Rhetoric: Suicide

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The terminally ill are not choosing between life and death, but between two ways of dying, according to their own beliefs and conscience. Photo: Andrew Drummond/AAP

In Monday’s Herald Sun, Victorian Archbishops Philip Freier and Denis Hart, and Bishops Ezekiel, Suriel, Lester Briebbenow, Bosco Puthur and Peter Stasiuk published a half-page advertisement admonishing the Victorian government for its initiative to legalise assisted dying for the terminally ill, an ad similar to the one published by religious figures in 2008.

I have no quarrel with individuals of faith regarding their own private beliefs. However, the bishops’ attempt at public “leadership” through the advertisement is deserving of redress for its multiple fallacies.

The ‘abandonment’ fallacy

The bishops claimed that assisted dying “represents the abandonment of those who are in greatest need of our care and support”. On the contrary: to ignore the deeply-held beliefs and rigorously-tested wishes of people at the end of life is to abandon their values and critical faculties in favour of the bishops’ own religious dogma.

The ‘competition’ fallacy

The bishops demand there should be more funding for healthcare rather than assisted dying, fallaciously pitting one option against the other. The Victorian government is indeed increasing funding for palliative care. It’s also aiming to provide lawful assisted dying for when even the best palliative care can’t help – which Palliative Care Australia has acknowledged – giving lie to the faux competition.

The evidential fallacy

Contrary to the bishops’ false presumption that legalised assisted dying will decrease trust in “the treatment and quality of care” from doctors, scientific studies into attitude change show that more people trust doctors when assisted dying is legal. Patients can then talk openly about options, even if they decide against assisted death. The bishops have abandoned facts in favour of religious assumptions.

The equivalence fallacy

The bishops refer to assisted dying as “government endorsed suicide”. They fallaciously equate a reasoned, tested and accompanied decision for a peaceful assisted death in the face of a terminal illness, with the impulsive, violent, isolated and regrettable suicide of individuals (many of whom have mental health and substance abuse issues) who are failing to cope with problems that can be addressed.

However, while the latter are choosing between life and death, the terminally ill are choosing not between life and death, but between two different ways of dying, according to their own beliefs and conscience. Rigorous 2016 research from Australian National University shows that the vast majority (79%) of Victorians support assisted dying choice for the terminally ill (with just 8% opposed), clearly distinguishing it from general suicide.

Shame on the bishops for disrespectfully equating the two.

The inconsistency fallacy

They also argue that assisted dying ought to remain prohibited because within healthcare, “mistakes happen and the vulnerable are exploited,” and “that in spite of our best efforts, our justice system could never guarantee” no one would die by mistake or false evidence. However, as I’ve pointed out before, an identical hypothetical problem exists under the refusal of life-saving medical treatment, a statutory right that Victorians have enjoyed for nearly 30 years. The statute has only three “safeguard” requirements, yet even those only apply if the refusal is formally documented, but not if it’s verbal.

Further, the United States Conference of Catholic Bishops directs that patients may refuse treatment if it imposes “excessive expense on the family or community,” yet makes no mention of the hypothetical “vulnerability” of the patient to be persuaded so, nor directs any requirements to assess the veracity of the refusal.

In stark contrast, the Victorian proposal for assisted dying legislation contains more than 60 safeguards and oversights.

The bishops are at risk of ridicule for such a gargantuan flip-flop: supporting the refusal of life-saving treatment with little or no oversight, while vocally opposing assisted dying legislation that mandates an armada of protections.

The not-so-hidden agenda

The bishops’ methods are rather unsubtle – hoping that these arguments, erroneous but carefully crafted to avoid any religious connotations, will be accepted as non-religious. Yet religion is writ large across their plea: as signatories to the letter they are all clerics employed directly and centrally in the promotion of their religions.

The authority fallacy

They might also rely on their religious status to convey gravity and authority to their pleas. Yet as people paid to do a job, like anyone else, their titles grant them no special privileges in lecturing Victorians about how they should die in the face of a terminal illness.

According to the 2016 census, just 23% of Victorians identified as Catholic, 9% as Anglican, 0.5% as Lutheran, and the other bishops’ signatory denominations so small as to not appear separately in the government’s statistics. Combined, the bishops’ faiths represent around 33% of the Victorian population, while 32% of Victorians identify with no faith at all. Surely the bishops are not arguing that they’re speaking for these other Victorians, too?

