Assisted dying (AD)

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Update: Margaret Somerville is now Professor of Ethics at the Catholic University of Notre Dame Australia.

In the previous video a claim by Catholic Professor of Ethics Margaret Somerville was rebutted: that the Dutch and Belgians seek health care in Germany because they fear being killed by their own doctors and without being asked. In this video, she furthers her bizarre claim by referring to Dutch and Belgian non-voluntary euthanasia rates as 'proof' of her border-crossing healthcare thesis.

However, her cherry-picked statistic establishes nothing, whereas her claim is contradicted by robust research, which I discuss in this video.

It's unclear why Professor Somerville seems to be unaware of or ignores readily-available yet contradictory evidence of central importance to her claim.

This 'non-voluntary slippery slope' claim is another one that's popular amongst campaigners against assisted dying.

 

Transcript

Neil Francis: In the last video, we established as false, Professor Margaret Somerville’s absurd claim of the Dutch going to Germany for health care because they feared being killed by their doctors. But she goes on.

Margaret Somerville: In actual fact they’ve got good reason to fear that, uh, there’s a minimum of, a minimum of 500 cases a year, of doctors who administer euthanasia to people in the Netherlands, where it’s legal, and the patient does not know they’re being given euthanasia, and has not consented to it. Some reports put the figure as high as 2000 cases a year.

Neil Francis: And she makes a similar case for Belgium. So let’s look at the empirical evidence.

Neil Francis: What she’s referring to is non-voluntary euthanasia, or NVE. It occurs in every jurisdiction around the world. A study published in 2003 found these rates. You’ll notice that Italy had the lowest and Belgium the highest NVE rates. And at the time of this study, which countries had legalised assisted dying?

Neil Francis: Switzerland had since 1942, and the Netherlands since 1982. But none of the others had. So the Swiss and Dutch NVE rates, with assisted dying laws, were lower than Denmark’s, without one. And the higher Belgian rate wasn’t caused by an assisted dying law, because none existed at the time.

Neil Francis: But did the Belgian and Dutch NVE rates go up when each country legalised assisted dying by statute in 2002? Here’s what happened in Belgium: the rate didn’t go up — it went down, and the drop is highly statistically significant.

Neil Francis: And in the time since Professor Somerville made her misleading claim, it’s remained lower.

Neil Francis: And here’s what happened in the Netherlands. This rate before the Act is around 1,000 cases a year, and this one after the Act is around 500, the rate that Professor Somerville refers to in her claim as “the minimum”. What she failed to mention is that since statutory legalisation of assisted dying, the Dutch NVE rate dropped, not risen, and to a similar level as the UK, the world’s gold standard for palliative care, and which has never had an assisted dying law.

Neil Francis: And since Professor Somerville made her misleading claim, it’s dropped even further.

Neil Francis: If Professor believes that she has verifiable empirical evidence to back up her claims, let her produce it for examination. Until then, her non-voluntary euthanasia “slippery slope ”is nothing more than fear-mongering innuendo.

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Update: Margaret Somerville is now Professor of Ethics at the Catholic University of Notre Dame Australia.

Catholic Professor of Ethics Margaret Somerville claimed in a University address that elderly Dutch people are fearful of being euthanased in nursing homes and hospitals and instead travel to Germany for health care.

She provided no sources or evidence for her claim.

Dr Els Borst, the Minister resonsible for the Netherlands' euthanasia law, reveals these claims about 'fear of being killed' in nursing homes as 'absolute lies.' Dutch Senator Heleen Dupuis confirms that it is untrue.

The claim is popular amongst opponents of assisted dying law reform. It raises questions about how a Professor of Ethics came to state is as authoriative fact.

Transcript

Neil Francis: Former Dutch Minister for Health, Dr Els Borst, shared an experience her Government had with the Vatican about assisted dying

Els Borst: Their journal, the Osservatore Romano, was writing, was publishing articles saying that in the Netherlands, people who went to a nursing home or an old people's home, didn't dare to do that any more because they were so afraid they would be killed by their doctor after a week or so.

Els Borst: And we were so angry about this, absolute lies, that we went together, to the Vatican, and we told them that if they didn't stop that sort of lies in their journal, that we would stop diplomatic relations with Vatican City.

Els Borst: We had an ambassador there, and my colleague the Minister for Foreign Affairs said, "I'll withdraw that ambassador and he'll never return."

Else Borst: And then it stopped.

Neil Francis: Well perhaps the Vatican did, but here's Catholic Professor of Ethics, Margaret Somerville.

Margaret Somerville: Old Dutch citizens are seeking admission to nursing homes and hospitals in Germany, which has a strict prohibition against euthanasia because of its Nazi past, and they're too frightened to go into nursing homes or hospitals in the Netherlands.

Neil Francis: I asked Dutch Senator, Professor Heleen Dupuis, about the claim.

Heleen Dupuis: OK, stupid. It is simply not true.

Neil Francis: It's time to stop spreading such fearmongering scuttlebutt.

