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

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

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

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

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

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

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

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

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

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


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

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

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

Hansard record makes compelling reading

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

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

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

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

The yawning Coalition chasm

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

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

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

It’s a national story

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

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

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

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

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

Inform your own voting

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

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

Full voting record – Victorian Legislative Assembly 2017 VAD Bill

Ayes

47

  

Noes

37

Allan, Jacinta

Labor

 

Angus, Neil

Liberal

Andrews, Daniel

Labor

 

Battin, Brad

Liberal

Britnell, Roma

Liberal

 

Blackwood, Gary

Liberal

Bull, Josh

Labor

 

Blandthorn, Lizzie

Labor

Carroll, Ben

Labor

 

Bull, Tim

Nationals

Couzens, Chris

Labor

 

Burgess, Neale

Liberal

D'Ambrosio, Lily

Labor

 

Carbines, Anthony

Labor

Dimopoulos, Steve

Labor

 

Clark, Robert

Liberal

Donnellan, Luke

Labor

 

Crisp, Peter

Nationals

Edbrooke, Paul

Labor

 

Dixon, Martin

Liberal

Edwards, Maree

Labor

 

Fyffe, Christine

Liberal

Eren, John

Labor

 

Gidley, Michael

Liberal

Foley, Foley

Labor

 

Guy, Matthew

Liberal

Garrett, Jane

Labor

 

Hodgett, David

Liberal

Graley, Judith

Labor

 

Kairouz, Marlene

Labor

Green, Danielle

Labor

 

Katos, Andrew

Liberal

Halfpenny, Bronwyn

Labor

 

McCurdy, Tim

Nationals

Hennessy, Jill

Labor

 

McLeish, Cindy

Liberal

Hibbins, Sam

Greens

 

Merlino, James

Labor

Howard, Geoff

Labor

 

Northe, Russell

Ind.

Hutchins, Natalie

Labor

 

O'Brien, Danny

Nationals

Kealy, Emma

Nationals

 

O'Brien, Michael

Liberal

Kilkenny, Sonya

Labor

 

Pesutto, John

Liberal

Knight, Sharon

Labor

 

Richardson, Tim

Labor

Languiller, Telmo

Labor

 

Riordan, Richard

Liberal

Lim, Hong

Labor

 

Ryall, Dee

Liberal

McGuire, Frank

Labor

 

Ryan, Steph

Nationals

Morris, David

Liberal

 

Smith, Ryan

LIberal

Nardella, Don

Ind.

 

Smith, Tim

Liberal

Neville, Lisa

Labor

 

Southwick, David

Liberal

Noonan, Wade

Labor

 

Suleyman, Natalie

Labor

Pakula, Martin

Labor

 

Thompson, Murray

Liberal

Pallas, Tim

Labor

 

Tilley, Bill

Liberal

Paynter, Brian

Liberal

 

Wakeling, Nick

Liberal

Pearson, Danny

Labor

 

Walsh, Peter

Nationals

Perera, Jude

Labor

 

Watt, Graham

Liberal

Sandell, Ellen

Greens

 

Wells, Kim

Liberal

Scott, Robin

Labor

     

Sheed, Suzanna

Ind.

     

Spence, Ros

Labor

     

Staikos, Nick

Labor

     

Staley, Louise

Liberal

     

Thomas, Mary-Anne

Labor

     

Thomson, Marsha

Labor

     

Ward, Vicki

Labor

     

Williams, Gabrielle

Labor

     

Wynne, Richard

Labor

     

 

 

 

 

 

 TOTAL AYES

 

 

 TOTAL NOES

 

Labor

38

 

Labor

6

Greens

2

 

Greens

0

Liberal

4

 

Liberal

24

National

1

 

National

6

Other

2

 

Other

1

TOTAL

47

 

TOTAL

37

         

Abstained

2

     

Asher, Louise

Liberal

     

Victoria, Heidi

Liberal

     
         

Did not vote

1

     

Brooks, Colin

(Speaker, Labor)

 

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


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

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

Major community support for VAD

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

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

Political support missing in action

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

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

New analysis

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

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

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

Hidden reasons behind MP opposition

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

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

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

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

In good conscience?

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

There are two significant issues with this state of affairs.