But the bishops don’t represent the views of their own flocks, either. According to the 2016 ANU study, 89% of non-religious Victorians support assisted dying law reform, as do 78% of Victorian Catholics and Anglicans. Indeed, opposition to assisted dying exists mostly among those who attend religious services once a week or more often – that is, those who are frequently exposed institutional religious messages of opposition – yet who comprise just 12% of Australians and 11% of Victorians.

Minding their own flocks

Australians are abandoning religion in droves. For example, when Freier ascended to the top job of Anglican Primate of Australia in 2006, some 19% of Australians identified as Anglican (2006 census). A decade later under his leadership, the 2016 census showed a drop of about a third to just 13%, and in Victoria, his home territory, to just 9%.

Hart’s Catholic church has experienced a drop in affiliation too, and it’s likely to continue and accelerate as Australians react with shock and disgust to the extent of child sexual abuse that the royal commission has exposed from under his organisation’s “pastoral umbrella”.

In conclusion, rather than bishops lecturing the government and Victorians with fallacious and faintly desperate arguments about the choices they shouldn’t have at the end of life, attending to their own flocks may be more useful Christian leadership.

May their God go with them in that endeavour.

 

This article was originally published in The Guardian.


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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 which 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 rather than per 100k population.)

The results are the opposite of Somerville’s theory which says that Region 3’s general suicide rate should be much higher than (not the same as) Region 5’s.

Those figures are the average for 2002–14. 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 alone, 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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Dr Michael Gannon announces the AMA's policy review to AMA members in 2015

In 2016, the Australian Medical Association (AMA) reviewed its policy on ‘euthanasia and physician assisted suicide.’ Despite ample evidence to the contrary, the AMA executive set its policy as opposed to assisted dying, when the only position that would have acknowledged and respected the views of most of its membership was a position of neutrality.

amauncoveredinfographicmar2017.jpg Infographic summary of 'AMA uncovered'

 

Get the PDFs: Infographic | 'Sixteen questions' | Full report

 

AMA policy review

The Australian Medical Association (AMA) has been historically opposed to legislative reform that would permit doctor-assisted dying for patients in unremitting and untreatable extremis. Its hostile position had been expressed through a Position Statement (PS) in effect for at least a decade, although its Code of Ethics has been completely silent on the matter.

The AMA’s opposition to doctor-assisted dying has been one of the factors leading to the failure of a number of attempts at assisted dying law reform.

In 2015 the AMA announced a review of its ‘policy’ on ‘euthanasia and doctor assisted suicide,’ managed through its Federal Council. The review was conducted from late 2015 and throughout 2016. It included an online survey of more than 3,700 Australian doctors.

Deeply flawed survey — against assisted dying

The survey methodology contained, however unconsciously, multiple serious design flaws biased against assisted dying: flaws which were brought to the attention of the AMA executive separately by two survey design experts. The executive dismissed the criticisms, incoherently arguing that while the AMA’s reviews are “fully-informed decisions based on well-researched, comprehensive information,” the survey was “not formal ‘research’ as such” and merely a “means to engage our members.”

The AMA relied on selected statistics from the survey to publicly explain the outcome of its review. It also provided its own members a private, detailed report of the review, of which more than half was a comprehensive statistical analysis of the survey.

The ‘Survey Limitations’ section of the report mentioned several minor issues, but not the significant biases brought to the attention of the executive by experts.

Yet supportive doctor responses

Despite these significant biases against assisted dying, the survey found:

  • 68% of doctors said that even with optimal care, complete relief of suffering is not always possible.
  • 60% of doctors said that if lawful, euthanasia should be provided by doctors, and more than half of them (total 32%) said that they would indeed practice it.
  • 52% of doctors said that euthanasia can form a legitimate part of medical care.
  • 50% of doctors expressly disagreed with the AMA’s statement that “doctors should not provide euthanasia under any circumstances.”
  • 38% of doctors expressly disagreed with the AMA’s policy opposed to assisted dying (only half expressly agreed), and 35% of doctors said that euthanasia should be lawful.
     

Some doctors oppose legalisation, not euthanasia itself

In relation to the last point, other scholarly research has found that an additional 25% of Australian doctors are opposed to law reform not because they are opposed to assisted dying itself, but because they would rather practice it in private without regulatory ‘interference.’ This confirms that more than half of Australian doctors believe assisted dying can be a legitimate and practical part of medical care.

