Margaret Somerville

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More Dutch evidence contradicts Margaret Somerville's 'suicide contagion' theory

I’ve previously published an extensive analysis of how Professor Margaret Somerville, of the Catholic Notre Dame University of Australia, cherry-picked her way through select data that seemed to be (but wasn’t) consistent with her ‘contagion’ theory from assisted dying to the general suicide rate. I provided ample evidence from lawful jurisdictions that comprehensively contradicts her claim. I also published the summary in ABC Religion & Ethics.

Yet Somerville still says despite extensive real-world experience to the contrary, that “I believe that my [suicide contagion] statement will prove to be correct.”

She and her Catholic colleagues still hold onto several tenuous threads of information that might — just might — appear consistent with her theory, despite the truckloads of evidence to the contrary.

One of those tenuous threads is that the general suicide rate in the Netherlands has increased from 2008, around the same time that use of the Dutch euthanasia law also increased. (The general suicide rate previously fell as assisted dying rates increased.)

I reported official Dutch government statistics and expert financial reports to show that the unemployment rate explains most (80%) of the variation in the Dutch general suicide rate since 1960, and that the Netherlands was particularly hard-hit by the global financial crisis from 2008 — whereas neighbouring Belgium wasn’t and its suicide rate dropped as assisted dying numbers increased. Unemployment in hard times is a known significant risk factor for suicide.

Now, a detailed and peer-reviewed analysis of Dutch data recently published in the Netherlands Journal of Medicine throws more mud in the face of Somerville’s theory.1

The research looked at the Dutch assisted death and general suicide rates from 2002 through 2014, separately for each of the five Euthanasia Commission reporting regions.

Headline results of the averages for 2002–14 are shown in Figure 1.

netherlandsfiveregionmap.jpgFigure 1: The average assisted death rate (and suicide rate) as a percent of all deaths by region, 2002-14
Source: Koopman & Putter 2016

As you can see, Region 3, which includes Amsterdam, had by far the greatest assisted death rate (3.4%), compared with the other four regions (1.7% – 2.0%). Yet Region 3’s suicide rate at 1.2% was the same as Region 5, while Region 5 had only half the assisted death rate of Region 3 (1.7% vs 3.4%). (The authors, unusually, expressed suicides as a percentage of all deaths.)

It's the opposite of Somerville’s theory which says that Region 3’s general suicide rate should be much higher (not lower, as it is) than Region 5’s.

Those figures are the average for 2002 – 14, and it’s possible that the picture is a little different for the more recent years in which the assisted dying rate is higher.

To answer that question, I’ve retrieved official Dutch Government data and calculated the assisted dying rates and general suicide rates for 2014, the most recent year for which all the data is available. I’ve also calculated the general suicide rate per 100,000 population, the more usual way of reporting and comparing suicide statistics. The results are shown in Figure 2.

dutchregionsveandsuicide2014.gifFigure 2: The Dutch assisted death rate and general suicide rate by region for 2014
Sources: Euthanasia Commission annual reports, Dutch Government statistics

While region 1 (the far north) has the lowest assisted death rate (3.2% of all deaths), it has by far the highest general suicide rate (13.6 per 100k population).

The latest Dutch regional data shows the opposite of Margaret Somerville’s ‘suicide contagion’ theory, adding to the already extensive evidence against it.Conversely, region 3 (which includes Amsterdam) has by a very large factor the highest assisted dying rate (6.0% of all deaths), yet it has the second-lowest general suicide rate (10.3 per 100k population).

This latest empirical evidence is consistent with other extensive evidence I’ve published showing an inverse — or no — relationship between assisted dying rates and general suicide rates.

The question is whether Margaret Somerville and her Catholic friends will pay the slightest attention, or continue to rely on invalid, cherry-picked morsels of data that they think support their theory, but don’t.

 

References

  1. Koopman, JJE & Putter, H 2016, 'Regional variation in the practice of euthanasia and physician-assisted suicide in the Netherlands', Netherlands Journal of Medicine, 74(9), pp. 387-394.

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Yet more research contradicts Prof. Margaret Somerville's Dutch NVE claim

I’ve criticised Catholic ethicist Professor Margaret Somerville in the past for promoting misinformation about assisted dying. One of her favourite stories is about supposed non-voluntary euthanasia (NVE) ‘contagion’ from voluntary euthanasia laws.

NVE is where a doctor deliberately hastens the death of a patient without a current explicit request from the patient.

Somerville claims that elderly Dutch citizens fear NVE — a slippery slope claim previously promoted by the Vatican. She stated that:

Old Dutch citizens are seeking admission to nursing homes and hospitals in Germany, which has a strict prohibition against euthanasia because of its Nazi past, and they're too frightened to go into nursing homes or hospitals in the Netherlands.”

She made the claim with certainty and without qualification.

She also stated it under the credentials of Professor, yet has offered not a shred of sound, verifiable evidence. That's unscholarly.

Her claim is premised on two false beliefs, that:

  1. The Dutch assisted dying law causes NVE —extrapolated to mean that elderly Dutch are therefore fearful of NVE in the Netherlands; and
  2. Because assisted dying is illegal in Germany, NVE doesn’t happen there — extrapolated to mean that elderly Dutch are confident in German healthcare and seek it in preference to their own.

Belief 1 is soundly contradicted by the evidence. Researchers have found small but significant rates of NVE in every country they’ve studied (though that to date hasn’t included Germany). They’ve also found that the rates of NVE in the Netherlands and Belgium have dropped (not risen) significantly since their assisted dying laws came into effect in 2002.

Now, new research comprehensively knocks Belief 2 off its perch, too.

In a pilot study just published in the German Medical Weekly, a team led by Professor Karl Beine of Witten/Herdecke University in Germany found that around 3.1% of doctors and nurses surveyed were aware of deliberately hastened deaths (which is illegal in Germany) in the past twelve months, and that 2.4% of them administered it themselves.

