Assisted dying (AD)

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The Belgian Euthanasia Commission has released its summary report for 2018

Belgium's Federal Commission for Control and Evaluation of Euthanasia has released a summary report of cases for the 2018 calendar year. Numbers have stabilised, with a tiny 1.8% increase on the figures for the previous year. All cases were found to have met the essential conditions of the Euthanasia Act. Below is an English translation of the report.

Belgium Euthanasia - Figures for the year 2018

By Jan Eyckmans
Posted on 28/02/2019

These figures relate to the registration documents for euthanasia carried out between 1 January 2018 and 31 December 2018 examined by the Commission. A more detailed analysis of euthanasia reported in 2018 will be made in the next biennial report of the Commission (gathering data for 2018 and 2019).

The number of reports received during this period was 2357. The majority were written in Dutch, concerned patients aged 60 to 89 years and slightly more women. Most often, euthanasia took place at home.

The main conditions causing the euthanasia claims were either cancers or a combination of several conditions (polypathologies) that were not likely to improve and that caused more and more serious disabilities up to organ failure. Death of patients was usually expected in the near future. Patients whose death is clearly not expected in the short term suffered mostly from polypathologies, while the death of cancer patients is rarely considered such.

Requests for euthanasia on the basis of mental disorders and behavior remain marginal (2.4% of all euthanasia). Like all euthanasia records, they comply with the legal requirements (patient capable, written request, medical situation without solution, constant suffering, intolerable and unbearable, caused by a serious and incurable condition, application and repeated request).

No euthanasia of unemancipated minors was recorded in 2018.

The Commission considered that all the declarations received met the essential conditions of the law and none were transmitted to the public prosecutor.

Detailed figures

The number of reports received in 2018 was 2357. The number of recorded euthanasia remained stable (only 1.8% increase).

The number of registration documents in French continues to increase (76% NL / 24% FR).

67.1% of the patients were older than 70 years and 41% were over 80 years old. Euthanasia in patients under 40 remains very limited (1.7%). It is mainly patients in the 60, 70, and 80 age groups who request euthanasia (75.8%). The largest group of patients is between 80 and 89 years old (29.9%).

In 2018, no statement regarding the euthanasia of minors was recorded.

The number of euthanasia in the home (46.8%) is still increasing, while those in the hospital are still decreasing (36.1%). The number of euthanasia in nursing homes and nursing homes continues to increase (14.3%). This corresponds to the patient's wish to end his life at home.

In the vast majority of cases (85.4%), the physician estimated that patient deaths were predictable in the near future.

For the majority of patients, several types of physical and psychological suffering (not to be confused with psychiatric conditions) were observed simultaneously (78.7%). These sufferings were always the consequence of one or more serious and incurable conditions.

Less than 1% of euthanasia involved unconscious patients who made an advance declaration.

The conditions causing the euthanasia were mostly tumours (cancers) (61.4%), polypathologies (18.6%), diseases of the nervous system (8.3%), circulatory system diseases. (3.8%), diseases of the respiratory system (2.4%) and mental and behavioural disorders (2.4%).

Press contacts

• Jacqueline Herremans, lawyer
+32 (0) 2 648 75 30
+32 (0) 475 74 40 92
jacqueline.herremans@lallemand-legros.be

• Michèle Morret-Rauïs, oncologist
+32 (0) 475 40 41 22
morret.rauis@gmail.com

Related documents:

 

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The original document in French is available here.


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Victoria has shown what happens at the ballot box to candidates who oppose VAD

Many news outlets are reporting that Victoria's voluntary assisted dying (VAD) Act comes into effect mid-year, and how other Parliaments around the country are likely to implement similar reforms. Moves are afoot in Western Australia, Queensland, NSW and Tasmania, with other jurisdictions to follow. Marshall Perron, former Chief Minister of the Northern Territory and architect of the first VAD law in Australia, has penned a media release to highlight how VAD influenced the Victorian election. The result wasn't pretty for opponents of VAD law reform.

Media release - Marshall Perron

Parliamentarians traditionally shy away from supporting voluntary assisted dying (VAD), believing it is politically toxic to do so. Victoria, under the Andrews government, has changed all that by showing the opposite to be true.

After legislating VAD – Victoria is the first Australian state to do so – Andrews won a thumping victory at the 2018 Victoria State election.

Former NT Chief Minister Marshall Perron said there is a common perception that the political class has not been listening to its constituents. VAD is a classic example.

There were multiple reasons for Victoria’s election result, and VAD was clearly one of them. With unprecedented 80-85% public support, it should be no surprise that Victorian candidates who supported VAD polled more strongly.

In the previous parliament, almost all Liberal members voted against the VAD legislation. The party suffered an average 6.04% swing against it in the State election.

In addition, two of the staunchest Liberal opponents of the VAD bill lost their seats. In the lower house, Robert Clark was tossed out as the Member for Box Hill, a seat he’d comfortably held for a quarter century. In the upper house, Inga Peulich was rejected by voters in South Eastern Metropolitan, a Region she’d represented for three terms.

Dying With Dignity Victoria and Andrew Denton ran targeted campaigns focusing on four electorates – Burwood, Albert Park, Bentleigh and Prahran.  They used Robo calls, advertising, social media and face to face meetings to inform voters about where their candidates stood on VAD.

The Liberal candidates (one a sitting member) in these four electorates all opposed VAD. They suffered an average 10.1% drop in primary votes compared with the average drop in the Liberal vote overall of 6.04%.

