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Anglican archbishop Kanishka Raffel doesn't know the views of his own flock on VAD

I've written previously about bishops demonstrating their ignorance, as in the example of Catholic Bishop Tim Harris who presumed most or all of his flock opposes voluntary assisted dying (VAD), when in fact a significant majority support it. This time it's the Anglican Sydney diocese archbishop who's loudly flaunting his biases.

Sydney Anglican archbishop Kanishka Raffel (pictured on the diocese website above), has launched a program calling on NSW parliamentarians to reject a bill that, with a large number of safeguards, seeks to make VAD lawful in the state. NSW is the last state in the nation that still outlaws the practice.

The problem is, the archbishop is clearly backing his own personal beliefs and interests when he calls upon Anglicans to sign and share his petition calling for the unanimous rejection of the bill. That's because most Australian Anglicans, including those in NSW, support the law reform.

In 2019, academic pollsters VoxPop obtained the attitudes of more than 155,000 NSW voters regarding VAD. The views of NSW Anglicans are shown, by electorate, in Figure 1. Electorates with an asterisk are (with some very minor boundary differences) those within the archbishop's own diocese.

nswanglicansonvad2019.gifFigure 1: Attitudes of NSW Anglicans towards VAD law reform.
Source: VoxPop 2019. * Electorates in the archbishop's own diocese.

Immediately obvious is that most NSW Anglicans, including those in the archbishop's own diocese, are in favour of VAD law reform. That is, NSW MPs would be most wise to thoughtfully consider the bill and pass it. To oppose the bill would be to invite the wrath of most voters across all electorates in the state.

The archbishop might attempt to argue that his flock would change their minds if only they "understood". But that would be a hubris-based claim that those of differing views are somehow uninformed or mentally defective because they disagree.

Indeed, as I have written in a major research series about religiosity in Australia, this profound disconnect between senior clergy and their flocks is a key reason that Australians have been deserting religion in droves. That applies especially to the Anglican church, whose membership plummeted by 28% in just the fifteen years between the 2001 and 2016 censuses. And subsequent polling suggests it has fallen further since then.

To argue the "evils" of VAD, archbishop Raffel also teamed up with well-known Catholic anti-VAD campaigners Margaret Somerville and Father Frank Brennan. More of the usual connections...


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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 Guardian reports a fracas within the Anglican church over a $1m political expenditure.

Anglican and Catholic bishops seem to be going out of their way to alienate their constituencies, including in respect of voluntary assisted dying and marriage equality law reform. As a result, the writing on the wall is writ large for the continued decline of religion in Australia.

Many Australian clerics are trying their hardest to foil Parliamentary attempts to drag Australia into the 21st century on social policy. They seem to care little for the ongoing demise of their own constituencies.

Religion declining since the 1960s

Religious affiliation in Australia has been declining consistently since the 1960s, consecutive Australian Bureau of Statistics (ABS) census figures show (Figure 1). At the 2016 census, somewhat more than half (60%) of all Australians claimed a religion. More Australians than ever before identified as ‘no religion’ — for the first time ever a larger group than any single religious denomination.

Chart: Australian religious affiliation by census yearFigure 1: Australian religious affiliation by census year
Source: ABS

Weak religious commitment

Not only has religious affiliation been dropping, but the nature of the affiliation is weak (Figure 2). Amongst the two largest religious denominations, a quarter of Catholics (26%) and nearly half of Anglicans (47%) are Notionals: that is, they identify with the denomination but never attend religious services. More than half of Catholics (52%), and four in ten Anglicans (41%), attend religious services only occasionally (Occasionals: several times a year or less often).

Chart: Australian denominations and Australian religious identity (ARI-6)Figure 2: Australian denominations and Australian religious identity (ARI-6)
Source: Australian Election Study (AES) 2016

Just 22% of Catholics and a mere 12% of Anglicans demonstrate commitment to their denomination through dedicated service attendance (Regular = monthly or more often, and Devout = weekly or more often).

