The No Euthanasia Alliance (NEA) believes in the value of each human person. We are concerned that our social conscience, and particularly society's views on the worth of human life will be permanently undermined by the legalisation of ‘voluntary assisted dying’. We believe that Queensland communities are strengthened and enriched through mutual respect for human life and through ensuring that effective, caring and compassionate care is readily available to the sick and dying.
A Parliamentary committee is currently considering whether to recommend that the Queensland Parliament legalise assisted suicide and euthanasia (termed ‘Voluntary Assisted Dying’ or VAD legislation by some).
The No Euthanasia Alliance is concerned that such legislation will undermine patient wellbeing and the provision of ethical healthcare and irrevocably impact upon our society. Queensland has the second highest rate of suicide in Australia.1 Mental health issues and suicide amongst particular groups, including our young, our elderly and our indigenous populations are already the focus of significant interventions and numerous programs.2 We are concerned that these programs are likely to be significantly undermined.
Legalised VAD places vulnerable people at risk.
As a society, one of our important roles must be to protect the vulnerable. VAD legislation undermines the worth of vulnerable people by offering a government-sanctioned option for ending life prematurely. We are concerned that the Government-sanctioned nature of this option will increase the likelihood of vulnerable people feeling that they are a burden on society, and has the potential to increase the likelihood of vulnerable patients being pressured or influenced into prematurely ending their life.
Feeling like one is a burden on society should never be an acceptable reason for the state to facilitate one’s suicide. And yet, in the state of Oregon in the USA—which has assisted suicide laws very similar to what is in operation in Victoria and likely to be what is proposed in Queensland—there has been a steady increase in the proportion of people who have listed ‘being a burden’ as a reason for using these laws to obtain a prescription for drugs that will kill them. Between 1997 and 2002, 34% of people listed ‘being a burden on family, friends/caregivers’ as among their reasons for ending their lives. By 2018, that had increased to 54%.3
Similar legislation in overseas jurisdictions reveals a progressive broadening of the categories of people who can avail themselves of state-sanctioned assisted suicide or euthanasia from the terminally ill whose death is imminent to people who are encountering normal aging processes, people with disabilities and individuals suffering from depression, and mental illnesses.4
- In the Netherlands, for example, where euthanasia and physician assisted suicide were legalised in 2002, one does not need to be terminally ill. Eligibility includes psychological suffering and the build-up of aging-related complaints. In 2014, a mobile euthanasia service (Levenseindekliniek) in the Netherlands reported that of all euthanasia’s it carried out, 10% had dementia, 9% had psychiatric conditions, and 25% had a build up of age-related complaints.5
- In Canada, where both physician-assisted suicide and euthanasia were legalised in June 2016, the original law required that death be reasonably foreseeable. In September 2019, a Quebec Superior court justice ruled this unconstitutional opening the way for people whose death is not foreseeable but who consider their own suffering intolerable to have access to euthanasia or physician assisted suicide.6
- In Belgium, in 2018, 3,5% of all euthanasia was of people who had only psychological suffering (not too be confused with psychiatric conditions). And 14,6% of all people euthanised, death was not foreseeable.7
We believe that it is important that patients who are vulnerable, whether due to ageing or physical or mental illness or incapacity can trust in a society and health system that continues to place the holistic care of that individual at the heart of patient care. We are concerned that this focus on the person will diminish if the State sanctions assisted suicide as an appropriate option for our vulnerable and dying.
Legalised VAD undermines the value and importance of palliative care and prioritises death over compassionate care.
Every Australian living with a life-limiting illness deserves timely and equitable access to quality, evidence-based palliative care and end-of-life care based on their individual needs.
According to Queensland Health, there are too few palliative care specialists in Queensland especially in rural and regional areas: “There are 49 palliative medicine specialists practicing in Queensland who work predominantly in a hospital setting for the public health system. The greatest number of specialists are found at Metro North, followed by Metro South, Gold Coast and Townsville HHSs.
While Queensland experienced exceptional growth of approximately 80 percent between 2013 to 2017, modelling suggests a large undersupply of palliative medicine specialists over the coming decade. … With an estimated resident population of over five million, and 49 palliative medicine specialists practicing in Queensland, Queensland currently has a deficit of approximately 50 specialist palliative medicine physicians when compared to this benchmark. Meeting this benchmark is a challenge given the demand issues that are impacting the palliative care sector.”8
The current lack of high-quality palliative care currently means that some Australians unnecessarily die in pain because of lack of access to palliative care. The solution is not assisted suicide and euthanasia but instead, properly funded, compassionate and effective professional palliative care. Research shows that high quality palliative care, when available, is effective.9 We need to ensure that it is available. Until then any legalisation of VAD is irresponsible.
Legalised VAD is a blank cheque for an unknown future.
While supporters of VAD will be eager to assert that safeguards prevent misuse, international experience shows that many of these safeguards are essentially ineffectual or can be changed over the course of time.