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

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

How the parry works

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

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

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

Australia’s special political conservatism

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

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

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

Borne out in state parliaments

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

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

Back to Victoria’s Bill under debate

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

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

An obvious solution

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

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

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

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

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

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


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The Parliament of Victoria is currently debating an assisted dying Bill.

As the Parliament of Victoria prepares to debate an assisted dying Bill, South Australian Catholic anti-assisted-dying lobbyist Mr Paul Russell is at it again. This time he's sent a missive to Victorian politicians shouting about, amongst other things, a crisis of assisted dying numbers in Washington state. He’s conveniently cherry-picked his arguments again.

Mr Russell wrote that in Washington state:

“deaths from lethal drugs prescribed under the Act have nearly quadrupled (376%) from 51 in 2010 to 192 in 2016.”

Now I’ve called Mr Russell out before for misinformation, for example his laughable ‘secret’ opinion poll, promoting a misrepresentation of a Council of Europe determination, complaining at the same time that people will die too early but yet live too long, and spreading despicable misinformation about Dutch neonatal euthanasia.

His latest claim extends his misinformation crown title.

Don’t get me wrong. He cites the correct raw data figures for Washington. But he packages them up handily with FUD (Fear, Uncertainty and Doubt) wrapping, all tied up with the most sinister bow he can muster.

I’ve criticised the use of uncontextualized raw data before, and I do so again.

The relevant facts

Washington state legalised assisted dying by ballot in 2008. The following year the law was put into practice, and 2010 was the first full year of its operation.

Here’s the rate of assisted deaths as a proportion of all deaths in Washington state for all the years on record. As you can see, the rate hasn’t even reached one half of one percent of all deaths in 2016.

 2009 

 2010 

 2011 

 2012 

 2013 

 2014 

 2015 

 2016 

 0.07% 

 0.11% 

 0.14% 

 0.17% 

 0.23% 

 0.24% 

 0.30% 

 0.35% 

 

Never ones to miss out on an opportunity to spread FUD, if it were just one case last year and two this year, assisted dying opponents would be shouting from the rooftops: “Crisis!! 100% increase!!”. But in reality, only a small minority use the law, yet thousands of patients and their families are given comfort by the option being avaialble even if they don't use it. That message was made loud and clear by Oregon Senator Ginny Burdick. Washington's Death With Dignity Act is modelled on Oregon's, and Oregon's Act has been in effect for twenty years.

A Catholic trifecta

Of course in his missive, Mr Russell, like his fellow Catholic whom I’ve also called out for misinformation, Prof. Margaret Somerville, avoids referring to Swiss data. And their fellow Catholic Mr Daniel Mulino, who furnished a minority report to the Victorian Parliament’s recommendations on end of life choices, a report I’ve also called out for stunning misinformation, fudges his numbers about Switzerland, referring to data from 1998 without further context.

Why do these lobbyists avoid or selectively refer to the Swiss situation? Because the actual data is an inconvenient truth to their FUD story-telling.

An inconvenient truth

Switzerland’s assisted dying law came into effect seventy-four years ago, in 1942. If just one person had used the law in 1942, using Mr Mulino’s favourite annual increase figure of 17.5%, that would equate to 110,338 people pursuing an assisted death in Switzerland in 2014.

I say 2014 because that’s the most recent year for which official Swiss Government assisted dying figures are available. And what was the actual figure in 2014? There were 742 cases of assisted dying amongst Swiss residents, and Dignitas reports that it assisted 198 foreign nationals. That’s a total of 940 assisted deaths.

Let’s add another 60 foreign-national assisted death cases from the much smaller Swiss society that provides accompaniment for foreigners. That makes around 1,000 cases in 2014, including all those who came from all over the world. And it’s less than one hundredth of the minimum rate the doomsayers predict by cherry-picking one statistic that suits their argument.

Swiss law has the fewest safeguards

The Swiss assisted dying law has none of the safeguards of the Washington law. By Mr Russell and Co’s reckoning, you’d think that the Swiss (and those who visit) would be dropping off like flies.

By way of further comparison, the doomsayer number of assisted deaths for 2014 (a minimum of 110,338 cases) is substantially greater than the total number of deaths in Switzerland that year: 63,938. It’s an obvious impossibility.