A new study has found that of German nurses and doctors who had intentionally administered life-ending drugs to patients (which is against the law), 40% of them had not been asked to do so by the patient: non-voluntary euthanasia. Further, of those who administered it themselves, 40% hadn’t been asked for it by the patient. That's NVE.

While previous evidence strongly suggested that NVE would occur in Germany as everywhere else, this study now factually establishes that it does.

The study authors concluded that “illegal intentional life-ending acts were administered by physicians and nurses in all healthcare areas [hospitals and nursing homes] under investigation.”

So much for Somerville’s second premise.

Now both premises of her misinformed NVE story are soundly contradicted by empirical research evidence.


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Patricia Flowers calls Margaret Somerville's arugments 'bullshit' on national television. Photo: ABC

Last week, Mr Xavier Symons published a defence of Professor Margaret Somerville, whose arguments against assisted dying were called ‘bullshit’ by Patricia Flowers on the ABC’s Q&A program. Symons and Somerville are colleagues at the Institute for Ethics and Society at the Catholic Notre Dame University of Australia.

Mr Symons made an important point: that a law about restricted self-choice for assisted dying is in no way comparable to the Nazi Germany euthanasia (or more correctly, eugenics) programme. While Prof. Somerville agrees that such comparisons are invalid, she nevertheless often mentions Nazi Germany as a ‘question’ when debating assisted dying. That’s a bit of a fudge.

And Mr Symons, in his defence of Prof. Somerville, offers some fudges of his own. While Dr Iain Brassington has offered a cool philosophical examination of Mr Symons’ opinion piece in a Journal of Medical Ethics blog, I’ll provide more of an evidential analysis.

Wrong on Dutch law and practice

Mr Symons said that euthanasia was legalised in the Netherlands in 2002. While technically that may be true, it's misleading. Assisted dying was actually made lawful in the Netherlands in 1982, after considerable debate and a number of court cases, when the Board of Procurators-General (the highest prosecutorial authority) formalised a set of conditions under which doctors would not be prosecuted for helping a patient die.

In practice, wider physician participation commenced in 1984 when the Royal Dutch Medical Association (KNMG) issued its own guidelines for clinical practice, based on the Procurators-General ruling, and grew to more than a thousand cases a year by the late 1990s.

It was in 2002 — when the Termination of Life on Request and Assisted Suicide (Review Procedures) Act came into effect — that the Dutch law on assisted dying changed from regulatory to statutory.

Mr Symons also claimed that since 2002, the “Dutch legislation [has] changed several times.” That’s not true: in fact, not one word of the Act has changed since it came into effect.

Nor has there been a “steady rate of increase” in the Dutch assisted death rate since 2002 “even when there was no legislative change” as he claimed. There has been an increase, but far from ‘steady.’ Rather, it’s a sigmoid (stretched-S) curve with very little initial increase, then increasing, and then levelling out again. It’s a pattern typical of human behaviour adoption, and has occurred in both Belgium and the Netherlands.

Selective Euro-evidence

Mr Symons also claimed “significant evidence from Belgium, Netherlands, Luxembourg” for his argued slippery slope. Yet he quotes percentages for only the Netherlands, correctly noting that assisted deaths increased from 1.3% of all deaths in 2002 to 3.7% in 2015.

Mr Symons doesn’t mention that:

  • the Dutch assisted dying rate was lower for a number of years after 2002 than before — as physicians and the public were still getting to grips with the new Act;
  • the Netherlands’ assisted dying rate dropped between 2014 and 2015;
  • the rate in Belgium (1.8% in 2015) is half the Netherlands’;
  • the rate in the Flanders (Dutch) north of Belgium (2.5% in 2015) is higher than in the Wallonia (French) south (0.87%), suggesting that higher rates may be a characteristic of Dutch culture;
  • the rate in Luxembourg, with very similar legislation, is a tiny one twentieth of the Dutch rate — 0.18% in 2014 (the most recent year of available data); or that
  • there is no evidence to date of the rate increasing in Luxembourg.
     

Selective North American evidence

While Mr Symons reports the Dutch rate as a percentage of all deaths, he reports his only other figures (for Oregon) as raw counts: rising from 16 in 1998 (before which assisted dying was entirely illegal) to 132 in 2015. (Actually, the final figure for 2015 was 135 cases.) What he fails to mention is that the Oregon rate in 2015 was 0.38% of all deaths, just one tenth of the Dutch rate. That is, the percentage is far less ‘impressive’ to his thesis and raises questions about ‘inevitable slippery slopes.’

The increase is hardly surprising given that when conduct is made newly lawful, only a few people might pursue it in its first year, with more people pursuing it seventeen years later. Even then, one hundred and thirty-five cases out of nearly thirty-six thousand deaths is hardly a “normalisation,” as Mr Symons argues.

He also argues that Quebec’s initial figures are “alarming,” without reporting the rate as a percentage of all deaths. Data from the first year (2015–16) indicates a rate of 0.74%, slightly lower than French-speaking Wallonia in 2015 (0.87%). (Half-way through the 2015–16 period, Canada’s Federal Parliament also passed an assisted dying law.)

The latest comparative data

The latest data on assisted death rates in Benelux and North America is shown in Figure 1. As I explain in one of the most detailed comparative analyses of lawful assisted dying practice conducted to date, it is likely that the higher rates are associated with Dutch culture.

adrates7jurisdictions.gifFigure 1: Assisted dying in Benelux and North America as a percentage of all deaths

Notes: Dutch cultures appear in orange. Flanders is the northern Dutch, and Wallonia the southern French, ‘half’ of Belgium.
Sources: Government statistics offices and assisted dying authority reports; Quebec, CBC News

The case of Vermont

In the USA state of Vermont (with an Oregon-like Act since 2013), a small number of people (38) have been prescribed lethal medication in the first three years. (Data is not available by year.) Assuming for the sake of argument that all of them took the medication (while Oregon and Washington data indicates that a third or more don’t), that would equate to an assisted dying rate of around 0.27% of all deaths as an annual average for 2013­–15.