The Liberal sitting member lost his seat. In the other three seats the sitting Labor and Greens members, who all supported VAD, were returned with significantly increased votes. The results for these four electorates were, compared to the 2014 election:

  • In Burwood, Liberal member Grahame Watt lost his seat with a 6.47% swing against. Labor candidate and VAD supporter Will Fowles was elected.
  • In Albert Park, Labor member and VAD supporter Martin Foley was returned with a massive 10.17% increase (two party preferred). The Liberal primary vote dropped 10.24%.
  • In Bentleigh, Labor member and VAD supporter Nick Staikos was returned with a massive 11.27% increase. The Liberal primary vote dropped 12.59%.
  • In Prahran, Greens member and VAD supporter Sam Hibbens was returned with a 7.0% increase. The Liberal vote dropped 10.29%.
     

Mr Perron, who introduced the world’s first successful VAD legislation in the Northern Territory in 1995 said candidates can increasingly expect to lose support when they ignore the wishes of the voters they seek to represent.

In a contest tighter than the Victorian election turned out to be, a handful of seats retained or lost on VAD could determine the outcome.

Marshall Perron


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The Canadian Medical Association (CMA) has quit the World Medical Association (WMA) over assisted dying and plagiarism.

The WMA has long held that assisted dying is unethical and must be condemned by the medical profession, despite a significant proportion of contemporary doctors believing it to be a valid and ethical option in restricted circumstances.

Assisted dying is lawful in Canada, where it is called Medical Assistance in Dying (MAiD).

The CMA has resigned from the WMA, citing a bad case of plagiarism by the current WMA head, but also reporting its considerable displeasure with the WMA's one-sided policy on MAiD.

This is the first example of a member medical society resigning from the WMA in part due to its assisted dying policy, and speaks volumes about medicine's slow but inevitable move to recognise patient well as doctor moral perspectives.

Predictably, Dr Kulvinder Gill (AKA Kulvinder Kaur) from tiny ginger group “Concerned Ontario Doctors”,1 which is strongly opposed to Canada's asssited dying law, slammed the CMA's resignation, claiming that the withdrawal leaves Canada's doctors "without international ethical oversight."

It's shabby framing to impute that Canadian doctors can't practice ethically without some kind of international Big Brother tapping in to their stethoscopes. Perhaps "Concerned Ontario Doctors" believes the Vatican should be monitoring and dictating doctors' conduct?

Predictably too, the Catholic church, with Dr Gill among them, as been actively advancing the right for doctors to ignore legal and valid patient requests to be considered for MAiD, refusing to refer them to other doctors for assessment.

The WMA will eventually have to update its stance to neutral, to honour the range of deeply-held perspectives across the medical spectrum instead of attempting to impose the views of just one end.


1 I was unable to find any other member or spokesperson for this “group” other than Kulvinder.


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Physician consultation and end of life decision quality improves under VAD law

Two DyingForChoice.com reports to the Western Australia Parliament committee inquiry into end of life choices furnish clear evidence from multiple peer-reviewed research papers that the quality of a broad range of end-of-life decision types have improved in jurisdictions with voluntary assisted dying (VAD) laws.

Training and decision making has improved under VAD

In the first report, studies show that the quality of palliative care education and the quality of decision making has improved when VAD is legalised: (PDF 0.6Mb).

Where decision making is best and worst

In the second report, studies show that clearly inappropriate doctor decisions (unilaterally making end of life decisions about a patient without involving the patient or her family) are lowest in the Netherlands with its extensive experience in VAD, and highest in Italy with its strong opposition to VAD: (PDF 0.2Mb).

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Which doctors 'play God' most with patient end of life decisions might surprise you

In two supplementary submissions to the Parliament of Western Australia, I report empirical evidence about the standards of end-of-life medical decision making in jurisdictions with and without voluntary assisted dying (VAD) laws. The evidence clearly contradicts the assumption of assisted dying opponents that legalised VAD will lead to worse end-of-life decision making by physicians. In fact, the evidence clearly shows which physicians are 'playing God' with their patients, and it's not the Dutch.

When I appeared as an expert witness before the Parliament of Western Australia's Joint Select Committee on end of life choices, the Hon. Nick Goiran, a staunch Christian opponent of VAD, asked me for evidence of bringing end of life decision making out of the 'dark shadows' and into the light in jurisdictions in which VAD is lawful.

Existing evidence

Of course, there's the clear evidence from both the Netherlands and Belgium that the rate of non-voluntary euthanasia (NVE) has dropped significantly and stayed lower after their Euthanasia Acts each came into effect in 2002. There's also the clear evidence that the rate of nurse administration of possible life-ending drugs has dropped significantly in Belgium with a VAD law, over a similar time period in which it had increased significantly in New Zealand, where there is no VAD law. These forms of evidence were already documented in the comprehensive submission (PDF 5.4Mb) I'd made to the Committee.

Training and decision making has improved (Supplementary 1)

Mr Goiran opined that any improvements in palliative care were not relevant to his question. In my first supplementary submission to the Committe (PDF 0.6Mb) to further inform it of the empirical evidence, I disagree. As I point out, VAD decisions are not made in a vacuum: they are made after other interventions have been considered and declined, or tried and failed to provide sufficient relief. Palliative care options are central to these considerations. Therefore, whether palliative care improves or deteriorates after VAD laws are introduced is crucial.

