Assisted dying (AD)

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Mr Steve Jalsevac of the Catholic LifeSiteNews blog who made a shocking and vile attack.

I recently exposed (another) piece of misinformation published by LifeSiteNews, and wrote courteously to them to request withdrawal of the offending article. While I wasn’t hopeful the request would be accepted, I wasn’t prepared for the shocking and vile response I received.

Exposing bull about assisted dying is a key purpose of DyingForChoice.com and it will continue to do so as long as bull is published or publicly spoken, and especially when it makes claims or generates innuendo that is at odds with the readily-available facts, as a smokescreen for fundamentally religious objections.

The specific request to withdraw

In a recent article I factually rebutted the allegation by Mr Brad Mattes that there is suicide contagion (from assisted dying to general suicide) in Belgium, in addition to other statements that were wrong in fact in his opinion piece published by LifeSiteNews. I wrote a courteous letter to the editor of LifeSiteNews to point out the errors and to seek withdrawal of the article. 

My full email to LifeSiteNews

Dear LifeSiteNews,

Clearly we are on different sides of the assisted dying conversation. I’m sure that we can mutually appreciate that different people bring different perspectives and apply some largesse in terms of world views.

However, one must draw the line (as your primary Principle does and upon which I think we agree) at the publication of information, however accidental, on your website that is in places fundamentally misleading and elsewhere quite false.

In this regard may I request that you withdraw the article by Mr Brad Mattes, Assisted suicide no longer just for the terminally ill, that contains multiple errors of evidential fact as well as fundamentally misleading statements, as I point out in this post?

Kind regards
Neil Francis

 

The shocking response

A firm believer in courteous debate even when one disagrees profoundly on important matters, I thought the most likely outcome would be a polite letter declining my request. But I received instead this response from LifeSiteNews Managing Director, Mr Steve Jalsevac.

Full response by Mr Steve Jalsevac of LifeSiteNews

Dear Neil,

I find it somewhat amusing that an advocate for legislation to allow people to kill themselves is demanding that we withdraw an article for supposedly publishing "misleading" or "false" information.

After many years of covering organizations such as yours which, typically cruelly manipulate vulnerable persons, violate or liberally interpret laws, understate their longer term objectives, have an extremely unhealthy and dangerous satisfaction in personally seeing people die before their eyes before their natural time, devastate family members whose loved ones had, unknown to them, been guided to kill themselves, and who have such perverse and wrong views on Christian beliefs and much more, I find it despicable that you would be so concerned about supposed accuracy. You, sir, are a hypocrite of the very worst kind. 

It is our view that you should be behind bars for what you advocate and for your dangerous manipulation of vulnerable persons.

I realize that you will not agree with anything that I write given how blinded your conscience and intellect have become by your death preoccupation. So, I just conclude that your claims, views and interpretations are all rejected because no one should trust anything that you say or do on this subject.

Steve Jalsevac
LifeSite

 

Who is LifeSiteNews, anyway?

LifeSiteNews is an online blog established by the conservative Christian Campaign for Life Coalition. It promotes that it “emphasizes the social worth of traditional Judeo-Christian principles.” Its principles are all very courteously worded and sound ‘respectful” (its principles expressly use that word several times) whilst indicating that it is a pro-life blog.

I’ve read its articles on assisted dying for several years and have not found a single one that is at odds with the position of the Vatican. That’s hardly surprising.

LifeSiteNews publishes a significant proportion of articles about the Catholic Church, as is its right. It is also the sole publisher of Faithful Insight, in its own words “hard-hitting,” “100% faithful” and “fearless Catholic news coverage from the Vatican and beyond.” I argue strongly for the right to publish material of faith. That is not a source of complaint. (Fair disclosure—I’m agnostic.)

faithfulinsightads.jpg
LifeSiteNews' hard-hitting and 100% Catholic-faithful publication.

And, Mr Jalsevac gives a clear indication that he’s at the 'Old School' end of the Catholic spectrum. He admires in multiple blogs the writings of conservative African Catholic Bishop Robert Sarah, noting John Paul II’s teachings as “definitive” and expressing disappointment in the current Pope. And that's entirely his right I again affirm.

Mr Jalsevac’s editor-in-chief, Mr John-Henry Westen has also published a number of articles critical of Pope Francis, also referring to previous Popes as more authoritative.

What do they claim to stand for?

LifeSiteNews’ first principle, in full, is this:

1. Accuracy in content is given high priority. News and information tips from readers are encouraged and validated. Valid corrections are always welcome. Writing and research is of a professional calibre.”—LifeSiteNews.com

Mr Jalsevac's response highlights these claimed priciples in stark relief by comprehensively breaching them.

Additionally, not only have I pointed out multiple falsehoods and inaccuracies in Mattes’ article, but I’ve reported LifeSiteNews previously for implying in a splashy headline that the Council of Europe had determined that “euthanasia must always be prohibited” (it most certainly did not), and publishing false information in multiple articles claiming that as many as 650 babies are or could be euthanized in the Netherlands (no they aren’t).

The ad hominem attack

The statements Mr Jalsevac makes about me are vile. And false. While I’m calling out his blogs’ misinformation for what it is, he’s calling for me personally to be thrown in jail for sins he falsely thinks I’ve committed. That’s squarely known as the ad hominem attack: attacking the person rather than the argument. It conveniently provides him with the excuse to totally ignore solid evidence that contradicts his beliefs.

