Assisted dying (AD)

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Catholic Archbishop of Canberra/Goulburn Christopher Prowse. CC: Bart-1011

Last month, the Catholic Archbishop of Canberra & Goulburn, Christopher Prowse, published an opinion piece about VAD in the Canberra Times. Naturally, Prowse's views were opposed, which is fine. A range of views is always welcome. Misinformation, however, is not.

It would be unreasonable to expect that the opinion editor of the Canberra Times, Andrew Thorpe, would be intimately versed in the empirical evidence about voluntary assisted dying (VAD). So, it was reasonable that he publish an opinion piece on the topic offered by Archbishop Prowse. What is not reasonable, however, is that the counter-opinion I promptly submitted, pointing out several points of significant misinformation, was not published. A month later, still nothing.

A critical feature of high-quality, mainstream media journalism (which includes editorialism) is to ensure that the public can be exposed to a range of views on important topics, and that those views are generally devoid of significant misinformation. I argue that the Canberra Times has profoundly failed in this instance, and could profitably reflect on improving its conduct.

Here's the op-ed I sent, which they failed to publish.

 

Archbishop Prowse sadly misinformed on assisted dying

Catholic Archbishop Christopher Prowse’s recent editorial against voluntary assisted dying (VAD) (Canberra Times, 11 Aug) contains numerous items of misinformation about the practice. While a range of views is welcome, misinformation is not an acceptable standard in public debate about such an important topic.

Unsurprisingly, Archbishop Prowse argues that more palliative care is “the answer” to end-of-life suffering. This ignores formal statements by both Palliative Care Australia and the Australian and New Zealand Society for Palliative Medicine acknowledging that even the best palliative care can’t address all extreme suffering. It’s not like he wouldn’t know: the Catholic church is the largest single institutional provider of palliative care services in the nation.

His editorial also paints VAD deaths as “fearful”, “depressed” and “lonely”. This not only contradicts evidence published in peer-reviewed scientific research and official reports from lawful jurisdictions, but is a slap in the face to those who have chosen a VAD death, and to their families.

For example, the second person to use WA’s VAD law was Mary-Ellen Passmore. Her family and friends gathered to say farewell and sang Hallelujah together during her final moments. Loved ones of those who have accessed VAD in Victoria have described the experience as “peaceful” and “beautiful”.

Ms Passmore was also an indigenous community leader. This is relevant because Prowse argues that indigenous Australians would be fearful of VAD law, avoiding needed medical services.

This old chestnut has been rattling around since the Northern Territory VAD days in the 1990s, but was dismissed as false after a formal investigation found no change in indigenous medical service attendance. Indeed, a parliamentary inquiry heard that it was church members [not referring to Prouse or his diocesan colleagues] who were causing any indigenous fears.

Prowse also enlists “elder abuse” into his supposed army of the “vulnerable”. But a key feature of elder abuse is that it’s commissioned in secret, while VAD has numerous points of assessment, referral, review and documentation by trained professionals.

Perhaps the most egregious misrepresentation is his claim that “reasons for euthanasia quickly expand once legalised”, levelling specific claims about the Netherlands.

In fact, the Netherlands made VAD lawful by regulation in the mid-1980s. Several test cases in following years clarified that certain conditions (like extreme and unrelievable mental suffering) qualified under the regulations. These were formalised (not changed) in legislation in 2001. And that legislation hasn’t changed since. Not. One. Word.

One could be forgiven for thinking that the archbishop represents the views of Catholic Australians. But this isn’t true either. ANU studies show that some three quarters of Catholic Australians support lawful VAD.

I analysed the major 2019 data set of VoxPop — the academics who run VoteCompass — about VAD attitudes in the archbishop’s own archdiocese. It comprises the ACT and the NSW electorates of Bega, Cootamundra, Goulburn, Monaro, and about a third of Wagga Wagga.

With a VoxPop respondent count across the archdiocese of more than 34,000 people, four out of five voters favour lawful VAD with just 9% opposed. Not only that, but more than three out of four Catholic voters (76%) in the archdiocese favour lawful VAD, with just 13% opposed.

canberravadattitudes2019.gif
Voter attitudes toward VAD in the Canberra-Goulburn Catholic Archdiocese
Source: VoteCompass/VoxPop 2019.
~ Archdiocese totals weighted by elector count per district, Wagga Wagga weighted as 1/3 of.

Thus, not only does Archbishop Prowse seem unfamiliar with VAD facts, he seems remarkably unacquainted with the real views of his own flock.

Prowse argues that we are all “made in the image of God so we have dignity”. As an agnostic I’m happy for him to believe such things, though I say that everyone has dignity and life is precious regardless.

But when the archbishop proclaims that allowing VAD is “abandonment” of the person and that his views must prevail over all Australians, I call out hubris. “Abandonment” is to deliberatively seek to quash the deeply-held values and beliefs of others.

Most Australians, including Catholic ones, agree.

 


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A new book of anti-VAD polemical anecdotes, published by Springer

The other day a TV commercial from more than 30 years ago popped into my head. It was a humorous slice-of-life scene in which a teenage son gobbles down a breakfast bowl of Sultana Bran cereal. He complains that his health-kick girlfriend had made him eat vegetarian the night before. His family eye each other with mirth as he eats.

The punch line? “Don’t mention it’s healthy and they’ll eat it by the boxful.”

sultana_bran_ad_1990.jpg The Kellogg's Sultana Bran TV commercial from 1990.

Despite having worked in advertising research for years, I’m sure I hadn’t thought of this ad for at least a couple of decades. So what brought this vignette suddenly to mind?

It was the release of a new book by academic publisher, Springer: Devos, T, (Ed.) 2021, Euthanasia: Searching for the Full Story - Experiences and Insights of Belgian Doctors and Nurses, Springer, Leuven.

How terrific to have a new academic tome on the Belgian voluntary assisted dying (VAD) experience, I thought, as I downloaded the eBook version.

But then…

Imagine my surprise and disappointment then, to discover this is no scholarly tome with ethics-committee-approved study methodologies, carefully cited and transparent sources whose authenticity and veracity could be checked by anyone with a smidgin of scholarly acumen.

No, the kindest description I can give this blancmange of offenses is… a series of “essays” all singing from the same hymn sheet. More on that shortly.

The book launches into — let’s not beat about the bush — bullshit from the get go. In the Foreword, Jacques Ricot invokes the Hippocratic Oath as a still-relevant “religious standard”. Oh dear. You mean that oath that prohibits surgery, prevents women from entering the profession, and swears allegiance to ancient Greek gods?

He then goes on to describe VAD as a “desperate act of two people [the doctor and patient] trapped by helplessness.” He invokes cracks opening up in sea walls and waves that can only widen them. There’s your horizontal oceanic equivalent of the inevitable “slippery slope”.

Helpfully, he forewarns that all the authors in the book “do not believe that euthanasia can be a medical or a caring act.” OK, so not a range of views, then.

He also refers to the authors as “resistance fighters”, giving a heads-up that these writers feel they’re losing the battle.

And yet more

Then, anti-VAD campaigner Margaret Somerville repeats her rubbish claims that legalised VAD leads to suicide contagion. I’ve repeatedly taken Somerville to task over her serial misinformation, as well as noting the latest evidence from Switzerland which VAD opponents never mention… for a reason.

Somerville repeats yet again her refrain that “the case against [versus for] euthanasia is much more difficult to promote … because it is more complex”. No, it isn’t. It’s just that the majority now no longer take conservative religious doctrine as … shall we say, “gospel”. That’s especially true when her strongest ambit is to appeal to “a human way of knowing” (without mentioning her hobby horse, “moral intuition”, by name), and expressly noting that the stories that follow are not based on the usual scientific standards of evidence.

And there you have it. A series of “essays” by persons ideologically opposed to VAD, adorned with numerous uncheckable anecdotes and tawdry claims, appeals to slippery slopes, misrepresentation of data such as the non-voluntary euthanasia rate in Belgium, “intuitive” claims that the bereaved suffer as badly from lawful VAD as do families of those who have suicided violently and alone (despite multiple peer-reviewed studies showing VAD bereaved cope well). The list goes on.

Who are these people?

This of course begs the question: who are these people putting themselves forward as experts in VAD? Remember, these are people claiming expertise in a subject they’ve never participated in, and swear they never will. No doubt they are indeed experts in their own individual disciplines. But not in VAD.

It’s like asking (only) a bunch of hardened atheists to write an authoritative book on Christian spirituality.

Well, many of the names are already well-known in VAD (and especially anti-VAD) circles. Others took a bit of research to track down. Much of the work for the following backgrounders was accomplished by my friend the talented Chrys Stevenson. We compared notes.

