Australia

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

Here we go again. Branca 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.

Branca 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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Home of the bible society in Launceston, from where the ACL's latest media release was launched

"Bullshit!"

That was the reaction of Dutch Senator Erik Jurgens when I asked him about a Dutch euthanasia anecdote spread by Mr Paul Russell, then head of the Australian anti-VAD Catholic front organisation "HOPE". In 2011, Mr Russell had been spreading the story:

"I often use the story of the death of a 26 year old ballerina in Holland [sic]. She had contracted a form of arthritis at this young age and her dancing career and dreams were dashed. An American oncologist who spoke later to the killing doctor reported the Dutch medico as saying something like 'One doesn't like doing it, but it was her choice.'" — Paul Russell, "HOPE" [my emphasis]

(Note: "Holland" comprises just the two north-west provinces of the Netherlands. "Holland" and "the Netherlands" are not correctly substitutable terms. The Dutch euthansia Act applies to the whole of the Netherlands, not to just two provinces.)

Checking with authoritative sources

In 2012, I travelled across the Netherlands with camera in tow, interviewing key stakeholders in the nation's assisted dying law about its operation. Nobody had heard of the supposed ballerina case, including long-serving politicians, the Royal Dutch Medical Association, nor even Professor Theo Boer or the Dutch Patient Rights Association who actively oppose the law.

robinbernhoffoncamera.jpgUSA doctor Dr Robin Bernhoft muses about a Dutch ballerina nobody in the Netherlands has heard of

It turns out that the meme was a bit of unverified nonsense put about by USA Catholic radio- and televangelist Dr Robin Bernhoft in an early 1990s polemic anti-VAD video, "False Light", narrated by staunch Catholic actor Joseph Campanella. Dr Bernhoft has castigated believers in evolution as "sexually immoral, abortion supporters, racists and violators of each of the Commandments".

In the video, Dr Bernhoft often gazes nonchalantly into the distance, or at his hands, as he narrates his stories. It's all very third-hand and mysterious, conspicuously devoid of even the faintest whiff of evidence. But Dr Bernhoft doesn't claim to have actually spoken to the doctor, as Mr Russell states. Perhaps the confidently stated direct-contact idea is a signal of confirmation bias.

Those little Dutch cards

Confidence was also common amongst VAD opponents, like Oregon Nurse Donna Howell also featured in "False Light", spreading the nonsense that the Dutch wander around carrying little cards pleading for protection from being killed.

"It's gotten so bad in Holland [sic] that people have in their wallets little cards that say 'Do not euthanise me without my permission'." — Nurse Donna Howell

donnahowelloncamera.jpgUSA Nurse Donna Howell confidently says the Dutch carry little cards saying 'do not euthanise me'

Just like the supposed ballerina, nobody I interviewed across the Netherlands, including the anti-VAD Patient Rights Association which would be the natural source of "little cards" for patients, had ever heard of the little cards, either.
 

Update 13-Oct-2020

A colleague reminds me of an event that's important and very revealing in this context. On 23rd February 2012, the President of the Royal Dutch Medical Association (KNMG) wrote to the President of the American Medical Association in response to "inadequacies" in Republican Presidential candidate Rick Santorum's statements about assisted dying practice and its supposed consequences in the Netherlands.

Mr Santorum, amongst other things, claimed that the Dutch wear bracelets saying "do not euthanise me". Notice how there can be random small, yet conspicuous, mutations in misinformational anecdotes.

The KNMG was unequivocal in its professional advice: "'Do not euthanise me' bracelets do not exist." The KNMG President closed with the observation that:

"Interpretations about the practice of euthanasia in other countries should not be biased by personal opinions whether or not euthanasia is justificed in situations of unbearable suffering without prospect of improvement."

The architect of the Dutch euthanasia law, Dr Els Borst, arguably the most informed stakeholder of the era, responded to the "little cards" claim in plainer language:

"That is an absolute lie." — Els Borst

A diet of evidence-less anecdotes

Anecdotes — devoid of verifiable evidence — about supposed dangers are a favourite diet of VAD opponents, like the nonsense put about by the Vatican, and Catholic Professor Margaret Somerville, that Dutch elderly are streaming into Germany for hospital treatment for fear of being euthanised in the Netherlands; that Els Borst supposedly regretted her law reform; or that there's some kind of slippery slope from VAD to non-voluntary euthanasia — which Rick Santorum handily mutated into involuntary euthanasia.

The anecdote is a favourite snack of opponents for dishing out when they've run out of other confectionery.

Back to now

One's being served up again in Tasmania right now, and it smacks of desperation. In its most recent media release, the Australian Christian Lobby, from the home of the Bible Society in St John Street, Launceston, launched its latest shrill warning with the claim that:

"In a conversation with a member of the British Parliament, one Dutch doctor explained what it was like when euthanasia laws first came to the Netherlands. He said, 'We agonised over our first case of euthanasia all day, but the second case was much easier and the third was a piece of cake.'"