Interestingly, an article by LifeSiteNews Editor Mr Westen quotes Pope Francis as saying,

We Catholics have some — and not some, many — who believe in the absolute truth and go ahead dirtying the other with calumny, with disinformation…”—Pope Francis.

Quite.

Conclusion

LifeSiteNews is an 'Old School' Catholic blog, and, I argue, has every right to be.

However, it has demonstrated by publishing multiple articles containing serious errors of fact as well as highly misleading statements, and by a gratuitous ad hominem attack on someone pointing this out, that it is not interested in evidence, reason or even civility as it claims. In my view it has unambiguously demonstrated itself to be a biased and unreliable Catholic source on matters of assisted dying.

I will continue to call out misinformation in LifeSiteNews when I see it.


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Brad Mattes' blog containing misleading and evidentially false statements.

The latest misinformation employed by assisted dying opponents is to imply that Belgium’s general suicide rate is high as a consequence of its assisted dying law: i.e. to argue the discredited 'suicide contagion' line which has in the past been peddled about the USA state of Oregon. I have demonstrated that it was false in Oregon, and I equally demonstrate here that it's false in Belgium.

Mr Brad Mattes recently published emotional anti-assisted-dying nonsense in LifeSiteNews. (LifeSiteNews is a Canadian blog site that was established by the conservative Christian Campaign for Life Coalition and which has a primary principle of promoting “traditional Judeo-Christian principles”. Mr Mattes is radio host for Ohio’s Life Issues Institute, an anti-abortion lobby group established by conservative American John C. Willke who claimed that women’s bodies were resistant to pregnancy as a result of rape.)

Putting on the misinformation running shoes

In his blog Mr Mattes quickly establishes a practice of communicating misinformation by first claiming that assisted dying laws have “devastating effects” around the world including Japan and Albania—which don’t have such laws.

He then sprints onwards to the ‘650 babies euthanized in the Netherlands’ claim—which I have already comprehensively exposed as fake in the Journal of Assisted Dying—and then onto the bogus claim that the Netherlands has descended into a mire of ‘killing’ without the patient’s ‘consent,’ contrary to empirical evidence I've published that such actions occur around the world regardless of assisted dying laws, and which have decreased significantly in the Netherlands and Belgium since their assisted dying statutes came into effect in 2002.

Let’s add fries to that

Having served up a lot of fat and salt that might appeal to those on a fast-food anti-assisted-dying diet, he then offers the unqualified statement:

By the way, Belgium has the second-highest suicide rate (nonrelated to euthanasia) in Western Europe.” — Brad Mattes

The ‘informational’ consequence is unequivocal: by Mr Mattes failing to contextualise this ‘incidental factoid’ in any way, the reader is destined to deduce that it is Belgium’s euthanasia law that causes Belgium’s suicide rate to be the second-highest in Western Europe. In other words, Mr Mattes is another poorly-informed commentator using the 'suicide contagion' line.

But what are the facts?

Depending on the source and year of data, one can certainly argue that Belgium’s general suicide rate is the second-highest in Western Europe. Setting aside for now the serious question of why it is valid to exclude all of the world’s other countries from the comparison, WorldLifeExpectancy.com reports figures that were published in 2014 (Table 1).

Table 1

Country

Suicides*

Finland

15.11

Belgium

14.64

Iceland

14.06

France

12.84

Austria

11.87

Sweden

11.43

Ireland

11.06

Germany

9.59

Switzerland

9.56

Norway

9.28

Denmark

9.19

Luxembourg

9.14

Netherlands

8.54

Portugal

8.49

Turkey

7.92

UK

6.28

Malta

5.75

Spain

5.23

Italy

4.76

Greece

3.86

* Suicides per 100k population, age-adjusted

The table includes all the countries in the wider definition of “Western Europe”, bar four: no suicide statistics are published for Liechtenstein, Monaco, Andorra or San Marino.

As you can see, Belgium is indeed the second-highest. But this begs the question:

If the reason Belgium is the second-highest is due to its assisted dying law, how come Finland, which Mr Mattes doesn't mention by name and which has no such law, is higher?

It also begs the question:

If assisted dying law were the fundamental cause of a high general suicide rate, how come Switzerland (statute since 1942), Luxembourg (statute since 2009) and the Netherlands (practice since the early 1980s and statute since 2002) have rates that are much lower, all key facts that Mr Mattes also fails to mention?

These are of course indications that the factoid has been included as a cherry-picked morsel of 'proof' because it sounds so compelling as a throw-away sentence amongst the other (false) statements.

But wait, there’s more

We can go further than merely wondering about the country comparisons, by comparing Belgium’s general suicide rate before and after assisted dying law reform. A critical step in establishing causation is to first establish correlation. If there is no correlation, there can be no causation.

Published OECD data shows that in 2013 (the most recent available data), Belgium’s general suicide rate was 16.7 per 100,000 population. What was it before their 2002 law reform? Well in 2000 it was 20.5, in 1990 it was 19.2, … you get the idea.

Has Belgium’s general suicide rate soared (or even increased modestly) since their 2002 assisted dying law came into effect? No. It’s dropped. Indeed, the slight downward trend apparent before the statute came into effect in 2002 has accelerated downward since (Figure 1).