The point of the research was not to attempt an inappropriate ad hominem attack. Without attempting to bore, I’ve already given a host of reasons as to why the quality of the essays in this book are very low. No, the point is to find common influences and agendas as to why that might be.

So lean in, dear reader, here we go. And to aid comprehension, may I suggest that you watch for the words in bold?

The editor — Timothy Devos

Timothy Devos is a Professor of Medicine (haematology) at Catholic University Leuven. He is a past president of the Medicine and Dignity of Man Association, an apostolate of the Catholic Regnum Christi movement, which believes that “the positions adopted by the Catholic Church in matters of bioethics are good, prudent”.

Foreword 1 — Jacques Ricot

Jacques Ricot is an Associate Researcher at Nantes University in France. In a 2003 paper he argues that secular philosophy needs to draw on the religious understanding of forgiveness. In 2014 he attended a conference on “dying with dignity” at the Catholic Notre Dame, Paris, articulating views harmonious with Catholic doctrine. In 2018, the European Federation of Catholic Doctors Associations and the Catholic Centre of French Doctors thanked him for valuable contributions to their thinking about human medicine.

Foreword 2 — Margaret Somerville

Professor of Bioethics at the (Catholic) University of Notre Dame Australia. (This is curious given that her CV mentions no earned tertiary qualification in either ethics or philosophy.) Somerville is a loyal Catholic who has for years been given pre-eminent position regarding Catholic bioethics above even the church itself at the L.J. Goody Bioethics Centre, as I’ve pointed out before.

The L.J. Goody Bioethics Centre is run by the Catholic Archdiocese of Perth. The Catholic Archbishops of Perth and Sydney are the ultimate controllers of the University of Notre Dame Australia.

Foreword 2 — Wesley Ely

Dr Wesley Ely is a Professor of Medicine at Vanderbilt University Medical Centre in Nashville, Tennessee. He is President of the Nashville Guild of the Catholic Medical Association. He has given numerous addresses from a Catholic perspective on topics such as “Preaching the gospel through service”, “Five principles of service in living the gospel”, “Deepening our prayer life”, “Viaticum: lessons learned from dying patients seeking our Lord”, “Top 10 tips at the heart of Christian discernment” and “A treatise on the true devotion to the blessed virgin by a lay doctor”.

Contributor — Eric Vermeer

Mr Vermeer is a nurse educator and the ordained Deacon of the Catholic diocese of Namur. His adopted son is also a Catholic priest. He is a past President of the European Institute of Bioethics, a group that claims to be independent and not of a religious nature, yet “attentive to religious traditions”. It lobbies for positions that are consistent with Vatican doctrine, such as against abortion and VAD. Quite a number of the Institute’s committees are known religious people, including some from the Catholic University of Leuven.

Mr Vermeer has recorded an anti-VAD video for ADF International, which runs the Arete Academy, a centre for religious academics based on “excellence and moral value”… at least according to their interpretation of the Bible.

Contributor — Catherine Dopchie

Dr Catherine Dopchie is an oncologist at the Centre Hospital of Wallonia. She told the Society for Religious Information Italy, published by the Catholic Press Agency, that “death is the enemy of mankind”, that “we have been created for life”, that “those who have met God in their lives, know that death is not the winner”, and that “every man is precious to God and that the entire life is sacred”.

Dr Dopchie has also recorded an anti-VAD video making unsubstantiated claims, for ADF International.

Contributor — Willem Lemmens

Having earned his doctorate at the Catholic University of Leuven, Professor Willem Lemmens is now Chair of the Department of Philosophy at the University of Antwerp. In 2018, Professor Lemmens argued against VAD at the (Catholic) Anscombe Bioethics Centre in the UK, and spoke with Catholic newspaper Crux, to spread the misinformation that Belgium’s law was originally only for terminal illness (it never was), and to complain that (Catholic) Belgian Brothers of Charity were now allowing VAD to occur in their healthcare facilities.

He also sits on the General Council of the University Centre Saint-Ignatius Antwerp, which was established by a Jesuit (Catholic) order, and whose purpose is to continue to promote Jesuit Christian ideology.

Contributor — An Haekens

Dr An Haekens was educated at the Catholic University Leuven. She is a psychiatrist and medical director at the (Catholic) Alexian Care Group in Tienen, Belgium. It was established by the (Catholic) Belgian Brothers of Charity and states that “we start from our own Christian identity” and “we want to keep alive and implement the spirituality of the Alexians”.

Dr Haekens writes periodically for Belgian Catholic magazine Tertio, including stating that she would never participate in VAD. In 2021 she was interviewed by Belgian Catholic radio station Radio Maria, having been awarded the annual prize for spiritual care by the Professional Association of Care Pastors, the association for Catholic chaplains.

She is married to Dr Didier Pollefeyt, Catholic Professor of Theology and Religious Studies at the Catholic University of Leuven. He is also an Honorary Professor at the Australian Catholic University.

Contributor — Rivka Karplus

Dr Rivka Karplus is a family physician and an internal medicine and infections specialist, based in Israel. In 2018 he attended a colloquium at the College des Bernardins in Paris — a Catholic theological and biblical studies centre — as a representative of the Jerusalem Kehilla, a congregation of Hebrew-speaking Catholics. He is warmly cited in a 2016 anti-VAD publication by the Catholic Caritas in Veritate Foundation, which attempts to provide representatives at the UN and other international organisations with Catholic, Christian “expertise and strategic thinking”.

Contributor — Marie Frings

Dr Marie Frings is a Brussells-based GP specialising in palliative care. She writes for Catholic group Consecrated Lives which promotes increasing evangelical commitments. In such an article in 2007, she cites the Catholic Congregation for the Doctrine of the Faith as an authority on end-of-life decisions, and notes that sometimes she felt uncomfortable that patients would have their arms tied to be force-fed against their wishes so they lived indefinitely. She firmed her views that tube feeding was not mandatory when it is an extraordinary measure, with the help of several Catholic theologians and the pro-life committee of the episcopal conference of American (Catholic) Bishops.

She argued “respecting the conscience of others” in this regard, yet expressly rejects such conscience when it comes to choosing a peaceful, hastened death by VAD.

Contributor — Benoit Beuselinck

Dr Benoit Beuselinck graduated from the Catholic University of Leuven in Belgium, and has for years worked in the university’s hospitals. In 2017 he spoke at an anti-VAD conference at the Catholic Anscombe Bioethics Centre in the UK.

In an article in the Catholic magazine Logia, he claims that “proper palliative care makes assisted dying unnecessary”, even though it is well-established that this isn’t true.

He alleges in the Catholic Herald that Belgian nurses and social workers are quitting their jobs because palliative care units are being turned into “houses of euthanasia”, and that doctors in palliative care units “have to euthanise patients”. He also claims that some patients are afraid to go to hospital in case they are either coerced into euthanasia or are deliberately killed without their consent. This is a perversion of the original Netherlands accusation by the Vatican, which itself was entirely false.

Dr Beuselinck has also made an anti-VAD video for ADF International, making unsubstantiated claims that “doctors hide behind their patients’ wishes”, “supply creates demand”, “the doctor has his back to the wall”, “we want euthanasia for everyone”, “doctors who prefer not to do it are not respected”. He cherry-picks Belgian non-voluntary euthanasia data to wrongly make the case that their VAD law has caused (or at least worsened) that practice; the opposite of the truth. He says that euthanasia is an act against nature, opens the floodgates, that we no longer favour the love we show in taking care of someone, and that the depressed may now think “if the doctor can kill, then what is my life worth?”

Contributor — Julie Blanchard

Dr Julie Blanchard is a French-trained GP who specialises in palliative care. She works at the Catholic University of Leuven’s second hospital, in Namur, and never participates in VAD. Contrary to Dr Beuselinck’s claims that palliative care workers opposed to VAD are disrespected and forced to participate, Dr Blanchard reports that other doctors respect her opposition, and that VAD teams take care to ensure those who are against VAD are not present at the time of a lethal injection.

It's astonishing how inconsistencies like this — those opposing VAD are respected but are not respected — reduce the book’s coherence.

Contributor — François Trufin

François Trufin is an emergency nurse at St Nikolaus Hospital in Eupen, Belgium. The hospital was founded and continues to be sponsored by the Catholic church, “continuing [the] obligation of the founders” for a “Christian worldview”.

Religious petticoats and the Catholic Communicator’s Guild

So there you have it: the Catholic connections of the people involved in the production of this risible nonsense, which brims with innuendo, arguments and misinformation consistent with those of the Catholic church and other Catholic apologists.