So let's reflect: on some unspecified date ("when euthanasia laws first came to the Netherlands": but that would be the mid 1980s) some unnamed British MP once said that an unnamed Dutch doctor once told him or her… that their third euthanasia case "was a piece of cake".

Who what now?

One only has to glance at readily-available records to see what a load of, um, how shall we put this?... bollocks, the claim is. The Australian Christian Lobby is not referring to a recent, documented, verfied fragment of evidence. Rather, the ACL has jauntily appropriated a statement from May 1998, by Lord McColl of Dulwich in the British parliament. Straight from the Hansard's mouth:

"The Dutch doctors told us: 'We agonised over our first case of euthanasia all day, but the second case was much easier and the third was a piece of cake.'" — Lord McColl

"Dutch doctors": plural. However, the statement is not of the kind that would be said by a broad collective of doctors as Lord McColl story relates.

Indeed, in 2006 his Hansard story mutated to "when a Dutch doctor was asked...". Suddenly from multiple doctors to just one; from direct, personal receipt of the claim, to the claim being made to an unspecified audience, stated in the tell-tale passive voice. If it were really said to you and you wanted to punch home a key point in a spirited on-the-record debate, you wouldn't forget, and you'd make a point that it was said to you, wouldn't you?

Piling up the anecdotes

What else has Lord McColl had to say about the Holland [sic] experience on the Hansard record in 2006? Ah, the "little cards" anecdote, still doing the rounds more than a decade after its invention:

"Many elderly people in Holland [sic] are so fearful of euthanasia that they carry cards around with them saying that they do not want it." — Lord McColl

An anecdotal claim without at least one independent, verifiable source isn't really evidence at all. It's just a myth. A handy but hollow sound bite. It reveals little about the subject... but rather a more about the claimant.

The "piece of cake" anecdote, like those before and since, are just myths conjured up to curry fear, uncertainty and doubt. Piling them up doesn't make them any more true.

Conclusion

As I put one anecdotal claim after another to each of my interviewees across the Netherlands, including VAD opponents, they'd roll their eyes and give courteous replies to the effect that, as one interviewee generously put it, "nobody in the Netherlands takes such commentary seriously."

But I think I prefer Senator Erik Jurgens' parsimony: Bullshit.

And if history is any guide it won't be long before the next re-moistened cowpat is heaved at the political reform fan in the hope that some of it sticks.


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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".

-----

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


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Deep and extensive Catholic connections are behind supposedly secular attacks on VAD.

A friend pointed out to me an opinion piece published this week in MercatorNet that slams Victoria's voluntary assisted dying (VAD) law. Written about an elderly woman with cancer who used the law to die peacefully, it's an angry diatribe written by the woman’s granddaughter-in-law: one Mrs Madeleine Dugdale.

Update 21-Sep-2020

Mrs Madeleine Dugdale's article has been withdrawn from MercatorNet without explanation. Here's a screenshot of the original.

dugdalegranscreenshot620.jpg

And this is Mrs Dougdale's "about" page after the article was withdrawn.

madeleinedugdaleatmercatornet2020_620.jpg

While it's far from my preferred practice to take on someone recently bereaved, Mrs Dugdale has put herself and her family firmly in the public square by publishing an editorial about her grandmother's death (actually her husband’s gran) the very day after she died.

All is not as it seems and a response is required.

Catholic talking points

Let's not beat about the bush: Mrs Dugdale's piece is a grotesque misrepresentation of Victoria's VAD law and relies on gallingly distorted framing. Despite not mentioning faith, religion or Catholicism, her opinion piece ticks most Catholic talking-point boxes I've pointed out previously, such as Mrs Dugdale’s:

  • Headlining that her gran was not in particular pain. We already know from extensive overseas experience that pain is a less common reason behind why people consider VAD.
  • Being sure to emphasise the death was a suicide, and that "suicide is not courageous, it's an horrendous act of desperation and defeat".
  • Linking it to loneliness caused by Covid-19 lockdown.
  • Shabbily inferring that doctors did not discuss and offer all and anything palliative care could bring to bear, when there's a consultation process mandated by law.
  • Suggesting that palliative care could alleviate all intolerable suffering, but which both palliative care peak bodies in Australia concede is not possible.
  • Scandalously implying that medical care workers were forced to participate in her assisted death against their will, when the law protects anyone who wishes to decline.
  • Suggesting her gran's choice was an issue of mental health, implying that she wasn't fit to decide, when in fact doctors must confirm decisional capacity.
  • Describing the process as "obfuscation and secrecy" when a strong chain of documentary evidence is mandated, while no process is mandated for the Catholic church's own accepted patient path to foreseeable death: refusal of life-saving medical treatment.

