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

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

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

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

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

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

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

But then…

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

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

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

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

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

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

And yet more

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

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

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

Who are these people?

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

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

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

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

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

The editor — Timothy Devos

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

Foreword 1 — Jacques Ricot

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

Foreword 2 — Margaret Somerville

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

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

Foreword 2 — Wesley Ely

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

Contributor — Eric Vermeer

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

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

Contributor — Catherine Dopchie

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

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

Contributor — Willem Lemmens

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

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

Contributor — An Haekens

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

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

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

Contributor — Rivka Karplus

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

Contributor — Marie Frings

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

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

Contributor — Benoit Beuselinck

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

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

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

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

Contributor — Julie Blanchard

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

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

Contributor — François Trufin

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

Religious petticoats and the Catholic Communicator’s Guild

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

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

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

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

Not the first time it’s been published

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

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

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

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

So: who paid for the book?

Conclusion

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

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

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

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


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

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

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

Australian Care Alliance gets the basics wrong

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

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

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

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

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

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

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

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

 
All these assumptions are patently false.

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

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

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

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

Cherry-picked overseas data, too

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

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

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

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

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

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

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

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

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

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

Enough of that.

Branka van der Linden cherry-picks, too

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

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

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

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

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

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

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

The actual numbers

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

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

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

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

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

Update 19-Mar-2021

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

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

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

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

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

Interpreting suicide data correctly

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

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

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

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

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

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

Getting all the numbers right

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

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

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

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

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

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

Don't get carried away

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

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

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

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

Conclusion

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

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

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


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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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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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Branka van der Linden on the "HOPE" website.

HOPE’s Director, Branka van der Linden, is at it again, foisting more misleading information about voluntary assisted dying (VAD) on unwilling members of Parliament. I expose the rot and provide some background on Mrs van der Linden.

Van der Linden’s latest email to all WA MPs states:

Subject: WA Report relies on troubling Belgian study

 
[MP Salutation] --

Did you know that a study showing that one person in Belgium is euthanised every three days without their explicit consent also found that:

  • in more than 77 per cent of cases, the decision was not discussed with the patient;
  • in more than half of cases, the patient had never expressed a desire for their life to be ended; and
  • in more than half of the cases, the reason given was because killing the patient was the wish of the family?

 
Did you know that the WA majority report cited this study as evidence of assisted suicide and euthanasia reducing the incidence of unlawful activity?

Warm regards,

Branka van der Linden
Director, HOPE

 
Van der Linden’s method is to create an impression of calumny against VAD law reform. She uses a nice PR formula of three bullet points per communication. With repetition. It’s a method I expressly warned the WA Parliament to watch out for in my submission to its inquiry. The growing list of emails is now starting to look like ‘harassment’.

So let’s look at van der Linden’s claims — again. She’s talking about non-voluntary euthanasia (NVE) — again.

In her email to MPs, she complains that the WA majority report on end-of-life choices cited the study as evidence of the NVE rate reducing when VAD is legalised.

Well, the WA majority report formed that correct conclusion because that’s precisely what the cited study reported: drops in the NVE rates in both the Netherlands and Belgium after their euthanasia Acts came into effect in 2002.

While concerns ought to be expressed about the deliberate hastening of death without an explicit request from the patient with a view to improving knowledge and practices, it’s not caused by VAD laws as van der Linden desperately tries to imply.

Here are highly relevant things the cited study’s authors had to say, but van der Linden astonishingly ignores:

“The use of life-ending drugs without explicit patient request are not confined to countries where physician-assisted death is legal.”; and

“[NVE’s] occurrence has not risen since the legalisation of euthanasia in Belgium. On the contrary, the rate dropped from 3.2% in 1998 to 1.8% in 2007. In the Netherlands, the rate dropped slightly after legalization, from 0.7% to 0.4%” [The Belgian rate was 1.7% in a more recent replication of the research.]; and

The NVE cases found in the study “in reality resembles more intensified pain alleviation with a ‘double effect’, and death in many cases was not hastened.”

But let’s not let the facts get in the way of a good story. Van der Linden’s recent emails about VAD to MPs reveal astonishing ignorance and a willingness to overlook critical evidence contrary to her position, contained in the very source she cites.