I’ve written before how Catholic Archbishop Anthony Fisher has expressly argued for organising a line-up of sympathetic (i.e. Catholic) doctors, lawyers and others to put such information about, and yet, how they hide their religious petticoats while doing so. I’ve further exposed a network of Catholics who promote the church’s line on VAD — a network I call the Catholic Communicator’s Guild.

This book furnishes an international example of the same principle: a group of Catholics promoting entrenched church lines on VAD, but hiding their religious petticoats all the while.

You may wonder how many times the word “Catholic” appears in said book. The answer is: exactly zero. And mentions of “religion” and “faith” appear as abstract and conceptual argument, e.g. if a person of faith…

Not the first time it’s been published

But a further issue arises in respect of this book: it’s not the first time it’s been published. It was published two years ago by Mols Editions (Wavre) under the title Euthanasia: Behind the Scenes — Reflections and Experiences of Caregivers. Tellingly, it was published in French and mentions the French parliament grappling with VAD law reform. (The current French VAD Bill, which appears to be supported by a majority of MPs, has been filibustered with well over 2,000 (two thousand) amendments submitted by just five MPs.)

Unlike the original which you have to buy, this Springer version is “Open Access”, meaning you can download the book from the publisher for free. So is this further edition vanity publishing?

The reason I ask is that Springer Publishing is owned by Springer Nature. That’s a company whose purpose is to make money for its owners via academic publishing. So publications have to be paid for either by sales, or by authors. Since there are no sales, the authors (or someone on their behalf) will have had to pay for the book.

According to their fee schedule, Springer charge US$15k (around AUD$20k) plus taxes for publishing a tome of this nature.

So: who paid for the book?

Conclusion

Far from a carefully researched collection of studies into VAD practice in Belgium, this polemical book relies heavily on the “moral intuitions” of innuendo, unverified anecdote and misinformation. It’s consistent with the propaganda put about by the Catholic church, yet not once throughout the entire book does anyone mention their deep Catholic connections. Indeed, you could be forgiven for thinking they’d taken some care to cover their religious petticoats.

A serious compendium of proper, scholarly studies of VAD practice, good and bad, is always welcome. This book is not it.

In my view, the tome does no favours for Springer, which has a solid reputation for academic and scholarly publication.

And, back to that 1990 TV commercial for boxes of breakfast cereal. It had popped into my head as an analogue: “Don’t mention it’s religious and they’ll publish it by the book-full.”


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The Netherlands 2020 assisted dying report card confirms a steady rate

The Netherlands euthanasia commission has just released its 2020 annual report.

The report shows that the number of cases rose around 9% over the 2019 year. However, the number of total deaths was also up, resulting in a continuation of relatively level rate in recent years (Figure 1).

netherlandsbelgium2020.gif
Figure 1: The assisted dying rate in the Netherlands and Belgium

With Covid-19 deaths having contributed towards a modest net increase in total deaths last year, the assisted dying rate is likely to be modestly higher in the coming year.


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"HOPE's" Branka van der Linden and the ACA misrepresent figures, again

Here we go again. Branka van der Linden of Catholic anti-VAD website “HOPE”, and the Australian Care Alliance — endorsed by a number of well-known, committed Catholic doctors — have just published more egregious misinformation against VAD. This time they've collectively piled it on Victoria's general suicide statistics, recently updated by the Victorian Coroner. So what did they say, and how did it misrepresent the actual situation? Let's take a look.

The reason the statistics are being discussed is because in 2017, Victoria's parliament legalised voluntary assisted dying (VAD) for the terminally ill. The law came into effect halfway through 2019, and 2020 was the first full year of its operation.

Australian Care Alliance gets the basics wrong

Here's the Australian Care Alliance's (ACA) splashy page trumpeting that Victoria's suicide rate has jumped 21.2% from 694 in 2017 to 842 in 2020.

acagetsstatswrongmarch2021.jpgFigure 1: ACA's splashy page trumpeting a 21.2% increase in Victorian suicides

That's... interesting. According to the Victorian coroner's official figures, there were indeed 694 suicides in Victoria in 2017. However, in 2020 the coroner's figure is actually 698, not 842 as claimed by the ACA. According to the ACA, Victoria's suicide count data looks like this (Figure 2).

acasuiciefigurewrong2021.gifFigure 2: The ACA polemically claims that Victoria's suicide count has increased 21.2%

So, how did the ACA reach a count of 842? Well, their argument is to shamefully and humiliatingly disrespect Victoria's terminally ill who died peacefully under its VAD law in 2020 — 144 of them according to the official 2020 reports of Victoria's Voluntary Assisted Dying Review Board — and add them to the coronial count of 698 suicides.

The ACA points out that VAD supporters have said that legalising VAD should decrease Victoria's general suicides by about 50 cases a year, but say the count's gone up substantially instead. See how they craftily deploy logical fallacy to fabricate a crisis?

Arguing that VAD law must reduce the suicide count by 50 cases a year (but seemingly didn't) and at the same time adding VAD cases to the suicide count to complain that it's gone up, requires at least three assumptions:

  1. that all terminally ill violent suiciders now automatically qualify for and easily gain access to VAD; and
  2. that nobody else with a terminal illness who would not have chosen violent suicide, should or would use the law; and
  3. that no other factors make a significant difference to trends in general suicides.

 
All these assumptions are patently false.

Obviously, some people will not legally qualify for VAD; for example, amongst its restrictions it requires death to be expected with 6 months; 12 months for a small set of specific illnesses.

Obviously, some who would not have suicided but instead would suffer intolerably and against their wishes until death, will now choose to pursue VAD.

And obviously, well-known factors such as rates of mental illness, substance abuse, intimate relationship troubles, bullying, financial or legal difficulties, and other factors are major influencers of general suicide rates. But to the ACA, the only factor that supposedly has any effect is the one they are ideologically opposed to: VAD.

It's worrisome that this nonsense is sold to the public by ACA's supposed experts: “health professionals and lawyers”.

Cherry-picked overseas data, too

The ACA's ideological bias is further revealed by their website page about the “social contagion of suicide”. In it, they cite as authoritative, the 2015 Jones and Paton (both firm Catholics) article purporting to show 6.3% suicide contagion from VAD to the general population. I've comprehensively exposed that article as an ideologically-driven mathematical farce fuelled by no fewer than ten major scientific offenses. It's interesting that the ACAs methodology is just like Jones' and Patons': reporting VAD supporter statements that legalisation should decrease the general suicide rate, and then adding VAD deaths to conclude the opposite.

They also commit one of Jones' and Patons' other offences: selectively quoting data from other studies that might be seen to support their theory, but excluding critical alternative information from the same study that runs counter to the theory.

The ACA cites a Swiss study to breathlessly report that 6.5% of those who witnessed an assisted death in that country experienced sub-threshold PTSD, and 13% full PTSD. The ACA expressly states:

“Like any other suicide, assisted suicide can profoundly affect surviving family members and friends.” — The Australian Care Alliance

There you have it: the ACA draws a direct equivalence between peaceful VAD deaths in the face of terminal illness and with loved ones present, and lonely, violent deaths by general suicide.

The ACA cites no other relevant material from the Swiss article. That's revealing, because the article clearly reported that the PTSD rates were higher than in the general population. There's what the ACA left out: the PTSD rates were higher than for almost everyone else who hadn't just suffered the loss of a loved one.

To draw valid and meaningful interpretations, it is necessary to compare the bereavement challenges of VAD family versus families of general deaths, deaths in the face of extreme suffering without hastened death, and cases of violent suicide. As I've published before from peer-reviewed studies, bereavement symptoms of VAD family are at least as good as, and can be better than those where the deceased has suffered in extremis at the end of life, and certainly relative to violent suicides.

The ACA also doesn't mention that the Swiss study found a "prevalence of complicated grief ... comparable to that reported for the general Swiss population". It's not like the information was hard to find. It's right there in the Abstract on the front page of the article.

That the ACA cherry-picked a couple of Swiss data points while omitting key “unhelpful” information, and argued, by linking the selected cherries with the above quote, that said Swiss data established something it clearly did not (that VAD deaths supposedly cause similar family trauma as violent suicides), suggests an astonishing degree of ignorance.

The ACA's cherry-picking of data, while omitting key unhelpful information, suggests an astonishing degree of ignorance.

Enough of that.

Branka van der Linden cherry-picks, too

I've crossed pens (or is that keyboards?) with Ms van der Linden several times before in regard to misinformation. She misinforms on this matter, too.

Curiously, like the ACA and also without explanation, she cherry-picks just the 2017 and 2020 suicide counts from the Victorian coroner's report (Figure 3). You'd think this was the only data in the report, but no, it isn't.

vanderlindenvicsuicidestats2021.gifFigure 3: Branca van der Linden's version of Victorian suicide counts by year

She uses these two figures to argue that said drop of 50 cases per year hasn't happened. This employs the same fallacies as the ACA: suggesting that two single data points strongly support a hypothesis, and assuming that the thing one is ideologically opposed to, VAD, is the only thing to alter the rate of general suicides over time.