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Update: Margaret Somerville is now Professor of Ethics at the Catholic University of Notre Dame Australia.

Catholic Professor of Ethics Margaret Somerville claimed in a University address that the Minister who brought in the Netherlands' euthanasia Act (that's Dr Els Borst), said that doing so had been "a serious mistake."

In an offence against scholalry standards, Prof. Somerville did not check her facts with the primary source before making the claim. I know, because I did. I interviewed Dr Borst in Utrecht: Prof. Somerville had not contacted Dr Borst, and Dr Borst stated clearly and without hestitation that she still thought it a good law.

Prof. Somerville instead chose to repeat scuttlebut circulating amongst assisted dying law reform opponents.

Transcript

Neil Francis: Before her death, I visited Dr Els Borst in Utrecht, to seek her current views about the Netherlands' euthanasia Act, which she introduced into the Dutch parliament, and which had been in effect for many years.

Voice of Neil Francis (interview): What are your feellings about the law?

Els Borst: I'm still very happy with it. I think we did the right thing there, also in the way we formulated it.

Neil Francis: But despite the clarity of Dr Borst's continued support for the law, Professor Somerville claimed the opposite in an address at the University of Tasmania.

Margaret Somerville: The Minister who was responsible for shepherding through the legislation that legalised euthanasia in the Netherlands admitted publicly that doing so had been a serious mistake."

Neil Francis: Oh dear. I showed Dr Borst the video of Professor Somerville's claim, and here's her response.

Els Borst: I know that story. I'd like to meet this Margaret S... what's her name?

Vice of Neil Francis: Margaret Somerville

Els Borst: ... well maybe she wouldn't listen anyway.

Neil Francis: The public have a right to ask why Professor Somerville chose to spread scuttlebut, instead of checking her sources in a proper, scholarly fashion.

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The IAHPC website home page.

In response to my previous post about the religious basis of organised opposition to assisted dying, Dr Katherine Pettus, Advocacy and Human Rights Officer at the International Association for Hospice and Palliative Care (IAHPC), tweeted:

Twitter “#Catholic church @Pontifex believes all life is sacred&supports #PalliativeCare and use of strong #pain medicines” — Dr Katherine Pettus

Her just-published IAHPC ‘Concept Note’ railing against assisted dying,1 and summarised on the European Association of Palliative Care’s (EAPC) website,2confirms and amplifies precisely the point I made.

Now you’d think that an organisation with a name like ‘International Association for Hospice and Palliative Care’ would be a neutral organisation representing the world profession irrespective of the faith or personal spiritual beliefs of its members.

But you’d be quite wrong.

Nothing but Catholic doctrine

The IAHPC's musings extensively cite several Popes as the authorities on the subject of — and exclusively against — assisted dying. They expressly use the term "Table of authorities," which includes Popes. And who else?

Precisely nobody: no other faith, and no impartial scientific research, is cited. Just Popes.

She also writes:

IAHPC wishes to encourage our partners to express clear support for faith based teachings on palliative care.”

It is important to clarify this misinformation [about ‘stealth euthanasia’] with the authoritative teachings of the Church.”

Hospice has always been faith based.” [As if ‘the way it’s always been’ is a sound argument for ‘the way it always should be.’ Perhaps we shouldn’t have moved from serfdom to democracy?]

The Catholic Church began the medieval hospice movement, and can lead the modern palliative care movement.” [They curiously neglect to mention that the palliative care (not hospice) movement rose from Anglican roots in the UK, helpfully confirming that this broadcast is primarily about promoting Catholic religion, not palliative care.]
 

Shameless self-promotion

But Dr Pettus and the IAHPC’s Concept Note don’t stop there.

The Word [sic] Day of the Sick (WDS) is a good opportunity to support faith based healthcare organizations.”

Contact your parish to see if you can hold a small event…”

Contact your local Catholic health care provider director to find out about…”

Make an announcement at your local church…”

Gosh, I must have been mistaken. I thought World Day of the Sick was about… the sick!?

But Dr Pettus and the IAHPC commandeer it to shamelessly further the Catholic religious agenda amongst palliative care service providers.

An unexamined conflict of interest

It's deeply disturbing that someone holding the position of “Advocacy and Human Rights Officer” considers the beliefs and values only of the service provider (who she represents) in promoting the world day about sick people (who her organisation serves).

Palliative care organisations repeatedly state that they aim to deliver patient-centred care. But the world palliative care peak body's self-adoration exposes the worst of them: taking the opportunity of a day supposedly for the values and needs of sick patients, and using it to glorify their own particular (Catholic) religious tenets which are to be lauded over those of the patients they serve.

Most of the world is not Catholic, and in Australia at least, most Catholics disagree with Vatican doctrine on assisted dying.

How astonishing then to dictate that Catholic doctrine must prevail over everyone, including Protestants, Hindus, Buddhists, Jews, Muslims, agnostics, atheists and others. Dr Pettus and the IAHPC comprehensively fail to demonstrate any awareness or reflection of potential conflicts of interest in serving people of different faiths and beliefs.