The picture is particularly grim for the Anglican church, dominant in Australia from Federation until the 1960s. With both a deeply impoverished affiliation rate in 2016 (13.3%), and just 12% of the flock dedicated to service attendance, a miniscule 1.6% of Australians are committed Anglicans.

The picture is only slightly better for the Catholic church. With 22.6% affiliation in 2016, and 22% of those committed to service attendance, it's a slightly larger but still damningly small 5.0% of Australians who are committed Catholics. Further, the Catholic church’s affiliation may be significantly lower at the next (2021) census, as Australians vent their dismay and disgust at how badly it’s handled the scourge of child sexual abuse that’s occurred under its ‘pastoral umbrella.’

Hollow ‘leadership’

Across all religious denominations, just 16% of Australians are committed to their denomination — Regular or Devout religious service attenders — while 30.1% Reject religion altogether.

And yet those at the head of their ships of faith still demand that we listen to and comply with their moral dictates, assuming that they have an automatic right to steer our morality in their own chosen direction. If they think they’re ‘leading,’ most Australians aren't following.

The indications are that they're going the way of Kodak, now a small, wan shadow of its former dominant self. If the Anglican and Catholic churches were companies with voting shareholders (or even not-for-profits with voting members), the Boards and executives (archbishops and bishops) would have been, for overseeing such profound and continuing erosion of their brand franchises, replaced long ago.

Entrenched rather than learning

You’d think all this would be a warning message to archbishops and bishops to seek to understand their flocks and build bridges for mutual understanding and engagement; to demonstrate a bit of flexibility in recognising alternative and equally respectable moral codes that were not established in ancient and very different times. But no.

Their recent performances on both voluntary assisted dying and marriage equality law reform suggest otherwise.

The fact is that to rebuild their franchises, the churches need to reach out to their Occasionals and to their Notionals — those who identify with the denomination but rarely if ever attend services. But the bishops have been pleasing only (some of) their Regulars and Devouts. It's a classic and literal case of “preaching to the converted.”

Voluntary assisted dying

In the matter of voluntary assisted dying (VAD) law reform, there are presently VAD Bills before both the NSW and Victorian parliaments. Figure 3 shows Australian attitudes toward VAD by religious affiliation.

Chart: Australian religious affiliation and attitudes toward voluntary assisted dyingFigure 3: Australian religious affiliation and attitudes toward VAD
Source: AES 2016

Opposition to VAD amongst most denominations is very small, and really only makes an appearance amongst minor Christian and non-Christian denominations. Just 10% of Catholics and 7% of Anglicans oppose VAD, 5% and 3% of them strongly.

Figure 4 shows the real story. Opposition to VAD amongst Rejecters, Socialisers, Notionals and Occasionals is almost non-existent, and support is in a huge majority (85% of Socialisers, 89% of Notionals and 78% of Occasionals). Opposition to VAD amongst religion Rejecters is less than 2%. That is, opposition to VAD is almost entirely religious, although religious opposers pretend their opposition is nothing to do with faith.

Chart: Australian religious identity (ARI-6) and attitudes toward voluntary assisted dyingFigure 4: Australian religious identity (ARI-6) and attitudes toward VAD
Source: AES 2016

Only amongst Regulars and Devouts does opposition to VAD make a real appearance. Yet even amongst Devouts, with the strongest opposition, it’s in the minority (47%).

And what have the bishops been doing? They’ve campaigned strongly against VAD, spreading misinformation. Take for example the Catholic Church’s latest version of its anti-euthanasia polemic ‘brochure’ (Figure 5).

The Catholic Church’s latest polemic brochure against voluntary assisted dyingFigure 5: The Catholic Church’s latest polemic brochure against VAD
Source: Catholic diocese of Byron Bay

This amateur production reveals a superficial understanding of the issues and a penchant for hyperbole. Worse, it employs significant misinformation in order to create FUD (fear, uncertainty and doubt), as does an advertisement taken out by a number of bishops from various denominations, in Melbourne’s major daily newspaper (Figure 6).