The superficiality of her cherry-picking is kind of embarrassing: she holds an arts/law degree from Australian National University, so you’d expect more intelligent engagement.

It begs the question: who is Branka van der Linden? The “HOPE” website reveals little if anything.
 

Who is Branka van der Linden?

Branka Van der Linden is the current Director of anti-VAD website “HOPE (Preventing euthanasia and assisted suicide)”. HOPE is an initiative of the Australian Family Association, a Catholic lobby group established by Australia’s most famous lay Catholic, B. A. Santamaria.

HOPE’s founding Director and van der Linden’s predecessor, was Mr Paul Russell, the former Senior Officer for Family and Life at the Catholic Archdiocese of Adelaide.

It turns out that Branka van der Linden (née Seselja) is a sister of Catholic ACT Senator Zed Seselja who voted against David Leyonhjelm's recent Restoring Territory Rights (to legislate on VAD) Bill. But there’s more. Far more.

Branka, who attended Catholic St Clair’s College primary school and Padua Catholic High School, both in the ACT, is a “senior lawyer” at the Truth Justice and Healing Council, which provides services to the Australian Catholic Bishop’s Conference and Catholic Religious Australia in relation to the Catholic Church’s response to the Royal Commission into Institutional Responses to Child Sexual Abuse.

She’s advisory legal counsel for the lay Catholic St Vincent de Paul Society Canberra/Goulburn Territory Council. (And good on her for supporting this philanthropic work.)

She and her husband Shawn represent (or at least represented) the Australian Catholic Marriage and Family Council, and were representatives of the Catholic Archdiocese of Canberra & Goulburn on the National Family Pilgrimage to the (Catholic) World Meeting of Families in Philadelphia in 2015.

Husband Shawn has been described by the church as a “loyal Catholic servant” for nine years of service as the director of CatholicLIFE at the Catholic Archdiocese of Canberra and Goulburn.

And as if this weren’t clear enough, a sample of Branka’s Facebook Likes is equally informative:

A sample of Branka van der Linden’s Facebook Likes

  • Archbishop Anthony Fisher (Catholic)
  • Archbishop Samuel J. Aquila (Catholic)
  • Archbishop Mark Coleridge (Catholic)
  • Bishop Robert Barron (Catholic)
  • Marist College Canberra Faith Formation (Catholic)
  • St Thomas the Apostle Kambah (Catholic)
  • Campion College (Catholic)
  • Teaching Catholic Kids
  • Ascension (Catholic Church)
  • CathFamily
  • St Therese of Lixieux (Catholic)
  • Dominican Sisters of Saint Cecilia in Australia (Catholic)
  • Fusion Youth Group (Catholic)
  • St Clare’s College (Catholic)
  • Marist Canberra Football Club (Catholic)
  • Light To The Nations (Catholic)
  • Catholic Voices USA
  • Centre for Faith Enrichment (Catholic)
  • World Meeting of Families 2015 (Catholic)
  • Quidenham Carmelite Monastery (Catholic)
  • Denver Catholic
  • Catholic Mission – Canberra & Goulburn
  • XT3 (Catholic youth association)
  • Missionaries of God’s Love Darwin (Catholic)
  • Marist College Canberra (Catholic)
  • Life, Marriage & Family Office (Catholic)
  • Infant Jesus Parish, Morley (Catholic)
  • MGL Priests and Brothers (Catholic)
  • Catholic Mission – Sydney, Broken Bay, Parramatta
  • Youth Mission Team Australia (Catholic)
  • Summer School of Evangelisation – Bathurst (Catholic)
  • Missionaries of God’s Live Sisters (Catholic)
  • Sisterhood National Catholic Women’s Movement
  • My Family My Faith (Catholic)
  • Catholic Talk
  • The Catholic Weekly
  • The Catholic Leader
  • Mercatornet (Catholic blog site)
  • BioEdge (Catholic blog site)

It’s clear that Branka van der Linden, like her predecessor Paul Russell, is very deeply invested in Catholic tradition. I will be the first to say I firmly believe that is entirely her right.