Belgium's suicide rate since 1987Figure 1: The Belgium general suicide rate before and after assisted dying law reform

Even the headline is misleading

Mr Mattes fails to point out in his blog that assisted dying statutes in Benelux countries (Belgium, the Netherlands and Luxembourg) never restricted access to only the 'terminally ill,' that is, those imminently dying. He also fails to point out that USA states whose laws do restrict assisted dying to the terminally ill—most notably Oregon and Washington—have not changed their statutes in this regard since they came into effect.

Therefore, his headling implying that lawful jurisdictions have broadened their laws from 'only the terminally ill' is also wrong.

Conclusion

Mr Mattes makes multiple false and misleading claims and it’s easy to see his opinion for what it is: an emotional dump that fails to engage with and indeed flies in the face of actual evidence. The latest 'suicide contagion' implication, that assisted dying law causes Belgium’s general suicide rate to be the “second-highest in Western Europe” is evidentially false.

I call on LifeSiteNews to withdraw Mr Mattes' article because it breaches their primary principle:

“1. Accuracy in content is given high priority. News and information tips from readers are encouraged and validated. Valid corrections are always welcome. Writing and research is of a professional calibre.” — LifeSiteNews

 

Summary of facts

Belgium's general suicide rate is one of the higher ones in Western Europe. However:

  1. At least one country without an assisted dying law has a higher suicide rate, inconsistent with 'suicide contagion' theory.
  2. Other Western Europe countries with assisted dying laws have suicide rates much lower than Belgium's, also at odds with 'suicide contagion' theory.
  3. But the clincher is that the suicide rate in Belgium has dropped, not risen, since their 2002 assisted dying law came into effect.

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In this interview segment, Dutch Professor Theo Boer self-identifies as a voluntary euthanasia sceptic.

I interviewed Dutch Professor Theo Boer—Social Professor of Ethics at Theological University, Kampen, the Netherlands, and a Dutch Euthanasia Committee ethicist—about the Netherlands' assisted dying law.

He volunteers that prior to joining a Euthanasia Committee he was an assisted dying sceptic, and remains so.

And yet he warmly endorses the Dutch leglislative model as a good one for other jurisdictions to emulate, a position that he says has become more clear with experience.

Visit the YouTube page.

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Mr Max Bromson (seated) at Parliament House Canberra in June 2014. He died not long afterwards.

Assisted dying critic Mr Paul Russell has done it again. I’m beginning to think that he’s a tremendous asset to the pro-assisted-dying movement. Why would I say that?

Well, this time his pronouncements appear in National Right To Life News, the online newspaper of the USA Catholic-founded National Right To Life Committee, and in which Mr Russell represents ‘HOPE,’ his anti-euthanasia lobby platform founded by the Australian Family Association—itself Catholic-founded and backed.

The complaint

In his opinion piece, Mr Russell complained that Mr Max Bromson of Adelaide, Australia, who ended his own life after a long period of serious suffering from advanced cancer, lived far longer than his doctors had estimated.1

That he outlived his diagnosis by more than four years confirms the observation that qualifying periods in euthanasia and assisted suicide about ‘six months to live’ or similar, are really meaningless.” — Paul Russell

The pro-assisted-dying message

Mr Russell, in a single sentence, unequivocally demolishes the foundation of his own arguments in opposition to legalising assisted dying. He is a huge fan of the ‘vulnerable’ argument: that once legalised, people will quickly be pressured into assisted dying.

If his ‘vulnerable’ argument held true (a hypothesis that peer-reviewed scientific research contradicts), those with the means to peacefully end their lives would do so. And they wouldn’t take four years to think about it.

By explicitly pointing out that Mr Bromson had survived for much longer than expected (as fellow assisted-dying critic Mr Wesley Smith pointed out in another case), Mr Russell directly disproves the rhetoric of his ‘vulnerable’ argument.

People will quickly end their own lives... but survive far longer than expected: It's a spectacular flip-flop.

Conclusion

Thanks, Mr Russell, for pointing out that people don’t want to die—that they live as long as they can possibly bear it—and disproving your own nonsense. Keep up the good work!

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Footnote: Blind ignorance?

I’m also curious as to whether Mr Russell advances misinformation in blind ignorance, or whether the situation is worse. Who can say?

I have on a number of occasions explained simply and clearly why the west-coast-USA state assisted dying laws require that for the patient to qualify for assisted dying, one of the conditions is that the patient’s doctor must assess that the patient is likely to die within six months.

The reason is not that those with five months to live are deserving of the choice, but those with ten months to live are not, as Mr Russell bizarrely assumes.

The very important outcome is that when the doctor makes that assessment, the patient then automatically qualifies for free hospice care. It takes monetary considerations out of the equation, which is important in the context of the expensive USA healthcare system.

So, Mr Russell demonstrates profound ignorance at best by opining that the prognosis of time remaining must be superbly accurate, when it can’t be except possibly in the last days.

It’s about quality of life, not quantity; framed by hospice care being readily and freely available.

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References

  1. Russell, P. 2016, No charges in suicide case in South Australia, including “Dr. Death,” Philip Nitschke, viewed 3-Aug-2016, https://www.nationalrighttolifenews.org/2016/08/no-charges-in-suicide-case-in-south-australia-including-dr-death-philip-nitschke/

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Lead author Professor Ezekiel Emanuel discusses the findings of the JAMA study.