Don’t mention Switzerland

Switzerland is perhaps the most ‘inconvenient’ case for slippery slope hypotheses, which might explain why assisted dying opponents usually avoid mentioning it. It has the world’s oldest assisted suicide law, in effect since 1942. It is also the least prescriptive: the only specific statutory requirement is that any assistance rendered must not be for reasons of self-interest. That’s it.

Surely a law in effect for 73 years and devoid of all the complex requirements of others would be the foundation for an out-of-control assisted dying rate, much higher than the Netherlands at 3.7%?

It isn’t. In 2015, the rate for Swiss-resident assisted deaths was 1.4%. The rate including foreigners — in other words, with a global population of potential ‘slippery slope candidates’ — was 1.7%. That’s less than half the Dutch rate.

Conclusion

To summarise, the lawful assisted dying rate varies widely between cultures, currently by a factor of twenty. Yet there’s one thing consistent amongst them all: the most common reason for pursuing an assisted death is advanced cancer.

Ultimately, the only thing Mr Symons’ argument establishes is that he prefers to negatively describe any use of a law of which he disapproves as “normalisation,” regardless of its usage rate. If this were not true it would be incumbent on him to nominate a non-zero assisted dying rate that he thinks acceptable, but not “normalised.”

To be sure, I agree with Mr Symons that it’s important to “review the hard facts” around assisted dying.

And yet, when he promised the reader that his “valid slippery slope” argument would be based on “compelling empirical” evidence, he made incorrect or misleading statements, provided cherry-picked morsels of data, and wrapped it all up in a loaded assumption. I think that Patricia Flowers would call that ‘bullshit.’


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In the previous video a claim by Catholic Professor of Ethics Margaret Somerville was rebutted: that the Dutch and Belgians seek health care in Germany because they fear being killed by their own doctors and without being asked. In this video, she furthers her bizarre claim by referring to Dutch and Belgian non-voluntary euthanasia rates as 'proof' of her border-crossing healthcare thesis.

However, her cherry-picked statistic establishes nothing, whereas her claim is contradicted by robust research, which I discuss in this video.

It's unclear why Professor Somerville seems to be unaware of or ignores readily-available yet contradictory evidence of central importance to her claim.

This 'non-voluntary slippery slope' claim is another one that's popular amongst campaigners against assisted dying.

 

Transcript

Neil Francis: In the last video, we established as false, Professor Margaret Somerville’s absurd claim of the Dutch going to Germany for health care because they feared being killed by their doctors. But she goes on.

Margaret Somerville: In actual fact they’ve got good reason to fear that, uh, there’s a minimum of, a minimum of 500 cases a year, of doctors who administer euthanasia to people in the Netherlands, where it’s legal, and the patient does not know they’re being given euthanasia, and has not consented to it. Some reports put the figure as high as 2000 cases a year.

Neil Francis: And she makes a similar case for Belgium. So let’s look at the empirical evidence.

Neil Francis: What she’s referring to is non-voluntary euthanasia, or NVE. It occurs in every jurisdiction around the world. A study published in 2003 found these rates. You’ll notice that Italy had the lowest and Belgium the highest NVE rates. And at the time of this study, which countries had legalised assisted dying?

Neil Francis: Switzerland had since 1942, and the Netherlands since 1982. But none of the others had. So the Swiss and Dutch NVE rates, with assisted dying laws, were lower than Denmark’s, without one. And the higher Belgian rate wasn’t caused by an assisted dying law, because none existed at the time.

Neil Francis: But did the Belgian and Dutch NVE rates go up when each country legalised assisted dying by statute in 2002? Here’s what happened in Belgium: the rate didn’t go up — it went down, and the drop is highly statistically significant.

Neil Francis: And in the time since Professor Somerville made her misleading claim, it’s remained lower.

Neil Francis: And here’s what happened in the Netherlands. This rate before the Act is around 1,000 cases a year, and this one after the Act is around 500, the rate that Professor Somerville refers to in her claim as “the minimum”. What she failed to mention is that since statutory legalisation of assisted dying, the Dutch NVE rate dropped, not risen, and to a similar level as the UK, the world’s gold standard for palliative care, and which has never had an assisted dying law.

Neil Francis: And since Professor Somerville made her misleading claim, it’s dropped even further.

Neil Francis: If Professor believes that she has verifiable empirical evidence to back up her claims, let her produce it for examination. Until then, her non-voluntary euthanasia “slippery slope ”is nothing more than fear-mongering innuendo.

Visit the YouTube page.

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Professor Margaret Somerville makes an indefensible 'suicide contagion' claim.

Catholic ethicist Professor Margaret Somerville claims that every assisted suicide jurisdiction shows 'contagion' to the general suicide rate. The empirical evidence contradicts her claim.

Get the full report here.

Professor Margaret Somerville, currently Professor of Ethics in the School of Medicine at the Catholic University of Notre Dame Australia,[1] has enjoyed ongoing publication of her opinions, with few challenges published to date.

Back in 2007, Somerville, then a Professor of Ethics at McGill University in Montreal, Canada, appeared as an expert witness in an Iowa District Court case. The court comprehensively rejected her testimony, determining that she:

“…specifically eschews empirical research and methods of logical reasoning in favour of ‘moral intuition.’ She has no training in empirical research…”

Professor Somerville, I argue, has again fallen short on empirical research and logical reasoning. To illustrate, I will analyse her claim, published in an opinion piece in ABC Religion and Ethics that:

“…the general suicide rate has increased in every jurisdiction that has legalized assisted suicide.