Adding to the body of knowledge about the quality of palliative care, in this first supplementary submission I report that Dutch and Belgian physicians attended palliative care professional training at vastly higher rates than most other countries in the several years after VAD was legislated.

I also report the research evidence showing increases in desirable end of life decision rates, and decreases in undesirable decision rates in both the Netherlands and Belgium.

Where decision making is best and worst (Supplementary 2)

In my second supplementary submission (PDF 0.2Mb), I report data from two careful scientific studies into end of life decision making by doctors across multiple countries, including the Netherlands, Belgium, Switzerland, Italy and Australia.

The results are striking: for clearly inappropriate decisions such as withholding chemotherapy or administering terminal sedation without consulting their mentally competent patient, the Netherlands was clearly the best performer with the lowest rates of these kinds of decisions amongst physicians. And who was the overall worst? Italy.

Yes, that jurisdiction that harbours the head office of the world's most actively VAD-opposing organisation, the Catholic church, and where 82% of physicians are Catholic, were by far the most likely overall to make medical end of life decisions about their mentally-competent patients without consulting either the patient or her family. Italian physicians were, respectively, more than five times, three times, and twice as likely as those from the Netherlands, Beligum or Switzerland, to make unilateral end of life decisions without consulting either the patient or her family.

So much for high moral standards under a more religiously-driven and VAD-opposing regime.

I also illustrate from another study how VAD decision making in the Flemish north of Belgium, where the rate of VAD deaths is higher, is significantly higher in quality than in the Walloon south.

Conclusion

The peer-reviewed research data currently available consistently and directly demonstrate improvements in end of life care education and decision making in jurisdictions with VAD compared with those that don't. In contradiction to VAD opponents' assumptions, it's Italian physicians — who largely oppose VAD — who tend to 'play God' most with their patients.

The evidence comprehensively supports the view that legalisation of VAD brings a wide range of end of life decision making out of the shadows and into the light, where critical and open appraisal results in significant improvements.


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Jones, Paton and Kheriaty's articles demonstrate poor science and multiple, egregious instances of bias.

In 2015, Dr David Jones and Prof. David Paton published an article titled “How does legalization of physician-assisted suicide affect rates of suicide?” in the Southern Medical Journal. The article purported to establish suicide contagion from Oregon and Washington Death With Dignity Act (DWDA) deaths to “total suicides.”  It also purported to establish no decrease in general suicide rates, which Jones & Paton argued should occur by substitution of assisted death for some general suicides. (Notice how these two ‘expected’ results — an anticipated rise and an anticipated fall in suicide rates — are at odds in principle.)

In my thorough and empirically-backed response, I expose the disgraceful playbook of these authors as they shambolically commit no fewer than ten deadly sins against science in the pursuit of their opposition to lawful assisted dying.

Get the full report here

Executive Summary

In 2015, Dr David Jones & Prof. David Paton published an article in the Southern Medical Journal titled “How does legalization of physician-assisted suicide affect rates of suicide?” This study examines the article, as well as an enthusiastic editorial of it by Dr Aaron Kheriaty in the same journal issue, both of which portray “suicide contagion” from Oregon and Washington’s death with dignity acts (DWDA).

However, while contagion from general suicides is a well-established phenomenon, there are multiple sound reasons to reject contagion theory in relation to assisted deaths, including:

  • Most healthcare professionals readily acknowledge key differences in the characteristics of assisted deaths: for example, a fully informed, tested and rational decision with shared decision-making.
  • Those using Oregon and Washington’s DWDAs are, by qualifying for it, already actively dying. Thus, they are choosing between two ways of dying rather than between living and dying.
  • Most of those using the DWDA discuss it with their families (expected, peaceful death), whereas most general suicides occur in isolation and without discussion (unexpected, often violent death).
  • Multiple studies show that while families of general suicide experience complicated bereavement, families of assisted dying cope at least as well as, and in some cases better than, the general population or those who considered but did not pursue assisted death.

 
Even if “suicide contagion from assisted dying” theory were sound, direct evidence from official government sources shows that the number of potential suicides in Oregon in 2014 would have been fewer than 2 in 855 cases: undetectable by general modelling methods.

Jones & Paton’s article title conveys an air of skilled and scientific neutrality. However, close examination of the article, and Kheriaty’s editorialisation of it, reveals least ten serious flaws or ‘scientific sins.’

The authors demonstrated little understanding of the complex issues surrounding suicide, willingness to unjustifiably equate assisted dying with general suicide, contentment with failing to search for, consider or include contrary evidence including from sources they cite to argue their case, unreasonable trust in a model that couldn’t hope to legitimately resolve their premises, satisfaction with executing their model amateurishly, a disposition to overstate confidence of causation in the absence of meaningful statistical correlations, and an inclination for emphasising results in accordance with their theories while de-emphasising or ignoring others.

Any of these flaws was serious enough to invalidate Jones & Paton’s article and Kheriaty’s conclusions of it, yet there is not one deadly flaw: there are at least ten.

Their claim of a supposed 6.3% suicide contagion rate from assisted dying in Oregon and Washington is a conceptual and mathematical farce.

The Southern Medical Journal is a peer-reviewed journal. However, it is difficult to reconcile the rigorous standards and sound reputation that peer review is intended to maintain, with the numerous, egregious flaws in this study and its dissemination.