 

Mrs Dugdale employs no fewer than eight Catholic church talking points in her attack on Victoria's VAD law.

Spurned "help"

Also of note is Mrs Dugdale's description that she and her husband were "silenced" and "quickly shut down" so there was "little my husband and I could do to help." Did the family actually want help of the kind Mrs Dugdale and her husband were determined to dispense?

One wonders what Mrs Dugdale's gran would think if she could see how a granddaughter-in-law had sought to weaponise her choice for VAD, against the law itself.

Update 24-Sep-2020

We now know what gran's immediate family thought of Madelein Dugdale's savage misrepresentation of their mum's death. It's not pretty, and they've asked Madeleine for a written apology. Read the full story at Go Gentle Australia.

Who is Madelaine Dugdale?

So who is Mrs Madelaine Dugdale? Her article bio reports only that she's a former Melbourne high school teacher and now a full-time mum of four with one on the way. Move along, nothing to see here…

Well, it’s worth looking a bit more carefully, elsewhere. Mrs Dugdale graduated from (Catholic) Campion College. And that high school where she worked? St Kevin’s (Catholic) College in Toorak, Melbourne, where she taught… religion.

She's a leading member of Catholic Voices Australia, whose purpose is "putting the Church's case in the public square."

So in summary, this anti-VAD diatribe bristling with Catholic church misinformation was penned by a leading member of Catholic Voices Australia whose remit is "putting the Church's case in the public square", but which failed to identify that religious connection and attempted to give the appearance of secular impartiality.

If there's any remaining doubt about Mrs Dugdale's Catholic devotion, here she is discussing the Pope's amoris laetetia (the joy of love) book with Fr Tony Kerin, an Episcopal Vicar for Life, Marriage and Family in Melbourne.

Hidden religious petticoats indeed.

And who is the publisher?

Mrs Dugdale's anti-VAD tirade is published online by the masthead MercatorNet. It declares itself to be "dignitarian", and reveals that its Editor is a Catholic who believes in God. The masthead is named after Gerardus Mercator, the C16th cradle Catholic cartographer.

MercatorNet's About webpage opines that "religion adds clarity and conviction to the task of defending human dignity" — as if that's an exclusive province or even necessary feature of "religion" — and insists that arguments it publishes are "based on universally accepted moral principles, common sense and evidence, not faith."

Pfft.

Another invitation to "dig here"

Methinks they doth protest too much. It doesn't take much effort to peel back the veneer of neutrality.

MercatorNet is a trading name of the company New Media Foundation Ltd. (For reference, another of its trading names is BioEdge, which has the same Editor as MercatorNet, but we'll get to that later.) It's a company limited by guarantee; a registered charity established in 2005 and based in NSW.

Oddly, its 2019 ACNC records claim 2 full-time and 10 casual employees for a full-time equivalent (FTE) of 5. However, their total payroll expenditure as lodged, "Editor fees", was less than $38k. But If FTE is 5, then that's an average of just $7,600 per full-time annum. A minimum wage of $16/h over a year, without holiday leave, would equate to around $27k per person, times 5 would make a total minimum lawful payroll budget of $135k per annum. Hmmm.

Other major expenses were website maintenance and hosting ($26k), paying contributors ($18k), and insurance ($4k).

The company's bare-bones website mysteriously states only that its mission is "to help people navigate modern complexities in a way that respects the fullness of human dignity."

Of its masthead MercatorNet, the company’s website says only that the outlet is "dignitarian" and "doesn't want to be trapped on one or the other side of the culture wars". Of its BioEdge masthead it says that it's "completely independent".

Double pfft.

Who controls the company?

According to ASIC's records, the four registered Directors of New Media Foundation Ltd are Romano and Francine Pirola, Jude Hennessy and Michael Cook. Romano Pirola is the Chairperson, yet it is Michael Cook and Jude Hennessy who signed off the company's latest financial statements. Who are these people?

Romano Pirola and his wife Mavis were Joint Chairs of the Australian Catholic Marriage and Family Council, which advises the Australian Catholic Bishops Conference. They were appointed by the Pope in 2014 as one of just 14 married couples worldwide to participate in the Extraordinary Synod of Bishops on the Family. They've been awarded the church's honour of Knight and Dame of the order of St Gregory for services to the Church, and in 2016 were awarded honorary doctorates by Australian Catholic University.

Francine Pirola is the wife of Byron Pirola, Romano and Mavis Pirola's son. Francine and Byron were awarded honours by Pope Francis in 2019, are directors of the Catholic Marriage Resource Centre (which, incidentally, acknowledges that Catholic wedding numbers have been falling for 25 years) and were joint Chairs (like Byron's parents before them) of the Australian Catholic Marriage and Family Council. They've even represented the Australian Catholic Bishops at meetings of the Pontifical Council of the Family.

