Western Australia

0
Which doctors 'play God' most with patient end of life decisions might surprise you

In two supplementary submissions to the Parliament of Western Australia, I report empirical evidence about the standards of end-of-life medical decision making in jurisdictions with and without voluntary assisted dying (VAD) laws. The evidence clearly contradicts the assumption of assisted dying opponents that legalised VAD will lead to worse end-of-life decision making by physicians. In fact, the evidence clearly shows which physicians are 'playing God' with their patients, and it's not the Dutch.

When I appeared as an expert witness before the Parliament of Western Australia's Joint Select Committee on end of life choices, the Hon. Nick Goiran, a staunch Catholic opponent of VAD, asked me for evidence of bringing end of life decision making out of the 'dark shadows' and into the light in jurisdictions in which VAD is lawful.

Existing evidence

Of course, there's the clear evidence from both the Netherlands and Belgium that the rate of non-voluntary euthanasia (NVE) has dropped significantly and stayed lower after their Euthanasia Acts each came into effect in 2002. There's also the clear evidence that the rate of nurse administration of possible life-ending drugs has dropped significantly in Belgium with a VAD law, over a similar time period in which it had increased significantly in New Zealand, where there is no VAD law. These forms of evidence were already documented in the comprehensive submission (PDF 5.4Mb) I'd made to the Committee.

Training and decision making has improved (Supplementary 1)

Mr Goiran opined that any improvements in palliative care were not relevant to his question. In my first supplementary submission to the Committe (PDF 0.6Mb) to further inform it of the empirical evidence, I disagree. As I point out, VAD decisions are not made in a vacuum: they are made after other interventions have been considered and declined, or tried and failed to provide sufficient relief. Palliative care options are central to these considerations. Therefore, whether palliative care improves or deteriorates after VAD laws are introduced is crucial.

Adding to the body of knowledge about the quality of palliative care, in this first supplementary submission I report that Dutch and Belgian physicians attended palliative care professional training at vastly higher rates than most other countries in the several years after VAD was legislated.

I also report the research evidence showing increases in desirable end of life decision rates, and decreases in undesirable decision rates in both the Netherlands and Belgium.

Where decision making is best and worst (Supplementary 2)

In my second supplementary submission (PDF 0.2Mb), I report data from two careful scientific studies into end of life decision making by doctors across multiple countries, including the Netherlands, Belgium, Switzerland, Italy and Australia.

The results are striking: for clearly inappropriate decisions such as withholding chemotherapy or administering terminal sedation without consulting their mentally competent patient, the Netherlands was clearly the best performer with the lowest rates of these kinds of decisions amongst physicians. And who was the overall worst? Italy.

Yes, that jurisdiction that harbours the head office of the world's most actively VAD-opposing organisation, the Catholic church, and where 82% of physicians are Catholic, were by far the most likely overall to make medical end of life decisions about their mentally-competent patients without consulting either the patient or her family. Italian physicians were, respectively, more than five times, three times, and twice as likely as those from the Netherlands, Beligum or Switzerland, to make unilateral end of life decisions without consulting either the patient or her family.

So much for high moral standards under a more religiously-driven and VAD-opposing regime.

I also illustrate from another study how VAD decision making in the Flemish north of Belgium, where the rate of VAD deaths is higher, is significantly higher in quality than in the Walloon south.

Conclusion

The peer-reviewed research data currently available consistently and directly demonstrate improvements in end of life care education and decision making in jurisdictions with VAD compared with those that don't. In contradiction to VAD opponents' assumptions, it's Italian physicians — who largely oppose VAD — who tend to 'play God' most with their patients.

The evidence comprehensively supports the view that legalisation of VAD brings a wide range of end of life decision making out of the shadows and into the light, where critical and open appraisal results in significant improvements.


Share This Post:
0
The Parliament of Western Australia is investigating end-of-life choices including VAD. Photo: WA Parliament

DyingForChoice.com's major submission to the Parliament of Western Australia on end-of-life choices, including assisted dying, has now been published and is available online. It contains recent updates to research data about assisted dying.

Download a full copy of the submission PDF.