Rather than inform the ongoing conversation about lawful assisted dying, the Jones & Paton and Kheriaty articles misinform and inflame it.

Given the numerous egregious flaws, both articles ought to be retracted.

 

Get the full report here

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The deeply-flawed Jones & Paton, and Kheriaty articles purporting to show suicide contagion.

In the ongoing political campaign against assisted dying law reform, opponents have spread one piece of egregious misinformation after another. One of the most common is supposed “suicide contagion” from assisted dying laws to general suicide, a theory popularised by Catholic Prof. Margaret Somerville. Despite the nonsense of her claim being comprehensively exposed, she still believes that her opinion “will prove to be correct.” Two journal papers published in 2015 purported to, but didn't, establish suicide contagion in Oregon and Washington states.

Note: the report is now published here.

Assisted dying law reform opponents are still relying on a 2015 paper by Catholics David Jones and David Paton, bolstered by a glowing editorial of it written by Catholic psychiatrist Aaron Kheriaty, published in the Southern Medical Journal, as continued ‘proof’ of suicide contagion theory, at least in respect of USA states Oregon and Washington (since data from other lawful jurisdictions contradicts the theory).

Jones & Paton’s article reported the use of econometric modelling to test for ‘suicide contagion’ from Oregon and Washington’s Death With Dignity Act (DWDA) laws. But, in an exposé to be published this week, no fewer than ten ‘deadly sins’ of the study are peeled back to reveal the rot within.

The very deep flaws and biases of the original articles include:

  • Cherry-picking information from cited sources to argue their case, while omitting information from the same sources that contradicted their case;
  • Including test and control subjects whose consequence was likely to maximise the likelihood of finding a positive association;
  • Demonstrating a poor understanding of suicide and its risk and protective factors and failing to control for most confounding effects in their econometric model ‘pudding’;
  • Overegging the “causative suicide contagion” interpretation when no correlation between assisted dying and general suicide rates was found; and
  • Failing to use direct, robust and readily-available evidence that showed their study couldn’t possibly have hoped to return scientifically valid “contagion” proof.

 
The USA’s National Violent Death Reporting System (NVDRS), of which Oregon is a founding member, shows that even if “assisted dying suicide contagion theory” were true, fewer than 2 of 855 Oregon “total suicides” in 2014 could have been attributed to “contagion” from DWDAs.

Further, both Oregon and Washington state rankings for suicide rates have improved, not deteriorated, since their DWDAs came into effect, while the suicide ranking for a relevant control state — Oklahoma — has deteriorated substantially over the same time.

Ultimately, through numerous and deep methodological flaws, the Jones, Paton and Kheriaty articles reveal a bias to promote “assisted dying suicide contagion theory” while ignoring the robust evidence from multiple lawful jurisdictions, including in their own ‘study,’ that contradict it.

The exposé, titled “The ten deadly sins of Jones, Paton and Kheriaty on ‘suicide contagion’,” will be published by DyingForChoice.com later in the week.

Note: the report is now published here.


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With a handful of exceptions, the Coalition has demonstrated itself to be 'unrepresentative swill' on assisted dying law reform.

It was with tongue in cheek that I recently quoted former Prime Minister Paul Keating to wonder if politicians voting on assisted dying Bills were ‘unrepresentative swill.’ The now-obvious answer to this question has become more than just humorous, with the publication yesterday of the Hansard record of Victoria’s Legislative Assembly vote on the Voluntary Assisted Dying Bill 2017.

How ironic it was that the very day after I quoted Keating’s slight against his then-hostile Senate, Keating himself, a conservative Catholic, would come out against voluntary assisted dying (VAD) reform.

Hansard record makes compelling reading

But, more importantly, the Hansard record of votes on the Victorian Bill in the lower house make for compelling reading.

Figure 1 shows Victorian voter support for VAD (from ANU Australian Election Study 2016 data) by political preference, and MP votes in support of the Victorian Bill (lower house, 2017).

Chart: Victorian electorate support and MP vote support for VAD (lower house, 2017)Figure 1: Victorian electorate support and MP vote support for VAD (lower house, 2017)
Sources: AES 2016; Hansard

It’s quite obvious that Greens MPs (100% v 91%) , Labor MPs (86% v 84%) and minor/independent MPs (67% v 76%) approximately represented the proportion of voter support. (It’s unsurprising that all Greens MPs vote in favour of VAD Bills: it’s Greens policy; while it’s a ‘conscience’ matter for other parties.)

The yawning Coalition chasm

But the yawning chasm of Coalition MPs not representing their own voters (14% v 73%) is even more stark. That’s a gap of nearly sixty percentage points. Surely that would be enough to raise the eyebrow of any conservative voter?

Aside from a handful of Coalition MPs who voted in support of the VAD Bill, it’s clear that there’s generally no real ‘conscience’ vote across the Coalition benches.

The corridors have been buzzing with stories of threats to Coalition promotions and preselections, and threats to preference deals for the state election next year, though of course there’s nothing public and on the record. Just the serene statement that “our members have a conscience vote.” The discrepancy amongst Australian Coalition ranks has been formally uncovered before in university research.

It’s a national story

However, it’s not like this is confined to Victoria. Here’s the same chart (Figure 2) for all state VAD bills across Australia since 2000 which have had a division on the vote — so we know who voted which way.