AMA not representative of Australian doctors

Only AMA members were invited and permitted to participate in the survey, and more than 70% of Australian doctors are not AMA members, despite the AMA expressly advancing itself as representing all Australian doctors. Non-members are likely to be more supportive of assisted dying — snubbing AMA membership due to the AMA’s ‘officially’ hostile stance.

Hostile tweets by President during review

During the review process, AMA President Dr Michael Gannon made repeated public statements hostile towards assisted dying, including a statement that doctor assisted dying would offend the Declaration of Geneva. The Declaration has nothing specific to say about assisted dying, and any general Declaration statements Dr Gannon relied upon would be equal arguments against abortion. Yet the AMA accepts abortion practice by doctors.

Indefensible conclusion by AMA Executive

Finally, in the face of ample evidence (despite the methodological biases) that at least half of the AMA’s own members favour doctor involvement in lawful assisted dying and deem it legitimate medical care, and 38% of its own members expressly disagreeing with its opposed policy, the AMA executive decided to maintain ‘official’ organisational opposition in the revised PS.

The PS, which was previously named broadly as about ‘end of life care’, is now exclusively named as about ‘euthanasia and physician assisted suicide,’ even though it continues its broad coverage. This suggests that, however unconsciously, the executive’s attitudes against assisted dying have become more entrenched.

The PS continues to unequivocally state as before that “The AMA believes that doctors should not be involved in interventions that have as their primary intention the ending of a person’s life.” In announcing the conclusions of its review the AMA has promoted this statement widely and as though it applies to all Australian doctors, most of whom are not AMA members.

Neither AMA 'policy' nor its Code of Ethics is binding

Despite the confidence and certainty of the statement, the AMA advises that neither Australian doctors in general nor even its own members are bound by its PSs. Thus, statements in AMA PSs are more ‘suggestions’ or ‘thought bubbles’ rather than authoritative statements.

More recently, the AMA’s Code of Ethics has been updated, yet remains entirely silent on doctor-assisted dying, in curious contradiction of the ‘certainty’ of its PS. The Code of Ethics is not binding on doctors (even AMA members), either.

Incoherent demands for policy consultation

The AMA executive continues to demand deep involvement in the development of a legal framework for assisted dying (despite saying that doctors should not be involved in the practice), yet it has developed no specific frameworks for three other related, already-lawful medical practices: refusal of life-preserving medical treatment, continuous deep sedation until death, and the voluntary refusal of food and fluids.

These discrepancies collectively raise the question as to whether the AMA’s ‘official’ opposition to assisted dying law reform is political rather than medical.

Conclusison

The evidence is clear that the only “justifiable” position the AMA executive could have taken was to declare the AMA neutral towards lawful assisted dying — a matter of individual conscience for its member doctors.

Australian doctors may well question the AMA executive as to how such a flawed process arrived at the outcome it did, and a collection of questions are posed for the AMA to answer. Sixteen questions are posed below.

 

Get the PDFs: Infographic | 'Sixteen questions' | Full report

 

Sixteen questions for the AMA

  1. Why does the AMA, through its Tasmanian representative, think it appropriate to state on national television that dying patients in extremis and without relief can suicide by themselves, even if the AMA doesn’t “encourage” it?
  2. Why did the AMA repeatedly delete corrections to its negative MJA misinformation about assisted dying practice in Belgium?
  3. Why did the AMA decide to review its “policy on euthanasia and physician assisted suicide” when it didn’t specifically have one? It had a policy on the role of doctors in end of life care.
  4. Why did the AMA review comprehensively ignore the substantial secondary data that already exists about the attitudes and practices of doctors and patients in end of life decisions?
  5. Why did the AMA not proactively obtain professional advice and assistance with the design and conduct of its doctor survey, and prefer to use such an amateurish one?
  6. If the AMA really represents all Australian doctors, why did it expressly exclude more than two thirds of them from its survey?
  7. Why did the AMA persistently use inappropriate language and inadequate definitions about assisted dying?
  8. Why did the AMA not make any serious attempt to understand patient perspectives beyond superficial statements that ‘opinions are divided’?
  9. Why did the AMA not report the multiple significant biases in its survey, which it knew about, in the ‘limitations’ section of its final report?
  10. Why did the AMA President consider it appropriate to make multiple statements hostile towards assisted dying while the review was underway?
  11. Why did the AMA executive decide to continue to demand doctors not participate in assisted dying, when more than half of its own members said it could be appropriate clinical practice provided by doctors, nearly four in ten expressly disagreed with the policy, and a third said they’d participate if assisted dying were legalised?
  12. Why does the AMA consider it appropriate to make repeated categorical, public statements that doctors should not be involved in assisted dying, when its Position Statement is not binding on its own members, let alone all Australian doctors?[1]
  13. How can the AMA justify the incoherence of having an expressly opposed stance to assisted dying in its revised Position Statement while it remains totally silent on the matter in its Code of Ethics, revised at the same time?
  14. How can the AMA legitimately demand to be centrally involved in developing an assisted dying framework — in which it says doctors should not be involved — for law reform, when it has no frameworks at all for the similar contexts of refusal of life-preserving medical treatment, continuous deep sedation until death, and the voluntary refusal of food and fluids (all currently lawful and practiced)? When will it develop and publish those?
  15. Why does the AMA continue to present itself to the media and the public as representing all Australian doctors, when more than two thirds of them are not members?
  16. Will the AMA include a formal analysis and critique of this deeply flawed policy review as part of its modernisation efforts in order to rebuild its brand value and stem the falling tide of its membership? That is, is the AMA prepared to learn from its mistakes?