Recently, Oregon, for example, created an exception to its 15-day waiting period, allowing people who are ‘likely’ to die within the 15-day period to end their lives earlier. It is not clear how one could ever be sure with Oregon’s oversight framework whether a person really was going to die within 15 days or not.
In Western Australia, the bill under consideration already liberalises the safeguards of Victorian legislation.
- It no longer requires a permit approval from a central authority
- It no longer requires that at least one of the doctors be a specialist in the person’s disease
- It no longer prohibits practitioners from initiating discussion about VAD, thereby exposing people to possible coercion and doctor steering
- It no longer protects people from negligence in the administration of euthanasia
- It no longer requires a disease to be ‘incurable’
- It no longer requires death to be expected within 6 month, merely probable within six months.10
Once we legally sanction physician assisted suicide or euthanasia there is nothing that prevents a government from liberalising those laws potentially at the expense of vulnerable people in our society.
Legalised VAD goes against the advice of medical professionals on the frontline.
VAD is opposed by the Australian Medical Association (AMA), as well as each state-based branch of the AMA. VAD is also opposed by the Australian and New Zealand Society of Geriatric Medicine. The World Medical Association and the American Medical Association are also opposed to it.
Medical practitioners have an ethical duty to care for dying patients so that death is allowed to occur in comfort and with dignity. Assisted suicide and euthanasia shifts the focus and role of caregivers, particularly physicians, from preserving life to ending it – a seismic shift in the role of medical professionals. According to the World Medical Association:
“Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically.”11
The No Euthanasia Alliance strives for compassion and dignity in our health system.
Legalised VAD presents a major threat to the ethos of our society by undermining the value we have always placed on the worth and dignity of every individual in society and their right to effective and compassionate care.
We urge all Queenslanders and our elected representatives to uphold these values and oppose state-sanctioned, tax-payer-funded assisted suicide.
1 Australian Bureau of Statistics, Causes of Death, Australia, 2018 (Australian Bureau of Statistics, 25 September 2019); available at https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3303.0Main+Features12018?OpenDocument
2 Josh Bavas and Allyson Horn, “Queensland Budget to direct $62m at reducing state's high suicide rate,” ABC News Online, 6 June 2019; available at https://www.abc.net.au/news/2019-06-06/queensland-budget-to-target-high-suicide-rate/11182856
3 Public Health Division, Center for Health Statistics, “Oregon Death with Dignity Act: 2018 data summary,” (Oregon Health Authority: February 2019); available at www.healthoregon.org/dwd
4 Christopher de Bellaigue, “Death on Demand: Has Euthanasia Gone too Far,” The Guardian, 18 January 2019; available at https://www.theguardian.com/news/2019/jan/18/death-on-demand-has-euthanasia-gone-too-far-netherlands-assisted-dying
5 Stichting Levenseindekliniek, “Levenseindekliniek: feiten en cijfers 2017,” (The Hague, n.d); available at http://slk-jaarverslag-beleidsplan.nl/Portals/0/Siteafbeeldingen/downloads/Levenseindekliniek%20Feiten%20%26%20cijfers%20totaal%20pdf.pdf
6 The Canadian Press, “Quebec won't appeal ruling that struck down assisted death provision,” City News 1130, 3 October 2019; available at https://www.citynews1130.com/2019/10/03/quebec-wont-appeal-ruling-that-struck-down-assisted-death-provision/
7 Federale Controle- en Evaluatiecommissie Euthanasie, “Euthansie – Cijfers voor het jaar 2018,” Press release of the Federal Control and Evaluation Committee for Euthanasia (Beglium), 28 February 2019; available at https://overlegorganen.gezondheid.belgie.be/nl/documenten/euthanasie-cijfers-voor-het-jaar-2018
8 Queensland Health, “Queensland Health Palliative Care Services Review – Key Findings,” (State of Queensland (Queensland Health), March 2019), pages 27,35; available at https://www.health.qld.gov.au/research-reports/reports/review-investigation/palliative-care
9 Kathy Eagar, Sabina Clapham, Samuel Allingham, “No, most people aren’t in severe pain when they die,” The Conversation, 11 December 2017; available at https://theconversation.com/no-most-people-arent-in-severe-pain-when-they-die-86835
10 Australian Medical Association Western Australia, “VOLUNTARY ASSISTED DYING BILL EXAMINED MORE THAN 1500 DOCTORS SPEAK THEIR MIND THE ONLY DEFINITIVE SURVEY” October 2019; available at https://www.amawa.com.au/changes-to-voluntary-assisted-dying-bill-vital/
11 World Medical Association, “WMA STATEMENT ON PHYSICIAN-ASSISTED SUICIDE,” Oslo, 2015; available at https://www.wma.net/policies-post/wma-statement-on-physician-assisted-suicide/