Blog by Neil FrancisPosted on Sunday 14th June 2015 at 4:28pm
The opinion piece in The Age.
In today’s Fairfax press, Sydney woman Mary Ticinovic advances a number of reasons as to why she believes that assisted dying is not merciful. The by-line identifies her as a “clinical psychologist”. But her arguments are not founded on the basic tenets of psychology. How so?
Mary argues that to support assisted dying is to go “against the principle that all life is precious.” She offers no substantive explanation, invoking the notion of ‘human worth’, stating that it exists regardless of the health state or suffering of the person, and complaining that assisted dying promotes the idea that “your life is no longer worth living”.
These are not psychological arguments. We can agree that life is precious. But reluctantly deciding to hasten one’s death in the face of intolerable and unrelievable terminal suffering doesn’t negate that preciousness. Indeed, to some people, choosing assisted dying can evidence the preciousness of one’s very capacities and values as a human.
Whose standards?
Mary further muses over “by whose standards would we judge if life is not worthwhile any more”, as though this is only some vague theoretical argument amongst philosophers or doctors. This is not a psychological argument, either. Under assisted dying law reform, it is only the dying individual’s world-view and circumstances that determine whether he or she feels life is worth living: not anyone else. General philosophical theory doesn’t come into it.
She further argues that assisted dying “promotes a utilitarian view of humanity”. This is not a psychological argument, either. Nor is it valid. Indeed, legalised assisted dying respects the very nature of the diversity of humanity by enabling the world-views many people hold most dear: that of making rational choices consistent with their own beliefs, values and circumstances. Some patients, for example in Oregon, are deeply religious and believe that their God is compassionate and understands and respects their choice to avoid intolerable suffering. That’s not utilitarian at all.
Harm and the Hippocratic Oath
Mary invokes the Hippocratic Oath said by her medical friends to oblige doctors to “do no harm” and that the medical role is “in healing and helping the patient to be restored to health.” This is simplistic nonsense, not a psychological argument.
Firstly, doctors do harm all the time: think of surgical procedures or chemotherapy. Many medical interventions do harm, but we accept the harm because we expect there to be a commensurately greater good as a result.
Secondly, medical practice cannot always “restore the patient to health” as Mary exclusively puts it. What then? The dying patient may judge that the unrelievable suffering they will experience along the path to death is a greater harm than dying a little earlier. And, doctors also have a primary duty to relieve suffering, which Mary doesn’t mention. What is under review is whether a doctor may participate in the relief of intolerable and unrelievable suffering— by hastening death—if the patient believes this is the lesser harm.
Thirdly, the Hippocratic Oath is around 2,300 years old. It requires doctors to swear allegiance to ancient Greek gods. It forbids women from becoming doctors. It requires current doctors to train the next generation free of charge, and it forbids surgery. Contemporary doctors don’t take it, and it’s certainly not “part of training” as Mary mistakenly states.
None of these are psychology arguments.
'Sucker’s choice'
Mary then argues that requiring dying patients to endure until the end promotes—and that assisted dying prevents—“fostering gratitude”, “reconciling hurts or differences with family members or friends” and “showing them strategies or different ways to approach their pain and suffering”.
But, in jurisdictions where assisted dying is legal, for example in Oregon in the USA, these are precisely things that are encouraged under assisted dying. Doctors are required to inform applicants of available medical and palliative interventions. Family gathers on notice of an anticipated death, music and poetry is shared, and expressions of love, devotion and gratitude are exchanged.
If a dying patient has no intention of reconciling with family or reflecting on approaches to dealing with their pain and suffering under an assisted dying law, precisely the same intention applies to the current regime that requires the patient to endure until the end. To assume a difference is a false dichotomy.
Obligatory compassion
Mary also argues that assisted dying ought to remain outlawed because “nursing a sick loved one is a way to give back”. This is yet another specious non-psychology argument. It promotes the ‘right’ of the ‘nurse’ to express love and devotion through ‘caring interventions’ at the expense of the dying patient’s own world view and deeply-held wish for a hastened death. Now who’s being utilitarian?
The upshot
I ran Mary’s opinion piece past an experienced psychologist, who described it as little to do with psychology. Note that neither of us has experience of or is commenting on Mary’s expertise as a clinical psychologist: she may indeed be a very good one.
My associate wondered out loud if Mary’s arguments were based more on underlying religious views than anything else. I agreed: they seemed to me remarkably consistent with the arguments advanced by religious opponents, even though they avoided directly religious words. So I did a little research.
It turns out that Mary is a committed and active Sydney Catholic.* Evidence abounds of her devotion to the Catholic tradition, and I commend her for her conscientious reflective practice and participation in it.
However, I argue that neither the stated psychological qualification nor the unstated religious affiliation make the offered arguments valid.