[1]   The AMA’s Code of Ethics is not binding even on its own members, either. So when the Code states “don’t engage in sexual, exploitative or other inappropriate relationships with your patients,” that’s merely a ‘suggestion’ or ‘recommendation’ rather than an ‘obligation’ as a member of the AMA.

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Schadenberg and Russell falsely call the Oregon Medical Association the "assisted suicide lobby" in contradiction of the facts.

Last week, Alex Schadenberg wrote—and Paul Russell republished—another nonsense article, this time about medical associations going neutral on assisted dying. They opine that there is no such thing as neutrality. And start out by getting their facts wrong... again.

Got the facts wrong yet again, lads

Messers Schadenberg and Russell claim that the Oregon Medical association is an "assisted suicide lobby" group. Had they bothered to check the rudimentary facts before sounding off, they would have known that the Oregon Medical Association remains neutral toward assisted dying. It reconfirmed its neutral stance as recently as early this month. It does not hold a 'supportive' stance.

How did Schadenberg and Russell come to their conclusion?

American Medical Association AGM

They refer to a motion that the Oregon Medical Association put to the recent annual general meeting of the American Medical Association. The motion sought to establish a process by which the American Medical Association would consult in order to re-evaluate its opposed stance to assisted dying, given that assisted dying is legal in a number of USA States and there are already many doctors who in good conscience provide assistance to die to qualifying patients.

Heavy-handed partisanship

In their usual style of heavy-handed partisanship, Schadenberg and Russell describe the Oregon motion as the "assisted suicide lobby" applying "pressure" to the American Medical Association.

They fail to level the same criticism at another group, the Louisiana Medical Society who put another motion to the meeting. The Louisiana motion sought to expressly confirm and entrench the American Medical Association's currently opposed stance. Schadenberg and Russell fail to criticize the Louisiana motion as "pressure," despite the fact that Oregon's motion was for open consultation, while Louisiana's was for a closed position.

Good sense prevails

In fact, they don't mention the Louisiana motion at all. Why? Because wiser heads prevailed at the national conference. The Louisiana motion was defeated and the Oregon motion was passed as I reported last week.

Desperate hyperbole

Schadenberg and Russell then desperately argue that you can only support or oppose assisted dying. There is no neutral, they say.

In the language of 'influence' we call this rhetoric "the sucker's choice." You put up just two options and demand folks pick one or the other.

"You're either for us or agin us!"

No other options, no nuances, no consideration of different options for different folks. Hardly the kind of stuff that would pass even a junior high school debate.

Back to the real world

Of course it's possible to be neutral.

Individually, a doctor may be personally opposed to assisted dying, but appreciate that another doctor, having equally examined their conscience, may support choice. Thus, the first doctor opposes for themselves but remains neutral to the position of other doctors. Indeed, an individual doctor may neither support nor oppose choice.

Collectively, it makes sense for a professional medical body to hold a neutral stance. How can it justify respecting the deeply-held beliefs and values of some of its members at the same time as explicitly disrespecting other members' views that are as closely examined and deeply held?

Conclusion

The best that opponents running the global charge against assisted dying can do is to first get their facts wrong (again), develop their false assumptions into shrill hyperbole, and then try to press the false dichotomy of a "suckers choice" into doing some heavy lifting: an exercise that falls flat on its face.

The evidence is crystal clear: they provide no real argument at all.