Yet how curious it is that while repeatedly advancing (secular) misinformation about VAD, Branka van der Linden doesn’t mention her profound religious convictions. It's surprisingly similar to the approach evidenced by Catholic Professor of Ethics, Margaret Somerville; and Catholic (then) Victorian MP Daniel Mulino; and Catholic Editor of The Australian, Paul Kelly (who warmly quotes Mulino); and Catholic director of the Euthanasia Prevention Coalition, Alex Schadenberg...

You get the idea: perhaps there's a pattern?

One possible source of pattern

What was it that the Catholic Archbishop of Sydney, Anthony Fisher, said at the 2011 Catholic Bioethics Conference in relation to opposing the legalisation of VAD?

"The most effective messengers may also vary: bishops, for instance, are not always the best public spokespeople for the Church on such matters."; and

"...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 also and carefully consider who should deliver them, where and how."

Nowhere in his address does Fisher propose actually testing whether his calamitous assumptions about VAD are true.

Gosh, another coincidence.

Epilogue

I want to be absolutely clear that I am not using a person’s religious conviction as a reason to dismiss their ideas. That’s called an ad hominem attack: an attack against the person rather than the substance of the argument (even assuming it has any substance to assess).

What I have done here and elsewhere, and I will continue to do, is to expose arguments that are false, misleading, illogical or otherwise unmeritorious on the basis of empirical evidence and reasoning.

It just turns out that organised misinformation against VAD law reform comes from deeply religious circles, and those religious circles often avoid mentioning their religiosity while spreading such nonsense under a ‘veneer of secularism’.

It’s in the public’s interest to understand where most organised misinformation against VAD comes from.


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An article in 'Anasthesia' did NOT find high rates of regaining consciousness in contemporary VAD practice.

A recent article by Sinmyee et al, "Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying", published in the journal Anasthesia1 was an attempt to identify a professional standard for inducing and maintaining unconsciousness prior to voluntary assisted dying (VAD) death, a laudable aim.

However, the authors’ underlying premise of contemporary VAD practice failing to reliably maintain unconsciousness — potentially leading to 'inhumane deaths' — is not established by their cited sources. They cite exactly three sources to establish their claim: their citations 31, 32 and 33.

Citation 31 — Iserson et al 1992

This is a qualitative article by Ken Iserson and colleagues.2 Published in 1992, it outlines a single case of assisted suicide, forming the backdrop for several Californian ethics committees to comment.

Not only was this a single case rather tha a sample of dozens or hundreds of cases, but assisted dying was illegal right across the USA in 1992 and earlier. Therefore, the article is wholly uninformative to contemporary practice under assisted dying laws.

Citation 32 — Groenewoud et al 2000

This is a study by Johanna Groenewoud and colleagues.3 Published in 2000, it analyses Dutch data collected between 1990 to 1996 — long before the Netherlands’ 2001 euthanasia Act, which came into effect in 2002.

In 1997 the Dutch medical association (KNMG) formed the Support and Consultation on Euthanasia in Amsterdam (SCEA) network to assist doctors implement the practice more reliably. The successful program was made national (…in the Netherlands, SCEN) in 1999, with a four-year implementation resulting in strong consultation and positive outcomes.4

In addition, the KNMG and Dutch pharmacy association (KNMP) have improved their guidelines for euthanasia practice since 1996: in 1998, 2007 and most recently in 2012.5 Independent studies show that use of opioids (inappropriate method) was high in the Netherlands in 1995-96,6 but replaced entirely with (appropriate) barbiturates and neuromuscular relaxants in reported VAD cases in 2010.7

The most recent published report of the Dutch Euthanasia Commission, which assesses every reported case of VAD, did not note any failures of the VAD procedures.8

Citation 33 — Lalmohamed & Horikx 2010

This is a study by Arief Lalmohamed and Annamieke Horikx, published in 2010, of doctor responses to a survey the KNMP conducted between 2007 and 2009.9 The study reported on issues with the storage, preparation and administration of VAD drugs. It noted that the recommended dose of Thiopental was increased from 1500mg to 2000mg so that patient-dependent dosages need not be calculated.

The study noted one negative experience for some patients: pain on injection of Thiopental. Recommendations were made for preparation and administration of the drug to avoid this problem. No other negative patient outcomes were reported.