While her claim may be her own personal opinion, she has presented it expressly stating that she is a Professor of Ethics at her current university of employment, lending the claim perceived authority.

This report demonstrates how her claim and her defence of it are contradicted by multiple sources of empirical government and other primary research evidence. It also demonstrates that she failed to engage appropriate scholarly standards that require the active search for, acquisition and analysis of all reasonably available relevant data in an attempt to answer a particular question.

In making her claim, Prof. Somerville:

  • Cites ‘supportive’ data from lawful jurisdictions while overlooking other data, sometimes even in the same data set, that are inconsistent with her claim;
  • Cites as supporting evidence an econometric modelling study that did not find a statistically-significant relationship between assisted dying law and the general (non-assisted) suicide rate;
  • Fails to consider data from all jurisdictions with assisted suicide laws while making a claim about them all — overlooking Switzerland, whose empirical data is clearly at odds with her claim;
  • Repeatedly cites non-academic anti-euthanasia lobbyist Mr Alex Schadenberg (who also cites her) as a source of evidence for her claim and who in turn quotes a television source and another lobbyist’s opinion to underpin his own beliefs about ‘suicide contagion’; and
  • Conflates voluntary euthanasia (physician-administration) with assisted suicide (patient self-administration) such that her argument, at least in the context of Belgium and the Netherlands, is substantially about the novel concept of ‘euthanasia contagion’ rather than the more familiar ‘suicide contagion’ expression she uses.
     

These findings are consistent with the Iowa court’s ruling that Prof. Somerville sometimes relies on ‘moral intuition’ rather than sound empirical research and logical reasoning.

My report also draws a number of connections between those advancing misinformation on assisted dying ‘suicide contagion,’ and Catholic identity. Catholic identity is not a reason to reject arguments, but it does help identify the source of a majority of ‘suicide contagion’ misinformation.

Finally, I argue that the appropriate course of action for Prof. Somerville is to retract her ‘suicide contagion in every jurisdiction’ claim.

 

Get the full report here.


[1]   Not to be confused with another Professor Margaret Somerville, who is Director of the Centre for Educational Research at Western Sydney University.

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Catholic Professor of Ethics Margaret Somerville claimed in a University address that elderly Dutch people are fearful of being euthanased in nursing homes and hospitals and instead travel to Germany for health care.

She provided no sources or evidence for her claim.

Dr Els Borst, the Minister resonsible for the Netherlands' euthanasia law, reveals these claims about 'fear of being killed' in nursing homes as 'absolute lies.' Dutch Senator Heleen Dupuis confirms that it is untrue.

The claim is popular amongst opponents of assisted dying law reform. It raises questions about how a Professor of Ethics came to state is as authoriative fact.

Transcript

Neil Francis: Former Dutch Minister for Health, Dr Els Borst, shared an experience her Government had with the Vatican about assisted dying

Els Borst: Their journal, the Osservatore Romano, was writing, was publishing articles saying that in the Netherlands, people who went to a nursing home or an old people's home, didn't dare to do that any more because they were so afraid they would be killed by their doctor after a week or so.

Els Borst: And we were so angry about this, absolute lies, that we went together, to the Vatican, and we told them that if they didn't stop that sort of lies in their journal, that we would stop diplomatic relations with Vatican City.

Els Borst: We had an ambassador there, and my colleague the Minister for Foreign Affairs said, "I'll withdraw that ambassador and he'll never return."

Else Borst: And then it stopped.

Neil Francis: Well perhaps the Vatican did, but here's Catholic Professor of Ethics, Margaret Somerville.

Margaret Somerville: Old Dutch citizens are seeking admission to nursing homes and hospitals in Germany, which has a strict prohibition against euthanasia because of its Nazi past, and they're too frightened to go into nursing homes or hospitals in the Netherlands.

Neil Francis: I asked Dutch Senator, Professor Heleen Dupuis, about the claim.

Heleen Dupuis: OK, stupid. It is simply not true.

Neil Francis: It's time to stop spreading such fearmongering scuttlebutt.

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Catholic Professor of Ethics Margaret Somerville claimed in a University address that the Minister who brought in the Netherlands' euthanasia Act (that's Dr Els Borst), said that doing so had been "a serious mistake."

In an offence against scholalry standards, Prof. Somerville did not check her facts with the primary source before making the claim. I know, because I did. I interviewed Dr Borst in Utrecht: Prof. Somerville had not contacted Dr Borst, and Dr Borst stated clearly and without hestitation that she still thought it a good law.

Prof. Somerville instead chose to repeat scuttlebut circulating amongst assisted dying law reform opponents.

Transcript

Neil Francis: Before her death, I visited Dr Els Borst in Utrecht, to seek her current views about the Netherlands' euthanasia Act, which she introduced into the Dutch parliament, and which had been in effect for many years.

Voice of Neil Francis (interview): What are your feellings about the law?

Els Borst: I'm still very happy with it. I think we did the right thing there, also in the way we formulated it.

Neil Francis: But despite the clarity of Dr Borst's continued support for the law, Professor Somerville claimed the opposite in an address at the University of Tasmania.

Margaret Somerville: The Minister who was responsible for shepherding through the legislation that legalised euthanasia in the Netherlands admitted publicly that doing so had been a serious mistake."

Neil Francis: Oh dear. I showed Dr Borst the video of Professor Somerville's claim, and here's her response.

Els Borst: I know that story. I'd like to meet this Margaret S... what's her name?

Vice of Neil Francis: Margaret Somerville

Els Borst: ... well maybe she wouldn't listen anyway.

Neil Francis: The public have a right to ask why Professor Somerville chose to spread scuttlebut, instead of checking her sources in a proper, scholarly fashion.

Visit the YouTube page.