In 2014, the Swiss rate of assisted deaths including all the foreign nationals who came to use its law, was 1.5% of all deaths; and 1.2% for resident-only cases.

And the rate of assisted deaths in Luxembourg in 2014 (legalised in 2009), whose laws are much more liberal than Washington’s though stricter than Switzerland’s, was 0.17% of all deaths. It’s odd how the doomsayers don’t report Luxembourg data, either.

And what are these cases?

These are cases of people in extremis with no realistic prospect of relief or improvement, choosing a peaceful assisted death as a better option than being forced to prolong their torture, according to their own deeply-held beliefs, values and examined consciences.

Mr Russell believes they should be required to endure their torture. There is a point to it, he says: because it joins them “in some mysterious way to the sufferings of Christ”... whether others believe in Christ, or at least Mr Russell’s version of him, or not.

You won't find this degree of candour on his anti-assisted dying website, but you can find it at NewsWeekly, which is run by the National Civic Council (NCC), itself established by Australia's most famous and conservative lay Catholic, B. A. Santamaria. Mr Russell has been President of the NCC South Australian chapter.

It’s not the numbers, it’s the circumstances

To be clear, in no jurisdiction has its legislature enacted access to assisted dying on the basis of a numeric ceiling. They’ve enacted access on the basis of intolerable and unrelievable suffering. And to this day, those are the folks who may be granted access to an assisted death.

Conclusion

Again, Mr Russell (and colleagues) do themselves no favours by conspicuously cherry-picking the data they want to use, and wrapping it up in threatening garb to create FUD amongst politicians.

Wiser heads will prevail in Victoria.


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Research results must be judged in relation to the study's methodology.

In his latest blog, titled “Who are you going to trust?”, anti-assisted dying lobbyist Mr Paul Russell says:

“Polling noted today in the Australian shows a significant level of distrust in our political classes to get the issue of euthanasia and assisted dying right.”

He then goes on to quote some select statistics from said poll. In his blog, he mentions nothing about the sponsorship or conduct of the poll. After some searching, I found no other reference to said poll on his ‘HOPE’ website.

This is rather curious, because The Australian article he quotes, points out that the ‘poll’ was commissioned by him (his website is called ‘HOPE’).

Thus, Mr Russell tries to add credibility to his ‘poll results’ in his blog by citing only that it has been reported in a national newspaper. This ‘quote-someone-else-so-it-must-be-authoritative’ rhetorical strategy has been used before by opponents of assisted dying (see Box at end).

But as Mr Russell has himself promoted — happily republishing the opinion of the CEO of Christian Medical Fellowship (UK) — “opinion polls add up to very little.” That’s quite true… when they’re poorly designed and run, including the big no-no, ‘push-polling’, in which the researcher attempts to get the answer they want by crafting questions more likely to get it.

I searched hard for any reference to the methodology of said ‘poll’, but was unable to identify any despite a diligent search. Therefore, we don’t know what approach Mr Russell took: robust or otherwise.

Let’s assume for the sake of argument (and the absence of public evidence) that a poll of some kind was actually conducted. If it were a truly legitimate poll, you’d think that Mr Russell would be shouting about the study from his own rooftop (the ‘HOPE’ website). But so far, he hasn’t.

Mr Russell, while quoting statistics, has said absolutely nothing about the methodology — that I can find via a quite diligent search.

Results can only be interpreted in light of how the research was actually conducted, so quoting a 'study' while failing to publish its methodology in full is an absolute no-no. It only invites derision.

Rebecca Urban, for The Australian, quotes a number of ‘statistics’ from the ‘poll’ seemingly without question. But she’s hardly to blame: she’s skilled at journalism, not primary research.

So, for the benefit of Paul Russell, Rebecca Urban and all journalists reporting claimed statistics, here’s your minimum standard of conduct if the public are not to guffaw at the claims. All reported results must be in relation to properly disclosed methodology:

  • Who commissioned the research? (✔ Ms Urban reports who)
  • Who conducted — actually carried out — the research (e.g. a reputable research company)?
  • What precise population were respondents drawn from, how were they recruited, and screened in or out? What were the counts and percentage participation (approached/participated)?
  • What were the dates of the fieldwork?
  • What procedures were used to establish and maintain the authenticity of who was sampled (e.g. if an online poll, could people from anywhere technically participate in this Victorian poll)?
  • How was the questionnaire administered (e.g. paper self-complete, online, CATI)?
  • What was the script of stimuli administered to respondents? In other words, what prompts were given and what questions were asked: exact order and wording?
  • What results were obtained for each question (i.e. full rather than selective crosstabs)?
     