Chart: Australian electorate support and state MP vote support for VAD (all state Bills since 2000)Figure 2: Australian electorate support and state MP vote support for VAD (all state Bills since 2000)
Sources: AES 2106; Hansards

Again, the largest and most striking gap between voter desire for reform and MPs opposing their voters’ wishes is amongst the Coalition ranks, at a full sixty percentage points short of proper representation.

It’s a similar picture to that published by university researchers in 2008, who found just 17% Coalition voting support in favour of VAD in the federal parliament, too.

As I’ve explained before, the Party leader’s public statements can be ‘persuasive,’ and Mr Matthew Guy, leader of the Victorian Parliamentary Coalition, has made his entrenched opposition to this reform loud and clear.

Inform your own voting

As debate in Victoria’s upper house commences tomorrow, we’ll be watching who’s in favour and who’s against. And we’ll report the voting record to help inform how you cast your own vote at Victoria’s state election in November next year.

In the meantime, here’s the full record of the Victorian Legislative Assembly votes.

Full voting record – Victorian Legislative Assembly 2017 VAD Bill

Ayes

47

  

Noes

37

Allan, Jacinta

Labor

 

Angus, Neil

Liberal

Andrews, Daniel

Labor

 

Battin, Brad

Liberal

Britnell, Roma

Liberal

 

Blackwood, Gary

Liberal

Bull, Josh

Labor

 

Blandthorn, Lizzie

Labor

Carroll, Ben

Labor

 

Bull, Tim

Nationals

Couzens, Chris

Labor

 

Burgess, Neale

Liberal

D'Ambrosio, Lily

Labor

 

Carbines, Anthony

Labor

Dimopoulos, Steve

Labor

 

Clark, Robert

Liberal

Donnellan, Luke

Labor

 

Crisp, Peter

Nationals

Edbrooke, Paul

Labor

 

Dixon, Martin

Liberal

Edwards, Maree

Labor

 

Fyffe, Christine

Liberal

Eren, John

Labor

 

Gidley, Michael

Liberal

Foley, Foley

Labor

 

Guy, Matthew

Liberal

Garrett, Jane

Labor

 

Hodgett, David

Liberal

Graley, Judith

Labor

 

Kairouz, Marlene

Labor

Green, Danielle

Labor

 

Katos, Andrew

Liberal

Halfpenny, Bronwyn

Labor

 

McCurdy, Tim

Nationals

Hennessy, Jill

Labor

 

McLeish, Cindy

Liberal

Hibbins, Sam

Greens

 

Merlino, James

Labor

Howard, Geoff

Labor

 

Northe, Russell

Ind.

Hutchins, Natalie

Labor

 

O'Brien, Danny

Nationals

Kealy, Emma

Nationals

 

O'Brien, Michael

Liberal

Kilkenny, Sonya

Labor

 

Pesutto, John

Liberal

Knight, Sharon

Labor

 

Richardson, Tim

Labor

Languiller, Telmo

Labor

 

Riordan, Richard

Liberal

Lim, Hong

Labor

 

Ryall, Dee

Liberal

McGuire, Frank

Labor

 

Ryan, Steph

Nationals

Morris, David

Liberal

 

Smith, Ryan

LIberal

Nardella, Don

Ind.

 

Smith, Tim

Liberal

Neville, Lisa

Labor

 

Southwick, David

Liberal

Noonan, Wade

Labor

 

Suleyman, Natalie

Labor

Pakula, Martin

Labor

 

Thompson, Murray

Liberal

Pallas, Tim

Labor

 

Tilley, Bill

Liberal

Paynter, Brian

Liberal

 

Wakeling, Nick

Liberal

Pearson, Danny

Labor

 

Walsh, Peter

Nationals

Perera, Jude

Labor

 

Watt, Graham

Liberal

Sandell, Ellen

Greens

 

Wells, Kim

Liberal

Scott, Robin

Labor

     

Sheed, Suzanna

Ind.

     

Spence, Ros

Labor

     

Staikos, Nick

Labor

     

Staley, Louise

Liberal

     

Thomas, Mary-Anne

Labor

     

Thomson, Marsha

Labor

     

Ward, Vicki

Labor

     

Williams, Gabrielle

Labor

     

Wynne, Richard

Labor

     

 

 

 

 

 

 TOTAL AYES

 

 

 TOTAL NOES

 

Labor

38

 

Labor

6

Greens

2

 

Greens

0

Liberal

4

 

Liberal

24

National

1

 

National

6

Other

2

 

Other

1

TOTAL

47

 

TOTAL

37

         

Abstained

2

     

Asher, Louise

Liberal

     

Victoria, Heidi

Liberal

     
         

Did not vote

1

     

Brooks, Colin

(Speaker, Labor)

 

Note: The vote represents 87 of 88 seats. The seat of Northcote was vacant owing to the untimely death of its representative, Fiona Richardson, from cancer.


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The Victorian parliament is debating the Government's Voluntary Assisted Dying Bill

Former Australian Prime Minister Paul Keating once famously branded the Senate “unrepresentative swill” for obstructing his legislative agenda. Today, the question of how representative our political masters are remains moot.

Major community support for VAD

Take voluntary assisted dying (VAD) for example. Poll after poll demonstrates that the overwhelming majority of Australians want this additional choice for people in extremis at the end of life. The impeccable Australian Election Survey (AES) conducted by Australian National University scholars last year confirmed that 77% of Australians want VAD reform, with 13% undecided and just 10% opposed.

