Rhetoric: Killing

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Wesley Smith and 'intelligent design' at the Discovery Institute

The Discovery Institute's Wesley Smith is at it again. In his latest anti-assisted-dying tirade published by LifeNews.com, he promote lies about the Dutch Groningen Protocol, despite my published detailed analysis — of how that regulation actually works in practice — providing ample evidence to disprove Mr Smith's polemic theories.

Creationism…with lipstick

Wesley Smith is a Senior Fellow at the Discovery Institute (DI). That's the organisation that promotes ‘human exceptionalism’ (the concept that humans are theologically pre-eminent in the universe), opposes the foundations of evolution, and controversially attempted to have ‘intelligent design’ taught as science in Pennsylvania public schools. The Pennsylvania District Court tossed out DI's ‘intelligent-design-as-science’ argument on the basis that:

“Teaching intelligent design in public school biology classes violates the Establishment Clause of the First Amendment to the Constitution of the United States (and Article I, Section 3, of the Pennsylvania State Constitution) because intelligent design is not science and ‘cannot uncouple itself from its creationist, and thus religious, antecedents.’” — Middle District Court of Pennsylvania

Intelligent design is, after all, merely creationism…with lipstick.

Mr Smith is also the fellow I've previously busted for promoting the false ‘suicide contagion’ theory about Oregon, and cherry-picking his way through other ‘evidence’ to fuel another of his polemics.

More nonsense — this time the Groningen Protocol

And now he's at it again. In his latest anti-assisted-dying tirade, he says this:

“Although technically illegal, infanticide happens regularly in Netherlands without legal consequence, and a bureaucratic checklist was published that determines which babies can be killed. Showing the direction of the current, the Groningen Protocol§ (as it is known) was published with all due respect and without criticism, in the New England Journal of Medicine.” — Wesley Smith

Mr Smith does nothing but parade astonishing ignorance and bias with this statement.

The facts

From my extensive and detailed research about the Groningen Protocol published in the Journal of Assisted Dying, Mr Smith ought to know that:

  • Neonatal euthanasia occurs around the world whether it is regulated or not. It occurs, for example, in France, where there is no protocol and no adult assisted dying law, at a rate far higher than the Netherlands.
  • The Groningen Protocol is lawful in the Netherlands and has recently been overhauled and further strengthened.
  • Its provisions are considerably more strict than are those of the Dutch euthanasia Act for decisionally-competent minors and adults.
  • In the nine years since the Protocol came into effect, there have been just two cases of neonatal euthanasia, both for cases of Herlitz type epidermolysis bullosa, a fatal and untreatable illness characterised by extreme internal and external blistering.
  • That compares with twenty two cases, mostly in relation to spina bifida, in the nine years prior to the Protocol coming into effect.
  • The Protocol was subject to considerable criticism from opponents when it was first published in the New England Journal of Medicine (NEJM).

 
Highly relevant too is that the Royal College of Obstetricians and Gynaecology also argued in 2006 (not long after the original Groningen Protocol was published in NEJM) for neonatal euthanasia to be possible in extreme cases in the UK.

Not the only criticism of Mr Smith

Mr Smith has been criticised before by others for selectively using evidence and being:

"prepared to bend the truth to make a point, turn a stomach, and potentially radicalize a reader." — Matthew K. Wynia and Arthur Derse, Medscape

Perhaps Mr Smith doesn't care for the facts getting in the way of a good polemic? While he's entitled to his opinions, by repeatedly bending the truth and making statements contrary to the readily-available evidence, I argue that Mr Smith directly undermines any apparent 'authority' he claims for his musings.

Conclusion

The recurring pattern of resorting to misinformation reveals a lack of any real argument. I challenge Mr Smith to lift his game or retire his quill.

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§ Mr Smith links ‘Groningen Protocol’ to a blog published by the Euthanasia Prevention Coalition which is run by Canadian Catholic Alex Schadenberg. That blog is in turn based on a blog published by the Catholic online blog Mercatornet. The Mercatornet blog is itself a reproduction of an article by Dr Felipe Vizcarrondo who was a Clinical Bioethicist at Georgetown University (a Catholic and Jesuit institution), and  which was originally published in Linacre Quarterly, the journal of the USA Catholic Medical Association.


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Jeanne Smits' completely false statement in LifeSiteNews

Well it didn't take long. Recently I posted a fact-based report card on Dutch euthanasia practice, based on the actual data from the 2015 annual report (and all the earlier reports) of the Dutch Euthanasia Commission. Now, just a few days later, conservative religious opponents have begun publishing completely untrue statements about Dutch euthanasia practice.