Chart: The June 2017 bishops' anti-VAD print advertisementFigure 6: The June 2017 bishops' anti-VAD print advertisement
Source: Herald Sun

The bishops’ manoeuvres will only alienate their congregation’s least committed members, the Notionals and Occasionals — the very people they should be wooing back to the pews, and who are strongly supportive of VAD as a valid and respectable response to intolerable and unrelievable suffering at end of life.

Perhaps the bishops would find this suggestion unpalatable, too much like a sales pitch. If that’s the case, one can only point out that selling the claim of saving of souls is the very task of evangelism. One could ask, “is your God likely to approve heartily of the continued withering of Australian faith?”

Marriage equality

The second contemporary example is marriage equality (ME). Figure 7 shows Australian attitudes to ME by religious denomination.

Chart: Australian religious affiliation and attitudes toward marriage equalityFigure 7: Australian religious affiliation and attitudes toward ME
Source: AES 2016. Note: There was no ‘neither/nor’ option in this survey question

A clear majority of Australians in all groups except minor Christian denominations support marriage equality. That includes 74% of Catholics, 63% of Anglicans and 60% of Uniting Church members.

Figure 8 shows attitudes toward marriage equality by religious identity.

Chart: Australian religious identity and attitudes toward marriage equalityFigure 8: Australian religious identity (ARI-6) and attitudes toward ME
Source: AES 2016

Support of marriage equality is in a clear majority amongst Rejecters (88%), Socialisers (82%), Notionals (73%) and Occasionals (71%). Around half (49%) of Regulars also support marriage equality.

Only amongst Devouts is support for marriage equality in the minority, with a quarter (25%) supporting and three quarters (75%) opposing it.

And what have the bishops been doing? They’ve run a massive campaign against marriage equality law reform. Indeed, the Anglican Archbishop of Sydney, Glenn Davies, announced that the diocese had donated, from precious church funds, $1 million to the ‘No’ campaign.

The public was even more dismayed to discover the diocese had granted just $5,000 to dealing with entrenched domestic violence in its ranks, at the same time as allocating the $1 million to preventing the equal expression of love.1

Given that marriage equality is almost certain to be legalised in Australia either directly after this voter ‘poll’ or in the term of the next Parliament, that’s an extraordinary squandering of a vast charitable sum for no net result. Calls have been made for the diocese’s tax-exempt status to be reviewed.

Substitute movements

In fact, so refractory has been the stance of many bishops, that Australians of faith have resorted to establishing their own networks outside the churches, for example Christians Supporting Choice for Voluntary Euthanasia, Australian Christians for Marriage Equality, and Australian Catholics for Equality.

Conclusion

The evidence is incontestable: opposition to VAD is almost completely religious, and opposition to ME is largely religious, despite protestations to the contrary.

Bishops’ conduct in relation to these reforms, which most Australians want, have been unhelpful by resisting Australia’s move into the 21st century — on the basis of ancient interpretations of scripture to which only a small minority of Australians subscribe.

The bishops' conduct has run strongly counter to the compassion and understanding they could have shown in order to engage the Notionals and Occasionals amongst their flocks; to halt the erosion of their religious capital, and to rebuild it.

These bishops most certainly don't represent the general views and beliefs of most Australians on VAD or ME. Rather, they give the appearance of administrators who are determined to preside over smaller and smaller congregations: a kind of “slow euthanasia.”

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  1. Gleeson, H 2017, Sydney Anglican church confesses to domestic abuse in its ranks, plans to reform with new policy, ABC News, viewed 10 Oct 2017, <https://www.abc.net.au/news/2017-10-10/sydney-anglican-church-to-unveil-domestic-abuse-policy/9033426>.

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

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

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

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

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

 

Transcript

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

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

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

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

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

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

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

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

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

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

Visit the YouTube page.

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

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

She provided no sources or evidence for her claim.

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

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

Transcript

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

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

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

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

Else Borst: And then it stopped.

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

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

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

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

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

Visit the YouTube page.