Like the ACA, she also suggests adding the VAD figures to the coroner's general suicide data to say that in that case, suicides have increased significantly.

Both the Australian Care Alliance and Branca van der Linden cherry-pick just two data points from more full and robust longitudinal data to try and argue their case against VAD.

So what does the coroner's full data set look like?

The actual numbers

The Victorian coroner's 2021 report into suicides contains data for all years 2016 to 2020 inclusive. And it looks like this (Figure 4).

viccoronersuicides2021.gifFigure 4: The complete set of data from the Victorian coroner's report on suicide counts per year

Now we're beginning to see a possible reason as to why the ACA and Ms van der Linden chose just two data points. Remember that VAD was legalised by the Victorian parliament in 2017. The law was not in effect for 2017, 2018, or the first half of 2019.

Well, the data clearly suggests an increasing suicide count trend up to 2018. The upward trend stops in 2019, when VAD was in operation for the second half of the year. And in 2020, the first full operational year of VAD, the upward trend has been interrupted by a downward result. Neither the ACL nor Ms van der Linden mention this.

Neither the Australian Care Alliance nor Branca van der Linden mention the fuller, longitudinal data that doesn't support, and indeed appears hostile to, their hypothesis.

Update 19-Mar-2021

I thought it so obvious that I didn't write it up, but a colleague points out it's important to highlight, that in picking just two data points to stake their claim, the ACA and Ms van der Linden chose 2017, and not 2018, as their reference year. To compare “after” with “before” in the most basicly valid manner (full longitudinal data is better), it is appropriate to compare the last data point that completely excludes the new condition (VAD law in operation), with the first data point that fully includes it.

Those years are 2018 (none of the year) and 2020 (all of the year). But the ACA and Ms van der Linden didn't pick 2018, they picked 2017.

What possible reason might explain that? Well, by comparing 2017 with 2020, they got to say that the general suicide count increased by 2 from 694 to 698. However, had they more validly compared 2018 with 2020, they would have had to report a drop of 19 from 717 to 698.

And that would have contradicted their flimsy confection that suicides hadn't gone down after VAD was introduced.

But even the raw suicide count statistics are a bit misleading.

Interpreting suicide data correctly

Using raw counts to compare suicide statistics (e.g. year to year or place to place) is lazy and wrong. All other things being equal, if you had twice the population, you'd expect twice the suicide count. To make valid comparisons, you have to compare rates, not raw counts. This is relevant because populations obviously change over time, and Victoria between 2016 and 2020 was no exception.

I've retrieved the official Victorian population figures by year and computed the standard official suicide rate statistic: suicides per 100,000 population. The Victorian suicide rates look like this (Figure 5):

vicsuiciderate2016-2020.gifFigure 5: Victorian suicides per 100k population by year

The data shows a rising suicide rate from 2016 to 2018, a levelling off in 2019 in which VAD was operational for half the year, and a fall back to the 2016 rate in 2020, the first full operational year of VAD.

Computing from the rate drop between 2018 (11.4 with no VAD law) and 2020 (10.8, first full year of VAD law), the equivalent count of suicide decrease in 2020 was 38 persons. And that's without assuming the general suicide rate would have continued its rising trend.

The equivalent suicide decrease from 2018 to 2020 was 38 persons.

Getting all the numbers right

The ACA correctly cites then Minister for Health, Ms Jill Hennessy, as stating in 2017 that "Evidence from the coroner indicated that one terminally ill Victorian was taking their life each week." That would be 52 cases a year, which the ACA rounds out to 50 a year. The headline figure from the coroner's report actually calculates to 48. No biggie, just round numbers.

But the figure is quite wrong. You have to read the coroner's special 2017 report to the Victorian parliament regarding suicides in cases of illness, to calculate the correct numbers.

The coroner's report didn't just include suicide data for terminally ill people. It also included cases of advanced incurable but not terminal illness, and cases of severe suffering resulting from injuries. So the terminal illness data (to which the VAD law is relevant) is a fraction of the total. We can calculate from the Tables in the report that 23% of the cases were in respect of injuries, so that leaves 77% for terminal and other advanced illnesses.

Of the illnesses listed, the relevant one as a proxy measure for terminal illness is “cancer”, and that comprises 50% of the illness cases. So, 50% of 77% of 48 cases a year = 19 cases a year in respect of terminal illness.

So that's an actual likely decrease of 19 suicide cases a year, compared with an equivalent drop in the actual data of 38 persons in the first full year.

The actual annual count of general suicides in respect of terminal illness, as reported to the Victorian parliament by the state coroner in 2017, was 19 persons a year, and not 50 as widely stated.

Don't get carried away

It's imporant to note that citing this interesting numeric analysis as “proof” of the law's effectiveness in respect of reducing Victoria's suicide rate, would, at present, be an overconfident claim. While far more firmly based in proper forms of evidence than the vapid nonsense promoted by the ACA and Ms van der Linden, this is a correlation. Correlation does not equal causation: the ACA and Ms van der Linden should remember that. For example, 2020 was a very unusual, Covid-19-dominated annus horribilis, which may have affected suicide rates in unexpected ways.

While the coroner's fuller data set so far is consistent with reasoned expectations of suicide substitution, it is premature to conclude the data proves the principle. More years' data, and more detailed, causative analysis involving the control of confounding factors, is necessary before reaching greater certainty in the association.

But as I've published in detailed and extensive analyses based on robust official data, so far all the longitudinal data on suicide rates in jurisdictions where VAD is lawful is consistent with suicide substitution, not suicide contagion. Some VAD opponents just cherry-pick their way through tidbits to try and argue the opposite.

To date, all the robust, longitudinal data on suicides in jurisdictions where VAD is lawful is consistent with suicide substitution, not suicide contagion.

Conclusion

The Australian Care Alliance and Ms van der Linden disgracefully cherry-pick and misrepresent Victoria's recent suicide data in a manner consistent with their own theories, while proper and appropriate analysis of the full data available shows results inconsistent with their hypothesis, and currently consistent with the opposite.

To paraphrase Ms van der Linden's own statement: “It is unfortunate that the deaths of terminally ill Victorians were politicised so shamelessly by [anti-]euthanasia activists for their own ends.”

These continued cherry-picked data gaffes are an embarrassment to their promoters.


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Beligum and Oregon released their annual VAD reports this week.

Belgium and the USA state of Oregon both released their annual voluntary assisted dying (VAD) reports this week. I report on the numbers.

While the Netherlands and Washington state haven't released their 2020 annual VAD report cards yet, Belgium and Oregon have.

Belgium

Back in 2016 I wrote a detailed Whitepaper on assisted dying practice in Benelux, including data up to 2015. In it, I pointed out that in several years' time the trend to increasing rates of VAD would level off, like a sigmoidal (stretched-S shape) curve, as does most human adoption of new behaviours.

That time has arrived. The most recent data from both the Netherlands and Belgium shows that in both countries, the VAD rate, as a proportion of all deaths, has generally levelled off (Figure 1).

dutchbeligianvadlong2021.gif Figure 1: VAD deaths as a proportion of all deaths in the Netherlands and Belgium
Sources: Official Euthanasia Commission reports; Government total death statistics

The cultural rate of VAD in the Netherlands appears to be around 4.3% of all deaths, while in Belgium it's around 2.4%. No doubt these figures will vary slightly over coming years, but shrill pronouncements that the rate would continue to rocket higher and higher are refuted by the evidence.

That Belgium's “level” VAD rate is significantly lower than the Netherlands' despite quite similar (though not identical) laws, suggests that VAD rates are influenced more by cultural and other factors beyond the specific provisions of formal statutes and regulations.

Oregon

Meanwhile, in the state of Oregon, the Death With Dignity Act (DWDA) was revised in 2019. Previously, some people suffering intolerably at the very end of life were excluded from using the Act if they died within 15 days of deciding to use the Act. This was due to a fixed, mandatory 15-day cooling off period. Yet in the last weeks and months of life, an individual's condition can take a sudden and dramatic turn for the worse, so that previously the person may have not qualified for other reasons or felt they still had time to apply for access, and now would not qualify the 15 day cooling off period.

The cooling off provisions were updated by Oregon's legislature in 2019 to allow access without the cooling off period, in cases where the person is, in professional medical opinion — and with a formal declaration to the effect — reasonably likely to die before the 15 days had elapsed.

The revision was in effect for the entire 2020 calendar year.

