Flip-flop

To use multiple inconsistent or opposed arguments to justify a position: or to change position back and forth.

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Mr Max Bromson (seated) at Parliament House Canberra in June 2014. He died not long afterwards.

Assisted dying critic Mr Paul Russell has done it again. I’m beginning to think that he’s a tremendous asset to the pro-assisted-dying movement. Why would I say that?

Well, this time his pronouncements appear in National Right To Life News, the online newspaper of the USA Catholic-founded National Right To Life Committee, and in which Mr Russell represents ‘HOPE,’ his anti-euthanasia lobby platform founded by the Australian Family Association—itself Catholic-founded and backed.

The complaint

In his opinion piece, Mr Russell complained that Mr Max Bromson of Adelaide, Australia, who ended his own life after a long period of serious suffering from advanced cancer, lived far longer than his doctors had estimated.1

That he outlived his diagnosis by more than four years confirms the observation that qualifying periods in euthanasia and assisted suicide about ‘six months to live’ or similar, are really meaningless.” — Paul Russell

The pro-assisted-dying message

Mr Russell, in a single sentence, unequivocally demolishes the foundation of his own arguments in opposition to legalising assisted dying. He is a huge fan of the ‘vulnerable’ argument: that once legalised, people will quickly be pressured into assisted dying.

If his ‘vulnerable’ argument held true (a hypothesis that peer-reviewed scientific research contradicts), those with the means to peacefully end their lives would do so. And they wouldn’t take four years to think about it.

By explicitly pointing out that Mr Bromson had survived for much longer than expected (as fellow assisted-dying critic Mr Wesley Smith pointed out in another case), Mr Russell directly disproves the rhetoric of his ‘vulnerable’ argument.

People will quickly end their own lives... but survive far longer than expected: It's a spectacular flip-flop.

Conclusion

Thanks, Mr Russell, for pointing out that people don’t want to die—that they live as long as they can possibly bear it—and disproving your own nonsense. Keep up the good work!

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Footnote: Blind ignorance?

I’m also curious as to whether Mr Russell advances misinformation in blind ignorance, or whether the situation is worse. Who can say?

I have on a number of occasions explained simply and clearly why the west-coast-USA state assisted dying laws require that for the patient to qualify for assisted dying, one of the conditions is that the patient’s doctor must assess that the patient is likely to die within six months.

The reason is not that those with five months to live are deserving of the choice, but those with ten months to live are not, as Mr Russell bizarrely assumes.

The very important outcome is that when the doctor makes that assessment, the patient then automatically qualifies for free hospice care. It takes monetary considerations out of the equation, which is important in the context of the expensive USA healthcare system.

So, Mr Russell demonstrates profound ignorance at best by opining that the prognosis of time remaining must be superbly accurate, when it can’t be except possibly in the last days.

It’s about quality of life, not quantity; framed by hospice care being readily and freely available.

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References

  1. Russell, P. 2016, No charges in suicide case in South Australia, including “Dr. Death,” Philip Nitschke, viewed 3-Aug-2016, https://www.nationalrighttolifenews.org/2016/08/no-charges-in-suicide-case-in-south-australia-including-dr-death-philip-nitschke/

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The more anti-euthanasia campaigner Mr Wesley Smith publishes, the more I think he’s missed his true vocation as a comedian. His latest comical gig against assisted dying is a gem.

Mr Smith starts with the case of two Californian doctors found guilty of Medicare fraud: billing fake hospice care for patients who weren't terminally ill. He artfully turns the story into a series of anti-assisted-dying gags.

Who’s on first, What’s on second?

Mr Smith directly connects the money-grabbing fraud case with the Obama administration, ribbing us that the President and federal authorities won’t hold doctors accountable for breaking assisted suicide law. Mr Smith, an attorney, is holding his breath to see if his audience figures out this little joke: oh, the confused jurisdiction names… right!

The Death With Dignity laws are State laws. If the law is broken it is State responsibility to pursue and prosecute offenders. The Feds have no jurisdiction. If, however, Medicare has been defrauded then it’s a Federal matter (FBI): and the Feds did indeed investigate and prosecute.