Several of the world's foremost researchers in medical end-of-life matters have released a detailed and comprehensive review of the practice of assisted dying in lawful jurisdictions around the world. Published in the Journal of the American Medical Association, it does not support slippery slope hypotheses.

Professors from universities in the USA, the Netherlands and Belgium studied data from government and statutory authority reports, primary scientific studies and other sources to examine how assisted dying has been practiced in different jurisdictions around the world where it is lawful in one form or another: self-administered medication (physician-assisted dying) or physician-administered medication (active voluntary euthanasia).1

Their primary conclusion is that:

"Euthanasia and physician-assisted suicide are increasingly being legalized, remain relatively rare, and primarily involve patients with cancer. Existing data do not indicate widespread abuse of these practices."

Key findings

Key findings include:

  • Public opinion favouring assisted dying in developed countries has been increasing, or remained stable at high levels of approval.
  • The trends seem to correlate with decreasing religiosity in Western countries.
  • The only place where assisted dying approval appears to be decreasing is in eastern Europe, where religiosity has been increasing.
  • Approval amongst physicians seems to be consistently lower than amongst the public.
  • Assisted dying occurs everywhere, including juridictions where it is unlawful (as I have previously reported).
  • Most individuals who choose assisted dying have advanced cancer (as I have previously reported).
  • Supposedly 'vulnerable' groups are not represented in assisted dying figures at rates any higher than their presence in the overall population.
  • Numbers of assisted deaths in lawful jurisdictions continue to increase, but represent a tiny minority of deaths.
    • In jurisdictions where only self-administration is permitted, assisted deaths represent around 0.3% of all deaths.
    • In jurisdictions where physicians may administer, assisted deaths represent around 3–5% of all deaths.
  • Assisted deaths for minors and those with dementia are a very small minority of cases (as I have previously reported).
  • The dominant reasons for requesting assisted death include loss of autonomy and dignity and the inability to enjoy life and regular activities; not physical pain.
  • Doctors still report that honouring a request for assisted death is emotionally burdensome; not a routine or welcomed option.
     

"In no jurisdiction was there evidence that vulnerable patients have been receiving euthanasia or physician-assisted suicide at rates higher than those in the general population."

Complication rates

One aspect of the study is worthy of special mention: the small rate of assisted dying procedure complications. The available data suggests that complications may occur more often for self-administered medication than for physician administration:

  • For self-administration—
    • Difficulty in swallowing in 9.6% of cases
    • Vomiting or seizures in 8.8% of cases
    • Awakening from coma in 12.3% of cases
  • For physician administration—
    • Technical problems such as difficulty in finding a suitable vein in 4.5% of cases
    • Vomiting or seizures in 3.7% of cases
    • Awakening from coma in 0.9% of cases
       

This data is however of Dutch practice in the 1990s, before assisted dying was codified in statute—at a time when practice was poorly defined and a range of drugs, including opioids, were widely used. Now, practice is well-defined with almost universal use of barbiturates. The researchers expressly note that these complication rates may well have reduced.

Further, the authors refer to more recent data from Oregon and Washington which indicate very much lower complication rates (in those jurisdictions for self-administration only):

  • In Oregon, the complication rates are around 2.4% for regurgitation and 0.7% for awakening from coma.
  • In Washington, the complication rates are around 1.4% for regurgitation, plus a single case of seizure.
     

The importance of context

It is worth comparing the complication rates of assisted dying procedures with rates for other medical interventions to provide an appropriate context so that they may be realistically interpreted.

For example, a study of common over-the-counter analgesics for short-term pain management2 found that significant adverse effects occurred amongst 13.7% of ibuprofen users, 14.5% of paracetamol useres and 18.7% of aspirin users.

In another example, an anlaysis of primary research about surgical outcomes found that 14.4% had adverse events, almost half of which (47.5%) were moderate to fatal in severity.3

Conclusion

The study is a solid synthesis of research data and indicates that assisted dying is accessed sparingly and in accordance with the intentions of each legislature.

The adverse event rate for assisted dying appears to be substantially lower than the rate of adverse events in the use of common over-the-counter analgesics and in surgery.

 

References

  1. Emanuel, EJ, Onwuteaka-Philipsen, BD, Urwin, JW & Cohen, J 2016, 'Attitudes and practices of euthanasia and physician-assisted suicide in the united states, canada, and europe', JAMA, 316(1), pp. 79-90.
  2. Moore, N, Ganse, EV, Parc, J-ML, Wall, R, Schneid, H, Farhan, M, Verrière, F & Pelen, F 1999, 'The PAIN Study: Paracetamol, Aspirin and Ibuprofen new tolerability study', Clinical Drug Investigation, 18(2), pp. 89-98.
  3. Anderson, O, Davis, R, Hanna, GB & Vincent, CA 2013, 'Surgical adverse events: a systematic review', Am J Surg, 206(2), pp. 253-62.
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Lyle Shelton's bunkum tweet is broadcast on ABC's Q&A program

The Managing Director of the Australian Christian Lobby, Mr Lyle Shelton, is at it again.

Yesterday, he tweeted ABC's Q&A program as thousands of people do while it is on air. His tweet was broadcast live to air as shown above. What did he say as panelists were discussing assisted dying law reform?