They're also the couple whose investment company loaned anti-marriage-equality lobby group Marriage Alliance $1.67m in support of anti-LGBTI flyers handed out to children on school buses. The Crikey exposé makes further interesting reading.

Jude Hennesy is director of the Confraternity of Christian Doctrine for the Catholic Diocese of Wollongong. It's responsible for "special religious education" in state schools.

Michael Cook is Editor of both MercatorNet and BioEdge. He's been a member of the devout lay Catholic group, Opus Dei for more than four decades. Unlike MercatorNet's About page, BioEdge's own About page doesn't mention religious links of any kind, and says it's "completely independent".

All four directors of MercatorNet's controlling company are very deeply and strongly invested in the Catholic church. One of them, Michael Cook, is its Editor.

MercatorNet's remit

Back in October 2016 I did a keyword breakdown of articles published by MercatorNet. In the then 11 years of its existence, assuming no articles were taken down, it had published more than 2,000 articles containing the word "Catholic". That's a lot for a small outlet: an average of 3.5 "Catholic" articles a week, every week, for 11 years.

In comparison, there were no articles containing the word "Anglican", and just 51 containing the expression "Church of England". There were also 121 mentioning "Hindu", and 868 mentioning "Islam", with many of those negative.

New Media Foundation Ltd's ACNC record indicates its qualifying charitable purpose is "advancing education". But publishing thousands of articles mentioning religion, most of them Catholic, would seem to more fully reflect the qualifying charitable purpose of "advancing religion". But they chose "advancing education" instead — which bypasses any mention of religion.

Tellingly, every visit to and search on the MercatorNet website currently results in a pop-up that invites you to join their "influential community of truth-tellers" to "push back against post-modern relativism". That "relativism" is a pet peeve (and language) of the Catholic church.
 

mercatornetpopup.gif MercatorNet  attacks post-modern relativism: a pet peeve of the Catholic church, to be countered by "truth-tellers".

MercatorNet headlines the Catholic church's pet peeve: post-modern relativism. This is hardly surprising given its controlling company is run by Opus Dei members, Catholic church staff, and church honours recipients.

The founding of New Media Foundation Ltd

When it was founded in 2005, New Media Foundation Ltd's registered address was 296 Drummond Street, Carlton, Victoria. Significant? Decide for yourself.

That's the address of the Drummond Study Centre. And its connection? "Spiritual activities in the centre are entrusted to Opus Dei, a personal prelature of the Catholic Church." Notice how the centre's name doesn't mention "Catholic" or even religion in any way, either. You have to delve through its web pages to find out.

Previous directors

Similarly, the list of former New Media Foundation Ltd company directors adds to its storyline.

One is Mr Richard Vella, who is or was the spokesperson for Opus Dei in Australia. He describes his personal relationship with God as "the greatest love of my life". Another is Fr Phillip Elias, who was ordained into Opus Dei in Rome in 2017.

Another founding director was Fr Amin Abboud, who died in 2013 and was given a full requiem mass funeral at St Mary's Cathedral in Sydney, presided over by church officials including Monsignor Victor Martinez, the then Regional Vicar of Opus Dei for Australia and New Zealand.

Yet another is Carolyn Moynihan, Deputy Editor of MercatorNet and frequent contributor to Crisis Magazine, "a voice for faithful Catholic laity" and a contributor to the Catholic Exchange. She rails repeatedly against the harms of marriage equality.

Get the picture?

New Media Foundation Ltd and its masthead MercatorNet's Catholic underpinnings are deep and strong.

The roots of the garden

But if you think it might simply be a small bunch of enthusiastic individuals, think again. This veritable garden of fertile Catholic plants arose from somewhere.

Where might that be? I've already pointed out seeding strategies for non-clerical commentary promoted by the Catholic Archbishop of Sydney, Anthony Fisher. It's also worth pointing out that, like any other major institution that seeks to influence public policy, the Catholic church in Australia maintains a whole media and communications department.

Further, the Australian Catholic Media Council hosted the triennial Australian Catholic Communications Congress in 2018, which notably for the first time ever was held together with the Australasian Catholic Press Association (ACPA) Conference. ACPA's brief is to "give voice to Catholic perspectives on the issues of our societies". Former Vatican journalist Greg Erlandson delivered the keynote address to the joint conference, and masterclasses were held to "hone particular skills".

Not a recent phenomenon

If you think this just a recent phenomenon you'd be mistaken. Back issues of the Vatican's own newspaper, L'Osservatore Romano, prove most enlightening.

At least as far back as the eighties, through the nineties and the noughties, the Vatican has been vigorous in its promotion of media engagement across Europe, Asia/Pacific and the Americas. For example, in March 1990 Pope John Paul II noted "unprecedented opportunities" to proclaim the word of God via media channels in central and eastern Europe.