It’s a bit like the Laurel and Hardy confused “Who’s on first, What’s on second” name sketch, isn’t it? But only if you get it. Grin.

I say, I say, I say: what’s worse—being evil or being dead?

Mr Smith then refers to the case of Michael Freeland, an Oregonian dying of lung cancer who considered using the Death With Dignity Act. Citing himself and referring to the physician who prescribed lethal medication, Mr Smith compares Dr Peter Reagan with the Medicare fraudsters, saying that Dr Reagan “regularly takes on patients solely for the purpose of facilitating their suicides.”

Defamation is always good for a cackle. It’s so droll, like saying that Mr Smith “opposes assisted dying solely because of the great value of redemptive suffering whether others agree or not.” Which, of course, your dear writer is not saying (because Mr Smith has already stated on the record that he doesn't think suffering is redemptive). I’m just saying, you know, for laughs.


PeterReaganEvilAndDead.gif

Wesley Smith jokes that Dr Peter Reagan is both evil and dead.


To add even greater mirth, Mr Smith describes Dr Reagan as “now late”. OMG, I've met Dr Reagan and he’s a top fellow. He’s died!? No, he hasn't. Fortunately, like Mark Twain, Dr Reagan happily reports that news of his death has been greatly exaggerated.

Phew, comic relief—what a hoot.

The Clause you have when you’re not having a Clause

Mr Smith then tells the one about how doctors ordinarily have to comply with an accepted medical “standard of care,” but that “death doctors” (love those stereotypes, chuckle!) only have to act in “good faith,” which, Mr Smith razzes us, is quite hard to assess. Oh. Awkward audience silence; a cricket chirps. Um, punchline please?

You have to supply your own punchline for this quip I’m afraid, because Mr Smith rather absent-mindedly forgets to. The Oregon Death With Dignity Act 1997 says explicitly in Clause 126.885 §4.01(7), “No provision [of this Act] shall be construed to allow a lower standard of care…”

Ah, more comic relief: the old 'pull-the-wool-over-your-eyes' caper, chortle.

The flip-flop routine 

But the most comical gag is the one I reckon Mr Smith doesn’t even realise he’s told: the joke that we’re all going to die from lethal prescriptions, artfully developed by featuring someone he carefully points out didn’t take the lethal prescription. We just love a good flip-flop. LOL.

Oh, that and teasing us that the Medicare fraud case in which the purpose was to get more money is a great story against assisted dying whose purpose, he banters, is to get less (save) money. Double flip-flop: Ta-ching!

Loud guffaws and applause all round.


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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).

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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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Bulldust is often advanced by opponents of assisted dying law reform—a reform which most citizens want—to scare or bamboozle us against the reform.

Why is there so much misinformation about? The answer is straightforward: because so far it's worked.

More than academic niceties

This isn't just an academic argument about getting the facts right. It's a fundamental battle between different world views, where misinformation against assisted dying law reform has often held sway. Here are just two real examples:

Examples of real impacts of misinformation

  1. In Australia, in every Parliamentary debate over an assisted dying Bill before them, numbers of opposed politicians have quoted the rhetorical sham "the vulnerable will be at risk" (see why it's a sham here). With the exception of the Northern Territory's Rights of the Terminally Ill Act in 1996, every Bill before Australian Parliaments has been lost or filibustered until the end of the Parliamentary term on this fearmongering. And the Rights of the Terminally Ill Act was annulled by the Federal Parliament in 1997 on the same grounds.
     
  2. In Ireland, the High Court made a determination as to whether Marie Fleming, with advanced multiple sclerosis, was constitutionally allowed to receive assisted dying (Fleming v. Ireland and Ors 2012 10589 P). The court rejected Fleming's claim, saying that the "strikingly high" rates of non-voluntary euthanasia in Switzerland, Netherlands and Belgium "speaks for itself as to the risks involved". But sound research shows that the rates in these countries are similar to rates in other countries without assisted dying laws: evidence of the high degree of 'evidential' bull that was served up to their Honours.