Incomprehensible arrogance

There is little issue with the Catholic Church directing its own willing adherents as to how they might end their days.

But for one religious institution to seek to impose its views on everyone worldwide is incomprehensibly arrogant. I guess it's no surprise then that a Catholic Bishop recently admitted — at a Royal Commission inquiry into the extensive, ongoing and horrific abuse of children under the Church's pastoral care — that the Catholic Church is a "law unto itself".

It would be helpful if the Holy See reflected on the principle: is it legitimate for another faith to force its own views on the Vatican or on Catholic patients?

It would also be helpful if the International Association of Hopsice and Palliative Care reflected on respecting and serving the wider community rather than behaving like a subsidiary of the Holy See.

Conclusion

The IAHPC has provided its own unequivocal proof that it is religious conservatism behind organised opposition to assisted dying, with the Catholic Church at the front of the pack.

You’ll understand why I tweeted in response to Dr Pettus:

Twitter.@kpettus @EAPCOnlus Thanks for confirming @Pontifex arrogance. Not once did you mention PATIENT’S PoV. All about YOU.” — Neil Francis

 

- - -

And furthermore

Parading ignorance

The IAHPC refers repeatedly to the treatment of ‘pain’ in its stand against assisted dying law reform. But pain is not amongst the leading reasons for assisted dying (it is a much less common reason). Key reasons are the inability to participate in any of life’s enjoyable activities, loss of independence and loss of dignity.

I guess the curious focus on ‘pain’ is understandable though, because the Vatican is very fond of the doctrine of double effect (DDE) — which the IAHPC specifically notes in Catholic Catechism 2279 although not by its DDE name, but rather bizarrely as “a special form of disinterested charity.”

The DDE posits that it’s OK for a doctor to administer high doses of analgesics to treat pain, even if an unintended consequence is to hasten the patient’s death. The Catholic Church treats this doctrine as uncontroversial, even though it remains controversial amongst other ethicists and philosophers: the principle says “it’s quite OK for a doctor to kill her patient, as long as she doesn’t really mean to.”

I would commend Dr Pettus and the IAHPC to do some proper research and understand the subject area more competently before pontificating (yes, intended meaning) further.

The smokescreen argument

The IAHPC also states that:

No country or state should consider the legalization of euthanasia or PAS until it ensures universal access to palliative care services.”

That’s purely a smokescreen argument for two reasons. Firstly, the Concept Note also argues that assisted dying:

both violate[s] the bond of trust within the profession of medicine, and undermine[s] the integrity of the profession and the dedication to safeguard human life.”

Setting aside the empirical falsehood of the statement, it furnishes the IAHPC a 'get-out-of-jail-free' card if and when palliative care becomes ‘universally’ available: it’s utterly irrelevant if that goal is reached because there’s a more fundamental objection behind it.

Secondly, it's an established fact that palliative care can’t always help, even when the best services are available. ‘Universal’ access won’t fix all the problems.

All these faux arguments are typical and common from religious opponents of assisted dying.

 

References

  1. International Association for Hospice & Palliative Care 2017, Concept note: Palliative care organisations support World Day of the Sick (WDS), IAHPC, viewed 11 Feb 2017, https://hospicecare.com/uploads/2017/1/concept-note-world-day-of-the-sick-2017.docx.
  2. Pettus, K 2017, Palliative care: A special form of disinterested charity, EAPC, viewed 11 Feb 2017, https://eapcnet.wordpress.com/2017/02/10/palliative-care-a-special-form-of-disinterested-charity/.

 


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Assisted dying rates in Dutch-speaking cultures (orange bars) are much higher than elsewhere.

In this whitepaper, Benelux (Belgium, Netherlands and Luxembourg) primary empirical data on assisted dying is analysed — including with new and advanced approaches — to provide fresh insights into contemporary practices. Investigation reveals that the assisted dying rate in Dutch-speaking cultures appears to be uniquely higher than in other cultures irrespective of the permissiveness of the legislative framework, yet is still practiced conservatively.

Download a full copy of the Whitepaper here: PDF (648Kb).

Summary

This new compilation and unique analysis of primary research data from statutory authorities and the peer-reviewed literature provides fresh insights into assisted dying practice in Benelux, including:

  1. Rates of assisted dying in the Netherlands and Belgium have followed an expected sigmoid curve, now beginning to level out.
  2. Several factors have contributed to the higher increase in the Netherlands rate, including recovery from a suppression of cases immediately following statutory reform, a rise in cancer diagnoses, and an increase in granting of assisted dying through new visiting teams launched in 2012.
  3. Both Netherlands and Belgium doctors demonstrate caution if not conservatism when assessing assisted dying requests.
  4. Despite most assisted dying occurring in cases of cancer, fewer than one in ten cancer deaths in the Netherlands and one in twenty in Belgium is an assisted death.
  5. Other conditions such as degenerative neurological, pulmonary and circulatory illnesses each account for a very small proportion of the increase in cases since legalisation in Benelux.
  6. The assisted dying rate in dementia and other mental illness is very low despite controversy around—and a tiny rise in granting of—such cases.
  7. The hypothesis that females or the elderly would be ‘vulnerable’ to assisted dying law is contradicted by the data.
  8. The rate of non-voluntary euthanasia has decreased significantly in both the Netherlands and Belgium since assisted dying was permitted by statute.
  9. Assisted dying rates in Dutch-speaking cultures are significantly higher than in non-Dutch cultures, seemingly unrelated to the permissiveness of the jurisdiction’s legal framework.