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

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

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

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

Transcript

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

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

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

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

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

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

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

Vice of Neil Francis: Margaret Somerville

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

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

Visit the YouTube page.

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antiassisteddyingadtheageheraldsun14jun08.gif

You only have to look to understand who is campaigning against your right to choose an assisted death in the face of intolerable and unrelievable suffering.

A case in point is a massive advertisement published in both of Melbourne’s daily newspapers: News Corp’s The Herald Sun (right-wing) and Fairfax Media’s The Age (left-wing). The ad was published in 2008 when Victorian MLC Colleen Hartland introduced the Medical Treatment (Physician Assisted Dying) Bill into the State legislature.

The Catholic Archbishop of Melbourne, Denis Hart, also sent the advertisement as a letter to all members of the Victorian Parliament.1

So, who are the advertisement’s signatories? I’ve listed them all in Table 1.
 

Table 1: Signatories to the 2008 Victorian anti-assisted-dying advertisement

Rt Rev. Graham Bradbeer
Moderator, Presbyterian Church of Victoria

The Rev. Fr Graeme A. Michell, FSSM
Parish Priest, Anglican Catholic Parish of St Mary the Virgin, Melbourne

Rev. Ross Carter
Uniting Church in Australia

Pastor Graham Nelson
Senior Pastor, Life Ministry Centre

Rev. Dr Max Champion
National Chair of the Assembly of Confessing Congregations within the Uniting Church in Australia

Rev. David Palmer
Convenor Church and Nation Committee, Presbyterian Church of Victoria

Pastor Mark Conner
Senior Minister of CityLife Church

Rev. Greg Pietsch
President, Victorian District, Lutheran Church of Australia

Dr Denise Cooper-Clarke
Adjunct Lecturer, Ridley Melbourne Mission and Ministry College

Marlene Pietsch
[Director of the Lutheran School of Theology]
Lutheran Church of Australia

Rabbi Dr Shimon Cowen
Director Institute for Judaism and Civilization

Very Rev. Dr Michael Protopopov
Dean - Russian Orthodox Church in Australia

Rev. Megan Curlis-Gibson
St Hilary’s Anglican Church, Kew

Marcia Riordan
Respect Life Office, Catholic Archdiocese of Melbourne

Archbishop Dr Philip Freier
Anglican Church of Melbourne

Metropolitan Archbishop Paul Saliba
Primate of Antiochian Orthodox Archdiocese of Australia, New Zealand & the Philippines

Imam Riad Galil
West Heidelburg Mosque
Member of the Victorian Board of Imams

Bishop Peter Stasiuk CSSR DD
Eparchy of Saints Peter and Paul of Melbourne, for Ukrainian Catholics in Australia and New Zealand

Rev. Father James Grant SSC
Chaplains Without Borders,
Melbourne Anglican Diocese

Dale Stephenson
Senior Pastor Crossway Baptist Church

Assoc. Professor Afif Hadj MB BS (Melb) FRACS
Director of Surgery, Director of Medical Training, Maroondah Hospital (A Monash University Teaching Hospital)

Pastor Peter Stevens
Victorian State Officer
Festival of Light Australia

Archbishop Denis Hart
Catholic Archdiocese of Melbourne

Dr Nicholas Tonti-Filippini
Associate Dean, JPII Institute for Marriage and Family Melbourne

Rev. Fr Geoff Harvey
Priest of the Good Shepherd Antiochian Orthodox Mission Parish, based at Monash University

Rob Ward
Victorian State Director Australian Christian Lobby

Assoc. Professor Rosalie Hudson
Aged Care & Palliative Care consultant/educator

Jim Zubic
President of Orthodox Chaplaincy Association

Peter McHugh
Senior Pastor Christian City Church, Whitehorse

Persons in blue: Career is religion

 

Almost all of them are religious by career

To save you a lot of time assessing who these people are, I’ve coloured in blue all the folks whose job it is to espouse religion — at least, their own hierarchy’s view of it.