As a consequence, some people felt they didn't need to apply quite so early “just in case” they might want to use the law, while others who would have been excluded altogether were able to use the law. This accounts for a slight dip in the “old” provisions rate, along with a rise in the total proportion of DWDA deaths (Figure 2).

oregondwdalong2021.gifFigure 2: Oregon DWDA deaths as a proportion of all deaths, new-rule data in light blue
Source: Oregon DWDA annual reports; Government total death statistics

Oregon's overall rate of VAD remains much lower than in the Netherlands and Belgium, whose laws are not restricted to cases of terminal illness.

However, in no case has any parliament legislated to limit cases to a numbered cap. In all jurisdictions, legislation focuses on the conditions under which a person may become eligible to access VAD choice, regardless of the actual numbers requesting and qualifying for access.


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There's a good reason why assisted dying opponents don't mention Switzerland. [Photo by Andrew Bossi]

Supposed Dutch suicide contagion from assisted dying

Recently, Dr Theo Boer, an Assistant Professor at a "black-stocking" (strongly conservative Protestant) theological college in the Netherlands, was at it again — criticising the Dutch euthanasia law to anyone who would listen: "don't follow the Dutch euthanasia law path because it leads to 'suicide contagion'".

I've exposed Prof. Boer's cherry-picked nonsense before. Astonishingly, he even ignores data from the Dutch Euthanasia Commission, despite the fact he used to serve on one of its five Regional Review Committees.

What he doesn't mention is that amongst the five Regions, the Region with by far the highest rate of assisted deaths had the second-lowest rate of general suicide, and the Region with the lowest assisted death rate had by far the highest general suicide rate (Figure 1) in 2014,1 the year Boer left his Committee and began bad-mouthing the Dutch law. Quite the opposite of "suicide contagion".

dutchvadandsuiciderates.gifFigure 1: Dutch assisted death and general suicide rates by region, 2014

From multiple safeguards to just one

The Dutch euthanasia Act has a number of safeguards that stipulate who may qualify to access assisted dying in the Netherlands, and how qualification is assessed, implemented and reported to the authorities.

But there's another country that permits assisted dying with just one provision: Switzerland.

In effect since 1942, an exception in the Criminal Code permits assisted suicide, provided assistance is rendered for non-selfish motives. That's it. There's no legislated (or even government-regulated) requirements for age, illness or condition, decisional capacity, cooling off periods, or anything else.

In the 1980s, two assisted dying associations were formed to make assisted dying generally possible: Exit Deutsche Schweiz for German-speaking Swiss residents, and Exit A.D.M.D. for French-speaking residents.

Since then, several other smaller associations have been formed, including in 1998 Dignitas, which provides assistance to foreigners. (The main societies assist only Swiss residents.) The current membership of the societies, combined, is well in excess of 150,000 people, in a population of just 8.5 million. Assisted dying is often discussed openly in the media.

If "contagion" anywhere, in Switzerland, right?

Given that Switzerland has an abundance of the ingredients that religious opponents of assisted dying claim lead to "suicide contagion", you'd think they'd be shouting about Swiss "suicide contagion" from the rooftops.

But they don't mention Switzerland.

There's a powerful reason why: the data is not only unhelpful to their "contagion" theory, but actively hostile to it.

Latest official government data

I've written about Switzerland before, but, given the ongoing "suicide contagion" misinformation, I thought an update warranted. On request, my contact in the Swiss Federal Statistical Office (FSO) promptly re-supplied all publicly-available statistics of assisted deaths and general suicides, with the data now running up to 2017.

It makes for interesting reading. Figure 2 shows Switzerland's (CH) long-term general (non-assisted) suicide rate, along with the domestic (Swiss resident) and Dignitas (foreigner) assisted death rates. All the official (Australian Bureau of Statistics) longitudinal data I could find for Australia's (AU) general suicide rate is also included.

swissdeathratesto2017.gifFigure 2: Swiss death rates 1969–2017; Australian suicide rates 1990–2017

Immediately obvious is that the Swiss general suicide rate has dropped massively and consistently since the two main assistance societies were formed in the early 1980s. And it's continued to drop even as the rate of assistance, and public discussion, has increased over the most recent three decades.

I also asked the FSO how many cases on record were of minors (persons under the age of majority or 18 years). The answer? None. I double-checked. Zero. Zip. No minors receiving assisted dying in Switzerland. Indeed, cases under the age of 35 years old are uncommon.

Consistent with best practice

Indeed, the data is consistent with suicide prevention. The societies help people get the medical care they need and consider assisted death only when other avenues have failed to provide acceptable relief. Every assisted death is reported as such by the association to the authorities — otherwise the unexpected death would result in a coronial inquiry.

Each association has clearly-defined processes and oversight by ethics specialists. Clients requesting access are assessed carefully by doctors. (In fact, the lethal medication can only be lawfully obtained by medical prescription.) The associations take their responsibilities very seriously.

The data is also consistent with substitution: that what would have been some violent and lonely suicides as a result of unrelievable suffering from intractable conditions, are now peaceful assisted deaths.

And for the record, despite the Swiss law being in effect since 1942 versus Dutch regulation from only 1984; and Swiss law having only one provision versus Dutch regulation/legislation with many; in 2017 the Swiss assisted dying rate, including Dignitas cases, as a percent of all deaths, was less than half that of the Netherlands' rate.

Reasons for requesting an assisted death

Exit Deutsche Schweiz, by far the largest of the Swiss associations, has published statistics of its cases (Figure 3).

exitdsreasons2015.gifFigure 3: Reasons for pursuing assisted dying, Exit Deutsch Schweiz 2015

In 2015, like other jurisdictions, cancer was by far the most common reason (40.8%) for requesting an assisted death. Polymorbidities (22.4%) was next, followed by refractory pain at 8.6%, lung diseases at 5.0% and Parkinsons at 4.3%.

Despite no government-regulated access requirements, assistance for mental illness was very low at 1.7% (Dutch 1.2% in 2015) and cases of dementia at 1.4% (Dutch 2.0%; Belgian combined mental/dementia 3.1% in 2015).

And compared to Australia?

In the 1990s, the Swiss general suicide rate, although falling, was significantly higher than Australia's (Figure 2) until 2010, when the rates were the same. Since 2010, the Swiss suicide rate (with no legislated procedures for its permitted assisted dying) has continued to drop, while Australia's (at that time with no assisted dying law at all), began to rise.

This difference highlights the clear anchoring bias exhibited by religious opponents who cherry-pick their data to try and claim the rise in the Dutch general suicide rate must be the result of "suicide contagion" from assisted dying, when Australia's rate also increased over the same time period, but in the complete absence of an assisted dying law. (Victoria's assisted dying legislation didn't come into effect until mid-2019.)

Further, the Swiss rate has continued to drop even with a significant increase in assisted dying.

Conclusion

Of course, general suicide is a serious issue. It has numerous well-known risk factors (e.g. mental health, substance abuse, unemployment, relationship breakdown, opportunity) and protective factors (e.g. hotlines, funding mental health programs, unemployment benefits, removing opportunity), none of which assisted dying opponents mention while cherry-picking their statistics.

Meanwhile, as legislators contemplate the specific safeguards contained in Bills before their legislatures, it's important to strike an appropriate balance between sufficient safeguards, and inappropriately requiring those considering an assisted death to climb Mount Everest with one hand tied behind their backs.

Switzerland shows that even in a jurisdiction without legislated practices, access to assisted dying is modest, with assistance groups establishing their own stringent ethical and procedural standards.

And it amply demonstrates even under those conditions, an absence of supposed "suicide contagion".

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1 Official Euthanasia Commission data and official Dutch government suicide statistics by region.


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Multiple "non-religious" anti-VAD campaigns are being run through the Catholic Archdiocese of Hobart

If you're wondering how religious the organised opposition to voluntary assisted dying (VAD) law reform is, current ructions in Tasmania provide a marvellous petri dish of evidence.

Catholic church call to arms

Back in 2011, the now Catholic Archbishop of Sydney, Anthony Fisher, wrote a lengthy, deliberative editorial against VAD, calling on the church to enlist people with no obvious religious connections to help the church fight VAD law reform. He wrote:

“The man or woman in the street … may well be open to persuasion that permissive laws and practices cannot be effectively narrowed to such circumstances”; and
“we need to research and propose new messages and carefully consider who should deliver them, where and how.”

He went on to describe how various doctor, patient, lawyer, indigenous, disability and palliative care specialist groups might be corralled into this public relations campaign. (Nowhere in this musing did he reflect that the church's expectations of VAD calamity themselves might actually be queried or tested.)

Despite this, when promoting anti-VAD messages, he argued, “we do not have to hide our religious petticoats altogether.”