 

beneluxratessmall.gif
Benelux country reported assisted dying rates (as a percentage of all deaths)
as at 2014. The three countries have similar assisted dying laws.
 

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The AMA fails to represent the breadth of physicians perspectives around assisted dying.

This informative Go Gentle Australia video explains why the Australian Medical Association is out of touch with the wider Australian doctor community. Around a third of Australian doctors are members of the AMA.

The AMA currently holds a position of hostility towards assisted dying law reform, as it did against abortion before that was formally legalised. The doctors in this video explain how the AMA does not represent their views on assisted dying in restricted circumstances.

Visit the YouTube page.

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BMA House in Tavistock Square, London, home to the British Medical Association since 1925.

The British Medical Association (BMA), in the latest incarnation of its policy on assisted dying (AD), insists that AD must not be legalised in the UK. I argue that its indefensible stance reveals ignorance, incoherence and hubris. It fails to respect the true range of views amongst UK doctors. I expose the comprehensive rot.

The BMA categorically states in its July 2016 policy update on assisted dying:

“The BMA policy … insists that voluntary euthanasia [and] physician-assisted suicide should not be made legal in the UK.” — British Medical Association1

BMA comprehensively out of touch

The BMA claims to represent UK doctors—though fewer than half are members. What is the empirical evidence for UK doctor attitudes toward assisted dying?

In a 2009 survey,2 35% said that AD should definitely or probably be legalised. The same study also found that 35% of UK doctors said AD should definitely not be lawful even in cases of terminal illness. That is, the stance of just 35% of UK doctors was identical to the BMA’s—insisting that it not be lawful, while an equal proportion thought AD could be legalised. “Greater religiosity” was the strongest correlative factor with opposition to lawful AD.

Indeed, numerous studies have found a substantial minority of UK doctors in favour of lawful AD, including results approaching equality with opponents.3 Even a survey commissioned by the UK Catholic Medical Association in 2003 found around 25% of UK doctors in favour of AD and who would practice it if legalised.4

UK doctor support for AD, then, is substantial and hardly restricted to a mere handful of fringe-dwelling medical crackpots.

Ignorant and disrespectful BMA stance

It is untenable that the BMA unilaterally ‘respects’ the views of 35% of UK doctors at the same time as expressly disrespecting the views of another significant cohort. Perhaps as in general politics, its power base is more heavily populated with religious souls: those who have a deeper interest in shaping what options others do and don’t have?

Appalling and trivialised ‘rationale’

Let’s take a look at the five moribund reasons the BMA offers in defense of its institutional opposition to AD and see how they use flapdoodle, fudge, fiction, fear-mongering, flip-flop and hubris to ‘advance’ their position.

“Current BMA policy firmly opposes assisted dying for the following [five] key reasons:”

1. Permitting assisted dying for some could put vulnerable people at risk of harm.

Flapdoodle. Firstly, as I have explained before, the “vulnerable at risk” argument is a rhetorical sham. People ‘at risk’ are by definition ‘vulnerable,’ and would still be so if we wore yellow socks on Wednesdays or outlawed pizza. It has nothing to do with AD being legalised or not.

Fudge. Secondly, the BMA ignores repeated reviews published in the professional literature indicating that supposed harms have not eventuated in jurisdictions with lawful assisted dying. Indeed, the quality of medical practice has improved.

Flip-flop. And thirdly, if ‘risk of harm’ was a sufficient condition to deny patients a particular option, we must equally ban the right to refuse life-saving medical treatment (no matter how unwanted or burdensome) because greedy relatives eyeing off the estate might convince the dying patient to refuse. It’s incoherent to oppose assisted dying, but to support refusal of treatment (as the BMA does), in the face of this identical possibility.

2. Such a change would be contrary to the ethics of clinical practice, as the principal purpose of medicine is to improve patients’ quality of life, not to foreshorten it.

Fudge. Medicine has a number of primary purposes. Relief of suffering is one.5 That may come into conflict with another purpose, “the avoidance of premature death and the pursuit of a peaceful death” (which itself has internal conflicts). A dying individual may herself believe that an AD would not be premature, and whose peaceful nature is vastly preferable to continued intolerable and unrelievable suffering.

3. Legalising assisted dying could weaken society's prohibition on killing and undermine the safeguards against non-voluntary euthanasia. Society could embark on a 'slippery slope' with undesirable consequences.

Fear-mongering. Non-voluntary euthanasia (NVE) is currently illegal. It remains illegal even when AD is legalised. The BMA therefore incoherently conjectures that NVE doesn’t occur while it’s illegal (before AD legalisation), but might occur while it is still illegal (after AD legalisation).