That’s 27 of the 29 signatories who by career are intensely immersed in their own religious perspective of the world; established and promoted through institutional doctrine.

But what about the other two?

What about the other two signatories, Assoc. Prof. Afif Hadi and Assoc. Prof. Rosalie Hudson (in yellow)?

Notice that Prof. Afif Hadi’s entry lists only his surgery profession. Highly relevant, but not mentioned, is that he was President (previously Vice Chairman) of the Australian and New Zealand Board of Trustees, Antiochian Orthodox Archdiocese of Australia and New Zealand. As head of the Board of the Archdiocese, his religious signature is intimately entwined with another: Metropolitan Archbishop Paul Saliba, the Primate of the Antiochian Orthodox Archdiocese.

Assoc. Prof. Rosalie Hudson’s listing too, mentions only seemingly secular links. What is omitted is that she is or was Chair of the University of Divinity (a multi-faith religious institution) Human Research Ethics Committee, Secretary of the Uniting Church’s committee on bioethics, a member of the Interfaith Committee, and an Academic Associate at Charles Sturt University’s School of Theology.

Thus, both Prof. Hadi and Assoc. Prof. Hudson are also deeply rooted in religious faith. The point is not to make any criticism of their faith or practice, but merely to observe the deeply religious connections to opposing assisted dying law reform. It’s worth mentioning that both Hadi and Hudson do valuable charity work.

So, all of them are deeply religious

A pertinent question to ask is: ‘What proportion of the signatories are neutral, scholarly researchers who have studied the empirical evidence from jurisdictions where assisted dying is already lawful?’ Answer: None of them. Enough said.

And what proportion of the signatories to this anti-assisted dying advertisement are very deeply invested in organised religion? The simple answer is as usual: 100%, all of them.

Disconnected from their flocks

Critically, these career-religious fail to reflect the views of their own flocks. We know from repeated polls, for example, that three out of four Australian Catholics, more than three out of four Uniting Church members, and four out of five Anglicans (Church of England) support assisted dying law reform.

How have the religious hierarchy become so out of touch? Perhaps Mr Ian Wood, co-founder of Christians Supporting Choice for Voluntary Euthanasia might be able to offer his own insights.

This kind of clerical disconnect from the contemporary will of the people is one of the key reasons Australians are deserting religion in droves, as successive censuses show.

Conclusion

The evidence is irrefutable. Those who are actively organised to oppose your right to choose an assisted death are deeply religious, even when they use seemingly secular arguments (more on those later).

They are entitled to their opinions for themselves. But what right do they have to deny the vast majority of Australians, who do not agree with their views, the right to choose?

To phrase it in the personal, why does the Catholic Archbishop of Melbourrne, Denis Hart, think it appropriate to demand that Mr Geoff Drummond, a Buddhist, should have suffered against his will at the end of life for the Archbishop's version of faith, rather than Mr Drummond's own spiritual beliefs? Why does Rabbi Shimon Cowen think it appropriate to demand that Mr Alan Rosendorff, a fellow Jew, should have suffered against his will at the end of life for the Rabbi's version of faith, rather than Mr Rosendorff's own carefully-considered and deeply-held views? And why does Imam Riad Galil think it appropriate to demand that Mr Peter Short, not a Muslim, should have suffered against his will at the end of life for the Imam's beliefs, rather than his own?

Perhaps hubris remains alive and well amongst religious conservatives?

-----

Declaration: In fairness to those mentioned in this article, I openly declare that I am agnostic.