Catholic blog LifeSiteNews' 'Paris correspondent' Jeanne Smits has bolted out of the misinformation blocks, assertively and categorically stating in respect of the small increase in number of euthanasia cases from 2014 to 2015, that:

"The rise is mainly due to the increase of euthanasia for demented, elderly people as well as psychiatric patients, two categories that raise even more questions than 'ordinary' euthanasia for untreatable physical pain."

Smits goes on to correctly report that dementia was an underlying factor in 109 of the cases in 2015 (against 81 in 2014) and psychiatric disorders in 56 patients (against 41 in 2014).

The total number of euthanasia cases increased from 5306 in 2014 to 5516 in 2015, an increase of 210 cases. The increase in dementia cases was 28 and in psychiatric disorders was 15. Therefore, underlying dementia accounted for 13% of the increase, and psychiatric disorders 7% of the increase.

Cherry-picking

Smits has cherry-picked just the dementia and psychiatric illness figures and presented them in a way that supports her story arc, painting a bleak picture.

But by no stretch of the imagination does dementia and psychiatric illness account "mainly" for the increase as she categorically states.

What didn't Smits report at all? Cancer: the Netherlands' leading cause of death. In 2015, cancer was the underlying condition in 4000 euthanasia cases, against 3888 in 2014, a rise of 112 cases or 53% of the increase. That compares with dementia at 13% and psychiatric illness at 7% (20% combined), which Smits selectively critiques as a 'sharp rise'.

In no way is Smits' statement true.

No, let's be frank: it's an outright lie. Cancer was the major underlying condition accounting for more than half of the small increase (4%) of cases in 2015.

More evidence refutes the claim

Comparing one years' data with just the preceding years' data can be misleading when the number of observations is low, as it is for dementia and psychiatric illness euthanasia cases. Fortunately, we have data for more than just the one year.

Since 2012 the Euthanasia Commission has consistently published specific figures for dementia and psychiatric illness cases, so we can compare a rise over four years rather than just one. On this basis as a proportion of total 2012 cases, there has been a 17.9% increase in cancer-related cases, a 1.6% increase in dementia cases, and a 1.0% increase in psychiatric illness cases.

Longitudinal data is even more clear than a single year. It unequivocally refutes Smits' silly claim.

Bull is spread

Does Smits' claim matter much? Won't it just slip into oblivion?

No. Michael Haverluck of the conservative Christian paper OneNewsNow has already picked up Smits' article and repeated her claim as gospel. It remains to be seen how many other anti-euthanasia bloggers republish this nonsense.

Unacceptable conduct

In my view, publishing such a categorical yet false statement — even when unintentional — without first properly checking the facts, is unacceptable conduct. The article (and its derivatives) ought to be withdrawn.


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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.

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  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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ABC TV's Q&A panel discusses assisted dying law reform on 9th Nov 2015

In a recent opinion piece in the ABC’s Religion and Ethics section, Bernadette Tobin1 rails against assisted dying, commencing with the criticism that the ABC’s Q&A discussion on the subject this week “lacked precision.” But Tobin’s opinion piece itself commits exactly this offence, as I explain.

For the sake of brevity I’ll only quickly mention that Tobin’s piece also fails on the score of accuracy. For example, she wrongly asserts that “euthanasia” means a doctor administering lethal medication to a patient. It doesn’t. “Euthanasia” simply means “good death”: nothing more and nothing less, regardless of how it occurs. Tobin also asserts that voluntary euthanasia in lawful jurisdictions has caused non-voluntary euthanasia to develop. This is the polar opposite of published empirical research evidence.

But back to precision. Tobin employs two imprecise and deeply flawed arguments in her objection to assisted dying. She variously rolls them in together, so let’s unpack what they are: (A) the “it’s only fair” slippery slope, and (B) “it’s OK if you don’t mean it”.

A: The “It’s only fair” slippery slope

Tobin directly links assisted dying for the terminally ill to “anyone who is in pain, discomfort, constipated, incontinent, depressed, anxious and so on” by way of potential “benefit”. She conjectures that increasing the restrictions to who may qualify, and the process of qualification, would then be “unfair” to these others. She then goes on to extend the argument to those lacking in decisional capacity such as infants and those with Alzheimer’s. Surely, she says, “it would be ‘unfair’ to deny these people the ‘benefit’ that we will make available to those who are able to request it?

Slippery slope indeed. And it’s wrong. Let me illustrate how, using a topic familiar in political debate over recent years: same-sex marriage.