In the same year, Archbishop John Foley, then President of the Pontifical Council for Social Communications, told media workers at a Catholic world congress not to "falsely" compartmentalise their lives into private piety versus professional work subjected to commercial pressure, but instead spread Catholic "truth". He also schooled filmmakers amongst the gathering that "great films are 'at least implicitly religious'".

The Vatican and its 'authorities' repeatedly cajole Catholics into "truth-telling", which means evangelising the church's stances.

Ongoing evangelisation focus

Pope John Paul II repeated his firm wish for more mass media coverage in a major address in 1992, and a follow-on note in the same year encouraged USA Catholic journalists to "put their professional skills at the service of the Gospel".
 

massmedianeedscatholicpresence.gifThe Catholic church believes the mass media needs a Catholic presence.

In another example in 1993 Pope John Paul II emphasised how new media — then videotapes and audiocassettes — could serve the "new evangelisation". And in 2002, he again implored Catholics to adopt the latest new media — the Internet — in "proclaiming the Gospel". Two years later MercatorNet was launched online, as were other similar sites.

And if there was any doubt as to what Catholic communications services were for, in October 2012, Pope Benedict XVI delivered a major address confirming that "the church exists to evangelise".

That's just a few of the many.

Media for the faithful

Back in Australia, B. A. Santamaria established the AD2000 journal in the late 1980s. It's an obviously Catholic publication published by the Thomas Moore Centre in Melbourne. A quality journal aimed squarely at and informative to Catholic adherents, it is of limited interest to the general public. What reaches the general public is mainstream media.

But "Houston, we have a problem"...

Mainstream media a "problem"

In a revealing narrative, loyal Catholic Professor Margaret Somerville, now at the (Catholic) University of Notre Dame Australia, laid out the critical importance of the media to the outcome of VAD law reform in her 2001 book Death Talk: The case against euthanasia and physician-assisted suicide (especially see Chapter 19).

In it, she highlights the Catholic communications problem (without mentioning Catholicism), railing against what she claimed even then was the mostly "small-l liberal" mainstream media as resistant to religious messages. She confirmed that religious media are much more accommodating of the "pro-life" world view.

She specifically noted the importance of "framing" the issues to "significantly influence political decisions", complaining that "anti-euthanasia arguments do not make dramatic and compelling television". She then went on to outline a collection of useful anti-VAD "frames", which were wholly consistent with the Vatican's position and language.

Indeed, you'd be forgiven for thinking Professor Somerville wrote the church's framings, because she's given pre-eminent billing over the Vatican itself in the Catholic Archdiocese of Perth's website for bioethics, the LJ Goody Bioethics Centre. Of further relevance is that the Catholic Archbishop of Perth is, along with the Catholic Archbishop of Sydney, the ultimate authority controlling the University of Notre Dame Australia, where Somerville is a Professor.

(Incidentally, the website's home page "What's new" announcement is more than 5½ years out of date, which gives the impression that the Centre was a hasty, event-specific confection whose purpose has long since passed.)
 

ljgoodybioethics2020-09small.jpg Professor Margaret Somerville gets pre-eminent billing on Catholic bioethics, above the Vatican itself.

Don't mention the war religion

Amongst Professor Somerville's numerous writings slamming VAD, some stand out more than others. One that does is a 2008 editorial titled Death talk in a secular age, in which she vigorously encourages religious opponents to "formulate a moral argument against euthanasia without resorting to religion" [my emphasis]. And who published this editorial? Why, it was MercatorNet!

Did the Catholic church take note of Professor Somerville's strategy? As I've pointed out before, Mr Ben Smith, Director of the Life, Marriage and Family Office at the Catholic Archdiocese of Hobart, fails to mention who he really is in at least two purportedly "independent" groups fulminating against Tasmania's current VAD Bill. One of the groups he leads, Live & Die Well, encourages people to write objections to their parliamentarians, but expressly commands "DO NOT use religious arguments."

Professor Somerville was also a keynote speaker at a 2008 conference of media professionals in Toronto, in which she advised journalists and editors how to "frame" the debate against VAD. But these were not just any journalists and editors at large. They were Catholic journalists and editors: members of the Association of Roman Catholic Communicators of Canada, whom she schooled alongside a number of Catholic church officials. The conference's title? "Proclaim it from the rooftops!"

Catholic Professor Margaret Somerville has been central to the Catholic church's hostile "framing" of VAD, and helping media specialists spread that framing through the media.

More religious frustrations

Over the years Professor Somerville continued to build upon the theme, including in her 2015 book, Bird on an Ethics Wire: Battles about values in the culture wars. She escalated her criticism of the "intense tolerance" of "the now ubiquitous moral relativism" as an illustration of how VAD law reform demonstrates what happens "if we take a purely secular approach not balanced by religious views."

A curated garden

You will have noticed by now significant common threads in favour of Catholic "truth"; against "relativism"; calls to evangelise using the media; calls to avoid and actual avoidance of religion in argumentation; avoidance of revealing religious connections in by-lines; and a united portfolio of Church-friendly framings of VAD by a busy theatre of players.