Until Mr Russell publishes in full how his ‘poll’ was conducted, the only honourable course of action for him to pursue is to withdraw the claimed results.

Until then, we can only see them as untrustworthy and a bit of a joke.

 

Rhetorical tactic — “Not” quoting yourself

This rhetorical tactic is also used by Mr Russell’s fellow Catholic, Prof. Margaret Somerville. For example, in her 2015 book Bird on an Ethics Wire, in relation to the supposed (but fanciful) fear of being euthanized in the Netherlands if adequate pain management is accepted, Somerville says in Chapter 4:

It has been alleged that Dutch physicians have interpreted patients’ consent to pain management as consent to euthanasia.38

If you’re like most people, you’d assume, given the effort of a citation (38), that an independent source had made the statement based on some evidence. Indeed, if you look at reference 38 you’ll see that the author is Lauren Vogel, and the source article is in the Canadian Medical Association Journal. All sounds like solid, legit stuff, doesn’t it?

However, Ms Vogel is a journalist, not a Dutch medic or a researcher, and what she reports in relation to Somerville’s claim is merely a quote of what someone said. And who is that someone? Why, it’s Margaret Somerville — what a coincidence!

Somerville could have just said “I’ve argued this before…”, but instead gives a seemingly robust reference to a source that has the appearance of independence and scholarship. Yet obviously she knows that the source is merely herself saying so.

Let’s be clear: something is not true just because someone alleges it. Even if they allege it twice or more. And happen cite themselves via someone else in the process.


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The Age reports a 'gloves off' campaign of misinformation

Both the Herald Sun and The Age reported last week that religious anti-assisted dying crusaders are running a 'gloves off' campaign in Victoria.

Religious forces are gathering once again to attempt to thwart the views of the great majority of Victorians in favour of assisted dying law reform.

Matt Johnston in the Herald Sun quoted Paul Russell, a long-term figure in Catholic circles, and Greek Orthodox Bishop Ezekiel, in statements against assisted dying.

Farrah Thomazin in The Age quoted religious stalwarts Margaret Tighe of Right To Life, and the Australian Christian Lobby, in further statements against assisted dying.

The crux of the story is that 'pollsters' claim to have run a survey in Victoria. They refuse to be identified. They refuse to publish their methodology. And they refuse to publish all their results. Enough said.

They cherry-pick an item from their supposed poll to claim that 33% of Victorians who oppose assisted dying will change their vote against a supporting politician at the next election. They neglect to mention that only a tiny minority of Victorians actually oppose assisted dying. Their analysis is astonishingly superficial, even assuming they ran a proper, robust poll and didn't manufacture the numbers themselves.

They then use this tidbit of 'data' to put the fear of electoral defeat into politicians who will soon to face an assisted dying Bill in the Victorian Parliament.

What rubbish. Assisted dying (AD) opponents seem to be utterly shameless in misrepresenting and distorting cherry-picked data to push their religious agenda — which they pretend isn't religious.

The real situation in respect of AD is the exact opposite of their claims as I show in a proper, robust analysis of legitimate data, demonstrating that:

  • A massive 78.9% of Victorians support AD, with only a tiny 8.1% opposed. Strong supporters outnumber strong opponents by more than ten to one.
  • Significantly more supporters of AD believe that law reform is personally important, than opponents believe the status quo (no law) is personally important.
  • At a general election, far more Victorian voters will punish Members who oppose the AD Bill than will punish Members who support it (3.5 to 1 overall, 2.4 to 1 for the Liberal/National Coalition and 6.6 to 1 for Labor).
  • The co-sponsors of Victoria’s 2008 AD Bill were returned with greatly increased majorities (including relative to their party’s overall performance) despite campaigns against them by anti-AD crusaders.