Fiction. There are no current ‘safeguards’ against NVE as the BMA statement implies. It is practiced in secret. There are no statutory requirements or reporting standards as there are for AD (where legal). Research clearly demonstrates that NVE occurs everywhere, including the UK. Further, the rate of NVE has significantly decreased in the Netherlands and Belgium since their AD statutes came into effect.

4. For most patients, effective and high quality palliative care can effectively alleviate distressing symptoms associated with the dying process and allay patients' fears.

Flapdoodle. The BMA says “effective … palliative care can effectively alleviate…”: another circular, self-‘proving’ argument.

Hubris. The BMA acknowledges here—as unarguably established in the professional literature—that palliative care can’t help everyone. And that’s precisely what assisted dying law reform is about: for people that palliative care can’t help. But the BMA brushes them under the carpet.

5. Only a minority of people want to end their lives. The rules for the majority should not be changed to accommodate a small group.

Flip-flop. In ‘reasons’ 1 and 3 above, the BMA speculates that too many people will die if AD is legalised. Here is it arguing that too few will. Which is it? Too many or too few? The argument also ignores the international evidence that dying individuals (and their loved ones) experience profound relief merely from knowing that AD is available, even if they don’t pursue it. That itself is good palliative care.

Hubris. And if “not changing the majority's rules to accommodate a small group” were a gold standard as the BMA argues, then there would be no leglisation to (a) ensure facilities access to people with a disability, (b) outlaw discrimination on the basis of race or religion, or (c) allow same-sex marriage: all enshrined in law in the UK.

Hubris argues for ignoring the BMA itself

If, as the BMA argues, we should override the wishes of a group on the basis of its small size, it’s pertinent to consider the size of the UK doctor population: around 0.4% of the total. By comparison, in jurisdictions where AD is legal, around 0.3% (Oregon) to 3.8% (Netherlands) ultimately choose an assisted death.

If we are to ignore 0.3%–3.8% of the population because it’s ‘too small,’ we must equally ignore 0.4% of it. This, by the BMA’s own argument, would be reason to force it to support AD because that’s what the majority (UK population) favour. After all, “the rules for the majority should not be changed to accommodate a small group [of doctors].”

Of course most of us recognise, unlike the BMA, that this is not a ‘popularity contest.’ A stance of neutrality would demonstrate respect for deeply-held views across the spectrum.

Conclusion

The British Medical Association demonstrates profound ignorance about the available evidence, and about UK doctor attitudes. It resorts to fear-mongering speculation, fudge, fiction, flapdoodle, flip-flop and hubris to maintain its indefensible opposition to assisted dying.

The BMA’s stance does a great disservice to the British people. It’s an embarrassment to professional doctors regardless of their stance on assisted dying. The policy deserves to be entirely scrapped, and one of neutrality adopted in its place.

 

References

  1. British Medical Association 2016, Physician-assisted dying: BMA policy, viewed 26 Sep 2016, https://www.bma.org.uk/advice-and-support/ethics/end-of-life/the-bmas-position-on-physician-assisted-dying.
  2. Seale, C 2009, 'Legalisation of euthanasia or physician-assisted suicide: survey of doctors' attitudes', Palliative Medicine, 23(3), Apr, pp. 205-212.
  3. McCormack, R, Clifford, M & Conroy, M 2011, 'Attitudes of UK doctors towards euthanasia and physician-assisted suicide: a systematic literature review', Palliative Medicine, 26(1), pp. 23-33.
  4. Catholic Medical Quarterly 2003, 'Euthanasia and assisted suicide: Results of survey of doctors attitudes', Catholic Medical Quarterly, May, pp. 1-3.
  5. Hastings Center Report 1996, 'The goals of medicine. Setting new priorities', The Hastings Center Report, 26(6), pp. S1-27.
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Palliative Care Australia's position statement on assisted dying.

I’ve written previously about palliative care specialists trying to filibuster assisted dying law reform. In this F file, I reveal how Australia’s peak body for palliative care (PC), Palliative Care Australia (PCA), segues from a state of ignorance to its own filibuster that would stall assisted dying choice.

First up, let me say that I hold deep admiration for the generally excellent services PC specialists provide at the bedside. I believe that PC deserves strong support and good funding. The peak body’s leadership in regard to its stance on assisted dying, however, is of a dramatically lower calibre.

Revised policy statement

In PCA’s latest incarnation of its Position Statement on ‘Euthanasia and physician assisted suicide’,1 the organisation says that:

“Public discussion and policy development on issues related to euthanasia and physician assisted suicide should be informed by research. There is insufficient research into euthanasia and physician assisted suicide.” — Palliative Care Australia, Position Statement

One can only agree wholeheartedly with the first sentence. Of course public discussion and policy development should be informed by research wherever possible.

The filibuster

And there follows the filibuster rub — PCA unequivocally claims that there is insufficient research. The logical consequence of PCA's juxtaposition is that we ought to muzzle public discussion and policy development because, PCA alleges, there is insufficient research to inform it.