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On 16th September 2015, the Victorian Director of the Australian Christian Lobby (ACL), Dan Flynn, appeared as a witness to the Victorian Parliament’s end of life choices inquiry being conducted by the Legal and Social Issues Committee. He made a number of mistaken statements, but what was most worrisome was the revelation of the ACL’s real agenda: to wind back patient rights more than a quarter century.

 

Out of touch

In his opening address, Mr Flynn opined that assisted dying was 'not supported' by a 'broad base' of Victorian Christians (not just the ACL). This belief is diametrically at odds with clear and repeated evidence from multiple sources.

In 2012, I reported on a Newspoll study into Australian attitudes towards assisted dying. Not only did a whopping majority of citizens support assisted dying, but so did a great majority of Anglicans, Catholics and other Christians (Francis 2012).

 

Australian attitudes to assisted dying law reform in 2012

Newspoll 2012: Australian attitudes to assisted dying law reform by religion (green=support, red=oppose)

These national results are reflected by a sample of over 60,000 Victorians through the VoteCompass system during the 2014 Victorian election (Stayner 2014). It confirms a substantial majority of Catholics, Protestants, other religious and non-religious Victorians support assisted dying law reform.

 

votecompassvicvereligion2014.jpg

VoteCompass 2014: Victorian attitudes to assisted dying law reform by religion (grey=population average)

Out of date

Mr Flynn then referred to a Tasmanian Parliament’s inquiry into assisted dying which rejected law reform. However, the inquiry to which he refers was held in 1998, when Oregon’s Death With Dignity Act had barely been established, the Northern Territory’s Rights of the Terminally Ill Act had been extinguished within just eight months of coming into operation, and the Dutch, Belgian, Luxembourg, Washington and other legislation and judgements did not yet exist.

So, the Tasmanian Parliament’s rejection came from a position of a then general lack of information. The Oregon law has been in effect since 1997, the Netherlands and Belgium since 2002, Washington since 2008, Luxembourg since 2009, and so on. There is now plenty of evidence that assisted dying law reform doesn’t cause slippery slopes that opponents love to theorise about.

Wrong about ‘United Nations’

Mr Flynn then said that the United Nations had in 2012 expressed concern about a ‘lax attitude’ towards euthanasia in Europe, specifically mentioning the Netherlands and Belgium. This is completely untrue. Because it’s easy to make a simple blooper during a presentation, we’ll put aside the fact that he meant to refer to a completely different organisation: the Council of Europe.

We know this because he read directly from Council of Europe declaration 1859 (Council of Europe Parliamentary Assembly 2012). His ACL submission (Australian Christian Lobby 2015) reports (as he read out) exactly one sentence of the declaration, with his added emphasis, as:

"Euthanasia, in the sense of the intentional killing by act or omission of a dependent human being for his or her alleged benefit, must always be prohibited."

But presented in this manner the statement is quite misleading. As I explain in a forensic analysis of the misinformation campaign about this resolution (Francis 2015), the resolution was utterly clear about its intent: it was not about euthanasia (it explicitly said so), but rather about advance care planning. What the resolution spoke against (in the one sentence conveyed above) is non-voluntary euthanasia, not voluntary euthanasia. Both sides of the assisted dying debate agree that non-voluntary euthanasia (one person deciding for a hastened death on behalf of another) is not acceptable. It is not contentious.

In no way did the Council of Europe's resolution critique voluntary euthanasia or comment on any jurisdiction in which it is legal. And, the United Nations source to which the ACL submission refers was released in 2001, fourteen years ago and at the time of the Netherlands' Euthanasia Act was before the Dutch Parliament. With then limited information about how such laws work in practice, it expressed concern about the upcoming Act.

Wrong about Belgium’s law and practice

Mr Flynn referred vaguely to two cases of euthanasia in Belgium in which persons who requested and received euthanasia were not experiencing intolerable pain, which Mr Flynn asserted was a required safeguard in Belgium’s euthanasia Act. This was another supposed example of transgression of safeguards.  Wrong again.

While the Belgian Euthanasia Act is officially published only in Dutch and French, a robust English translation has been prepared under the supervision of Professor Herman Nys of the Centre for Biomedical Ethics and Law at the Catholic University of Leuven (see Parliament of Belgium 2002). The word ‘pain’ does not appear in the Act… at all. What does the Act have to say about the legislature’s intent on who may qualify? The relevant clause in Section 1 says:

"the patient is in a medically futile condition of constant and unbearable physical or mental suffering that can not be alleviated, resulting from a serious and incurable disorder caused by illness or accident."