The upshot

Thus, of the three sources the authors employed to make the case of a significant and systematic problem in the conduct of contemporary VAD cases, none did so: the first was a single case outside the law in the early 1990s, the second a study from the early to mid 1990s from whence contemporary practice has greatly improved, and the third a 2010 pharmacological investigation that found some patients experiencing pain on injection and recommending improvements to avoid it. Nevertheless, Sinmyee et al concluded that:

“For all these forms of assisted dying, there appears to be a relatively high incidence of vomiting (up to 10%), prolongation of death (up to 7 days), and reawakening from coma (up to 4%), constituting failure of unconsciousness.”

These assertions are highly misleading in regard to contemporary VAD practice.

The most recent Oregon Death With Dignity Act annual report, covering all cases from 1997 to early 2019 reports that just eight of 1,467 deaths where lethal medication was consumed, resulted in the patient regaining consciousness.10 That’s an efficacy rate of 99.5%, a high standard for a medical procedure.

There have been no cases of regaining consciousness in Washington state under their Death With Dignity Act.11

In comparison, regaining consciousness under professional surgical anaesthesia is a problem12 with an incidence rate of around 0.13% in the USA13 though the rate appears to be much lower in the UK.14 Even over-the-counter analgesics like paracetamol, ibuprofen and aspirin have significant adverse effects rates of 14.5%, 13.7% and 18.7% (respectively).15

From unsubstantiated to polemical

While Sinmyee and colleagues were attempting, via their article in Anasthesia, to argue the case for improved VAD practice, it was inevitable that ginger groups opposing the legalisation of VAD would commandeer cherry-picked extracts from the article to further their cause, painting a picture of disaster and mayhem.

Sure enough, the Catholic-backed Euthanasia Prevention Coalition’s Alex Schadenberg ran with it, cherry picking the “190 times higher” rate the authors claim for “failure of unconsciousness” using their invalid citations. Schadenberg conspiratorially concluded that “the laws are designed to cover-up [sic] problems with the law”.16

Also, predictably, Catholic-backed HOPE’s Branka van der Linden followed suit, plucking quotes like “…failure rates of assisted dying by these other methods seems extraordinarily high” without similar context.17

It’s disappointing that the original article with its misleading statistics based on figures plucked from a single historical article and in the absence of considering significant intervening improvements, passed peer review. Its misinformation led to more nonsense being energetically pedalled by anti-VAD campaigners.

 