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Notre Dame University welcomes Professor Margaret Somerville via its website.

In two opinion pieces recently published in the ABC’s conservative Religion & Ethics blog,1,2 Margaret Somerville, Professor of Bioethics at Notre Dame University, railed against marriage equality law reform using reasoning that I contend fails not only appropriate standards of ethics argument but indeed her own stated standards. Here’s why.

Railing against careful and reasoned language

In two ABC opinion pieces, Margo (as she refers to herself) railed extensively against the term ‘marriage equality,’ arguing that it ought to be referred to instead as ‘same-sex marriage.’ She volunteers that the real motive for her preferred term is that in her opinion fewer people will support ‘same-sex’ marriage than will support ‘equality’ of marriage.

Margo quite overlooks the fact that some folks deliberatively eschew gender identity or are asexual, yet may wish to honour a loving, life-long relationship through marriage. There’s also the issue of a change of gender identity within marriage, not just when entering into marriage.

The goal of Australian marriage law reform is a single, revised Act which articulates a uniform, equal set of provisions for marriage regardless of sexual orientation or gender identity: not a separate Act which permits a different version of marriage only for same-sex-attracted people.

Therefore, ‘marriage equality’ is indeed an appropriate expression for revised legislation while ‘same-sex marriage’ is less so.

“But what about the children!?”

Margo also railed extensively against marriage equality because, she claims, marriage is primarily about the rights of children, not the married couple.

However, the Marriage Act3 makes no assumptions about the marriage being for the purpose of producing children. Indeed, this would be foolish as it would preclude infertile couples from marrying. Here’s the entire definition of marriage under the Act:

“Marriage means the union of a man and a woman to the exclusion of all others, voluntarily entered into for life.” — Marriage Act 1961 (as amended)

Sure, the Act does have a couple of things to say about children, but in relation to the status of a legally adopted child, and child ‘legitimacy’ (which confers rights to use the family name and inherit titles, for example).

While the Act provides largesse for religious marriage celebrants to include any wording they deem appropriate (and which might cover the subject of procreation) in a marriage service, the minimum required civil celebrant wording is:

“I call upon the persons here present to witness that I, (first and last name), take thee, (first and last name), to be my lawful wedded wife/husband.” — Marriage Act 1961, S45(2) [or words like it]

No mention of children there, either. Section 1A.3 of the Marriage Regulations4 requires a marriage celebrant (religious and civil alike) to recognise “the importance of strong and respectful family relationships.” Notice again the absence of the presumption of producing children.

No necessary connection between children and marriage

Separate State and Territory Acts provide for the recognition of de facto relationships, over which the Commonwealth has no special jurisdiction. While recognised by the state these relationships are legally distinct from marriage.

In terms of unions that Australians willingly establish, Australian Bureau of Statistics data shows that:5

  • Around three quarters of marriages are now conducted by a civil celebrant rather than a religious one; and
  • Around one third of all Australian births are now to non-married partners.

 
It’s obvious that many marriages are now non-religious, that they can be childless, and, conversely, that many children are born in the absence of marriage. There is no necessary relationship in either direction between marriage and children that underpins Margo’s contentions.

No necessary link to assisted reproduction, either

Margo then goes on to rail against assisted human reproduction (surrogacy, gamete donation and IVF), complaining that non-hetero married couples would have to ask for such help to produce children. But, like the child argument itself, this is not unique in any way to marriage. De facto couples and even single women can ask for reproductive assistance, as can infertile hetero couples within marriage. As with children, assisted reproduction and marriage are not uniquely entwined as Margo wrongly argues: they are separate in law and practice even if the link is critical to some couples.

Why the confected 'necessity'?

So why then, does Margo go to such lengths to instil ‘children’ as central to the purpose of marriage? A potential explanation is that her expressed views, while reflecting neither law nor practice, are consistent with her Catholic faith. Catholic tradition is very deeply steeped in the notion that marriage is primarily for the purpose of procreation.

In her 2015 Bird on an Ethics Wire book, Margo invokes the 'would-if-they-could' defence for opposite-sex couples who want to marry but are intfertile (while remaining mute about married couples who expressly don't want children). She fails to articulate any sound reason as to why this is a different 'would-if-they-could' argument from same-gendered or non-gendered partners, except to argue, offensively, that same-sex partners are socially infertile for “lack of an opposite-sex partner.” In her ABC opinion pieces she simply says the hetero version is “symbolic.” Curiously for an ethicist, she fails to reflect on who gets to decide which are valid symbols and whether any symbolism ought to be mandatory for everyone.

Margo asserts that marriage between opposite-sex partners is ‘traditional.’ I say, good on her for personally sticking to a tradition she thinks important: but ‘tradition’ is a poor foundation for continuing to impose historical views on Australians who are not Catholic nor any longer support those views… which is the great majority of us.

The bogeyman argument

Margo then makes vague claims that marriage equality ‘takes away children’s rights’ and causes ‘harms.’ The ‘harm’ she does articulate is the “right to know one’s biological parents.” She speaks of anonymous gamete donation, but fails to note that it occurs equally both inside and outside of — and therefore isn’t conditioned by nor conditions — marriage. Therefore, any “right to know one’s biological parents” is, like children themselves and assisted reproduction in general, entirely independent of the marital status of the parents and is of no special force or relevance in marriage equality debates.

The not-as-good-as-heteros argument

Margo then promotes the importance of the “complementarity in parenting between a mother and father,” with the innuendo that same-sex parents are at least a much lesser standard for raising children, if not unsuitable altogether. Let’s examine this hoary old chestnut, particularly in relation to ‘expert’ evidence Margo proffered in a USA Court case.