Certainly in terms of Australia there are only a handful of published studies into attitudes and practices. But assisted dying is illegal in Australia. There are very substantial ethical and legal issues when it comes to conducting research.

Who is PCA to claim "insufficient research"?

PCA is the peak body for PC, a specific discipline within medicine that represents (well-paid) doctors. It runs a staffed office in Fyshwick ACT, and is overseen by a Board and Executive. It has a key purpose of lobbying in the halls of power in the Federal Parliament, and, presumably on the basis of the statement above, has a goal of ensuring that government PC policy (and funding) is informed by research. You'd think it might have some resources and connections to go looking for some research evidence.

A revealing comparison

In comparison, I conduct my assisted dying law reform work on a completely pro-bono basis, as a single individual, in my spare time. I have a formal literature collection on end-of-life decision making, including assisted dying, of currently over six thousand articles. I’m not talking about mere opinion published in the media: I’m talking about articles published in professional journals and in official government and agency reports.

I just ran a quick check across my database, looking for items specifically in respect of assisted dying (not medical or palliative care in general) in the Netherlands, Belgium and Oregon, where assisted dying has been legal for some time. Here’s what I found.

In respect of assisted dying the Netherlands I hold 366 journal articles and 25 official reports. For Belgium, I hold 152 journal articles and 11 official reports. And for Oregon I hold 144 journal articles and 32 official reports.

That’s a total of 662 journal articles and 68 official reports in respect of three lawful assisted dying jurisdictions. And that doesn’t count any holdings of book chapters, conference papers and the like. The journal article count will be somewhat overstated because a minority of journal papers are about more than one lawful jurisdiction (e.g. the Netherlands and Belgium). So let’s estimate that downwards to, say, a mere 400 journal articles.

That’s an abundance of evidence from and review about jurisdictions where assisted dying is legal. Could we always know more about assisted dying? Sure.

Double standards when it comes to evidence

We could also know a lot more about PC. I recently asked PCA for a simple but critical headline statistic — one you’d think was necessary to inform policy about PC resources and funding: “what proportion of Australians who experience a non-sudden death (i.e. deaths where PC might be relevant) actually receive PC?”

PCA kindly responded, but the answer in a nutshell was “we don’t know.”

But I wouldn't suggest for a moment that we muzzle “public discussion and policy development on issues related to PC” because the peak body hasn't done enough research to calculate (or even estimate) a fundamental policy-informing statistic.

Conclusion

The Australian community would be better served if PCA acquainted itself with the extensive available literature on assisted dying in lawful jurisdictions (as well as headline PC statistics), and dropped its inappropriate filibuster.

 

References

  1. Palliative Care Australia 2016, Euthanasia and physician assisted suicide: Position statement, viewed 1 Sep 2016, <http://palliativecare.org.au/download/2448/>.
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Mr Steve Jalsevac of the Catholic LifeSiteNews blog who made a shocking and vile attack.

I recently exposed (another) piece of misinformation published by LifeSiteNews, and wrote courteously to them to request withdrawal of the offending article. While I wasn’t hopeful the request would be accepted, I wasn’t prepared for the shocking and vile response I received.

Exposing bull about assisted dying is a key purpose of DyingForChoice.com and it will continue to do so as long as bull is published or publicly spoken, and especially when it makes claims or generates innuendo that is at odds with the readily-available facts, as a smokescreen for fundamentally religious objections.

The specific request to withdraw

In a recent article I factually rebutted the allegation by Mr Brad Mattes that there is suicide contagion (from assisted dying to general suicide) in Belgium, in addition to other statements that were wrong in fact in his opinion piece published by LifeSiteNews. I wrote a courteous letter to the editor of LifeSiteNews to point out the errors and to seek withdrawal of the article. 

My full email to LifeSiteNews

Dear LifeSiteNews,

Clearly we are on different sides of the assisted dying conversation. I’m sure that we can mutually appreciate that different people bring different perspectives and apply some largesse in terms of world views.

However, one must draw the line (as your primary Principle does and upon which I think we agree) at the publication of information, however accidental, on your website that is in places fundamentally misleading and elsewhere quite false.

In this regard may I request that you withdraw the article by Mr Brad Mattes, Assisted suicide no longer just for the terminally ill, that contains multiple errors of evidential fact as well as fundamentally misleading statements, as I point out in this post?

Kind regards
Neil Francis

 

The shocking response

A firm believer in courteous debate even when one disagrees profoundly on important matters, I thought the most likely outcome would be a polite letter declining my request. But I received instead this response from LifeSiteNews Managing Director, Mr Steve Jalsevac.

Full response by Mr Steve Jalsevac of LifeSiteNews

Dear Neil,

I find it somewhat amusing that an advocate for legislation to allow people to kill themselves is demanding that we withdraw an article for supposedly publishing "misleading" or "false" information.