It's time to stop the bull in its tracks

DyingForChoice.com believes it's time for the bull, the misinformation, to stop. It is unacceptable for rational citizens to be denied freedoms on the basis of scaremongering and erroneous information. This is the purpose of the F files. It provides citizens, politicians, policy advisors, healthcare workers, media professionals, researchers and others the evidence, arguments and resources to be properly informed and to avoid misinformation.

 

The F Files

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The F files
 

The public conversation about assisted dying law reform has been influenced by misinformation from opponents for far too long. Often, misinformation is simply given in ignorance, but sometimes not. It is mandatory that a conversation as important as assisted dying for those suffering at the end of life is informed by accurate information and evidential and reasoned views. Arguments that deceive or attempt to shut down the conversation have no place.

Whether misinformation is Fearmongering, Filibuster, Flip-flop, Flapdoodle, Fudge, or Fiction or Faith, the F files identifies misinformation and those who are providing it.

You can help by sending records of misinformation claims to us, and asking claimants to correct the errors.

 

Fundamental forms of misinformation

fearmongering.jpg      

Fearmonger

Represent something as considerably more sinister or dangerous than it is when judged by objective criteria.

filibuster.jpg  

Filibuster

Artificial and overly-lengthy process used in an attempt to stall or block a political outcome.

flip-flop.jpg  

Flip-flop

Multiple inconsistent or opposed arguments used to justify a position.

flapdoodle.jpg  

Flapdoodle

An argument that superficially seems intuitively attractive, true or real, but is in fact meaningless or nonsensical.

fudge.jpg  

Fudge

Unscientific analysis (e.g. selective data) used to support an argument that is not supported by proper, full analysis.

fiction.jpg  

Fiction

A thing that is untrue, or invented or feigned by imagination with no sound or verifiable evidence.

faith.jpg  

Faith

An argument that all others should adhere to a particular religion's values, tenets and rules.

 

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Medical group Doctors for Voluntary Euthanasia Choice has sent a letter of complaint, criticising the RACP executive for unilaterally cancelling its invitation to Dr Rodney Syme to address its annual Congress.

Dr Arnold Gillespie heads a list of more than sixty doctors who have signed a letter of criticism and censure sent to the Board and Executive of the Royal Australian College of Physicians, in response to their insulting and controversial flip-flop on Dr Rodney Syme giving a key address at its 2015 Congress. This is the letter.

 

Dr Catherine Yelland
President-Elect and Acting President
Royal Australasian College of Physicians, and
Executive Royal Australasian College of Physicians

 

Dear Dr Yelland and Executive RACP

The homepage of the RACP Congress in May 2015 proudly proclaims that the title of the Congress is “Breaking Boundaries Creating Connections”.  It is claimed that the “Diverse Program” will provide opportunities for delegates to” Interact debate and connect”.

The intent of the title of the Congress is amplified a little lower on the page by the statement that “In 2015, we are building on the past theme of Future Directions in Health, and moving forward to reinvigorate Congress and challenge delegates to break boundaries and create connections”.

 More specifically under the heading of “What to Expect”, is the statement” Expand your thinking on gender identity, refugee health, indigenous health, ageing physician and end of life care”.

We hope that the Congress is a successful learning and development experience for delegates and we wish the College success in its aims of moving forward and expanding thinking in the areas of gender identity, refugee health, indigenous health and the ageing physician.  We are certain that the expansive aim will not be achieved in relation to end of life care.  It seems that in this area a decision, more in keeping with a totalitarian authority than a group committed to breaking boundaries and encouraging debate, has been made and instigated. We refer of course to the very late removal from the program of Dr Rodney Syme, an invited speaker.  The theme of Dr Syme’s presentation was to be a discussion of the gap between the rhetoric and the reality of palliative care, based on published material. 