Court assessment of Margo’s ‘evidence’

Historically, Iowa’s statute §595.2 restricted marriage to between only a man and a woman. A series of Iowa Court cases overturned that limitation in 2006–9. Margo and two of her colleagues from McGill University’s School of Religious Studies were advanced to the court as ‘expert witnesses’ against the reform, in relation to the ‘perils’ of marriage equality including the ‘harms’ to children. Here’s what the Iowa District Court concluded:6

“Though they may have expertise in certain areas, such expertise is insufficient to qualify Ms Somerville [and her two colleagues from the School of Religious Studies] to answer the particular questions that they are asked. Though these experts desire to make statements regarding gender, results of same-sex marriage on children and the universal definition of marriage, they do not appear to possess expertise in relevant fields such as sociology, child development, psychology or psychiatry. Ms Somerville specifically eschews empirical research and methods of logical reasoning in favour of ‘moral intuition.’ She has no training in empirical research and admits having no knowledge of existing social science research relevant to this case. She concedes that her views do not reflect the mainstream views of other ethicists.”

and

“The views espoused by these individuals appear to be largely personal and not based on observation supported by scientific methodology or based on empirical research in any sense.”

and

“…the Court concludes that these individuals are not qualified to testify as experts regarding the issues in this matter.”

The Court then expressly identified substantive harms that accrue to non-heterosexual partners through denial of marriage.

The case then went to Iowa’s Supreme Court. In a unanimous decision, the Supreme Court upheld the District Court’s determination, noting that:7

“The research appears to strongly support the conclusion that same-sex couples foster the same wholesome environment as opposite-sex couples and suggests that the traditional notion that children need a mother and a father to be raised into healthy, well-adjusted adults is based more on stereotype than anything else.”

and

“Many leading organizations, including the American Academy of Pediatrics, the American Psychiatric Association, the American Psychological Association, the National Association of Social Workers, and the Child Welfare League of America, weighed the available research and supported the conclusion that gay and lesbian parents are as effective as heterosexual parents in raising children.”

and

“For example, the official policy of the American Psychological Association declares, ‘There is no scientific evidence that parenting effectiveness is related to parental sexual orientation: Lesbian and gay parents are as likely as heterosexual parents to provide supportive and healthy environments for children.’”

So much for Margo’s ‘authority’ on the subject of marriage equality.

Those interested in a thorough rebuttal of Margo’s arguments against marriage equality might be interested to read papers by Scoff F. Woodcock of the University of Victoria (BC), an Associate Professor specialising in normative and applied ethics,8 and Timothy F. Murphy of the University of Illinois, Professor of Philosophy in the Biomedical Sciences specialising in professional ethics, assisted reproductive technologies, medicine and sexuality.9 Both these Professors hold earned doctorates in philosophy; whereas Margo, according to her own biography, holds earned academic qualifications in pharmacy and law, but none in philosophy or ethics.

The importance of relevant and persuasive facts

In an important recognition, a highly-published ethicist once wrote that:

“We sometimes overlook the importance of having good facts in dealing with ethical issues. This is a serious mistake. Good facts (including, if necessary, research to establish them) are essential to good ethics, which, in turn, is essential to good law.” and “Good ethical and legal ‘facts’ start with primary sources that are up to date and accurate.” [Italics are original]

That ethicist was… Margo Somerville.10 My view is that Margo has failed to live up to her own standards by getting some fundamental facts expressly wrong and misrepresenting others with innuendo whilst failing to mention readily-available and widely-agreed facts that contradict her thesis.

Also surprising is that she continues to opine against marriage equality law reform in Australia using the same opinions that were publicly and expressly rejected by a USA court; the same opinions that have been insightfully dissembled and rebutted by appropriately-qualified academics via analyses published in professional peer-reviewed journals.

Conclusion

An Iowa Court has determined that Margo Somerville’s views on marriage equality are largely personal and eschew empirical research and methods of logical reasoning in favour of ‘moral intuition.’ (More on ‘moral intuition’ in another blog.) Further, they are at odds with readily available research evidence. Her opinions then are not founded on scholarly verification and fail to reflect the highest standards of thought and deduction.

I firmly believe that Margo is entitled to her opinions. However, it is my view that appeals for her marriage equality opinions to be acclaimed on the basis of the authority bias — as “Professor of Ethics at Notre Dame University” and “a preeminent public intellectual in Bioethics” — are unjustifiable.

And if the ABC chooses to publish any more of Margo’s nonsense about ‘the perils of marriage equality to children,’ I might just ask for a refund of my twelve cents a day.*

-----

Up next: Who is Margo Somerville? Up later: Why is she so comprehensively wrong on assisted dying law reform?

* The ABC (Australian Broadcasting Corporation) is the nation’s public broadcaster and advertises that it provides its services for a mere twelve cents a day from each of the country’ residents.

 

Footnote: yet another fundamental (and simple) fact wrong

You’d think that being an accomplished Commonwealth legal scholar that Margo would understand the fundamental structure of Commonwealth legislatures.

But in her ABC missives against marriage equality, she concluded by remarking that same-sex couples often lament the lack of marriage equality “…such as we saw in the anguish Senator Tim Wilson manifested in his maiden speech in the Senate.” Here’s a photo of Tim Wilson delivering that speech:

Tim Wilson delivers his maiden speech in ParliamentTim Wilson delivers his maiden speech in Parliament. Video still: ABC News

In Commonwealth countries, the upper house (Australia, federal: Senate) is fitted out in red (the colour of royalty and cardinals), while the lower house (Australia, federal: House of Representatives) is green (the colour of ‘common’ fields).

Immediately evident from glancing at his maiden speech for a mere millisecond is that Mr Wilson is not a Senator: all the livery is green. He is MHR for the Victorian Division of Goldstein, not a Senator for the State of Victoria.