"Sadly voluntary euthanasia quickly became involuntary euthanasia in Holland. #qanda" LyleShelton

Mr Shelton's claim is bunkum.

Confused language

Firstly, he's confused involuntary with non-voluntary euthanasia.

Involuntary euthanasia is the deliberate hastening of the death of an individual in contravention of the express wishes to the contrary of that individual.  Nobody (except the Australian Christian Lobby in its confusion) is seriously suggesting that involuntary euthanasia happens in the Netherlands, even as a 'result' of the country's euthanasia law.

Non-voluntary euthanasia is the deliberate hastening of the death of an individual without an explicit request from that individual. Increased doses of analgesics and sedatives are administered to alleviate intractable symptoms at the end of life, as a result of discussion between doctors and the patient's family (the patient is not currently competent to participate in decisions). The drugs may hasten death and if this happens, life is shortened by hours, or less often, days. Despite claims by some assisted dying opponents that this is unique to the Netherlands, scientific research shows clearly that the practice occurs all over the world and is not 'caused' by voluntary euthanasia laws.

ACL staff sing from the same hymn book

Daniel Flynn, Victorian Director of the Australian Christian Lobby, made a similar claim in a formal submission (#694) to the Victorian Parliament's Inquiry into End Of Life Choices:

"There is sufficient evidence to suggest that involuntary euthanasia is frequent in jurisdictions in which euthanasia has been legalised." [p 4.]

Not a shred—let alone 'sufficient'—evidence was offered to back up this silly myth, though it's hardly surprising given that there isn't any.

What does the evidence actually show?

The scientific evidence is crystal clear and it is the opposite of Lyle Shelton and the Australian Christian Lobby's claim. Since around 1985 the Netherlands had permitted assisted dying by regulation: under agreement amongst relevant authorities. The rate of non-voluntary euthanasia remained relatively unchanged under this arrangement (Figure 1). In 2002 the Netherlands' euthanasia Act came into effect, replacing regulatory arrangements with a comprehensive set of legislative (i.e. statutory) requirements.

 

dutchanduk-nve01.jpg
Figure 1: Netherlands and UK non-voluntary euthanasia rates

Since 2002, the rate of non-voluntary euthanasia in the Netherlands has dropped, not risen.1 The drop is statistically significant. The rate of non-voluntary euthanasia in the Netherlands is now around the same level as in the United Kingdom.2 The UK is generally accepted as the world's gold standard in palliative care practice and it does not have an assisted dying law.

Absolutely contrary to the claim of the Australian Christian Lobby's Lyle Shelton, the rate of non-voluntary euthanasia in the Netherlands has dropped, not risen. It's now similar to the rate in the UK, which has no assisted dying law.

ABC news standards

Since the ABC moved the Q&A program from its entertainment division to its news division there is a heighted obligation on the broadcaster to ensure that the show's content is reason- and evidence-based, and not merely a platform for anyone to promote silly misinformation in support of a perspective.

No doubt the ABC will rise suitably to the occasion of discouraging misinformation and ensuring that any is corrected.

We'll be watching the next episode of ABC Q&A closely to fact check anything Mr Shelton and others say about assisted dying law reform. Give us a bell if you spot anything you know or suspect is untrue.

---------------

  1. Onwuteaka-Philipsen, BD, Brinkman-Stoppelenburg, A, Penning, C, de Jong-Krul, GJF, van Delden, JJM & van der Heide, A 2012, 'Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey', The Lancet, vol. 380, no. 9845, pp. 908-915.
  2. Seale, C 2009, 'End-of-life decisions in the UK involving medical practitioners', Palliative Medicine, vol. 23, no. 3, pp. 198-204.

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Dr Syme consults with Mr Bernard Erica (ABC Australian Story)

Australia's Medical Registration Board (AHPRA) has told Dr Rodney Syme that he is a serious danger to patients.

Dr Rodney Syme, who occasionally provides advice and medication for dying patients to give them control over their dying process, has been reprimanded by Australia's Medical Registration Board (AHPRA) for posing a 'serious danger' to such patients. The story has been reported widely in the media.

On ABC's Australian Story on Monday night, "My conscience tells me", patient Mr Bernard Erica clearly volunteers that this is utter nonsense, and that like former journalist Mr Steve Guest, who Dr Syme also provided advice and medication to control the end of his life, Mr Erica in no way felt Dr Syme was a threat of any kind. Indeed, like Mr Guest, he has experienced profound and lasting relief from the very knowledge he would have control if and when the time for him came.

Mr Erica's GP, who was aware of and seemed initially supportive of Mr Erica's stance and Dr Syme's advice and medication, lodged a complaint with AHPRA when the ABC's Australian Story contacted him (the GP) for an interview in relation to the case, it was explained on Australian Story. Did this doctor suddenly feel frightened into 'protecting his own arse'?

Coroner's Court data shows that 8.5% of suicides in Victoria are the result of dying patients in extremis being denied the right to a peaceful, doctor-assisted death.

AHPRA need to hear from ordinary Australians, and doctors, that they disagree with the stance it has taken in relation to Dr Syme's careful and compassionate consultations with dying patients. Indeed, to oppose careful and considered medical assessment that providing control is the only way for this particular patient to obtain relief from intolerable psychological suffering—of the State's refusal to allow rational and deeply valued paths to death—is to condemn such patients to a high chance of violent and undignified suicide.