It has been claimed that this action was taken because of considerable discontent amongst Fellows of the College regarding Dr Symes’s presentation.  Neither the magnitude of the dissent, nor the composition of the dissenting group, has been clarified.  Clearly the dissenters were not willing to countenance any discussion that might encourage them to move forward, break boundaries, nor even to interact and debate.  Are they so insecure in their beliefs that they are unwilling for them to be challenged openly?  If this is true, why has the Executive of the College acquiesced to a group which has prohibited free thought and whose actions should be anathema to a College which states on its homepage that it is “...striving for excellence in health and medical care through lifelong learning, quality performance and advocacy”?  Only the Executive knows the answer to this question, but it is not only the Executive which bears the burden of the action.  The integrity of other members of the College committed to practicing medicine in accord with the motto of the College has been tainted by those whom they had elected to be their public representatives. 

We are dismayed that this intellectually restrictive act could be perpetrated by our fellow medical practitioners, in Australia, in the 21st century and are appalled by the discourtesy shown to an invited speaker whose credentials in end of life care are widely admired.

Yours sincerely

Associate Professor Arnold Gillespie
For Doctors for Voluntary Euthanasia Choice
and 63 other signatories.

 


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The Royal Australian College of Physicians (RACP) invited reasoned and measured assisted-dying doctor, Dr Rodney Syme, to address its annual conference in Cairns, and then unceremoniously pulled the plug. Cowardice? Flip-flop? You bet.

In February this year, Dr Syme says he was approached by a member of the the RACP 2015 Congress committe to attend and deliver a paper to the annual conference, in Cairns 24-27 May. The title of his paper was "Caring for those at the end of their journey." Dr Syme accepted the invitation and spent considerable time and effort preparing and polishing his paper. He was quite clear that a polemic on assisted dying was not suitable for this occasion, and wrote a paper discussing the gap between the rhetoric and the reality of palliative care: in other words, as is well-established, that despite the excellent quality of pallaitive care in Australia, it simply can't relieve the intolerable suffering of all dying patients. In any case, it would be unrealistic to expect palliative care to be perfect: we live in an imperfect world.

Dr Syme has been in the news recently in regard to providing medication and advice to Mr Ray Godbold, who is dying of advanced gatroesophageal cancer. The medication and advice gives Mr Godbold control over the end of his life.

Then, the RACP dropped a bombshell on 8th May. It unilaterally cancelled Dr Syme's invitation. It claimed to have done so in response to complaints by palliative care specialists.

Given that the RACP congress is titled "breaking boundaries, creating connections", and promises delegates a "diverse program" that facilitates "interaction and debate", this is an appalling development.

Dr Syme responded that:

  1. I personally feel deeply insulted.
  2. I regard the behaviour of those at the highest level of the college, an academic institution of high repute, as being less than expected of an academic body.
  3. For the college to surrender to “significant disquiet” from an unknown and undisclosed number of members in this way is cowardly.
  4. The Lead Fellow who invited me was incensed at the College’s reaction.
  5. The outcome is an act of academic censorship of the worst kind – they did not know the content of my address.
  6. It illustrates the extreme depths to which those opposed to open debate on an important medical and social issue will descend to stifle debate.”

I'm not surprised by that view. If palliative care specialists (and/or others) do not believe Dr Syme's points to be valid or defensible, then let him put them, and then rebut them. To reneg on the original invitation because someone might disagree is academic censorship.

That the RACP would stoop to such insulting flip-flop is not a great endorsement of their stature as an esteemed medical body.  It's time we had open and frank debate about end-of-life matters. Of course there will be disagreements—that is the point of debate.

The RACP owes a full explanation to both Dr Syme and to medical colleagues throughout Australia as to how many people demanded Dr Syme's invitation be withdrawn, and precisely on what basis, not merely that "they might not have liked what Dr Syme may  have to say."

Mr Marshall Perron, former Chief Minister of the Northern Territory, wrote the following to the RACP:

As a supposedly professional body the [RACP] organisation should encourage open and honest discussion on issues of great interest to our ageing citizens.  Instead you demonstrate a cowardly approach of which you should be ashamed.

 

 


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