Canadian Parliament housesThe Canadian federal Parliament’s green House of Commons and red Senate (Margo has recently returned to Australia from decades in Canada) Photo: Mightydrake

It’s bewildering then that when Margo saw Mr Wilson’s maiden speech she utterly failed to establish which house he was in, nor took the trouble to examine or test her assumptions before publishing her ‘expert’ opinion about it online.

 

References

  1. Somerville, M 2016, 'Marriage equality' or 'same-sex marriage'? Why words matter, ABC Religion & Ethics, viewed 28 Oct 2016, http://www.abc.net.au/religion/articles/2016/10/14/4556874.htm.
  2. Somerville, M 2016, Same-sex marriage: It's about children's rights, not sexual orientation, ABC Religion & Ethics, viewed 28 Oct 2016, http://www.abc.net.au/religion/articles/2016/10/07/4552500.htm.
  3. 1961, Marriage Act (Cth), Australia, pp. 120.
  4. 1963, Marriage Regulations 1963 (Cth), Australia, pp. 85.
  5. Australian Bureau of Statistics 2015, 3310.0 - Marriages and Divorces, Australia, 2014, viewed 28 Oct 2016, http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/3310.0Main%20Features112014?opendocument&tabname=Summary&prodno=3310.0&issue=2014&num=&view=.
  6. Iowa District Court for Polk County 2007, Katherine Varnum et al. v. Timothy J. Brien, CV5965, pp. 63.
  7. Supreme Court of Iowa 2009, Katherine Varnum et al. v. Timothy J. Brien (Polk County), SCC No. 07-1499, Des Moines, pp. 69.
  8. Woodcock, S 2009, 'Five reasons why Margaret Somerville is wrong about same-sex marriage and the rights of children', Dialogue-Canadian Philosophical Review, 48(4), pp. 867-887.
  9. Murphy, TF 2011, 'Same-sex marriage: Not a threat to marriage or children', Journal of Social Philosophy, 42(3), pp. 288-304.
  10. Somerville, MA 2014, Death talk: The case against euthanasia and physician-assisted suicide (2nd Ed.), 2nd Ed. edn, McGill-Queen's University Press, Montreal.

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Back in 2013 the High Court of Ireland rejected a legal bid by multiple sclerosis sufferer Marie Fleming to achieve a lawfully-assisted peaceful death.

The Court naturally relied on expert testimony in reaching its judgement, yet its conclusions included a statement containing significant errors of fact.

The erroneous statement

In its judgement,1 the Court made the following statement:

Above all, the fact that the number of LAWER (“legally assisted deaths without explicit request”) cases remains strikingly high in jurisdictions which have liberalised their law on assisted suicide (Switzerland, Netherlands and Belgium) — ranging from 0.4% to over 1% of all deaths in these jurisdictions according to the latest figures — without any obvious official response speaks for itself as to the risks involved.” [My emphases in bold]

In fact, the Court's judgement is wrong on not one, not two, but three significant matters. But that hasn't stopped opponents of assisted dying law reform from quoting the judgement as though it were factual and persuasive, when it isn't: relying on it because it was made by a High Court—the 'authority bias.'

Consequences

Here are just a few examples of the Court's statement being wielded by assisted dying opponents as though it were conclusive evidence against law reform:

 
These examples illustrate the frequency of quoting the misinformation and how it feeds into and wrongly shapes public policy formation.

Three strikes

So what are the three counts on which the Court's judgement was seriously wrong?

Strike 1: Wrong concept

First, let’s get the concepts right. LAWER is not “legally assisted deaths without explicit request.”

Such nomenclature is an oxymoron. To ‘assist’ is to accommodate, serve or help someone accomplish something. But if there has been no request then one cannot be helping. You can’t ‘assist’ a little old lady across the road if she has expressed no interest in going there: you’d be forcing her across the road. Equally, you can’t ‘assist’ a death if there’s no proper ‘request.’

LAWER in fact stands for “Life-ending Acts Without Explicit Request” (of a competent patient).5 And with the exception of the possible ‘lawfulness’ of the doctrine of double effect, such acts are illegal.

Further, if such acts were legal as the Court’s statement posits, then there would be no need for an “obvious official response” as the Court then concludes. The statement lacks fundamental coherence.

Strike 2: Not ‘strikingly high’

The Court's judgement states unequivocally that LAWER (otherwise known as Non-Voluntary Euthanasia or NVE) rates in Switzerland, the Netherlands and Belgium are ‘strikingly high’, though no comparative yardstick is recorded in the judgement by which one might draw or justify that subjective judgement. Similar 'strikingly high' statements also appear in sections 102 and 104 of the judgement.

There is in fact a scientific study, published in The Lancet in 2003, that provides sound empirical evidence that could have properly informed the Court (Figure 1).6

Non-voluntary euthanasia in seven European countriesFigure 1: The non-voluntary euthanasia (NVE) rates of seven European countries in late 2001/early 2002

As revealed by this study, the NVE rates in Switzerland and the Netherlands were in fact lower than in Denmark, a country which has never had an assisted dying law.

The only country which did appear to have an NVE rate notably higher than the others was Belgium. The research study collected the data for analysis between June 2001 and February 2002. However, Belgium’s Euthanasia Act was not passed by its Parliament until 28th May 2002, well after data collection was complete. Thus, even in describing Belgium’s NVE rate as ‘strikingly high’ compared to a number of other European countries, it cannot be attributed to an assisted dying law because none existed at the time.

In fact, the NVE rate in Belgium had been found to be high back in 1998,7 well before the Bill for the country's Euthanasia Act was even tabled in Parliament.

Further, if assisted dying laws had such effects, it might be expected that the NVE rate would increase the longer that assisted dying laws were in place. In that case the NVE rates in Switzerland (statute since 1942) and the Netherlands (regulation since the early 1980s) would have NVE rates much higher than Belgium’s (statute since 2002). But the exact opposite is true.