Strong support (43%) is ten times greater than strong opposition (4%), and support is high across the political spectrum: amongst minor/independent (69%), Coalition (77%), Labor (80%) and Greens (87%) voters. Public support has been in the majority for more than four decades.

Political support missing in action

But since the Northern Territory Rights of the Terminally Ill Act in 1996, none of the many VAD Bills before various state parliaments has passed. And the Northern Territory’s Act was torn down by the federal parliament just eight months after coming into effect.

A 2008 university study of federal MP voting opportunities found 100% of Greens, 55% of Labor, and a paltry 17% of Coalition MPs voting in favour of VAD.

New analysis

Now, a new analysis of the ten state VAD Bills since 2000 where final divisions were called, offers further insights. It found 100% of Greens MP voting opportunities were in favour, along with 51% of Labor, 29% of minor party and independent, and a similarly paltry 17% of Coalition MPs. Excluding South Australia, whose parliament has debated the greatest number of VAD Bills, the Coalition support rate was just 9%.

Overall, while state Labor MP votes fell 29% short of Labor voter attitudes, Coalition MP votes fell an astonishing 60% short of Coalition voter attitudes. At the state level, Coalition MPs had the most voting opportunities — nearly half (48%). No wonder passing VAD Bills is challenging.

It begs the question, how is it that our legislative representatives fail to reflect clear public majority views on matters of conscience for so long?

Hidden reasons behind MP opposition

Obviously, lobbying on both sides of the conversation in part informs MPs’ views, but there are several more persuasive factors.

For a start, there’s a “truism” held by many MPs that their vote in favour of a VAD Bill would lose them more votes at a general election than would a vote against the Bill. However, the opposite has been demonstrated in multiple studies.

Further, I’ve shown before that opposition to VAD is largely religious.  A university study has also found that those who are more religious and who are politically engaged tend to hold very conservative views. So while there are religious MPs on both sides of politics, Coalition MPs are naturally more inclined to hold much more conservative views.

But that doesn’t fully explain the massive 60% representation gap on the Coalition side, either.

In good conscience?

A key factor lies in the seemingly reassuring principle of the “conscience vote.” The major parties have announced that their members are accorded a conscience vote (also known as a “free vote”) on the VAD Bill. That simply means that there’s no official published party policy on the matter and party members may vote freely on the basis of their own conscience.

There are two significant issues with this state of affairs.

The first is that the member may refer exclusively to their own conscience. But what if the MP’s conscience is at odds with the electorate’s? For my home state of Victoria, the 2016 AES study found 79% of the community in favour of VAD. There are 88 members of the Victorian parliament lower house, and just 40 members in the upper house. Therefore, it’s possible for as few as just 20 Victorian MPs to vote “no” in order to extinguish the will of 3.2 million Victorians (79% of 4.05 million Victorian voters).

If that weren’t enough, the second issue is that the right to ‘conscience’ is granted only in respect of the Bill itself, not on procedural matters about the Bill. It can make a huge difference.

How the parry works

Here’s what happened in 2008 when Victorian Greens MP Colleen Hartland’s VAD Bill was before the Legislative Council. MPs were afforded a conscience vote, and many of them had said they were supportive of VAD in general, but couldn’t support Hartland’s Bill in its current form. (That’s also a common ruse of MPs who in reality oppose the reform in principle but wish to appear ‘open minded’.)

When the final vote on Hartland’s Bill was lost, then Greens MP Greg Barber immediately moved a motion to refer the Bill to a parliamentary committee so that it could be improved to MPs’ satisfaction. Neither Labor nor Coalition parties afforded their members a conscience vote on this procedural matter, instead directing MPs to vote against such motions. The referral, which may have resulted in Victorians having wider end-of-life choices years ago, was cynically buried.

Most voters remain unaware of the shenanigans played in the corridors of power to achieve such results.

Australia’s special political conservatism

They’re not the only shenanigans, though. Another university study comparing federal MP conscience voting patterns in the UK, New Zealand and Australia found Australia to be different, accounting for why the UK and NZ have legalised marriage equality, while Australia hasn’t.

Firstly, the centre-left in Australia has a larger proportion of Catholic members than in the UK and NZ, accounting for some of the shortfall in Labor representation of progressive views.

Secondly, those amongst Coalition ranks, but with more liberal social consciences, had been lashed by Coalition party whips to vote against progressive reform. So while there was a public display of fairness and neutrality, the reality was quite different.

Borne out in state parliaments

These findings are replicated in Australian state parliament votes too, with Coalition MPs rarely if ever voting in favour of progressive social reform. Coalition MP votes on VAD including and since Hartland’s legislative attempt in 2008 are telling: in Victoria 2008 10:5 against, in Tasmania 2009 6:0 against; in Western Australia 2010 19:1 against; in NSW 2013 10:0 against; in South Australia 2016 14:7 against and in Tasmania 2017 13:1 against.

Rather than reflect 77% Coalition voter support for VAD, Coalition MP voting patterns reflect the highly negative stance of party leaders, whipped through the parliamentary party membership. For example, then WA Premier Mr Colin Barnett made it clear he thought assisted dying was “government-sanctioned killing”. Tasmanian coalition leader Mr Will Hodgman said that “protection for [vulnerable] people cannot be guaranteed.” Then-NSW Premier Mr Barry O’Farrell declared himself “strongly opposed”.