However, this standard of transparency seems to have been abandoned in recent years.

Pop-up group "Live & Die Well"

Take the Tasmanian pop-up group Live & Die Well, for example. Convened just six weeks ago for the sole and express purpose of defeating Tasmanian MLC Michael Gaffney's VAD bill, its website doesn't mention religion… at all. No identified religious connections nor religious arguments of any kind. Meticulously absent.

Indeed, the anti-VAD campaigning pamphlet the group puts about expressly advises folks when writing to their MPs, "DO NOT use religious arguments".

That's quite curious given the religious backing of the group, headed by Mr Ben Smith.

The Catholic church gets busy

Who is Mr Smith? He's the Director of the Life, Marriage and Family Office at the Catholic Archdiocese of Hobart. He reports directly to Archbishop Julian Porteous.

Unsurprisingly, core attributes given in the 2017 job advertisement for which Mr Smith was the successful applicant, require deep knowledge of the Catholic church, unquestioning support for its doctrines, and “highly-developed communication skills” to promote the church's agenda.

And, Messrs Smith and Porteous' arguments are strikingly similar, as I've revealed previously.

Does Mr Smith declare this on the Live & Die Well website? Nope. He's just a "resident of Hobart".

And the other "leaders"?

The other three "team leaders" at Live & Die Well are Mrs Patricia Gartlan, Mrs Karen Dickson, and Mr Daniel Bosveld.

Mrs Gartlan is a recipient of the Catholic church's Knights of the Southern Cross National Award for services to the "sanctity of life". (Recently, her "team leader" entry has been removed from the website.)

Mrs Karen Dickson is Chair of Mothers of Pre-Schoolers (MOPS) Australia, a Christian fellowship group. She's previously campaigned against same-sex adoption, which she opined is against God's will and would result in inevitable "moral decay" and the destruction of "the very foundations upon which society is built". Predictably, she's also actively campaigned against marriage equality, likening it to "dropping a brick on your foot".

Mr Bosveld is a university student (most likely protestant) and President of LifeChoice Tasmania, a tiny student group promoting the "life from conception through [to] natural death" position. His Facebook page "Likes" more than 20 Christian groups, including the Australian Christian Lobby.

Look… over there!

The extent to which Live & Die Well exquisitely attempts to paper over its religious petticoat is exemplified by the inclusion of two articles purporting to strengthen the non-religious case against VAD law reform.

The first is a piece republished from Spectator Australia, in which an atheist says he opposes VAD law reform. Of course there are non-religious people who oppose VAD law reform: but robust survey evidence shows that they're rare, and that in fact strong opposition is strongly correlated with high religiosity. Nor are there teams of atheists actively organising others, as the churches are, to oppose law reform.

The second is an article by Mr Wesley J. Smith which tries to imply that opposition to VAD law reform is more widespread amongst humanists than it is. He's a Senior Fellow at the Discovery Institute. Remember them? They tried and failed to have "Intelligent design" (creationism with lipstick), taught as science in US schools.

I've had words to say about his misinformation and incoherent slippery slope nonsense here, here and here. Oh, and Live & Die Well omits the real publication date of the reproduced op-ed — which is more than a decade ago — presenting it as though it's fresh and contemporary.

Another group

Another group that's been actively and vocally opposing Mr Gaffney's VAD bill is Health Professionals Say No.

A major newspaper ad against the bill was recently taken out in the group's name. It was authorised by a certain Mr Ben Smith. Yes: that's the same Mr Ben Smith who is Director of the Life, Marriage and Family Office at the Catholic Archdiocese of Hobart. And the authorisation address is… the Catholic diocesan centre of Hobart.

One might wonder who actually paid for the ad…

The who's who

The group's website advances the usual slippery slope conjectures, and promotes the video Fatal Flaws, produced by Canadian loyal Catholic, Mr Kevin Dunn. That's the "documentary" that Go Gentle Ausralia's Fatal Fraud film exposes for its extensive religious connections, revealing how it employs emotional manipulation, fear, framing and omission to sow Fear, Uncertainty and Doubt (FUD) in the minds of legislators and the public.

Prominent members of Health Professionals Say No include:

  • Prof. David Kissane, a Knight of Obedience to the (Catholic) Order of Malta.
  • Dr Maria Cogolini, a Catholic bioethicist.
  • Dr Megan Best, a Catholic bioethicist who got her facts fundamentally wrong.
  • Dr Douglas Bridge who has identified his "supreme Christian calling".
  • Prof. John Murtagh who says medicine and Christian ethics are inextricably linked.
  • Prof. Ian Olver, a lay preacher.
  • Dr Peter Coleman who has called for "placing the Christian revelation at the centre of university education."
  • Dr Peter Ravenscroft, past Chairman of the International Christian Medical & Dental Association.
  • Dr Anthony Herbert, former National Secretary of the Australian Christian Medical Fellowship.
     

Too many yet too few

It also includes Victorian, Dr Roger Woodruff. That's significant because one of the group's key claims is that people will feel unduly influenced to use VAD law, i.e. too many people will die from VAD. Yet Dr Woodruff previously published an opinion in the Journal of Palliative Medicine that the most striking feature of the VAD experience in Oregon is “almost total disinterest shown by the terminally ill” due to the small numbers of VAD compared to the number of cancer deaths.

So to sum up that approach: VAD mustn't be legalised because too many people will use it, but it's not worth legalising because too few people use it. Which is it? It can't be both.

Avoiding the ad hominem fallacy

We should be sure not to reject arguments automatically just because they are made by religious people. People of faith have just as much right to be heard in the public square: otherwise one would be arguing special privileges for non-faith Australians. Standards for public discourse are necessary, however.

“Dig here”

The connection being made here is not to reject arguments because of the religion of the informant, but to identify where misinformation almost exclusively comes from. I've been writing about this for years, with exposés on deep religious misinformation like:

  • The Vatican claim that Dutch elderly supposedly go to Germany for medical treatment because they fear being euthanised in Dutch care homes (the claim causing a diplomatic crisis).
  • The Catholic church in Australia spreading grotesque propaganda about Belgium's assisted dying practices, prompting a rare, savage rebuttal from the authors of the scientific study the church misrepresented.
  • The claim that a Council of Europe resolution "banned euthanasia" throughout Europe, when the resolution did no such thing.
  • Spreading the appalling conspiracy theory that 650 babies a year are euthanised in the Netherlands when no such thing happens.
  • Catholic Professor Margaret Somerville's repeated claims, based on cherry-picked data, wrongly claiming suicide contagion from VAD laws, and loftily dismissing extensive evidential rebuttals.
  • A mathematical confection by Catholic bioethicist Dr David Jones and Catholic loyalist and economist Prof. David Paton to attempt to "prove" suicide contagion in Oregon, in which they committed ten deadly sins.
  • The above report being glowingly endorsed by a Catholic psychiatrist, Dr Aaron Kheriaty.
  • Catholic-backed Alex Schadenberg of the "Euthanasia Prevention Coalition" and Catholic "HOPE"'s Branka van der Linden polemicising an article purporting to show 'inhumane deaths' under VAD, but which established no such thing. ("HOPE" was established by the Australian Family Association, a Catholic lobby group founded by Australia's most famous lay Catholic, B. A. Santamaria).
  • Indefensible slippery slope argument from Dr Bernadette Tobin, Catholic ethicist and daughter of B. A. Santamaria.
  • Serious cherry-picking including the negation of cited source meaning, by Victorian Catholic MP, Mr Daniel Mulino, whose report is hosted online by the Catholic Archdiocese of Melbourne.
  • Senior clerics of the Catholic Archdiocese of Melbourne misinforming a parliamentary inquiry.
     

One could go on, but I think the point is amply made.

Conclusion

Public misinformation about VAD law reform and practice arises largely via organised religious commentators who coalesce and focus their efforts against parliamentary law reform bills.

Given how common misinformation about VAD can be from organised religious sources, it's understandable that the public and legislators alike might simply 'switch off' if a commentator reveals a religious background.

It's no surprise then that coordinated religious public relations efforts against VAD law reform try to look as non-religious and as broad-based as possible.

 

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With thanks to my friend Chrys Stevenson for contributing research details in this report regarding members of Health Professionals Say No.


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A recent article in The Guardian reports that most Queensland churchgoers support voluntary assisted dying (VAD), citing a recent YouGov poll commissioned by the Clem Jones Trust.

In fact, attitudes in support of VAD have been strengthening across Australia for many years, and the last few are no exception. In this analysis I explain, using impeccable Australian Election Study (AES) data gathered by a specialist team at Australian National University.