Table of Contents

Terms of reference. p5

Definitions. 6

Statement of Barbara Roberts, former Governor of Orergon. 7

Part A: Introduction. 8
  A critical principle. 8
  Decision-making biases to be avoided. 8
  Potential bias 1: Strong emotional language diminishes critical faculties. 8
  Potential bias 2: Repetition doesn’t make a falsehood true. 8
  Potential bias 3: Use of ‘authorities’ as undeserved ‘evidence’ cues. 8
  Assisted dying law reform is necessary. 9
  Consequences of denying lawful assisted dying choice. 10
  Overmedicalisation and institutionalisation of death. 12
  Choice to die can be rational 13
  Regulation of existing underground practice. 14

Part B: Overwhelming support. 16
  Australian voter attitudes by demographic. 16
  Assisted dying a major issue for voters. 20
  More supporters than opponents think reform important. 20
  Voters will punish opposing MPs more. 20
  Not just a silver-hair issue. 21
  Summary of Australian public attitudes. 22
  Australian health professional opinion.. 23
  AMA opposed stance indefensible. 23
  RACGP supportive stance. 23
  Nurses & Midwives’ Federation supportive stance. 23
  Australian Psychological Society supportive stance. 24

Part C: Opposing arguments critiqued. 25
  Time to name up filibustering for what it is. 25
  Hippocratic Oath fictions. 25
  ‘First do no harm’ fails in the real world. 26
  Assisted dying is not about ‘saving money’. 27
  Assisted dying is consistent with the right to life. 28
  Palliative care availability improves. 28
  Trust in doctors remains high. 28
  Ample evidence against ‘slippery slope’ theories. 30
  Failure 1: Rhetorical sham. 30
  Failure 2: Unsupported by overseas evidence. 32
  Failure 3: Unsupported by domestic evidence. 33
  Opposing world views can be concurrently accommodated. 35

Part D: Correcting misinformation about lawful jurisdictions. 37
  Dr Els Borst remains proud of euthanasia law reform. 37
  Dutch elderly happy with nursing homes. 38
  Non-voluntary euthanasia rates fall, not rise. 39
  No suicide contagion. 42
  Not in Oregon. 42
  Not in Switzerland. 45
  Not in the Netherlands. 46
  Not in Belgium. 48
  Belgian nurses are like anywhere else. 49
  Dutch happy to go to hospital 51
  Groningen Protocol a wise policy. 52
  Theo Boer always an assisted dying law sceptic. 52
  Women are not vulnerable to voluntary euthanasia laws. 53
  Victorian MP publishes extensive misinformation..\ 54
  Opponents admit no slippery slope ‘cause and effect’. 54

Part E: Potential models of assisted dying law reform. 56
  Oregon/Washington model. 56
  Benelux model. 56
  Swiss model. 57
  Options for Western Australia. 58

Conclusion. 59

Statement of Ginny Burdick, Acting Senate President, Parliament of Oregon. 60

Summary of recommendations. 61

References. 62

Share This Post:
1
The WA Parliament has established a Committee to investigate end-of-life choices

After months of public remarks about end-of-life choices by the WA Premier Mark McGowan, the WA Parliament has just passed a resolution to establish a Joint Select Committee to investigate end-of-life choices for Western Australians.

Similar to the Victorian Parliamentary inquiry in 2015/16, the move is a strong step forward in assessing current practice and recommending improvements to both legislative and regulatory oversight of end-of-life for Australians in the west.

The Joint Committee is comprised of eight members, four from the Legislative Assembly (Reece Whitby, Labor, Baldivis; Amber-Jade Sanderson, Labor, Morley; Simon Millman, Labor, Mount Lawley; John McGrath, Liberal, South Perth) and four from the Legislative Council (Robin Chapple, Greens, Mining and Pastoral; Nick Goiran, Liberal, South Metropolitan; Colin Holt, Nationals, South West; Sally Talbot, Labor, South West).

Its terms of reference are:

That the Committee inquire into and report on the need for laws in Western Australia to allow citizens to make informed decisions regarding their own end of life choices and, in particular, the Committee should—

  1. assess the practices currently being utilised within the medical community to assist a person to exercise their preferences for the way they want to manage their end of life when experiencing chronic and/or terminal illnesses, including the role of palliative care;
  2. review the current framework of legislation, proposed legislation and other relevant reports and materials in other Australian States and Territories and overseas jurisdictions;
  3. consider what type of legislative change may be required, including an examination of any federal laws that may impact such legislation; and
  4. examine the role of Advanced Health Directives, Enduring Power of Attorney and Enduring Power of Guardianship laws and the implications for individuals covered by these instruments in any proposed legislation.

 
The Committee will soon meet for the first time to elect a Chair and Deputy Chair. It will have up to twelve months to report back to both Houses.

 


Share This Post:
Subscribe to RSS - Western Australia