 

References

  1. Bradbeer, G, Rt Rev., Carter, R, Rev., Champion, M, Rev. Dr, Conner, M, Pastor, Cooper-Clarke, D, Dr, Cowen, S, Rabbi Dr, Curlis-Gibson, M, Rev., Freier, P, Archbishop Dr, Galil, R, Imam, Grant SSC, J, Rev. Fr, Hadj, A, Assoc. Prof., Hart, D, Archbishop, Harvey, G, Rev. Fr, Hudson, R, Assoc. Prof., McHugh, P, Michell, GA, Rev. Fr, Nelson, G, Pastor, Palmer, D, Rev., Pietsch, G, Rev., Pietsch, M, Protopopov, M, Very Rev. Dr, Riordan, M, Saliba, P, Metropolitan Archbishop, Stasiuk, P, Bishop, Stephenson, D, Stevens, P, Pastor, Tonti-Filippini, N, Dr, Ward, R & Zubic, J 2008, Reject physician assisted dying - An open letter to Victorian MPs, Catholic Archdiocese of Melbourne, viewed 13 Jun 2008, http://www.cam.org.au/Euthanasia.aspx.

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

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

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

Visit the YouTube page.

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St Patrick's Cathedral, Melbourne, Australia. Photo: Donaldytong

Against current moves to legalise assisted dying, Australian Catholic Father John George invokes Nazi Germany, resorts to ad hominem attacks to dismiss those who disagree with him, and demands that the Pope’s edicts are binding on everyone regardless of their own faith or world view.

On 24th September 2016, Journalists Greg Brown and Rick Morton published an article in The Australian, Victorian coroner credited with turning tide on euthanasia, summarising recent Australian moves to legalise assisted dying choice.

Catholic Father John George commented on the article online, quoting four sections of the Catholic Church’s catechism that prohibit assisted dying (sections 2276–9).

Pushback

Other readers of The Australian remarked that they respected his view for himself but they had no interest in the Pope’s views given the readers were not Catholic. In fact, repeated polls in Australia have shown that even the great majority of Catholics (three out of four) do not agree with the Vatican on the matter of assisted dying, a matter which Fr George dismisses merely as ‘fickle votes and polls.’

I would remind Fr George that these are not fickle: Australian public opinion in favour of assisted dying choice has been consistently in the majority for now more than four decades.

Fr George further quoted Catholic sources, for example the LJ Goody Bioethics Centre in Perth, Australia, which he failed to mention is, literally, an agency of the Catholic Archdiocese of Perth. He also selectively quoted Palliative Care Australia, failing to mention that they have acknowledged that not all pain and suffering can be eliminated at the end of life, even with the best palliative care.

Ad hominem attack

In response to a rising tide of objections to his musings, including from Mr Ian Wood, a fellow Christian and co-founder of Christians for Voluntary Euthanasia Choice, Fr George resorted to the ad hominem attack: to attack the person (or persons) rather than the arguments. He said:

“The pro euthanasia claque here make professional Nazi propaganda expert Goebbels look like a 5th rate amateur.” — Father John George.

For anyone in the dark, a claque is a group of sycophants hired to applaud a performer or public speaker. How rude. Fr George seems to have neglected to reflect that it is he who is hired to promote the performance of the Vatican. I applaud his right to do so, and I do not compare him to a treacherous propagandist in a murderous wartime regime in order to dismiss his arguments: I address the arguments themselves.

Nazi Germany

Fr George makes repeated mentions of Nazi Germany as a core reason to deny assisted dying choice.

In contrast, several years ago I was chatting at a conference with the pleasant and engaging Peter McArdle, then Research Director of the Australian Catholic Bishop’s Conference. He volunteered that he very much disliked the “Nazi Germany” argument so often used in religious circles, and wished it would stop because in so doing it meant they’d already lost the debate.

I agree. It’s a lazy and indefensible argument: that rational people in a functioning democracy must be denied choice for themselves on the basis of what some murderous regime did against others at the point of a gun.

Indeed, to rely on such a standard would be to equally argue against the right to religious practice, because the Catholic Church, through its inquisition practices (medieval C12th, papal C13th, Spanish C15th, Roman and Portuguese C16th) relied on torture and resulted in confiscation of property and at least tens (if not hundreds) of thousands of executions for witchcraft and heresy.

Ultimate hubris

But the real crux is that Fr George then unequivocally demands that:

“Principles elaborated by the pope are universally applicable.” — Father John George.