Each federal election, the AES gathers extensive demographic and attitudinal data from a substantial sample of Australians. That means we have comparable snapshots from each election in recent times, including 2019, 2016, 2013, 2010 and 2007 (though attitudes toward VAD have been asked only since 2016).

First up, given the well-documented strong connection between higher religiosity and less favourable attitudes towards VAD, let’s take a quick look at Australia’s changing religious landscape.

Abandoning religion: from trickle to torrent

Since federation, periodic census data collected by the Australian Bureau of Statistics (ABS) confirms a long-term decline in religious affiliation (Figure 1).

ABS Census data of religion since FederationFigure 1: Religious affiliation in Australia by census year (ABS data)
NOTE: Figures are nett of typically 10% non-response

Even this data generally overstates actual religious affiliation, compared with repeated good-quality polls. Census data has pegged religious affiliation typically 4-8% higher than do most polls.

That’s because until the most recent census (2016), collections had primarily or exclusively used a single, massive booklet for household completion. Mr Jones was unlikely to upset Mrs Jones by ticking the “No religion” box when he thinks she’s sure the family is Anglican, and she can see his answers. In contrast, relatives are not looking over the shoulder of an opinion poll respondent, which allows them to be more frank.

Additionally, a formal booklet is more likely to prompt respondents to answer in terms of historical household identity (a lagging indicator), while ad hoc surveys are more likely to prompt answers in terms of recent, pragmatic attitudes and practices (current indicator).

Abandoning religious identity

AES data clearly shows that for major denominations, Australians are leaving institutionalised religion in droves (Figure 2).

Religious affiliation by federal election yearFigure 2: Religious affiliation by federal election year (AES data)

Over just 12 years Catholic affiliation has dropped from 28% to 21% (a drop of 26% of its flock); Anglican from 21% to 15% (-29%); and Uniting/Methodist from 8% to 4% (-52%). In total, minor Christian denominations have remained around the same, while non-Christian denominations have experienced a small increase, mostly from immigration.

But by far the most dramatic change over the 12 years is that No Religion has soared from 26% to 41% of the population, an increase of 61%. The largest increase was between 2016 and 2019, most likely a result of Australians’ dismay at the 2017 reports of the royal commission into institutional responses to the sexual abuse of children. It found that most offenses occurred in religious institutions, more than half of them in the Catholic church alone.

Abandoning religious practice

Not only have Australians been abandoning religious identity, but for the most part increasingly abandoning religious practice (Figure 3).

Religious service attendance by denominationFigure 3: Almost never/never attend religious services (AES data)

At the same time as many Australians have abandoned religious identity, those still identifying with Catholic, Uniting, and non-Christians faiths are attending services less than before.

Overall, service attendance has remained about the same amongst minor Christian denominations, and there has been an increase amongst Anglicans (actually because far more Notionals — people who identify with a denomination but never attend religious services — have “left” the Anglican church).

Indeed, in 2019, fewer than half of Australians (47%) ever attend religious services, just a third (32%) attend more often than once in a blue moon, and a mere 16% are consistent attenders.

Clerics might still be talking, but fewer Australians than ever want to listen.

Abandonment to continue

Australians will continue to abandon religion given that most younger Australians reject religion at the same time that older, more religious Australians pass away (Figure 4).

Religion by age cohort 2019 (AES data)Figure 4: Religion by age cohort 2019 (AES data)

This picture is even more dire for clerics than it was just three years earlier in 2016 (Figure 5).

Religion by age cohort 2016 (AES data)Figure 5: Religion by age cohort 2016 (AES data)

Over the next 25 years the Catholic church and minor Christian denominations will struggle, while the Anglican and Uniting churches will almost cease to exist if current trends continue.

An integrated measure of religion

For further analysis, we’ll use the Australian Religious Identity 6-Factor (ARI6) model. It segments on the combined basis of religious attitudes and behaviour across a spectrum from Rejecters to Devouts.

Unsurprisingly over the past decade, Devouts have remained firmly entrenched in their faith (Figure 6), while there has been a small downward trend amongst Regulars.

ARI6 by year (AES data)Figure 6: Australian Religious Identity 6-Factor (ARI6) by year (AES data)

Most of the abandonment of religion in recent years has been amongst Occasionals, those who identify with a religious denomination but rarely attend services. This begs the question as to whether clerics were right to assume that they spoke for many in their flocks in the first place.

Attitudes toward VAD — Overall

Between 2016 and 2019 there was a small but statistically non-significant increase in total support for VAD, while there was no change in total opposition (Figure 7).

Australian adult VAD attitudes by yearFigure 7: Australian adult attitudes toward VAD by year (AES data)

What is readily apparent, though, is a substantial increase in the number of Australians strongly in support of VAD (from 43% to 53%), while total opposition has remained tiny at fewer than one in ten Australians (9%).

Attitudes toward VAD — Religious affiliation

Amongst Australians who still count themselves as religiously affiliated in 2019, a majority of all religions except minor Christian denominations clearly favour VAD (Figure 8), including three quarters (74%) of Catholics, four in five Anglicans (78%) and Uniting/Methodists (81%), and almost all non-Christian religious (96%) and non-religious (92%).

Even amongst the minor Christian denominations with nearly half (49%) in support, just one in five (20%) were opposed to VAD, the rest being neutral.

VAD attitudes by religion 2019Figure 8: Attitudes toward VAD by religious affiliation 2019 (AES data)

Strong support amongst Catholics increased massively from 36% in 2016 to 48% (close to half in strong support) in 2019, highlighting the irony of Catholic clergy continuing to actively oppose VAD law reform.

Given the tiny minorities opposed across the religious spectrum, those clerics who continue to vocally oppose the legalisation of VAD — including some employing serious misinformation — in no way are speaking for the majority of their flocks.

Attitudes toward VAD — Religiosity

Unsurprisingly, given the vast body of existing scholarly research evidence, opposition to VAD is largely religious (Figure 9).

VAD attitudes by ARI6, 2019Figure 9: Attitudes toward VAD by ARI6 2019 (AES data)

Nearly half of all opposition to VAD (44%) is of Devouts, with an additional quarter (26%) amongst Regulars and Occasionals, and a smaller proportion (17%) from Notionals.

Tellingly, even amongst the most religious, opposition to VAD has dropped significantly in just three years since 2016 (Figure 10). Opposition to VAD amongst Devouts dropped from nearly half (46%) to just over a third (35%), and amongst Regulars from 25% to just 15%.

VAD attitudes by ARI6, 2016Figure 10: Attitudes toward VAD by ARI6 2016 (AES data)

For 2019, proportions of the most opposed religious segment, Devouts, are almost evenly split amongst supporters, neutrals and opposers.

Amongst the next most religious, Regulars, supporters outnumber opponents by three to one, and in all the other segments supporters outnumber opponents by more than ten to one.

The evidence is clear: even amongst the most religious Australians, opposition to VAD is melting away.

The lowdown for politicians

What does this mean for legislators, who the community is asking to legalise VAD with responsible safeguards? Figure 11 shows VAD attitudes of Australians by the political party they identify with.

VAD attitudes by political party identity 2019Figure 11: Attitudes toward VAD by political party identity 2019 (AES data)

It’s obvious why VAD Bills have been sponsored by Greens members and/or facilitated by Labor governments.

In contrast, Australian Coalition parliamentary parties (with notable exceptions of a handful of Coalition members) have steadfastly obstructed consideration and passage of VAD Bills. This is not because the party machinery is representing the broader Coalition voter, whose overall support stands at 74% versus a tiny 13% opposed. Rather, it’s because of the (widely reported) takeover of the party machinery by the religious right.

The natural home of VAD opponents is minor right parties, comprising overall a slight majority (53%) opposed to VAD. [Addendum: those identifying with minor right parties comprise just 3.1% of the adult Australian population.]

Given that minor right party voters are most likely to give their major party preference flow to the Coalition, the real concern for Coalition election strategists is to minimise first preferences going to a minor right party in the one or two electorates (if any) in which such a minor party win might even be on the cards.

The lowdown for election candidates

It’s been a firm belief among the political class for a long time that candidates openly supporting VAD would be punished at the polls on election day, with little to no downside for candidates opposed to VAD. That, however, is fake news.

A 2012 Newspoll survey asked voters if, all other things being equal, they would change their vote if their otherwise preferred election candidate’s stance was the opposite of their own (support vs opposition). (Full disclosure: as CEO of YourLastRight.com I commissioned the survey.)

VAD-supporting voters stated they would punish their preferred candidate (opposing VAD) at three times the net rate that VAD-opposing voters would punish a supporting candidate. I’ve subsequently published various other observations that are consistent with this finding.