 

You can read the full analysis here.

So that Victorian politicians are not misled, I have forwarded my report to the Victorian Government's Cabinet and other selected members of Parliament.

The only way in which this campaign could be called 'gloves-off' is that opponents, lurking around with their shadowy misinformation, don't want to get bullshit on their mittens. Hands seem to be much easier to wash. And hide.


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Dr Megan Best and the AMA profoundly misrepresent what this research says.

In my report about Dr Megan Best misreporting research findings about assisted dying practice in Belgium, I said that I would ask the Australian Medical Association (AMA) to publish a correction statement. I did just that, posting a courteous notice explaining the misinformation and requesting the correction, as a comment to their online article. What happened next was supremely revealing about how the conservative medical establishment opposes your right to choose assisted dying. I expose six reprehensible aspects of Dr Megan Best’s ‘expert’ opinion and MJA InSight’s response to my report.

 

Response 1—Try to bury the correction request

How did the AMA respond? Well, first of all, they simply deleted my post from the Medical Journal of Australia article (in MJA InSight).1

Subsequently, AMA member Dr Rosemary Jones posted my advice and request for correction. They dared not delete the post of a member, because Dr Jones’ post remains and MJA InSight have now responded… in a fashion.

Response 2—Plead it’s not the AMA

First up, Cate Swannell, editor of MJA InSight as well as “MJA news and online,” wrote that MJA InSight is:

“…editorially independent from the AMA and the AMA does not influence our content and editorial decisions in any way, shape or form … Thanks.” — Cate Swannell

It would be fair to take Ms Swannell’s word for it that the AMA doesn’t make a habit of sticking its nose into individual items at the Medical Journal of Australia (MJA). But consider this: MJA, of which MJA InSight is a part, is published by a wholly owned subsidiary of the AMA. That is, even in the absence of direct influence, one might reasonably expect that the AMA has broader, long-term influence over “content and editorial decisions.” After all, a core purpose of establishing a wholly-owned subsidiary is to help promote owner’s interests (which at present are officially and trenchantly opposed to the legalisation of assisted dying).

Those interests are further intertwined at DoctorPortal which is co-owned and operated by the AMA and its entity that publishes MJA. The portal includes the ‘MJA Bookshop’ where doctors must log in using their AMA credentials to obtain discounts.

MJA InSight is in real and practical terms a publication of the AMA.

Refresher: The original allegations

Before we cover the further AMA responses, let’s remind ourselves of the ‘expert opinion’ the AMA obtained from Dr Megan Best about Belgian assisted dying practice as published in MJA InSight:

“I am concerned by the reduction in referral to palliative care doctors and specialists in the euthanasia approval process, as GPs are less likely to know whether or not the suffering can be alleviated – the keystone of the act,” she said.

“This is a weakening of the due process of the act and suggests that the ‘safeguards’ are seen more as a barrier to be overcome than an opportunity to improve life to the extent that euthanasia is no longer necessary.” — Dr Megan Best

Response 3—Confirm the ‘cherry-picking’ misrepresentation

Here’s how Sarah Colyer, author of the article in which Dr Best’s nonsense was quoted, responded to Dr Rosemary Jones’ objections:

“…there are two findings related to the involvement of palliative care doctors in the study. First, the study found palliative care physicians were less likely to be the legally-required ‘second doctor’ to sign off on the decision for euthanasia, as more GPs took on the role.” — Sarah Colyer

What a profound fudge. The paper does not say that. There is a notional mathematical decrease in palliative care (PC) ‘sign-offs,’ but with a p value of 0.3 it is not in the slightest bit statistically significant. In other words, it is not possible to validly assert that it became “less likely.” And this is the reason that the researchers correctly didn’t draw such an inference in their discussion and conclusions.

This is extraordinary. In its defence, this AMA publication confirms and defends that Dr Best had cherry-picked a supposed trend with no statistical significance and which seems to (but doesn’t) support opposition to assisted dying law reform, while utterly failing to mention a highly significant trend (p = 0.001) in the opposite direction, present in the very same table of data (Table 3 of the cited research paper).2

While the original MJA article reported on both data series, it failed to identify that one was in no way statistically significant while the other was highly so.