Back to Victoria’s Bill under debate

The situation in Victoria is looking somewhat more positive, with Premier Mr Daniel Andrews and many in his Cabinet publicly supporting reform. A lengthy, detailed, professional and well-resourced process has informed the crafting of the Bill.

However, opposition leader and would-be Premier Mr Matthew Guy has stated his resolute opposition to it and that he intends to vote “no”. That would mean he is quite comfortable for his own personal view to extinguish the contrary views also held in good conscience by 34,626 of the 43,831 voters in his own electorate of Bulleen, and 3.20 million of Victoria’s 4.05 million voters. (Electorate numbers as at 10 October 2017.)

An obvious solution

There’s an obvious solution for MPs whose own consciences disallow them from reflecting the overwhelming majority conscience of the electorate.

They could consider abstaining — simply absenting themselves from the chamber during the division. That would keep their own consciences intact while allowing the electorate’s conscience to be reflected.

I’m a constituent of Mr Guy’s. Over a period of months I made six robust attempts to meet with him to discuss these matters, especially the covert whip arrangements and the consideration of abstention. I can be persuasive in obtaining appointments, but my best efforts proved wholly unfruitful.

As I said to Mr Guy’s private assistant after the last failed attempt, voters could be forgiven for believing he’s more interested in meeting allegedly shady characters in fancy Brighton restaurants, than meeting with his own constituents.

Victorians are watching the parliamentary VAD debate. We’re taking notes that will inform our votes at the state election late next year.

Indications are at present there’s a good chance that Victorian MPs won’t be “unrepresentative swill”.


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The Guardian reports a fracas within the Anglican church over a $1m political expenditure.

Anglican and Catholic bishops seem to be going out of their way to alienate their constituencies, including in respect of voluntary assisted dying and marriage equality law reform. As a result, the writing on the wall is writ large for the continued decline of religion in Australia.

Many Australian clerics are trying their hardest to foil Parliamentary attempts to drag Australia into the 21st century on social policy. They seem to care little for the ongoing demise of their own constituencies.

Religion declining since the 1960s

Religious affiliation in Australia has been declining consistently since the 1960s, consecutive Australian Bureau of Statistics (ABS) census figures show (Figure 1). At the 2016 census, somewhat more than half (60%) of all Australians claimed a religion. More Australians than ever before identified as ‘no religion’ — for the first time ever a larger group than any single religious denomination.

Chart: Australian religious affiliation by census yearFigure 1: Australian religious affiliation by census year
Source: ABS

Weak religious commitment

Not only has religious affiliation been dropping, but the nature of the affiliation is weak (Figure 2). Amongst the two largest religious denominations, a quarter of Catholics (26%) and nearly half of Anglicans (47%) are Notionals: that is, they identify with the denomination but never attend religious services. More than half of Catholics (52%), and four in ten Anglicans (41%), attend religious services only occasionally (Occasionals: several times a year or less often).

Chart: Australian denominations and Australian religious identity (ARI-6)Figure 2: Australian denominations and Australian religious identity (ARI-6)
Source: Australian Election Study (AES) 2016

Just 22% of Catholics and a mere 12% of Anglicans demonstrate commitment to their denomination through dedicated service attendance (Regular = monthly or more often, and Devout = weekly or more often).

The picture is particularly grim for the Anglican church, dominant in Australia from Federation until the 1960s. With both a deeply impoverished affiliation rate in 2016 (13.3%), and just 12% of the flock dedicated to service attendance, a miniscule 1.6% of Australians are committed Anglicans.

The picture is only slightly better for the Catholic church. With 22.6% affiliation in 2016, and 22% of those committed to service attendance, it's a slightly larger but still damningly small 5.0% of Australians who are committed Catholics. Further, the Catholic church’s affiliation may be significantly lower at the next (2021) census, as Australians vent their dismay and disgust at how badly it’s handled the scourge of child sexual abuse that’s occurred under its ‘pastoral umbrella.’

Hollow ‘leadership’

Across all religious denominations, just 16% of Australians are committed to their denomination — Regular or Devout religious service attenders — while 30.1% Reject religion altogether.

And yet those at the head of their ships of faith still demand that we listen to and comply with their moral dictates, assuming that they have an automatic right to steer our morality in their own chosen direction. If they think they’re ‘leading,’ most Australians aren't following.

The indications are that they're going the way of Kodak, now a small, wan shadow of its former dominant self. If the Anglican and Catholic churches were companies with voting shareholders (or even not-for-profits with voting members), the Boards and executives (archbishops and bishops) would have been, for overseeing such profound and continuing erosion of their brand franchises, replaced long ago.

Entrenched rather than learning

You’d think all this would be a warning message to archbishops and bishops to seek to understand their flocks and build bridges for mutual understanding and engagement; to demonstrate a bit of flexibility in recognising alternative and equally respectable moral codes that were not established in ancient and very different times. But no.

Their recent performances on both voluntary assisted dying and marriage equality law reform suggest otherwise.

The fact is that to rebuild their franchises, the churches need to reach out to their Occasionals and to their Notionals — those who identify with the denomination but rarely if ever attend services. But the bishops have been pleasing only (some of) their Regulars and Devouts. It's a classic and literal case of “preaching to the converted.”

Voluntary assisted dying

In the matter of voluntary assisted dying (VAD) law reform, there are presently VAD Bills before both the NSW and Victorian parliaments. Figure 3 shows Australian attitudes toward VAD by religious affiliation.