Given the church's perceptions of a hostile mainstream media, is it any wonder that some devout Catholic contributors, and deeply Catholic media outlets, hide their religious petticoats and zucchetti while publishing grave misinformation in the curry of fear, uncertainty and doubt (FUD) against VAD?

This isn't a random jungle.

No, it's a curated garden, tended to by what we might call the 'Catholic communicators guild'.

Failure to mention deep Catholic roots behind purported "secular" attacks on VAD law reform is a strategy of the 'Catholic communicators guild'.

Conclusion

In this review, I've revealed only some of the deep Catholic connections that resulted in a shocking appropriation of the death of an elderly woman with cancer, using misinformation and framing wholly consistent with the Catholic church's evangelisation, but withholding key information about those deep religious underpinnings.

It's clear the Catholic church understands that its religious arguments are unpersuasive to the wider community. It's also important that the public and legislators understand how religious forces attempt to sow fear, uncertainty and doubt about VAD law reform by giving the appearance of secular neutrality to its messages.

Mrs Dugdale’s gran deserved better than to be appropriated for the aggrandisement of an agenda that is clearly at odds with her own beliefs and values… and the values of the overwhelming majority of Australians.

May she rest in peace.


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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.

 

-----

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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St Mary's Cathedral, Hobart, Tasmania

Hobart Catholic Archbishop Julian Porteous makes a number of incorrect representations about voluntary assisted dying (VAD) in his recent Talking Points article (Hobart Mercury 23rd Aug). And, most of his own flock disagree with his opposed stance.

Let's take a look at the facts, and the Archbishop's 'alternatives'.

NOTE: While The Hobart Mercury published Archbishop Porteous' arguments, they declined to publish this rebuttal.

Key points

  1. Archbishop Porteous wrongly equates VAD with general suicide and insinuates they are lonely deaths when they aren't.
  2. He claims that palliative care can always help, when palliative care peak bodies clearly state that it can't.
  3. He insensitively co-opts Covid-19 victims and their families into his arguments, despite them having nothing to do with VAD.
  4. He doesn't represent his own flock: three quarters (74%) of Australian Catholics support VAD, including near half (48%) who strongly support VAD. A tiny 15% are opposed.
  5. In just twelve years (2007─19), the Australian Catholic church has lost a quarter (26%) of its flock. Of those remaining, an increasing proportion, now half (50%), never or almost never attend services.
  6. Diocese Director of Life, Marriage and Family, Mr Ben Smith, encourages Catholics to write to their politicians using the same talking points as Porteous, and with express instructions "DO NOT use religious arguments".

Assisted deaths completely different from general suicide

One particularly egregious aspect of Archbishop Porteous' rhetoric is the innuendo he employs to equate VAD with general suicide, including liberally sprinkling the word "suicide" through his narrative.

But there are profound differences between general suicide and VAD. Most Australians understand that, and research shows that most Australian doctors agree.

Assisted deaths are not lonely

The Archbishop, with astonishing misjudgement, also co-opts the Covid-19 deceased into his story arc: people whose funeral can't be attended by loved ones because of government-imposed lockdown. He obliquely infers that VAD users are or will be naturally unattended by loved ones — even without imposed lockdown.

He further slathers on observations about family reconciliations during the natural dying process, with the implicit meaning that's the only dying context in which families might reconcile.

His presumptions skirt extensive evidence that one of the most treasured factors amongst both VAD law users and their loved ones is the opportunity to express love and caring, and the ability to gather and say goodbye.

Further, multiple scholarly studies show that loved ones recover from bereavement after an assisted death at least as well as those bereaved from natural death, and in some cases, better.

Contrary to Archbishop Porteous' sinister insinuations, VAD deaths can prompt families to gather, express love, say goodbye, and grieve well.

Palliative care can't always help

Archbishop Porteous also argues that palliative care "is able to manage pain and suffering" such that nobody should experience a bad death. He ought to know better: more than half of all palliative care services in Australia are delivered via Catholic institutions.

Palliative Care Australia has clearly stated that "complete relief of all suffering is not always possible, even with optimal palliative care". Even Catholic Doctor's Association palliative care specialist Dr Odette Spruyt, a past President of the Australian and New Zealand Society of Palliative Medicine, has said "it is simplistic to argue that palliative care can remove all suffering at the end of life."

Both of Australia's peak palliative care bodies acknowledge that even the best care can't relieve all terrible suffering at the end of life.

Less treatment but more treatment

Then there's the incoherence of the Archbishop’s argument acknowledging that people want to avoid more medical intervention, while arguing at the same time that more medical intervention (palliative care) is always the only answer to end-of-life suffering.

What about the devout religious?

He adds an odour of hubris to this unctuous spread by noting with disapproval that "family members of those who have had difficult deaths" are the most vocal supporters of law reform. Indeed. These are real people with real experiences of when even the best palliative care can't help.