After many years of covering organizations such as yours which, typically cruelly manipulate vulnerable persons, violate or liberally interpret laws, understate their longer term objectives, have an extremely unhealthy and dangerous satisfaction in personally seeing people die before their eyes before their natural time, devastate family members whose loved ones had, unknown to them, been guided to kill themselves, and who have such perverse and wrong views on Christian beliefs and much more, I find it despicable that you would be so concerned about supposed accuracy. You, sir, are a hypocrite of the very worst kind. 

It is our view that you should be behind bars for what you advocate and for your dangerous manipulation of vulnerable persons.

I realize that you will not agree with anything that I write given how blinded your conscience and intellect have become by your death preoccupation. So, I just conclude that your claims, views and interpretations are all rejected because no one should trust anything that you say or do on this subject.

Steve Jalsevac
LifeSite

 

Who is LifeSiteNews, anyway?

LifeSiteNews is an online blog established by the conservative Christian Campaign for Life Coalition. It promotes that it “emphasizes the social worth of traditional Judeo-Christian principles.” Its principles are all very courteously worded and sound “respectful” (its principles expressly use that word several times) whilst indicating that it is a pro-life blog.

I’ve read its articles on assisted dying for several years and have not found a single one that is at odds with the position of the Vatican. That’s hardly surprising.

LifeSiteNews publishes a significant proportion of articles about the Catholic Church, as is its right. It is also the sole publisher of Faithful Insight, in its own words “hard-hitting,” “100% faithful” and “fearless Catholic news coverage from the Vatican and beyond.” I argue strongly for the right to publish material of faith. That is not a source of complaint. (Fair disclosure—I’m agnostic.)

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LifeSiteNews' hard-hitting and 100% Catholic-faithful publication.

And, Mr Jalsevac gives a clear indication that he’s at the 'Old School' end of the Catholic spectrum. He admires in multiple blogs the writings of conservative African Catholic Bishop Robert Sarah, noting John Paul II’s teachings as “definitive” and expressing disappointment in the current Pope. And that's entirely his right I again affirm.

Mr Jalsevac’s editor-in-chief, Mr John-Henry Westen has also published a number of articles critical of Pope Francis, also referring to previous Popes as more authoritative.

What do they claim to stand for?

LifeSiteNews’ first principle, in full, is this:

1. Accuracy in content is given high priority. News and information tips from readers are encouraged and validated. Valid corrections are always welcome. Writing and research is of a professional calibre.”—LifeSiteNews.com

Mr Jalsevac's response highlights these claimed principles in stark relief by comprehensively breaching them.

Additionally, not only have I pointed out multiple falsehoods and inaccuracies in Mattes’ article, but I’ve reported LifeSiteNews previously for implying in a splashy headline that the Council of Europe had determined that “euthanasia must always be prohibited” (it most certainly did not), and publishing false information in multiple articles claiming that as many as 650 babies are or could be euthanized in the Netherlands (no they aren’t).

The ad hominem attack

The statements Mr Jalsevac makes about me are vile. And false. While I’m calling out his blogs’ misinformation for what it is, he’s calling for me personally to be thrown in jail for sins he falsely thinks I’ve committed. That’s squarely known as the ad hominem attack: attacking the person rather than the argument. It conveniently provides him with the excuse to totally ignore solid evidence that contradicts his beliefs.

Interestingly, an article by LifeSiteNews Editor Mr Westen quotes Pope Francis as saying,

We Catholics have some — and not some, many — who believe in the absolute truth and go ahead dirtying the other with calumny, with disinformation…”—Pope Francis.

Quite.

Conclusion

LifeSiteNews is an 'Old School' Catholic blog, and, I argue, has every right to be.

However, it has demonstrated by publishing multiple articles containing serious errors of fact as well as highly misleading statements, and by a gratuitous ad hominem attack on someone pointing this out, that it is not interested in evidence, reason or even civility as it claims. In my view it has unambiguously demonstrated itself to be a biased and unreliable Catholic source on matters of assisted dying.

I will continue to call out misinformation in LifeSiteNews when I see it.


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Brad Mattes' blog containing misleading and evidentially false statements.

The latest misinformation employed by assisted dying opponents is to imply that Belgium’s general suicide rate is high as a consequence of its assisted dying law: i.e. to argue the discredited 'suicide contagion' line which has in the past been peddled about the USA state of Oregon. I have demonstrated that it was false in Oregon, and I equally demonstrate here that it's false in Belgium.

Mr Brad Mattes recently published emotional anti-assisted-dying nonsense in LifeSiteNews. (LifeSiteNews is a Canadian blog site that was established by the conservative Christian Campaign for Life Coalition and which has a primary principle of promoting “traditional Judeo-Christian principles”. Mr Mattes is radio host for Ohio’s Life Issues Institute, an anti-abortion lobby group established by conservative American John C. Willke who claimed that women’s bodies were resistant to pregnancy as a result of rape.)

Putting on the misinformation running shoes

In his blog Mr Mattes quickly establishes a practice of communicating misinformation by first claiming that assisted dying laws have “devastating effects” around the world including Japan and Albania—which don’t have such laws.