References

  1. Sinmyee, S, Pandit, VJ, Pascual, JM, Dahan, A, Heidegger, T, Kreienbühl, G, Lubarsky, DA & Pandit, JJ 2019, 'Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying', Anaesthesia, 74(5), pp. 630-637.
  2. Iserson, KV, Rasinski Gregory, D, Christensen, K & Ofstein, MR 1992, 'Willful death and painful decisions: A failed assisted suicide', Cambridge Quarterly of Healthcare Ethics, 1(2), pp. 147-158.
  3. Groenewoud, JH, van der Heide, A, Onwuteaka-Philipsen, B, Willems, DL, van der Maas, PJ & van der Wal, G 2000, 'Clinical problems with the performance of euthanasia and physician-assisted suicide in the Netherlands', New England Journal of Medicine, 342(8), pp. 551-556.
  4. Jansen-Van Der Weide, MC, Onwuteaka-Philipsen, BD & Van Der Wal, G 2004, 'Implementation of the project 'Support and Consultation on Euthanasia in the Netherlands' (SCEN)', Health Policy, 69(3), pp. 365-373.
  5. KNMG/KNMP 2012, Guidelines for the practice of euthanasia and physician-assisted suicide, Utrecht, pp. 56.
  6. van der Maas, PJ, van der Wal, G, Haverkate, I, de Graaff, CL, Kester, JG, Onwuteaka-Philipsen, BD, van der Heide, A, Bosma, JM & Willems, DL 1996, 'Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995', N Engl J Med, 335(22), pp. 1699-705.
  7. Onwuteaka-Philipsen, BD, Brinkman-Stoppelenburg, A, Penning, C, de Jong-Krul, GJF, van Delden, JJM & van der Heide, A 2012, 'Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey', The Lancet, 380(9845), pp. 908-915.
  8. Regional Euthanasia Review Committees (Netherlands) 2018, Annual report 2017, Arnhem, pp. 66.
  9. Lalmohamed, A & Horikx, A 2010, '[Experience with euthanasia since 2007: Analysis of problems with execution] Ervaringen met euthanastica sinds 2007: Onderzoek naar problemen in de uitvoering', Ned Tijdschr Geneeskd, 154(A1983), pp. 1-6.
  10. Oregon Health Authority 2019, Oregon Death With Dignity Act: 2018 data summary, Department of Human Services, Portland, pp. 16.
  11. Washington State Department of Health 2018, Washington State Department of Health 2017 Death with Dignity Act Report, Olympia, WA, pp. 15.
  12. Cook, TM, Andrade, J, Bogod, DG, Hitchman, JM, Jonker, WR, Lucas, N, Mackay, JH, Nimmo, AF, O'Connor, K, O'Sullivan, EP, Paul, RG, Palmer, JH, Plaat, F, Radcliffe, JJ, Sury, MR, Torevell, HE, Wang, M, Hainsworth, J, Pandit, JJ, Royal College of, A, the Association of Anaesthetists of Great, B & Ireland 2014, 'The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent and medicolegal issues', Anaesthesia, 69(10), pp. 1102-16.
  13. Sebel, PS, Bowdle, TA, Ghoneim, MM, Rampil, IJ, Padilla, RE, Gan, TJ & Domino, KB 2004, 'The incidence of awareness during anesthesia: A multicenter United States study', Anesthesia & Analgesia, 99(3), pp. 833-839.
  14. Thomas, G & Cook, TM 2016, 'The United Kingdom National Audit Projects: a narrative review', Southern African Journal of Anaesthesia and Analgesia, 22(2), pp. 38-45.
  15. Moore, N, Ganse, EV, Parc, J-ML, Wall, R, Schneid, H, Farhan, M, Verrière, F & Pelen, F 1999, 'The PAIN Study: Paracetamol, Aspirin and Ibuprofen new tolerability study', Clinical Drug Investigation, 18(2), pp. 89-98.
  16. Schadenberg, A 2019, Assisted dying can cause inhumane deaths, Euthanasia Prevention Coalition, viewed 25 Feb 2019, http://alexschadenberg.blogspot.com/2019/02/assisted-dying-can-cause-inhumane-deaths.html.
  17. van der Linden, B 2019, The "myth" of a pain-free euthanasia death, HOPE, viewed 22 Mar 2019, https://www.noeuthanasia.org.au/the_myth_of_a_pain_free_euthanasia_death.
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The Canadian Medical Association (CMA) has quit the World Medical Association (WMA) over assisted dying and plagiarism.

The WMA has long held that assisted dying is unethical and must be condemned by the medical profession, despite a significant proportion of contemporary doctors believing it to be a valid and ethical option in restricted circumstances.

Assisted dying is lawful in Canada, where it is called Medical Assistance in Dying (MAiD).

The CMA has resigned from the WMA, citing a bad case of plagiarism by the current WMA head, but also reporting its considerable displeasure with the WMA's one-sided policy on MAiD.

This is the first example of a member medical society resigning from the WMA in part due to its assisted dying policy, and speaks volumes about medicine's slow but inevitable move to recognise patient well as doctor moral perspectives.

Predictably, Dr Kulvinder Gill (AKA Kulvinder Kaur) from tiny ginger group “Concerned Ontario Doctors”,1 which is strongly opposed to Canada's asssited dying law, slammed the CMA's resignation, claiming that the withdrawal leaves Canada's doctors "without international ethical oversight."

It's shabby framing to impute that Canadian doctors can't practice ethically without some kind of international Big Brother tapping in to their stethoscopes. Perhaps "Concerned Ontario Doctors" believes the Vatican should be monitoring and dictating doctors' conduct?

Predictably too, the Catholic church, with Dr Gill among them, as been actively advancing the right for doctors to ignore legal and valid patient requests to be considered for MAiD, refusing to refer them to other doctors for assessment.

The WMA will eventually have to update its stance to neutral, to honour the range of deeply-held perspectives across the medical spectrum instead of attempting to impose the views of just one end.


1 I was unable to find any other member or spokesperson for this “group” other than Kulvinder.


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