Indeed, Rietjens and colleagues8 further concluded in their review of NVE in the Netherlands, Belgium, Denmark and Switzerland that “the use of drugs with the intention to hasten death without an explicit request of the patient is part of medical end-of-life practice in the studied countries, regardless of their legal framework, and it occurs in similar fashion.” The study, published in 2007, would also have been important evidence before the Court.

Strike 3: Not ‘remaining’ high

The Court's judgement states unequivocally that the LAWER (NVE) rate of the three countries ‘remains’ strikingly high. No specific evidence was supplied in the judgement to support this statement. Indeed, the judgement notes:

  • In section 28 that Dutch NVE had been “consistently declining.”
  • In section 91 that “the number of LAWER deaths has significantly declined in both [Dutch and Belgian] jurisdictions.”
  • In section 94 that “the trend in [Dutch] LAWER cases are declining in numbers (from 1,000 in 1990 to 550 in 2005)” and that in Belgium “the number of LAWER cases has declined since legalisation of assisted death.”
  • In section 101 that the NVE rates of both the Netherlands and Belgium had dropped.

 
Despite this clear and repeated evidence, the Court summarises in section 96 that the evidence cannot be “regarded as encouraging or satisfactory.”

But what does empirical research tell us about the NVE trends? In both the Netherlands and Belgium, since assisted dying was enshrined in statute and became effective in 2002, the rate of NVE has decreased significantly (Figure 2).7,9-11 In fact, the rate in the Netherlands is now similar to that in the UK, a country which has never had an assisted dying law and which provides the world’s gold standard in palliative care practice.

Non-voluntary euthanasia rates have decreased in the Netherlands and BelgiumFigure 2: Empirical trends in NVE rates before and after legalisation of assisted dying

These are critical yardsticks by which to judge practice in jurisdictions that have assisted dying laws with jurisdictions that don't. The UK study was published in 2009 and was readily available prior to the High Court’s hearings, yet appears not to have been presented in evidence.

The final (2010) Dutch NVE statistic in Figure 2 may or may not have been available to the Court: it was published in 2012 around the time the Court was taking evidence. The final (2013) Belgian statistic would not have been available to the Court as it was published in 2015.

Conclusion

While the High Court worked diligently within the scope of evidence brought before it:

  • The Court’s definition of LAWER is incorrect and incoherent;
  • Its statement that the NVE rates of the Netherlands and Switzerland are ‘strikingly high’ are evidentially wrong when compared with other countries without assisted dying laws;
  • Its implication that the higher NVE rate in Belgium was caused by assisted dying law reform is evidentially wrong; and
  • Its statement that the rates remain high is evidentially wrong.

 
The High Court's judgement does not provide defensible evidence or argument against assisted dying law reform.

Many lobbyists have repeated these incorrect statements, significantly misleading media, policy makers and legislators.

Now that the facts are readily available it’s appropriate to avoid repeating evidentially wrong statements, regardless of the apparent 'authority' of their source.
 

Summary of facts

  1. LAWER stands for "Life-ending Acts Without Explicit Request". Its practice is similar in countries with and without assisted dying laws.
  2. The NVE rates in the Netherlands and Switzerland are lower than the rate in Denmark, a country which has never had an assisted dying law.
  3. The NVE rate in Belgium appears higher, but was so long before assisted dying law reform and so cannot have been caused by such a law.
  4. The NVE rates of the Netherlands and Belgium have both decreased significantly since their assisted dying statutes came into effect in 2002.

References

  1. High Court of Ireland 2013, Fleming v Ireland & Ors - Determination, [2013] IEHC 2, Dublin.
  2. Boudreau, JD, Somerville, MA & Biller-Andorno, N 2013, 'Physician-assisted suicide: should not be permitted/should be permitted', New England Journal of Medicine, 368(15), pp. 1450-1452.
  3. Somerville, M 2016, 'Killing as kindness: The problem of dealing with suffering and death in a secular society', The Newman Rambler, 12(1), pp. 1-26.
  4. Keown, J 2014, 'A right to voluntary euthanasia? Confusion in Canada in Carter', Notre Dame Journal of Law, Ethics & Public Policy, 28(1), pp. 1-45.
  5. Pijnenborg, L, van der Maas, PJ, van Delden, JJM & Looman, CW 1993, 'Life-terminating acts without explicit request of patient', Lancet, 341(8854), pp. 1196-1199.
  6. 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, 362(9381), pp. 345-350.
  7. Bilsen, J, Cohen, J, Chambaere, K, Pousset, G, Onwuteaka-Philipsen, BD, Mortier, F & Deliens, L 2009, 'Medical end-of-life practices under the euthanasia law in Belgium', New England Journal of Medicine, 361(11), pp. 1119-1121.
  8. Rietjens, JA, Bilsen, J, Fischer, S, Van Der Heide, A, Van Der Maas, PJ, Miccinessi, G, Norup, M, Onwuteaka-Philipsen, BD, Vrakking, AM & Van Der Wal, G 2007, 'Using drugs to end life without an explicit request of the patient', Death Studies, 31(3), Mar, pp. 205-21.
  9. Seale, C 2009, 'End-of-life decisions in the UK involving medical practitioners', Palliat Med, 23(3), pp. 198-204.
  10. 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, 380(9845), pp. 908-915.
  11. 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, 372(12), pp. 1179-1181.
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Opponents of assisted dying law reform often invoke fictional slippery slopes as objections to law reform. In this video, Neil Francis gives three examples of supposed slippery slopes argued by opponents, explains why they are fictional, and shares the perspectives of several recognised experts from the USA state of Oregon about their Death With Dignity law which has been in effect since 1997. Three long-time Oregonian Death With Dignity Act opponents also admit there's no cause-and-effect relationship established between law reform and supposed slippery slopes.

This is the second of three videos sent to South Australian MPs in 2013.

Visit the YouTube page.

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