This ultimate hubris reveals a profound lack of self-reflection, both personally and organisationally. Even entertaining for a moment the premise that one individual (or even organisation) can tell everyone on the planet how they must live their lives, how would we choose that person or organisation? Why is it less valid for the head of any other branch of Christianity, of Judaism, Islam, Hinduism, Buddhism (or any other religion) or an agnostic (which I am) or an atheist, to set such rules for everyone, overriding other deeply-held beliefs and values?

A keener example of ‘blinded by faith’ would be hard to find.

Conclusion

I argue that Fr John George displays some of the gravest hubris of some members of the Catholic church. I respect and applaud his world views for himself and those who wish to subscribe. But using canonincal arguments (that is, religious arguments demanded as universally true by virtue of the supposed authority that dispensed them) is probably a major contributor to the current flight of people away from organised religion.

More happily, such an attitude is also contributing to accelerating the legalisation of assisted dying choice because folks can see these arguments for what they are. For that I doff my hat to Fr George.


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Back in 2013 the High Court of Ireland rejected a legal bid by multiple sclerosis sufferer Marie Fleming to achieve a lawfully-assisted peaceful death.

The Court naturally relied on expert testimony in reaching its judgement, yet its conclusions included a statement containing significant errors of fact.

The erroneous statement

In its judgement,1 the Court made the following statement:

Above all, the fact that the number of LAWER (“legally assisted deaths without explicit request”) cases remains strikingly high in jurisdictions which have liberalised their law on assisted suicide (Switzerland, Netherlands and Belgium) — ranging from 0.4% to over 1% of all deaths in these jurisdictions according to the latest figures — without any obvious official response speaks for itself as to the risks involved.” [My emphases in bold]

In fact, the Court's judgement is wrong on not one, not two, but three significant matters. But that hasn't stopped opponents of assisted dying law reform from quoting the judgement as though it were factual and persuasive, when it isn't: relying on it because it was made by a High Court—the 'authority bias.'

Consequences

Here are just a few examples of the Court's statement being wielded by assisted dying opponents as though it were conclusive evidence against law reform:

 
These examples illustrate the frequency of quoting the misinformation and how it feeds into and wrongly shapes public policy formation.

Three strikes

So what are the three counts on which the Court's judgement was seriously wrong?

Strike 1: Wrong concept

First, let’s get the concepts right. LAWER is not “legally assisted deaths without explicit request.”

Such nomenclature is an oxymoron. To ‘assist’ is to accommodate, serve or help someone accomplish something. But if there has been no request then one cannot be helping. You can’t ‘assist’ a little old lady across the road if she has expressed no interest in going there: you’d be forcing her across the road. Equally, you can’t ‘assist’ a death if there’s no proper ‘request.’

LAWER in fact stands for “Life-ending Acts Without Explicit Request” (of a competent patient).5 And with the exception of the possible ‘lawfulness’ of the doctrine of double effect, such acts are illegal.

Further, if such acts were legal as the Court’s statement posits, then there would be no need for an “obvious official response” as the Court then concludes. The statement lacks fundamental coherence.

Strike 2: Not ‘strikingly high’

The Court's judgement states unequivocally that LAWER (otherwise known as Non-Voluntary Euthanasia or NVE) rates in Switzerland, the Netherlands and Belgium are ‘strikingly high’, though no comparative yardstick is recorded in the judgement by which one might draw or justify that subjective judgement. Similar 'strikingly high' statements also appear in sections 102 and 104 of the judgement.

There is in fact a scientific study, published in The Lancet in 2003, that provides sound empirical evidence that could have properly informed the Court (Figure 1).6

Non-voluntary euthanasia in seven European countriesFigure 1: The non-voluntary euthanasia (NVE) rates of seven European countries in late 2001/early 2002

As revealed by this study, the NVE rates in Switzerland and the Netherlands were in fact lower than in Denmark, a country which has never had an assisted dying law.