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* By way of fairness, I place on the record that I am agnostic.
Blog by Neil FrancisPosted on Sunday 14th June 2015 at 4:06pm
Neil Francis announces the official launch of DyingForChoice.com, the world's premier source of reliable, evidence-based information about assisted dying, and responsible law reform to permit it in restricted circumstances.
Hi, and thanks for dropping by.
I'm delighted to announce the official launch of DyingForChoice.com. The mission is to help society work towards responsible assisted dying law reform, a reform wanted by the great majority of citizens in many countries. Yet assisted dying (in one form or another) is still illegal in many jurisdictions.
DyingForChoice.com will lay out the case for restricted assisted dying including world-view arguments, but also importantly provide rigorous factual evidence and analysis. This approach is a deliberate counter-measure to mistaken information — 'misinformation', more colloquially known as 'bull' — that is available so widely and repeated so often.
Misinformation can take the form of flapdoodle, filibuster, flip-flop, fudge or outright fiction. Ultimately it's fear-mongering via the promotion of bull. Legislative reform — so that all citizens are afforded the right to enact their own deeply-held world views and cherished values at the end of life, whatever those may be — deserves to be informed by quality information.
Exposing misinformation works. Already, my exposure of the 'suicide contagion' myth has resulted in selected website 'information' being withdrawn. It's up to all of us to hold a bright spotlight up to misinformation and to ask people not to spread bull.
So subscribe to our monthly newsletter to keep abreast of developments. You can also create your own login which will allow you to comment on posts, subject of course to our terms of use. Just use the Register link in the header bar.
You can also subscribe to our Twitter feed, catch up with our Facebook page, and watch any of our videos on our YouTube channel: just click the relevant button in the header bar.
So, keep in touch, stay up to date, and if you have a burning issue you would particularly like us to report on, just send a message using our Contact form.
Victoria's VAD Bill has passed both Houses and is now an Act.
Update 7th December 2017
At 4:10pm on Wednesday 22nd November, the Voluntary Assisted Dying Bill passed both Houses of the Victorian Parliament. The Victorian Governor has signed the Bill into an Act, so it is now law in Victoria, though not yet in effect. The Act will come into effect in June 2019, given Victorian residents facing intolerable suffering from an incurable illness, and who meet a number of hurdles, to lawfully request and obtain a peaceful death assisted by their doctor.
Update 20th October 2017
Victorians are a step closer to having the choice of assisted dying in the face of a terminal illness. After a marathon all-nighter sitting, the Legislative Assembly (lower house) this morning passed the Voluntary Assisted Dying Bill 2017. The Bill will now be sent to the Legislative Council (upper house).
The vote was won convincingly at 47:37, despite heroic efforts of opponents to create FUD (fear, uncertainty and doubt) through extensive misinformation, and filibustering the Bill's progress by putting up amendements to numerous clauses.
The Legislative Council is expected to debate the Bill next month.
Update 21st September 2017
In great news for Victorians, yesterday (20th September 2017), the Government tabled its Voluntary Assisted Dying Bill into the lower house of the legislature. The Bill is comprehensive, offering Victorians a further end-of-life choice, with numerous safeguards, and the stiffest pentalties worldwide for breaking the rules.
Read the Bill's explanatory memorandum (PDF, 273Kb).
Parliamentary debate on the Bill is likely to commence mid October, so now is the time to contact your own members of the Victorian parliament and let them know you support the Bill. If you don't know which electorate you live in or who your members are, or don't have their contact details, then:
Visit the Victorian Electoral Commission website and enter your home address, at the top of the page, to find out. It will show you your upper and lower house electorates. Make a note of the lower house electorate (District, in purple).
Then go to the Victorian Parliament website and enter your lower house electorate name in the Electorate field (the last one) and click Search, to find your lower house member. Note down your Member's contact details.
Then, also click the [Electorate] button on the Member's page (on the right) and then click the Region link on the target page. This also gives you the names and details of your five upper house parliamentarians.
Take down their contact details and let them all know you're asking them to support the Bill.
The Standing Committee on Legal and Social Issues (Legislation and References) of the Parliament of Victoria, Australia, has recommended that the Government introduce leglislation to allow assisted dying in restricted circumstances.
Update 9th June 2016
In excellent news for Victorians, the LSIC has recommended that the Government legislate to allow assisted dying in restricted circumstances.
"Recommendation 49: The Government should introduce legislation to allow adults with decision making capacity, suffering from a serious and incurable condition who are at the end of life to be provided assistance to die in certain circumstances."
The recommendations include:
Eligibility:A mentally competent adult experiencing intolerable and unrelievable suffering, with weeks or months to live. Must be ordinarily resident in Victoria and an Australian citizen or permanent resident.
