-approved assisted suicide by lethal drugs.

In my view these tragic, avoidable suicides should prompt us to work harder and smarter to address the underlying issues that lead to them. We should ensure all Victorians have equitable access to gold-standard palliative care. We should improve early intervention for people suffering chronic pain to ensure that best practice pain management is provided. We should train doctors to better identify depression and other mental health issues in persons with deteriorating physical health and refer to psychiatric specialists for appropriate treatment. We should ensure that appropriate follow-up, in accordance with the Victorian suicide prevention framework for 2016 to 2025, be given to all people who attempt suicide, including those with deteriorating physical health.

We should continue community campaigns such as R U OK? Day to broaden community knowledge of mental health issues, including suicidal ideation, and increase the likelihood that persons who express suicide ideation to family members or neighbours will be given appropriate and timely expert help.

Finally, we should reaffirm that the Victorian suicide prevention framework for 2016 to 2025 applies to all Victorians, including those with physical health issues due to illness, disability or injury.

We should consider adding 'people with deteriorating physical health' as a particular risk category in the next revision of the framework. It would be appalling if the Victorian Parliament affirmed the counsel of despair, offered by the coroner and apparently endorsed by the health minister, that Victorians suffering from depression, anxiety, social isolation, strained family relationships or disability such as loss of vision or mobility are inevitably going to commit suicide and the best way to do this is with a voluntary assisted dying self-administration permit and a bottle of poison. We can and must do better than that.”

I hope that you will affirm that suicide is not a solution for any Victorian facing distress of any kind by voting against the Voluntary Assisted Dying Bill 2017 and rejecting the idea of suicide permits for some Victorians.

Tuesday, 17 October 2017

As you consider the Voluntary Euthanasia Bill 2017, please ask yourself whether it will pose an unacceptable risk to vulnerable people in the community, such as those living with a disability.

Candice Lewis is a 25 year old Canadian woman who happens to have cerebral palsy.

In September 2016, Candice went to the emergency room at Charles S. Curtis Memorial Hospital in St. Anthony after having seizures.

Dr Aaron Heroux told her she was very sick and likely to die soon. He offered her assisted suicide.

The doctor also proposed assisted suicide for Candice to her mother Sheila Elson.

This offer was repeated despite both Candice and her mother making it clear that this was not an option Candice would consider. Dr Heroux told Sheila she was being selfish by not encouraging her daughter to choose assisted suicide.

Candice describes how bad it made her feel that a doctor was offering her assisted suicide.

More than twelve months later, Candice has recovered well and her health has much improved.

Candice hasn’t been having any seizures, is now able to feed herself, walk with assistance, and use her iPad. She is more alert, energetic and communicative.

She was able to walk down the aisle as a bridesmaid at her sister’s wedding in August 2017. She is doing what she loves most: painting and being with her family.

Candice and her mother Sheila have been interviewed by Kevin Dunn, who is producing a film on euthanasia and assisted suicide called Fatal Flaws. The film of the interview can be viewed here.

There are three key take home lessons from Candice’s experience:

Doctors can get the prognosis wrong. Candice was told she was dying, but is flourishing twelve months later. A wrong prognosis can lead to assisted suicide or euthanasia. A life can be thrown away needlessly;

Under the Voluntary Euthanasia Bill 2017 Candice would have met the eligibility criterion of less than 12 months to live.

People with a disability already suffer discrimination in health care. When assisted suicide and euthanasia are legal, people with a disability are more at risk of being offered death as a solution because doctors and others consider that they would be better off dead;

Under the Voluntary Euthanasia Bill 2017 people with a disability can be assisted to commit suicide or killed by euthanasia if doctors assess them at meeting the eligibility criteria.

Once doctors are authorised by the law to provide assisted suicide and euthanasia some of them will feel empowered to see it as a solution for anyone they think would be better off dead. This damages the relationship of trust between patients and doctors.

Legalising assisted suicide and euthanasia puts people at risk of being wrongfully killed due to errors in prognosis or discrimination. It subverts the nature of the medical profession and destroys trust in doctors.

It is not a path Victoria should follow.

Thursday, 12 October 2017

“It must be noted that every society puts some limits on respect for autonomy, which must be balanced against the greater good of society” (High Court citing British Geriatrics Society).

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.

It has been reported to be very caustic and to cause a profound burning in the throat.

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.

READ MORE ON THE WASHINGTON DATA HERE →

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.

See more on the conflict between suicide prevention and assisted suicide here →

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.

See more on the disability perspective on assisted suicide here →

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.

Daniel Andrews is speaking more like a snake oil salesman touting the latest cure all pill than a statesman proposing a considered public policy change. Victorians and the MPs who represent them in Parliament need to examine with great care what the Voluntary Assisted Dying Bill 2017 actually would allow, and how practically enforceable the so-called safeguards are, rather than drink the Kool Aid being promoted by Daniel Andrews.

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.

Read our Fact Sheet on Assisted Suicide and the Death Penalty

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.

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.

Thursday, 17 August 2017

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.

Stephanie explains:

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.

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