He then sprints onwards to the ‘650 babies euthanized in the Netherlands’ claim—which I have already comprehensively exposed as fake in the Journal of Assisted Dying—and then onto the bogus claim that the Netherlands has descended into a mire of ‘killing’ without the patient’s ‘consent,’ contrary to empirical evidence I've published that such actions occur around the world regardless of assisted dying laws, and which have decreased significantly in the Netherlands and Belgium since their assisted dying statutes came into effect in 2002.

Let’s add fries to that

Having served up a lot of fat and salt that might appeal to those on a fast-food anti-assisted-dying diet, he then offers the unqualified statement:

By the way, Belgium has the second-highest suicide rate (nonrelated to euthanasia) in Western Europe.” — Brad Mattes

The ‘informational’ consequence is unequivocal: by Mr Mattes failing to contextualise this ‘incidental factoid’ in any way, the reader is destined to deduce that it is Belgium’s euthanasia law that causes Belgium’s suicide rate to be the second-highest in Western Europe. In other words, Mr Mattes is another poorly-informed commentator using the 'suicide contagion' line.

But what are the facts?

Depending on the source and year of data, one can certainly argue that Belgium’s general suicide rate is the second-highest in Western Europe. Setting aside for now the serious question of why it is valid to exclude all of the world’s other countries from the comparison, WorldLifeExpectancy.com reports figures that were published in 2014 (Table 1).

Table 1

Country

Suicides*

Finland

15.11

Belgium

14.64

Iceland

14.06

France

12.84

Austria

11.87

Sweden

11.43

Ireland

11.06

Germany

9.59

Switzerland

9.56

Norway

9.28

Denmark

9.19

Luxembourg

9.14

Netherlands

8.54

Portugal

8.49

Turkey

7.92

UK

6.28

Malta

5.75

Spain

5.23

Italy

4.76

Greece

3.86

* Suicides per 100k population, age-adjusted

The table includes all the countries in the wider definition of “Western Europe”, bar four: no suicide statistics are published for Liechtenstein, Monaco, Andorra or San Marino.

As you can see, Belgium is indeed the second-highest. But this begs the question:

If the reason Belgium is the second-highest is due to its assisted dying law, how come Finland, which Mr Mattes doesn't mention by name and which has no such law, is higher?

It also begs the question:

If assisted dying law were the fundamental cause of a high general suicide rate, how come Switzerland (statute since 1942), Luxembourg (statute since 2009) and the Netherlands (practice since the early 1980s and statute since 2002) have rates that are much lower, all key facts that Mr Mattes also fails to mention?

These are of course indications that the factoid has been included as a cherry-picked morsel of 'proof' because it sounds so compelling as a throw-away sentence amongst the other (false) statements.

But wait, there’s more

We can go further than merely wondering about the country comparisons, by comparing Belgium’s general suicide rate before and after assisted dying law reform. A critical step in establishing causation is to first establish correlation. If there is no correlation, there can be no causation.

Published OECD data shows that in 2013 (the most recent available data), Belgium’s general suicide rate was 16.7 per 100,000 population. What was it before their 2002 law reform? Well in 2000 it was 20.5, in 1990 it was 19.2, … you get the idea.

Has Belgium’s general suicide rate soared (or even increased modestly) since their 2002 assisted dying law came into effect? No. It’s dropped. Indeed, the slight downward trend apparent before the statute came into effect in 2002 has accelerated downward since (Figure 1).

Belgium's suicide rate since 1987Figure 1: The Belgium general suicide rate before and after assisted dying law reform

Even the headline is misleading

Mr Mattes fails to point out in his blog that assisted dying statutes in Benelux countries (Belgium, the Netherlands and Luxembourg) never restricted access to only the 'terminally ill,' that is, those imminently dying. He also fails to point out that USA states whose laws do restrict assisted dying to the terminally ill—most notably Oregon and Washington—have not changed their statutes in this regard since they came into effect.

Therefore, his headling implying that lawful jurisdictions have broadened their laws from 'only the terminally ill' is also wrong.

Conclusion

Mr Mattes makes multiple false and misleading claims and it’s easy to see his opinion for what it is: an emotional dump that fails to engage with and indeed flies in the face of actual evidence. The latest 'suicide contagion' implication, that assisted dying law causes Belgium’s general suicide rate to be the “second-highest in Western Europe” is evidentially false.

I call on LifeSiteNews to withdraw Mr Mattes' article because it breaches their primary principle:

“1. Accuracy in content is given high priority. News and information tips from readers are encouraged and validated. Valid corrections are always welcome. Writing and research is of a professional calibre.” — LifeSiteNews

 

Summary of facts

Belgium's general suicide rate is one of the higher ones in Western Europe. However:

  1. At least one country without an assisted dying law has a higher suicide rate, inconsistent with 'suicide contagion' theory.
  2. Other Western Europe countries with assisted dying laws have suicide rates much lower than Belgium's, also at odds with 'suicide contagion' theory.
  3. But the clincher is that the suicide rate in Belgium has dropped, not risen, since their 2002 assisted dying law came into effect.

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