A process by which requests may be made (and rescinded).
Checks and tests to ensure that relevant critieria have been met.
Establishment of an authority to receive reports of assisted dying and present reports to Parliament.
That conscientious objection (to not participate) is protected.
That in the case that a patient cannot self-administer lethal medication, a doctor may do so at the patient's request.
The recommendation has yet to translate into a Bill and a majority vote of both Houses of the Victorian Parliament. Some parliamentarians are intractably opposed to this reform and it's important that policitians hear from you to know that you want them to support the reform.
Sign the petition to go to all Victorian parliamentarians now, and spread the word!
Submissions were invited from interested individuals and organisations into end-of-life decision-making in Victoria, including:
current practices including palliative care;
whether current legislation satisfactorily encompasses contemporary community standards, aspirations and views;
a review of legislation and practices in other jurisdictions, both within Australia and overseas; and
what types of legislative change may be required.
Submissions to the inquiry, which have not been requested to remain confidential, are published on the Parliamentary website here.
Despite the Terms of Reference for the inquiry (below) do not mention assisted dying, almost all submissions to the inquiry have been made either to support or oppose the legalisation of voluntary euthanasia or physician-assisted dying. Clearly, the community is strongly engaged with the issue.
More information is available on the Victorian Parliament Inquiry's website.
Submissions have now closed.
Terms of Reference
STANDING COMMITTEE ON LEGAL AND
SOCIAL ISSUES
(Legislation and References)
Terms of Reference
58th Parliament
Inquiry into End of Life Choices
On 7 May 2015 the Legislative Council agreed to the following motion:
That pursuant to Sessional Order 6 this House requires the Legal and Social Issues Committee to inquire into, consider and report, no later than 31 May 2016, on the need for laws in Victoria to allow citizens to make informed decisions regarding their own end of life choices and, in particular, the Committee should —
assess the practices currently being utilised within the medical community to assist a person to exercise their preferences for the way they want to manage their end of life, including the role of palliative care;
review the current framework of legislation, proposed legislation and other relevant reports and materials in other Australian states and territories and overseas jurisdictions; and
consider what type of legislative change may be required, including an examination of any federal laws that may impact such legislation.
News reportPosted on Sunday 17th May 2015 at 7:28pm
The launch of DyingForChoice.com, a service dedicated to reasoned argument in supported of assisted dying law reform, and underpinned by sound evidence, has been announced.
Assisted dying law reform leader, Mr Neil Francis, today announced the launch of a new assisted dying service, DyingForChoice.com. Mr Francis said that in addition to solid and reliable evidence about assisted dying practice, a key goal of the new service is to highlight false and misleading arguments used by opponents of assisted dying law reform.
"We can respect deeply-held views in opposition to assisted dying law reform," said Mr Francis, "but it is not appropriate to advance misinformation, however unintentionally, in opposition to reform."
The great majority of citizens of many countries want the right, if faced with the unrelievable torture of a terminal illness, to choose a hastended death on their own terms. In Australia, opinion in favour of assisted dying choice has been in the majority for over four decades.
Initiatives are underway in numerous jurisdictions to bring statutory reform to permit assisted dying choice. Mr Francis said it was the goal of DyingForChoice.com to provide empirical support for reform initiatives. "It's critical that legislators are well-informed, and not swayed inappropriately by specious argument or misleading claims," said Mr Francis.
He stated that while the initial website was fairly simple, a range of services were in planning to deliver enhanced value to campaigners.
Dying Victorian man Peter Short, and his wife Elizabeth talk about coping with Peter's terminal illness, and make a plea to Australian Prime Minister Tony Abbott to meet with them to discuss responsible assisted dying law reform. Peter has since died.
The Hon. Bob Such's Ending Life With Dignity Bill 2013, before the South Australian Parliament, contains a strong compliment of safeguards, as Neil Francis explains in this video. The refusal of life-saving treatment, to which Australians are entitled but with the same direct and foreseeable consequence as doctor-assisted dying requests, have practically none of these safeguards, yet there has been NO avalanche of inappropriate persuasion to refuse life-saving medical treatment, as the so-called "slippery slope" hypothesis would have us believe.
This is the third of three videos sent to South Australian MPs in 2013.
VideoPosted on Saturday 21st September 2013 at 5:45pm
Opponents of assisted dying law reform often invoke fictional slippery slopes as objections to law reform. In this video, Neil Francis gives three examples of supposed slippery slopes argued by opponents, explains why they are fictional, and shares the perspectives of several recognised experts from the USA state of Oregon about their Death With Dignity law which has been in effect since 1997. Three long-time Oregonian Death With Dignity Act opponents also admit there's no cause-and-effect relationship established between law reform and supposed slippery slopes.
This is the second of three videos sent to South Australian MPs in 2013.