Now that strong support for VAD amongst the Australian public is significantly higher than it was in 2016 (let alone 2012), it would be foolhardy for any supportive politician to hide their light under a bushel, or for an opposed candidate to effectively thumb their nose at the majority of voters.

I’m reminded of a favourite remark of Sir Humphrey Appleby (Nigel Hawthorn) in the 1980s British political comedy series Yes Minister, who would gently point out his Minister’s policy folly (Jim Hacker played by Paul Eddington) with the light remark, “that would be very courageous, Minister!”

It’s now a very courageous candidate indeed who believes their personal opposition to VAD ought to trump the support of the vast majority of their constituency. And, given the ongoing abandonment of religion in Australia, such candidates will soon find themselves on the wrong side of history.

The lowdown for campaigners and voters

Given that most Australians — increasingly including the religious — are in favour of responsible VAD law reform, and with a growing proportion strongly in support, it’s more important than ever to determine election candidates’ real attitudes toward VAD.

Some candidates provide prompt and candid responses to help voters decide. But many candidates obfuscate, either failing to respond at all or responding with non-answers such as they haven’t seen specific legislation yet so cannot answer, or cynically stating only the obvious such as “opinions vary” and it can be “an emotive issue”.

The key action with obfuscators is to get a real answer to the question “could there be any version of a VAD Bill that could enjoy your support?” And assume those who still obfuscate would have said “no”, had they been candid.


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The Catholic Church's video which blatantlly misrepresents Belgium

The Catholic Archdiocese of Sydney has released a video which blatantly misrepresents scholarly research about non-voluntary euthanasia practices in Belgium. The lead author of the peer-reviewed research has slammed the video as "cherry-picked", "scaremongering" and "appalling". His full statement about the video appears below.

 

Watch the 1 minute video here.

 

Back in 1998, non-voluntary euthanasia  — or NVE — was carefully studied by Belgian scholars. It’s a problematic practice, even though often the medication doctors administered didn’t actually hasten death. They found it occured in 3.2% of all deaths.

In 2002, the Belgium parliament legalised voluntary assisted dying — or VAD.

In 2007, the Belgian scholars repeated their study and found that NVE had dropped by nearly HALF, to 1.8% of all deaths. Again in 2013, it was found to remain at a lower level, 1.7% (Figure 1).

belgiumnvechart2.jpg
Figure 1: Belgium's NVE rate has dropped dramatically since VAD was legalised

Thus, the State shining a bright light on end-of-life practices, including VAD, has resulted in improvements.

NVE has also been found to occur in every jurisdiction that’s been studied, VAD law or not, including Australia and New Zealand (Figure 2).

nvecountries.jpg
Figure 2: NVE has been found in every jurisdiction that's been studied

But the Catholic church would have you believe otherwise.

In a recent video, the Catholic Archdiocese of Sydney grotesquely misrepresented a single statistic from the Belgian studies. Using cold colours and the sound of a flatlining heartbeat, the Catholic video claims Belgium’s VAD law has caused its NVE. It’s a chilling confection of innuendo that thumbs its nose at the facts.

The Belgian study the church relies on expressly points out the significant NVE drop, so it’s not like they wouldn’t know.

 belgianstudyreportsdrop.jpg
Figure 3: The study expressly points out the significant drop

It's no wonder that lead scholar of the Belgian research, Assistant Professor Kenneth Chambaere, called the Church’s video “cherry-picked", “a blatant misrepresentation”, “scaremongering” and “appalling”. Professor Chambaere's full response appears below.

Despite the unambiguous evidence, multiple Catholic lobbyists have used cherry-picked NVE rates in a similar way, like:

 
I’ve directly corrected their misleading claims before. Yet here we go again with the same unconscionable nonsense.

Interestingly, at a 2011 Catholic conference, Archbishop Anthony Fisher said:

“the man or woman in the street … may well be open to persuasion that permissive laws … cannot be effectively narrowed to such practices”

and

“we need to research and propose new messages”

Note that the Archbishop proposed... new messages. In his address he didn't propose to examine if his assumed calamities were valid or not.

The Church is entitled to opinions, but promoting misinformation doesn’t seem to be very Christian. The Church should withdraw its grotesque propaganda and apologise.

In conclusion, repeating fake news doesn’t make it true. The fact remains that Belgium’s NVE practice was considerably higher before it legalised VAD, and dropped significantly after.


Prof. Kenneth Chambaere's response in full

On viewing the Catholic Archdiocese of Sydney's video on Belgian NVE, which cites Prof. Chambaere's 2007 study, Prof. Chambaere made the following statement:

13th July 2019
 
Recently, a Vimeo video of the Archdiocese of Sydney on 'Debate on Euthanasia Laws' was brought to my attention: https://vimeo.com/339920133.

As lead author of the cited research, I was appalled at the video's blatant misrepresentation of the robust and honest research that we have been conducting in Belgium. It is quite frankly an insult to us as researchers who day in day out work to generate reliable and trustworthy insights into end-of-life practice in Belgium.
 
It is clear to me that the video has cherry-picked results from our studies to the effect of scaremongering among the public. As researchers, we fully grasp the emotional, ethical and societal gravity of the euthanasia practice and therefore also euthanasia research, and we never take it lightly. We believe we are always as objective and impartial as possible, as is to be expected of independent and free research. This only adds to my duty as a scientist to respond to the video in question and correct its mistakes. The general public and politicians must have access to reliable and correct evidence.
 
First of all, the figures shown in the video do not concern euthanasia practices at all. Euthanasia is by definition always at the explicit request of the patient. What the figures do refer to are physician acts to hasten a dying patient's death without their explicit request, a separate type of end-of-life practice altogether (see further).
 
Secondly, yes, this problematic practice does exist in Belgium. But so does it exist in every other country where anyone has had the audacity to conduct research into it, euthanasia law or no euthanasia law.
 
Thirdly, the incidence of such practices has halved since the euthanasia law was enacted in Belgium.
 
Conclusion: acts of hastening death without explicit request are not a by-product of euthanasia legislation, and if anything, euthanasia legislation seems to decrease the occurrence of these practices. This conclusion features prominently in the paper cited in the video.
 
This practice even exist in Australia, and in significant numbers, according to one (potentially outdated) study. While this study was not identical to ours in Belgium, it still provides clear evidence of its occurrence in Australian end-of-life practice. The authors of the video ask whether Victoria will become like Belgium? If it means diminishing rates of these questionable practices, then surely becoming more like Belgium is a good thing!
 
Lastly, a 2014 detailed analysis in CMAJ Open clarified much about what these cases of hastening death without explicit request entail. I quote our conclusion here: "Most of the cases we studied did not fit the label of "nonvoluntary life-ending" for at least one of the following reasons: the drugs were administered with a focus on symptom control; a hastened death was highly unlikely; or the act was taken in accordance with the patient's previously expressed wishes. Thus, we recommend a more nuanced view of life-ending acts without explicit patient request in the debate on physician-assisted dying."
 
This is not to condone or excuse physicians who engage in such practices, but it is important to know and be clear about what we are focusing our societal discussions on.
 
The question then is, why did the authors of the video overlook these clear conclusions during their extensive review of the evidence? It is very difficult to see how our research could be misrepresented in the way it has been in the video. The research is very clear and it does not support the claims made in the video. I urge anyone relying on the large body of peer-reviewed evidence to analyse it carefully, and if necessary consult with the authors, before communicating to the general public.

Assistant Professor Kenneth Chambaere
End of Life Care Research Group
Vrije Universiteit Brussel
Belgium


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The Catholic Archdiocese of Sydney has released a grotesque and appalling video that blatantly misrepresents Belgium's non-voluntary euthanasia practices as being 'caused' by their voluntary assisted dying law. They're not.

 

Read a more detailed report here.

 

Video narrative

“Belgian scholars have researched the country's non-voluntary euthanasia rate (or NVE) over a number of years.

Their findings unambiguously show that Belgium's NVE rate was much higher BEFORE it legalised voluntary assisted dying (or VAD), and dropped significantly afterwards.

Yet the Catholic Archdiocese of Sydney has released a grotesque video which cherry-picks just the 2007 figure to claim that Belgium's VAD law has caused its NVE practices.

But the NVE drop is no secret: it's expressly stated in the very research the Church cites.

It's no wonder that lead researcher, Assistant Professor Kenneth Chambaere, called the Church’s video “cherry-picked", “a blatant misrepresentation”, “scaremongering” and “appalling”.

The video casts serious doubts over the Church's competence in assessing scholarly evidence, and calls into question its desire to avoid misinformation.

To conclude, Belgium's NVE rate dropped dramatically, and has remained lower, after it legalised voluntary assisted dying.”

 

Visit the YouTube page.

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