Chart: Australian religious affiliation and attitudes toward voluntary assisted dyingFigure 3: Australian religious affiliation and attitudes toward VAD
Source: AES 2016

Opposition to VAD amongst most denominations is very small, and really only makes an appearance amongst minor Christian and non-Christian denominations. Just 10% of Catholics and 7% of Anglicans oppose VAD, 5% and 3% of them strongly.

Figure 4 shows the real story. Opposition to VAD amongst Rejecters, Socialisers, Notionals and Occasionals is almost non-existent, and support is in a huge majority (85% of Socialisers, 89% of Notionals and 78% of Occasionals). Opposition to VAD amongst religion Rejecters is less than 2%. That is, opposition to VAD is almost entirely religious, although religious opposers pretend their opposition is nothing to do with faith.

Chart: Australian religious identity (ARI-6) and attitudes toward voluntary assisted dyingFigure 4: Australian religious identity (ARI-6) and attitudes toward VAD
Source: AES 2016

Only amongst Regulars and Devouts does opposition to VAD make a real appearance. Yet even amongst Devouts, with the strongest opposition, it’s in the minority (47%).

And what have the bishops been doing? They’ve campaigned strongly against VAD, spreading misinformation. Take for example the Catholic Church’s latest version of its anti-euthanasia polemic ‘brochure’ (Figure 5).

The Catholic Church’s latest polemic brochure against voluntary assisted dyingFigure 5: The Catholic Church’s latest polemic brochure against VAD
Source: Catholic diocese of Byron Bay

This amateur production reveals a superficial understanding of the issues and a penchant for hyperbole. Worse, it employs significant misinformation in order to create FUD (fear, uncertainty and doubt), as does an advertisement taken out by a number of bishops from various denominations, in Melbourne’s major daily newspaper (Figure 6).

Chart: The June 2017 bishops' anti-VAD print advertisementFigure 6: The June 2017 bishops' anti-VAD print advertisement
Source: Herald Sun

The bishops’ manoeuvres will only alienate their congregation’s least committed members, the Notionals and Occasionals — the very people they should be wooing back to the pews, and who are strongly supportive of VAD as a valid and respectable response to intolerable and unrelievable suffering at end of life.

Perhaps the bishops would find this suggestion unpalatable, too much like a sales pitch. If that’s the case, one can only point out that selling the claim of saving of souls is the very task of evangelism. One could ask, “is your God likely to approve heartily of the continued withering of Australian faith?”

Marriage equality

The second contemporary example is marriage equality (ME). Figure 7 shows Australian attitudes to ME by religious denomination.

Chart: Australian religious affiliation and attitudes toward marriage equalityFigure 7: Australian religious affiliation and attitudes toward ME
Source: AES 2016. Note: There was no ‘neither/nor’ option in this survey question

A clear majority of Australians in all groups except minor Christian denominations support marriage equality. That includes 74% of Catholics, 63% of Anglicans and 60% of Uniting Church members.

Figure 8 shows attitudes toward marriage equality by religious identity.

Chart: Australian religious identity and attitudes toward marriage equalityFigure 8: Australian religious identity (ARI-6) and attitudes toward ME
Source: AES 2016

Support of marriage equality is in a clear majority amongst Rejecters (88%), Socialisers (82%), Notionals (73%) and Occasionals (71%). Around half (49%) of Regulars also support marriage equality.

Only amongst Devouts is support for marriage equality in the minority, with a quarter (25%) supporting and three quarters (75%) opposing it.

And what have the bishops been doing? They’ve run a massive campaign against marriage equality law reform. Indeed, the Anglican Archbishop of Sydney, Glenn Davies, announced that the diocese had donated, from precious church funds, $1 million to the ‘No’ campaign.

The public was even more dismayed to discover the diocese had granted just $5,000 to dealing with entrenched domestic violence in its ranks, at the same time as allocating the $1 million to preventing the equal expression of love.1

Given that marriage equality is almost certain to be legalised in Australia either directly after this voter ‘poll’ or in the term of the next Parliament, that’s an extraordinary squandering of a vast charitable sum for no net result. Calls have been made for the diocese’s tax-exempt status to be reviewed.

Substitute movements

In fact, so refractory has been the stance of many bishops, that Australians of faith have resorted to establishing their own networks outside the churches, for example Christians Supporting Choice for Voluntary Euthanasia, Australian Christians for Marriage Equality, and Australian Catholics for Equality.

Conclusion

The evidence is incontestable: opposition to VAD is almost completely religious, and opposition to ME is largely religious, despite protestations to the contrary.

Bishops’ conduct in relation to these reforms, which most Australians want, have been unhelpful by resisting Australia’s move into the 21st century — on the basis of ancient interpretations of scripture to which only a small minority of Australians subscribe.

The bishops' conduct has run strongly counter to the compassion and understanding they could have shown in order to engage the Notionals and Occasionals amongst their flocks; to halt the erosion of their religious capital, and to rebuild it.

These bishops most certainly don't represent the general views and beliefs of most Australians on VAD or ME. Rather, they give the appearance of administrators who are determined to preside over smaller and smaller congregations: a kind of “slow euthanasia.”

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  1. Gleeson, H 2017, Sydney Anglican church confesses to domestic abuse in its ranks, plans to reform with new policy, ABC News, viewed 10 Oct 2017, <http://www.abc.net.au/news/2017-10-10/sydney-anglican-church-to-unveil-domestic-abuse-policy/9033426>.

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