In a key submission to the Victorian Parliament's current inquiry into end-of-life choices, the Coroner's Court of Victoria reported that, after intensive and exquisitely careful analysis, rejecting any equivocal cases, 8.5% of suicides in Victoria are of dying persons experiencing unrelievable and intolerable suffering, and for whom current law does not provide a compassionate and peaceful doctor-assisted death.

By censuring doctors who provide patient choice, it is my view that AHPRA becomes complicit in violent suicides amongst the terminally ill. Thus it is AHPRA and not Dr Syme who represents a 'serious danger' to terminally ill patients.

By reprimanding Dr Syme for his careful and considered private medical practice and for placing additional conditions on his medical license, it is my view that AHPRA becomes complicit in violent suicides amongst the terminally ill. Thus it is AHPRA and not Dr Syme who represents a 'serious danger' to terminally ill patients.

I wrote to AHPRA to express my displeasure at their failure to recognise contemporary community standards, which are enormously in favour of providing terminally ill people the right to a peaceful, doctor-assisted death. Here is what I said.

 

Dear AHPRA,

I write to express my dismay, along with millions of Australians, at your hostile attitude towards Dr Rodney Syme and your farcical claim that he is a danger to patients. Clearly, you are mired in nineteenth century medical paternalism and are out of touch with contemporary Australian attitudes about having control over one's death in the face of intolerable and unrelievable end-of-life suffering.

Dr Syme will speak for himself of course. But I will also say that having worked with Dr Syme for years, NEVER ONCE in my experience has his "primary intention " (as you put it) been for his patient to end their life when he provides advice and medication. He provides GOOD PALLIATIVE CARE: relieving intolerable psychological suffering. Many of his patients never take the medication.

Please lift your game and modernise. Dr Syme is giving patients control to live better, not inciting them to die: a choice between ways of dying, not between living and dying.

Neil Francis

 

I urge you to write to AHPRA as well, which you can do here. Scroll down the page to use the web form.

Let us know what response you receive.


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Around the world, doctors help patients with assisted dying, regardless of whether it is legal in their jurisdiction or not.

For example, in Australia, where assisted dying is illegal, research reveals that assisted dying is widely practiced. Many Australian nurses have collaborated with doctors to provide assisted dying, and have occasionally even done so without consulting a doctor (Kuhse & Singer 1993). Nurses in New Zealand also provide assisted dying, sometimes without consulting a doctor (Malpas, Mitchell & Koschwanez 2015; Mitchell & Owens 2004).

"Euthanasia is common. It's practiced out of sight, under wraps, no regulation, no rules, no supervision." Prof. Peter Baum (Baum 2001)

Professor Baum's statement is borne out by scientific research. A national survey of Australian doctors in 1996 found that 1.9% of deaths were the result of voluntary euthanasia (VE) or physician-assisted dying (PAD) (Kuhse et al. 1997). By comparison, the rate in the Netherlands in 1995 (the closest year of empirical research data) was 2.6% (Onwuteaka-Philipsen et al 2012). The rate of medically assisted deaths in Australia, where the practice is illegal, was three quarters the rate of the Netherlands, where the practice is legal.

Dutch and Australian assisted dying rates comparedSimilarly, Douglas and colleagues (2001) surveyed Australian surgeons, finding that more than a third had provided drugs with the intention to hasten patient death, and with more than half of cases lacking an express request from the patient.

Forms of medically assisted dying have been found to occur not only in Australia (and in the Netherlands where it has been lawful for decades), but in Belgium prior to its law reform (Chambaere et al. 2015); Switzerland, Denmark, Sweden and Italy (van der Heide et al. 2003); the UK (Seale 2009a; Seale 2009b); the USA (Back et al. 1996; Bonn 2000; Emanuel, Fairclough & Clarridge 1996; Lachman 2010; Schwarz 2003; Schwarz 2004); France (Riou et al. 2015); Norway (Forde & Aasland 2014; Forde, Aasland & Falkum 1997); and even in conservative Greece (Voultsos, Njau & Vlachou 2010); Northern Ireland (McGlade 2000) and Pakistan (Imran et al. 2014).

Indeed, "euthanasia is performed worldwide, regardless of the existence of laws governing it" (Gastmans et al. 2006), "in all countries studied" (Muller, Kimsma & Van Der Wal 1998), "albeit in a secretive manner" (Rosenfeld 2000), "in the privacy of their [doctor-patient] relationship" (Cassell 1995), with repeated involvement of some physicians (Smith 2007), and frequent failure to adhere to high standards when illegal (Emanuel et al 1998).

Even Dr Brendan Nelson, while President of the Australian Medical Association, acknowledged that he had helped hasten the death of a patient. He stated that in the "2 percent of cases" where there was no hope of recovery, that "patients, their families and their doctors make those decisions [for euthanasia]" though clandestinely, because "technically it would be illegal" (Nelson 1995).

 

nelsoneuthanasiasecretsmall.jpg

AMA's President, Brendan Nelson, in 1995.

 
The evidence is irrefutable: there is underground assisted dying worldwide
and it demonstrates that there is a profound need for assisted dying law reform to allow dying patients the right to seek a peaceful hastened death, and to protect doctors and nurses who provide that assistance. Law reform would also force assisted dying from the dark shadows, creating transparency and accountability around the process, which would then be open to discussion and improvement if required.