For balance, it's worth pointing out that numerous research studies show that it's the most religious who are the most vocal opponents of VAD law reform.

Numerous scholarly studies show that it's the most religious who are the most vocal opponents of VAD law reform.

But don't mention religion

It's curious then that the Archbishop — a senior cleric — invokes not a single religious statement or reference in his narrative. Perhaps he's coordinated well with his diocesan Director of Life, Marriage and Family Office, Mr Ben Smith, who advises in an anti-VAD letter-writing guide handed out at Tasmanian masses last week, "DO NOT use religious arguments".

Unsurpisingly, Mr Smith also recommends other language demonstrated in the Archbishop's opinion piece: imply that people will be vulnerable, say that palliative care is the answer, bring up the Covid-19 pandemic, and refer to assisted suicide rather than assisted dying.

Director of Hobart's Catholic Life, Marriage and Family Office, Mr Ben Smith, urges Catholics to write to their politicians to oppose VAD, but directing them “DO NOT use religious arguments”.

Far from representing the 'everyman'

Rather than use any religious references, Archbishop Porteous carefully crafts his grave implications in 'everyman' language as though the points he makes are naturally agreeable to everyone.

But he doesn't represent the great majority of Australians, four out of five (80%) of whom support VAD, according to the most recent (2019) impeccable national study from Australian National University.

Far from representing Australian Catholics

Nor does Archbishop Porteous represent the views of most Australian Catholics. The ANU study also found that three quarters (74%) of them support VAD, with only a tiny minority (15%) opposed. A staggering near-half (48%) of Australian Catholics now strongly support VAD, up from around a third (36%) just three years earlier in 2016.

Three quarters of Australian Catholics support VAD law reform, almost half of them strongly.

At the same time, the ANU study reveals that the Catholic Church represents fewer and fewer Australians. In just the twelve years between 2007 and 2019, the Catholic Church lost a quarter (26%) of its flock. Australians with no religion (41%) now outnumber Catholics by two to one (21%).

In addition, of the fewer still identifying as Catholic, there's been an increase of more than one in five — now comprising half (50%) — who never, or almost never, attend services.

It's worth emphasising that even amongst those who haven't abandoned the Catholic church altogether — the more entrenched — strong support for VAD law reform has soared.

The Australian Catholic church has lost a quarter of its flock in 12 years, and half of those remaining never or almost never attend services.

Not the best spokesperson

Amid shrinking flocks, withering attendance and a weighty jump in strong Catholic support for VAD, it's curious that the Archbishop continues to vocally push entrenched opposition. Perhaps Sydney's Catholic Archbishop Anthony Fisher was right when he said in 2011, "Bishops, for instance, are not always the best public spokespeople for the Church on such matters." Indeed.

As politicians are only too keenly aware, they're elected by the people, not appointed by religious officials.

Australians unambiguously show a determined and increasing appetite for lawful VAD. It would be a courageous politician indeed who resolved to trudge the road now so obviously on the wrong side of history.


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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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The Parliament of Victoria passed the Voluntary Assisted Dying Act in 2017

Victoria's Voluntary Assisted Dying Act (2017) has now come into effect. Including 68 safeguards, the Act gives Victorians with a terminal illness another option to consider at end of life, if it is of interest to them. As overseas evidence shows, the possible choice of voluntary assisted dying provides comfort and relief for the terminally ill and their loved ones. It demonstrates that the State respects the wider range of alternatives that dying patients may choose to pursue when faced with intolerable and unrelievable suffering.

The Act contains what is arguably the world's most detailed and carefully laid out safeguards.

Key aspects of the provisions are:

  • The person must be 18 years or over; and
  • Be ordinarily resident in Victoria and an Australian citizen or permanent resident; and
  • Have decision-making capacity in relation to voluntary assisted dying; and
  • Be diagnosed with an incurable disease, illness or medical condition that:
    • is advanced, progressive and will cause death; and
    • is expected to cause death within 12 months; and
    • is causing suffering that cannot be relieved in a manner the person deems tolerable; and
  • Doctors and other healthcare workers are not permitted to raise assisted dying — only to respond to formal patient requests.
  • The person must make three formal requests, the second of which must be written and witnessed by two independent people.
  • The person must make the request themselves. Nobody else is authorised to make the request, and the request cannot be made via an advance care directive.
  • Ordinarily, the minimum timeframe between first request and opportunity to take the medication is ten days.
  • The person must maintain decisional capacity at all three requests.
  • Two doctors must reach independent assessments that the person qualifies.
  • Only doctors who have completed specialist training for voluntary assisted dying may participate.
  • Any healthcare worker may decline to participate for any reason, without penalty.
  • A prescription dispensed for the purpose of voluntary assisted dying must be kept in a locked box and any unused portion returned to the pharmacy after death.
  • The person must self-administer the medication; except if the person is unable to, a doctor may administer. An independent witness is required if the doctor administers.
  • Establishment of an authority to receive assisted dying reports, to assess reports, and to refer unacceptable cases to disciplinary or prosecutorial authorities.
  • For Parliament to review summary reports; twice in the first two years and annually thereafter; a formal review at five years.
     