Response 4—Execute an impressive flip-flop

“Second, and as Sarah Edelman is quoted saying, 39% of patients had contact with palliative care teams in the lead up to euthanasia (but these doctors were not necessarily involved in sign-off).” — Sarah Colyer

Both Dr Megan Best, and Sarah Collyer in defence, express concern about what they see as the insufficient ‘signing off’ or approval of assisted dying by Belgian PC specialists. Yet Palliative Care Australia explicitly states that:

“The practice of palliative care does not include euthanasia or physician assisted suicide. Palliative care does not intend to hasten or postpone death.” — Palliative Care Australia3

So on the one hand Australia's national PC body demands that PC have nothing whatever to do with assisted dying, while an Australian PC specialist (who is opposed to assisted dying) demands that it must: not just ‘incidental’ involvement to ensure the patient is well-informed as to what PC may offer, but to directly insert itself in the assisted dying approval process.

What an impressive ‘must not, yet must’ flip-flop.

Response 5—Confirm bias about consultations

Sarah Colyer goes on to say:

“Although this latter figure is an increase from 33%, the article makes clear that this is more about palliative care doctors being ‘notified’ than necessarily having any professional input into the decision-making process.” — Sarah Collyer

If my point 3 above exposed a ‘profound’ fudge, this is a spectacular one. Indeed it’s utter fiction. Nowhere in the cited research report do the data or authors suggest in any way that PC teams were merely ‘notified.’ They were consulted. The word is used explicitly in no fewer than seventeen times specifically in relation to PC. What is a professional ‘consultation’?: “a meeting or discussion to obtain advice.”

To suggest that these are mere ‘notifications’ is absurd: why would a physician even bother to formally ‘notify’ other relevant carers if he or she had no intention of the notification having any meaningful consequence?

The only outcome of this ‘notification’ fiction is to make Belgian physicians seem careless or disinterested—a shabby and biased approach to describing overseas colleagues who engage in lawful conduct of which the commentators (at least, Dr Best) personally disapprove.

Response 6—Demonstrate fundamental ignorance about research

Remember that Dr Best complained about her perception of a low assisted dying PC consult rate as obstructing the “opportunity to improve life to the extent that euthanasia is no longer necessary”. Sarah Colyer defends and amplifies the ‘low consult rate’ message of the Belgian research:

“Although Dr Edelman and the study authors said this [increase in palliative care consults] was a positive development, Dr Best and another respected palliative care doctor who provided background for the article said it was still overall a very low rate of palliative care involvement.” — Sarah Colyer

These remarks reveal a deep ignorance about research evidence. The reported data the 'experts' criticised was only in respect of PC involvement after a request for assisted dying. It did not include any PC consults that occurred in the patient’s care trajectory prior to the assisted dying request. (Indeed, the assisted dying request may in some cases have developed as a consequence of palliative futility.) The research authors are even explicit about this:

“The reporting form does not record whether patients have previously received palliative care.” — Dierickx, Deliens, Cohen et al2

Contrary to Best and Colyer’s indefensible assumption, empirical research evidence indicates that around 74% of assisted dying cases in 2013 at least in Flanders, the Dutch-speaking larger half of Belgium, involved specialist PC services.4 The Dierckx et al2 data is also in respect only of PC-primary-specialist consults. Many Belgian physicians, especially but not only many oncologists, themselves hold PC sub-specialty endorsements, yet only their primary organ or disease specialty is recorded on the report forms.

The 74% PC consult figure of course by definition excludes those who made a request but who subsequently rescinded it (i.e. not captured in the data because there was no assisted death). The patient may have rescinded their request as a consequence of PC consultation. Other published scientific research indicates that in 2013 around 18% of Belgian assisted dying requesters revoked their request.5

Indeed, more than half (59%) of Belgian patients making a request in 2013 died before the consulting team had reached a decision, and 7.5% of requests were denied by physicians because the patient wasn’t terminally ill even though that is not a requirement of the law.5 The wider evidence suggests that Belgian doctors remain conservative and cautious rather than pursuing poor practice as Dr Best and Ms Colyer invalidly attempt to conclude.

What is “very low”?