It’s abundantly clear: mental suffering from an illness or accident qualifies as much as physical suffering, and the suffering does not need to be ‘pain’ as Mr Flynn mistakenly asserted to the Parliamentary Committee.

Mr Flynn also stated that there are mobile end-of-life units in Belgium. There aren’t. (But there are in the Netherlands, and they must follow precisely all the same requirements as anyone else. They operate to provide choice to patients whose regular or reachable doctors disagree with assisted dying and therefore decline to evaluate whether the patient may qualify under the Act.)

Confused about Advance Care Directives

In further testimony, Mr Flynn opined that the degree to which a doctor should be allowed to override a patient’s Advance Care Directive (ACD) is in part influenced by whether the doctor can speak with the patient.

But if the patient can currently speak and participate in decision-making, the advance care directive doesn’t apply: it is mute and of no effect. An ACD only applies when the patient cannot currently participate in their own decision making. That’s (only) what it’s for.

Winding rights back more than a quarter century

But the most worrying aspect Mr Flynn’s testimony was the revelation of ACL’s opposition to the right to refuse unwanted medical treatment.

The Medical Treatment Act 1998 (Vic) has enshrined for now more than twenty five years a patient’s right to refuse any unwanted medical treatments. In 2003 the Supreme Court of Victoria determined that artificial nutrition and hydration (i.e. via tubes) is medical treatment and can therefore be refused under the Act.

But Mr Flynn repeatedly argued that withholding or withdrawing artificial nutrition and hydration, if the patient’s body could ‘absorb’ them, could amount to physician-assisted suicide, and that doctors must be allowed to override refusals. On the matter of patient autonomy, he said that some autonomy rests "with the patients, but a lot of the autonomy in fact is with the doctor”.

When asked if a Jehovah's Witness who refuses a life-saving and simple blood transfusion ought to be allowed to do so, he conceded that they should be entitled to, but that such a case was a “bit of an outlier”. He didn’t explain on what moral grounds one person could refuse a simple procedure to save their life, but another person mustn’t be allowed to even if the likelihood of saving life was doubtful.              

So, the ACL’s real agenda is revealed: it recommends winding back the legislative clock more than a quarter century so as to force patients to endure some medical interventions that they don’t want and firmly refuse, if the doctor wishes to proceed.

No wonder the Committee repeatedly questioned Mr Flynn to ensure they had heard and understood his testimony correctly. In conclusion, Committee Chair Edward O’Donohue observed that Mr Flynn’s evidence was “quite surprising” and “quite contrary” to wide evidence already given.

And it’s no wonder that Theo Mackaay, General Secretary of the Victorian Council of Churches—a group of 30 member churches representing mainstream Christianity—criticised the ACL as “fundamentally conservative” and expressed “deep concern that media portrayal of statements from an established and narrow focused lobby group is presented as being representative of the entire Christian community” (Uniting Church in Australia 2011).

-----

References

Australian Christian Lobby 2015, Submission to the Legal and Social Issues Committee on the Inquiry inito End of Life Choices, Parliament of Victoria, Melbourne, pp. 1-17.

Council of Europe Parliamentary Assembly 2012, Resolution 1859 (2012): Protecting human rights and dignity by taking into account previously expressed wishes of patients, Europe, 25 Jan, pp. 2.

Francis, N 2012, Australian public desire for legalisation of assisted dying in restricted circumstances, YourLastRight.com, Melbourne, pp. 11.

Francis, N 2015, Conservatives fudge Council of Europe declaration 1859, DyingForChoice.com, viewed 2 Jun 2015, <http://www.dyingforchoice.com/f-files/conservatives-fudge-council-europe-declaration-1859>.

Parliament of Belgium 2002, 'The Belgian Act on Euthanasia of May 28th 2002 (unofficial English translation)', Ethical Perspectives, vol. 9, no. 2-3, pp. 182-188.

Stayner, G 2014, Victorian election 2014: Electorate overwhelmingly back voluntary euthanasia, Vote Compass reveals, ABC News, viewed 4 Dec 2014, <http://www.abc.net.au/news/2014-11-23/victorians-back-voluntary-euthanasia-vote-compass/5910668>.

Uniting Church in Australia 2011, Australian Christian Lobby does not represent all Australian Christians, nor all Christian viewpoints, 8 Dec, Media Room, viewed 11 Dec 2011, <http://blogs.victas.uca.org.au/mediaroom/?p=971>.


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