Opponents of same-sex marriage law reform, when using arguments of the kind Tobin offers (as they often do), say that we can’t allow two men to marry, or two women to marry, because then we would have to allow three or more people to marry. Further down the slippery slope, we would have to allow people to marry animals. Don’t laugh: such things have been argued.

Next—given that under the Corporations Act 2001 (Cth), companies, owners’ corporations and incorporated associations are at law ‘persons’, and now that persons may marry—it would be “unfair” (note that I’ve used imprecision quotation marks around the word as Tobin does) to disallow people from marrying companies and companies from marrying each other.

Finally, using Tobin’s own line of argument, it would be “unfair” to deny infants and those with Alzheimer’s being married off for the alleged “benefit” (those quotation marks again) that everyone else is enjoying, so we must as an unavoidable consequence of the first step of allowing same-sex marriage, allow arranged marriages for babies and those with advanced dementia.

By now it’s easy to spot two terminal flaws in Tobin’s argument.

Firstly, the use of just one criterion (“fairness”—which she leaves imprecisely undefined) as the sole basis for decision making about this legislative reform is indefensible. What about other critical factors such as well-informed, rational, decisional capacity, judging and weighing what a “benefit” is, in the face of intolerable and unrelievable suffering, consistent with one’s own values and beliefs, who may decide, and the right not to participate?

Secondly, any slippery slope’s purported summit (from which changes are argued only to slip downwards) is deeply rooted in the normativity of the present. We are used to marriage being between a man and a woman. In our relative comfort we accept it as ‘normal,’ ‘good’ and the ‘right thing’.

In decision-making scholarship this normativity is known as “anchoring”. Like an anchor around which a boat will swing according to the wind and tide, we take the pivot point (the anchor of the now), as the natural starting point for future decisions, comparing changes only to the present state of affairs.

But it isn’t a valid anchor, and assuming that it is seriously biases our thinking. We need cast our anchor back just one mooring from the current point to see how the anchor tints our decision-making spectacles:

We can’t allow a man and a woman to marry, because then it would be unfair to not allow two men to marry, or two women to marry, and then…”

Clearly, it is imperative that we outlaw marriage altogether.

The upshot of this slippery slope, when followed properly to its own logical conclusions, is that we must deny all rights because we can confect a slippery slope into a hypothetical moral abyss for any right.

B: It’s OK if you don’t mean it

Tobin further argues that relieving distressing symptoms “is good palliative care, even when that relief happens to hasten death.”

She doesn’t name it explicitly, but this is the doctrine of double effect, an argument first crafted in the thirteenth century by Catholic priest Thomas Aquinas. The doctrine suggests that a bad consequence of an action is justifiable if the agent did not intend the bad effect, if the intended good effect outweighs the bad effect, and if the agent applies diligence in attempting to minimise the bad effect. Notice that the doctrine speaks directly about the intentions of the agent and is silent on the views of the person upon whom the agent might act.

Tobin rails against a doctor intentionally administering a lethal dose to a patient (regardless of whether it is the dying patient’s most fervent wish) and slams the expressions “dying with dignity” and “aid in dying” as “fudges”.

Yet the doctrine of double effect, for which she argues in support, is itself a fudge because it says:

It’s OK to for a doctor to decide to and actually kill their patient (after all, they hastened the patient’s death), as long as they don’t mean to, and they mean well.”

What kind of standard is the secret stuff that goes on inside a doctor’s head without reference of any kind to the patient’s own views and desires, when compared to a fully informed, documented and tested request from the patient?

It’s no wonder that many scholars (as do I) consider the doctrine of double effect problematic.

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Bernadette Tobin is the Director of the Plunkett Centre for Ethics, a joint initiative of St Vincent’s Hospital, Sydney, and Australian Catholic University (ACU). According to ACU, a core mission of the Centre is to “bring a Catholic perspective to all its endeavours”.2

It’s unsurprising then that I detected neither broad thrust nor any detail of Tobin’s ABC opinion piece that deviated from the views of the Vatican. So be it.

There are many points on which Tobin and I agree, such as the potential benefits of palliative care for the dying. I argue, though, that basic scrutiny of the proffered 'principles' reveal them as deeply flawed and unpersuasive.

 

References

1  Tobin, B 2015, Voluntary euthanasia: It can only be a way station to the non-voluntary, ABC Religion and Ethics, viewed 14 Nov 2015, <http://www.abc.net.au/religion/articles/2015/11/13/4351675.htm>.

2  Australian Catholic University 2015, About the Plunkett Centre for Ethics, viewed 14 Nov 2015, <http://www.acu.edu.au/about_acu/faculties,_institutes_and_centres/centres/plunkett_centre_for_ethics/about_the_centre>.


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