Ten things you should know about the WA End of Life Choices Report

On 23 August 2018, the Joint Select Committee on End of Life Choices of the Western Australian parliament (Committee) released its report, the subject of a year-long inquiry and ultimately, recommended the legalisation of euthanasia and assisted suicide in that state.

Even at 608 pages, the sizeable report nonetheless fails to address or casually glosses over key concerns about the consequences of the legalisation of euthanasia and assisted suicide.  In an attempt to discredit any serious critique of the gaping holes within the report, the Committee predicts that any criticism of the report will come from those opposed to euthanasia and assisted suicide, and dismisses it as lacking ”rigorous evidence” to back it up.

Notwithstanding the Committee’s unwillingness to address concerns about the evident holes in the report, it is important that these are pointed out.

Below are ten key things to know about the majority report.

1. Death does not need to be imminent

In the report, the Committee declares that requiring death to be expected to occur within a predicted timeframe means that “some individuals being unfairly excluded.”  Accordingly, it recommends that euthanasia and assisted suicide be available to those even who are expected to live for many years after the request to die.

2. A patient does not need to be suffering from a terminal illness to access euthanasia

The Committee has recommended that an illness not be terminal in order for a person to be eligible for euthanasia or assisted suicide, but simply that they be experiencing “grievous and irremediable suffering related to an advanced and progressive terminal, chronic or neurodegenerative condition that cannot be alleviated in a manner acceptable to that person, where death is a reasonably foreseeable outcome of that condition.”

It is important to note that the test of whether the suffering can be alleviated is a subjective one; ie, completely the decision of the patient.

3. Physical symptoms are unnecessary, with “existential suffering” deemed sufficient for euthanasia

The report equates “existential suffering” with other types of suffering and distress, and argues that because existential suffering is subjective, it may not be relieved by palliative care.  The Committee uses this to further its claim that not all end-of-life suffering can be palliated, and thus support its proposal for legalised euthanasia and assisted suicide.

4. WA has the lowest number of publicly-funded palliative care beds per capita in the country

In the report, the Committee acknowledges that “Western Australia has the lowest number of publicly funded in‐patient beds per capita and access to specialist palliative care is limited across the state.”   It goes further to say that access to palliative care is further limited in rural areas and “almost non-existent in remote regions” and acknowledges that it is tied with South Australia with the “second lowest number of FTE palliative care nurses per capita” as well.  Even so, the Committee does not require the palliative care situation to be rectified – and Western Australians be given real choice in end-of-life options – before euthanasia and assisted suicide be implemented.

Additionally, the Committee also included in the report that Palliative Care Western Australia had told the Committee that the low number of publicly available palliative care beds meant that wealthier and better-educated people have better access to palliative care, with services clustered in “areas of high socioeconomic advantage.”

This is especially alarming given that the Committee also found that “access to specialist palliative care in the early stages of a diagnosis might improve remaining quality of life, mood, resilience, symptom management and allow for death in the patient’s preferred location.”

5. WA has the lowest uptake of Advance Care Planning in the country

The report has found that the rate of Advance Care Planning instruments for adults in Western Australia is just over half the national average (7.5% and 14% respectively.)  The Committee blames this on a poor understanding of Advance Care Plans in the medical profession and the general community and – tellingly – that medical professionals are unprepared to talk about death and dying with their patients.  It also found that the benefits of palliative care would be more readily available to patients “if difficult discussions about death and dying took place earlier.”

The Committee does not explain why it considers that health professionals who are unwilling to frankly discuss death and dying with their patients in the context of palliative care and Advance Care Plans will suddenly be able to adequately converse with them about so-called “assisted” death and dying.

6. Doctors lack appropriate education in terminal sedation, a process that could assist the small percentage of patients for whom palliative care is not suitable

The report states that confusion amongst health professionals around terminal sedation “is likely to result in the denial of adequate symptom relief to some patients at end of life.”

Education about terminal sedation is important because, in an open letter from more than 100 palliative medicine specialists written last year, the specialists stated that the rare cases in which palliative care is insufficient for pain management (estimated by the Committee in the report to be between 2% and 5%), terminal sedation works.

7. The Committee could not find reliable information about palliative care spending in WA

Despite its year-long inquiry, the Committee was still incapable of ascertaining basic facts about palliative care.  It admits its own difficulty to ascertain exact public expenditure on palliative care in Western Australia, and recommends an auditor be appointed to assess palliative care activity and expenditure in Western Australia.

Even without this basic information about palliative care – an important end-of-life choice for West Australians – the Committee still comes to the conclusion that palliative care is not sufficient and recommends that euthanasia and assisted suicide be legalised without finding out this information.

8. The Committee provides no analysis of how legalised euthanasia might affect dementia patients, despite it being the second-leading cause of death in the country

The report acknowledges that dementia, a terminal illness, is now the second leading cause of death in Australia.  They describe it as a “challenge of monumental proportions” for policy makers and governments, particularly around decisions made following a dementia diagnosis but prior to the patient losing decision-making capacity.

The Committee does not attempt to address how this “challenge of monumental proportions,” and it does not prevent the Committee from recommending euthanasia and assisted suicide, including for dementia patients.

9. The Committee fails to address concerns about the expansion of euthanasia regimes overseas

The Committee attempts to dismiss credible concerns that the availability of euthanasia and assisted suicide will expand to more groups if legalised by setting up a straw man argument which it then proceeds to destroy.  The report acknowledges that Belgium expanded its law to make euthanasia available to “legally competent minors,” but suggests that this could not support a “slippery slope” argument because the same change has not also occurred in Oregon, a jurisdiction in which assisted suicide is legal.

It seems that the Committee’s view is that, until all jurisdictions make euthanasia and/or assisted suicide available to minors, the “slippery slope” argument holds no water. 

10. The Committee fails to address the issue of suicide contagion in places where assisted suicide is legal

The Committee dismisses concerns about suicide contagion (ie, the risk that the legalisation of assisted suicide increases the overall suicide rates) by again, setting up a straw man argument.  It refers to a single study, conducted by Jones and Paton, and comments that there is “some dispute in the academic literature” about its accuracy.  Based on this alone, the Committee dismisses the suicide contagion risk.

However, the Committee does not address other statistics, including ones that originate from government bodies.  For example, a report prepared by the Oregon state department has found that the suicide rate has been increasing since 2000, and that in 2014, Oregon’s suicide rate was 43.1% higher than the national average.  It does not acknowledge these figures, let alone provide any explanation for them.

The Committee needs to be held to account for this obviously biased report.  Thankfully, one Committee member, Nick Goiran MLC, studiously created his own dissenting report, itself some 200+ pages.  We will break down this helpful report in the coming days.  Stay tuned!