More information about the Act and how to access voluntary assisted dying are available from Health Victoria.

 

-----

Full list of safeguards in Victoria's voluntary assisted dying framework

Access

  1. Voluntary
  2. Limited to 18 years and over
  3. Residency requirement [Victorian resident and Australian citizen or permanent resident]
  4. Limited to those with decision-making capacity
  5. Must be diagnosed with condition that meets restrictive set of criteria [advanced, progressive and will cause death]
  6. End of life is clearly defined [death expected within weeks or months, not more than 12 months]
  7. End of life condition combined with requirement for suffering
  8. All of the eligibility criteria must be met
  9. Mental illness alone does not satisfy the eligibility criteria
  10. Disability alone does not satisfy the eligibility criteria

Request

  1. Must be initiated by the person themselves
  2. No substitute decision makers allowed
  3. Cannot be included as part of an advance directive
  4. Health practitioner prohibited from raising voluntary assisted dying
  5. Person must make three separate requests
  6. Must have written request [witnessed in the presence of a medical practitioner]
  7. Two independent witnesses to request [exclusions for family members, beneficiaries, paid providers]
  8. Specified time must elapse between requests [first and third requests must be at least 10 days apart with exception when death imminent]
  9. Additional time required to elapse between steps of completing process [second assessment and third request must be at least one day apart
  10. Must use independent accredited interpreter [if an interpreter is required]
  11. No obligation to proceed, may withdraw at any time

Assessment

  1. Eligibility and voluntariness assessed by medical practitioners
  2. Must be two separate and independent assessments by medical practitioners
  3. Assessing medical practitioners must have high level of training/experience
  4. Assessing medical practitioners must have undertaken prescribed training [to identify capacity and abuse issues]
  5. Requirement to properly inform person of diagnosis, prognosis and treatment options, palliative care, etc, [by both assessing medical practitioners]
  6. Referral for further independent assessment if there is doubt about decision-making capacity
  7. Coordinating medical practitioner must confirm in writing that they are satisfied that all of the requirements have been met

Medication management

  1. Person required to appoint contact person who will return medication if unused
  2. Medical practitioner must obtain a permit to prescribe the medication to the person
  3. Medication must be labelled for use, safe handling, storage and disposal
  4. Pharmacist also required to inform the person about administration and obligations
  5. Medication must be stored in a locked box

Administration

  1. Medication must be self-administered [except in exceptional circumstances]
  2. If physical incapacity, medical practitioner may administer
  3. Additional certification required if administered by medical practitioner
  4. Witness present if medical practitioner administers

Practitioner protections

  1. Health practitioner may conscientiously object to participating
  2. Explicit protection for health practitioners who are present at time of person self-administering
  3. Explicit protection for health practitioners acting in good faith without negligence within the legislation
  4. Mandatory notification by any health practitioner if another health practitioner acting outside legislation
  5. Voluntary notification by a member of the public of a health practitioner acting outside legislation

Mandatory reporting

  1. Reporting forms set out in legislation
  2. Reporting mandated at a range of points and from a range of participants to support accuracy
  3. First assessment reported [to Board]
  4. Second assessment reported [to Board]
  5. Final certification for authorisation reported [to Board, incorporates written declaration and contact person nomination]
  6. Additional form reported [to Board] if medication administered by medical practitioner
  7. Prescription authorisation reported by DHHS [to Board]
  8. Dispensing of medication reported [to Board]
  9. Return of unused medication to pharmacist reported [to Board]
  10. Death notification data reported [to BDM and collected by Board]

Offences

  1. New offence to induce a person, through dishonesty or undue influence, to request voluntary assisted dying
  2. New offence to induce a person, through dishonesty or undue influence, to self-administer the lethal dose of medication
  3. New offence to falsify records related to voluntary assisted dying
  4. New offence of failing to report on voluntary assisted dying
  5. Existing criminal offences for the crimes of murder and aiding and abetting suicide continue to apply to those who act outside the legislation

Oversight

  1. Guiding principles included in legislation
  2. Board is an independent statutory body
  3. Board functions described in legislation
  4. Board reviews compliance
  5. Board reviews all cases of [and each attempt to access] voluntary assisted dying
  6. Board has referral powers for breaches
  7. Board also has quality assurance and improvement functions
  8. Board has expanded multidisciplinary membership
  9. Board reports to publicly [to Parliament every six months for first two years, thereafter annually
  10. Five year review of the legislation
  11. Guidelines to be developed for supporting implementation

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