Intolerable and unrelievable patient suffering drives underground assisted dying across the world in jurisdictions where it is illegal, with no standards of practice or transparent oversight.

 

References

Back, AL, Wallace, JI, Starks, HE & Pearlman, RA 1996, 'Physician-assisted suicide and euthanasia in Washington State: Patient requests and physician responses', JAMA, vol. 275, no. 12, pp. 919-925.

Baum, P 2001, ABC News, TV broadcast 23 Jan, ABC, Sydney.

Bonn, D 2000, 'Support for euthanasia falls as care of dying patients improves', The Lancet Oncology, vol. 1, no. 3, p. 133.

Cassell, EJ 1995, 'Treating the patient's subjective state', Pain Forum, vol. 4, no. 3, pp. 186-188.

Chambaere, K, Vander Stichele, R, Mortier, F, Cohen, J & Deliens, L 2015, 'Recent trends in euthanasia and other end-of-life practices in Belgium', N Engl J Med, vol. 372, no. 12, pp. 1179-1181.

Douglas, C, Kerridge, IH, Rainbird, KJ, McPhee, JR, Hancock, L & Spigelman, AD 2001, 'The intention to hasten death: a survey of attitudes and practices of surgeons in Australia', Medical Journal of Australia, vol. 175, no. 10, pp. 511-515.

Emanuel, EJ, Daniels, ER, Fairclough, DL & Clarridge, BR 1998, 'The practice of euthanasia and physician-assisted suicide in the United States: adherence to proposed safeguards and effects on physicians', JAMA, vol. 280, no. 6, pp. 507-513.

Emanuel, EJ, Fairclough, DL & Clarridge, BR 1996, 'Euthanasia and physician-assisted suicide: Attitudes and experiences of oncology patients, oncologists, and the public', Lancet, vol. 347, no. 9018, pp. 1805-1810.

Forde, R & Aasland, OG 2014, 'Are end-of-life practices in Norway in line with ethics and law?', Acta Anaesthesiol Scand, Aug 14.

Forde, R, Aasland, OG & Falkum, E 1997, 'The ethics of euthanasia -- attitude and practice maong Norwegian physicians', Social Science & Medicine, vol. 45, no. 6, pp. 887-982.

Gastmans, C, Lemiengre, J, van der Wal, G, Schotsmans, P & Dierckx de Casterle, B 2006, 'Prevalence and content of written ethics policies on euthanasia in Catholic healthcare institutions in Belgium (Flanders)', Health Policy, vol. 76, no. 2, pp. 169-78.

Imran, N, Haider, II, Jawaid, M & Mazhar, N 2014, 'Health ethics education: Knowledge, attitudes and practice of healthcare ethics among interns and residents in Pakistan', Journal of Postgraduate Medical Institute, vol. 28, no. 4, pp. 383-389.

Kuhse, H & Singer, P 1993, 'Voluntary euthanasia and the nurse: an Australian survey', International Journal of Nursing Studies, vol. 30, no. 4, pp. 311-322.

Kuhse, H, Singer, P, Baume, P, Clark, M & Rickard, M 1997, 'End-of-life decisions in Australian medical practice', Medical Journal of Australia, vol. 166, no. 4, pp. 191-196.

Lachman, V 2010, 'Physician-assisted suicide: compassionate liberation or murder?', Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses, vol. 19, no. 2, pp. 121-125.

Malpas, P, Mitchell, K & Koschwanez, H 2015, 'End-of-life medical decision making in general practice in New Zealand—13 years on', New Zealand Medical Journal, vol. 128, no. 1418, pp. 27-39.

McGlade, KJ, Slaney, L, Bunting, BP & Gallagher, AG 2000, 'Voluntary euthanasia in Northern Ireland: General practitioners' beliefs, experiences, and actions', British Journal of General Practice, vol. 50, no. 459, pp. 794-797.

Mitchell, K & Owens, G 2004, 'End of life decision-making by New Zealand general practitioners: A national survey', New Zealand Medical Journal, vol. 117, no. 1196, pp. 1-11.

Muller, MT, Kimsma, GK & Van Der Wal, G 1998, 'Euthanasia and assisted suicide: Facts, figures and fancies with special regard to old age', Drugs and Aging, vol. 13, no. 3, pp. 185-191.

Nelson, B 1995, 'Euthanasia a family affair says top doc', The Sunday Territorian, Darwin, 21 May.

Onwuteaka-Philipsen, BD, Brinkman-Stoppelenburg, A, Penning, C, de Jong-Krul, GJF, van Delden, JJM & van der Heide, A 2012, 'Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey', The Lancet, vol. 380, no. 9845, pp. 908-915.

Riou, F, Aubry, R, Pontone, S & Pennec, S 2015, 'When physicians report having used medical drugs to deliberately end a patient's life: Findings of the "end-of-life in France" survey', Journal of Pain and Symptom Management, vol. 50, no. 2, pp. 208-215.

Rosenfeld, B 2000, 'Assisted suicide, depression, and the right to die', Psychology, Public Policy, and Law, vol. 6, no. 2, pp. 467-488.

Schwarz, JK 2003, 'Understanding and responding to patients' requests for assistance in dying', Journal of Nursing Scholarship, vol. 35, no. 4, pp. 377-384.