Just for good measure, let’s compare a Belgian assisted dying 74% PC consult rate with the general PC rate in Australia (where assisted dying is illegal). There’s precious little data around and Palliative Care Australia didn’t respond to two requests. [Addendum 5th Oct: Palliative Care Australia responded but advised that to the best of their knowledge the specific statistics were not available.] The closest relevant official data I could find with hours of intensive research, reports that in 2011-12, 39.5% of hospital inpatients who died received PC consults.6 Of course, PC consults can only be relevant in respect of non-sudden deaths because there’s no opportunity to make such decisions in a relatively sudden death. About two thirds of all deaths are not ‘sudden,’ so let’s adjust up the original figure to reflect that, resulting in a hospital non-sudden-death PC consult rate of around 60%.

Half (50%) of all deaths in Australia occur in hospitals, 38% in residential and community (i.e. other institutionalised) care, and just 12% elsewhere (mostly at home).6 Let’s say for the sake of argument (and lack of data) that the PC consult rate for other institutions is similar to hospitals. Let’s also assume that of (two thirds non-sudden) deaths at home, all of them received palliative care consults. That raises the Australian PC consult rate to around 68% of all non-sudden deaths. Maybe the real figure is somewhat higher or lower.

But it is wholly incorrect to conclude, given Belgium’s Flemish PC consult rate for assisted dying at 74%, that the Belgian palliative care consult rate is “very low” as the two ‘expert’ PC commentators wrongly assert and Sarah Colyer reports on the basis of data about a different measure.

Conclusion

The AMA widely promotes evidence-based decision making, but it has comprehensively offended its standard in regard to this issue. The AMA’s response to this further critique will give the Australian public a strong indication as to its intent, ethics and credibility. Of course, I'll let you know how they respond.

As for Dr Megan Best offering such ill-considered and evidence-defying nonsense as ‘expert opinion,’ I would hope that she permanently retires from offering commentary.

Now at least you can see the kinds of rubbish arguments that the conservative medical establishment uses to justify opposing your right to consider an assisted death.

 

Inexpert opinion via the AMA’s MJA

Through its MJA InSight article and response, the AMA has published and defended misinformation against assisted dying, a choice that the overwhelming majority of Australians want on the table, but which the AMA explicitly opposes.

  1. First up, the AMA tried to bury my critique of its incoherent and incorrect ‘expert opinion’ by deleting the critique.
  2. Then it tried to argue that its published misinformation was nothing to do with the AMA.
  3. It confirmed that it had reported a cherry-picked non-significant ‘trend’ from a research paper’s data that was, coincidentally, consistent with AMA opposition to assisted dying, while omitting to mention a highly statistically significant trend—in the same table of data—that contradicted the AMA and commentators’ stance.
  4. Its article and critique response argued that PC must be involved in approving assisted dying requests at the same time that Palliative Care Australia insists that assisted dying is nothing to do with PC.
  5. It fictionally asserted that the Belgian research paper suggested PC specialists were merely ‘notified,’ while the research paper said no such thing and referred repeatedly to ‘consultation.’
  6. It ignorantly claimed that the Belgian PC consult rate was “very low” (when it isn’t) on the basis of what happened only after an assisted dying request, ignoring that PC consults can and do occur before an assisted dying request.

 

References

  1. Colyer, S 2016, Belgian euthanasia model splits Aussie experts, MJA InSight, viewed 26 Sep 2016, https://www.doctorportal.com.au/mjainsight/2016/37/belgian-euthanasia-model-splits-aussie-experts/.
  2. Dierickx, S, Deliens, L, Cohen, J & Chambaere, K 2016, 'Euthanasia in Belgium: Trends in reported cases between 2003 and 2013', CMAJ, September 12, 2016.
  3. Palliative Care Australia 2016, Euthanasia and physician assisted suicide: Position statement, viewed 1 Sep 2016, http://palliativecare.org.au/download/2448/.
  4. 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.
  5. Dierickx, S, Deliens, L, Cohen, J & Chambaere, K 2015, 'Comparison of the expression and granting of requests for euthanasia in Belgium in 2007 vs 2013', JAMA Internal Medicine, 175(10), pp. 1703-1706.
  6. Swerissen, H & Duckett, S 2014, Dying well, Grattan Institute, Carlton, Victoria, pp. 37.

 

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