Schwarz, JK 2004, 'Responding to persistent requests for assistance in dying: a phenomenological inquiry', International Journal of Palliative Nursing, vol. 10, no. 5, pp. 225-235.

Seale, C 2009a, 'End-of-life decisions in the UK involving medical practitioners', Palliat Med, vol. 23, no. 3, pp. 198-204.

Seale, C 2009b, 'Hastening death in end-of-life care: a survey of doctors', Social Science & Medicine, vol. 69, no. 11, pp. 1659-1666.

Smith, SW 2007, 'Some realism about end of life: The current prohibition and the euthanasia underground', American Journal of Law and Medicine, vol. 33, no. 1, pp. 55-95.

van der Heide, A, Deliens, L, Faisst, K, Nilstun, T, Norup, M, Paci, E, van der Wal, G & van der Maas, PJ 2003, 'End-of-life decision-making in six European countries: descriptive study', The Lancet, vol. 362, no. 9381, pp. 345-350.

Voultsos, P, Njau, SN & Vlachou, M 2010, 'The issue of euthanasia in Greece from a legal viewpoint', J Forensic Leg Med, vol. 17, no. 3, pp. 131-6.

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Dr William Toffler (left) acknowledges no slippery slope cause-and-effect evidence, with Drs Bentz and Stevens

A new scholarly journal focused on end-of-life ethics, decision-making and practice has just been launched: the Journal of Assisted Dying. In the first article, claims by Oregon lobby group Physicians for Compassionate Care (PCC), including Doctors Bill (William) Toffler and Ken Stevens (and others) are assessed against empirical evidence and found to be completely wrong, or highly misleading as a result of selective use of data.

The new scholarly journal, the Journal of Assisted Dying, is dedicated to careful and holistic analysis of evidence in regard to the various forms of assisted dying that are lawful in a number of jurisdictions around the world... and to practices in jurisdictions where assisted dying remains illegal.

In the first article of a series on Oregon, I examine claims and speculations made by various doctors (and others who quote them), that Oregon has the second-highest suicide rate in the USA (or is always in the top 10), that Oregon's Death With Dignity Act has resulted a massive increase in the state's general suicide rate, and other astonishing statements.

Of course, the empirical evidence from the Oregon Health Authority and from the USA Centers for Disease Control and Prevention does not support these statements and interpretations, and I analyse and critique the evidence.

Some of the claims are just plain factually and hugely wrong. Others are the result of failing to read their sources more carefully, misunderstanding what the data actually represents. Still further claims are made on the basis of selectively-chosen statements from government reports, while omitting statements that are contrary to, or provide alternative and well-researched explanations for Oregon's recently rising general suicide rate.

Drs Toffler and Stevens have even published some of their claims and speculations in the British Medical Journal.1 It goes to show that even good journals sometimes publish bunkum:  their article was a letter to the editor rather than peer-reviewed research. Great care is required to sort real evidence from hype and opinion.

Ultimately, Dr Bill Toffler of PCC has acknowledged on video that there is no cause-and-effect evidence between Oregon's Death With Dignity Act and Oregon's suicide rate, an acknowledgement that went unchallenged by his two PCC colleagues present at the time, Dr Ken Stevens and Dr Chuck (Charles) Bentz. You can see Dr Toffler's statement here (at 10'50").

The Journal of Assisted Dying is an open-access journal, and you can read the full article here.

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1. Toffler, WL & Stevens, K 2015, 'Re: Assisted dying: law and practice around the world', BMJ, vol. 351, 19 Aug, p. h4481.


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Physician use of misinformation to speculate 'assisted dying suicide contagion' in Oregon


Author(s)

Neil Francis

Journal

Journal of Assisted Dying, vol. 1, no. 1, pp. 1–6.

Abstract

Background: Several physicians have speculated that Oregon’s general suicide rate is evidence of suicide contagion as a result of Oregon’s Death With Dignity Act (‘the Act’).
Methods: Search and analysis of physician and related online sources of Oregon suicide contagion speculation; retrieval and analysis of cited Centers for Disease Control and Prevention (CDC) and other publications relied upon; analysis of authoritative, public Government mortality data for Oregon and other USA states.
Results: Several physicians have speculated about Oregon suicide statistics in a manner that is not supported by the cited publications, or by public CDC mortality database data. The claims variously (a) misrepresent key data in the publications, (b) omit information in the publications that is at variance with suicide contagion speculation, and (c) overlook other significant information at variance with speculation. The physicians have previously acknowledged inability to prove perceived “slippery slope” effects of the Act. Other opponents of the Act have republished the physicians’ erroneous information.
Conclusions: Evidence advanced by several physicians to speculate that Oregon’s Death With Dignity Act causes suicide contagion in Oregon is variously false, misleading or highly selective—omitting key facts—and has arisen even though the physicians acknowledge they have no proof of ‘slippery slope’ effects.

Article keywords

suicide contagion, copycat suicide, Werther effect, slippery slope, misinformation, Oregon, Dr William Toffler, Dr Kenneth Stevens, Physicians for Compassionate Care

Full PDF

Download the full PDF: Download the full article (390Kb)

Citation

Francis, N 2016, 'Physician use of misinformation to speculate 'assisted dying suicide contagion' in Oregon', Journal of Assisted Dying, vol. 1, no. 1, pp. 1-6.

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