The only country which did appear to have an NVE rate notably higher than the others was Belgium. The research study collected the data for analysis between June 2001 and February 2002. However, Belgium’s Euthanasia Act was not passed by its Parliament until 28th May 2002, well after data collection was complete. Thus, even in describing Belgium’s NVE rate as ‘strikingly high’ compared to a number of other European countries, it cannot be attributed to an assisted dying law because none existed at the time.

In fact, the NVE rate in Belgium had been found to be high back in 1998,7 well before the Bill for the country's Euthanasia Act was even tabled in Parliament.

Further, if assisted dying laws had such effects, it might be expected that the NVE rate would increase the longer that assisted dying laws were in place. In that case the NVE rates in Switzerland (statute since 1942) and the Netherlands (regulation since the early 1980s) would have NVE rates much higher than Belgium’s (statute since 2002). But the exact opposite is true.

Indeed, Rietjens and colleagues8 further concluded in their review of NVE in the Netherlands, Belgium, Denmark and Switzerland that “the use of drugs with the intention to hasten death without an explicit request of the patient is part of medical end-of-life practice in the studied countries, regardless of their legal framework, and it occurs in similar fashion.” The study, published in 2007, would also have been important evidence before the Court.

Strike 3: Not ‘remaining’ high

The Court's judgement states unequivocally that the LAWER (NVE) rate of the three countries ‘remains’ strikingly high. No specific evidence was supplied in the judgement to support this statement. Indeed, the judgement notes:

  • In section 28 that Dutch NVE had been “consistently declining.”
  • In section 91 that “the number of LAWER deaths has significantly declined in both [Dutch and Belgian] jurisdictions.”
  • In section 94 that “the trend in [Dutch] LAWER cases are declining in numbers (from 1,000 in 1990 to 550 in 2005)” and that in Belgium “the number of LAWER cases has declined since legalisation of assisted death.”
  • In section 101 that the NVE rates of both the Netherlands and Belgium had dropped.

 
Despite this clear and repeated evidence, the Court summarises in section 96 that the evidence cannot be “regarded as encouraging or satisfactory.”

But what does empirical research tell us about the NVE trends? In both the Netherlands and Belgium, since assisted dying was enshrined in statute and became effective in 2002, the rate of NVE has decreased significantly (Figure 2).7,9-11 In fact, the rate in the Netherlands is now similar to that in the UK, a country which has never had an assisted dying law and which provides the world’s gold standard in palliative care practice.

Non-voluntary euthanasia rates have decreased in the Netherlands and BelgiumFigure 2: Empirical trends in NVE rates before and after legalisation of assisted dying

These are critical yardsticks by which to judge practice in jurisdictions that have assisted dying laws with jurisdictions that don't. The UK study was published in 2009 and was readily available prior to the High Court’s hearings, yet appears not to have been presented in evidence.

The final (2010) Dutch NVE statistic in Figure 2 may or may not have been available to the Court: it was published in 2012 around the time the Court was taking evidence. The final (2013) Belgian statistic would not have been available to the Court as it was published in 2015.

Conclusion

While the High Court worked diligently within the scope of evidence brought before it:

  • The Court’s definition of LAWER is incorrect and incoherent;
  • Its statement that the NVE rates of the Netherlands and Switzerland are ‘strikingly high’ are evidentially wrong when compared with other countries without assisted dying laws;
  • Its implication that the higher NVE rate in Belgium was caused by assisted dying law reform is evidentially wrong; and
  • Its statement that the rates remain high is evidentially wrong.

 
The High Court's judgement does not provide defensible evidence or argument against assisted dying law reform.

Many lobbyists have repeated these incorrect statements, significantly misleading media, policy makers and legislators.

Now that the facts are readily available it’s appropriate to avoid repeating evidentially wrong statements, regardless of the apparent 'authority' of their source.
 

Summary of facts

  1. LAWER stands for "Life-ending Acts Without Explicit Request". Its practice is similar in countries with and without assisted dying laws.
  2. The NVE rates in the Netherlands and Switzerland are lower than the rate in Denmark, a country which has never had an assisted dying law.
  3. The NVE rate in Belgium appears higher, but was so long before assisted dying law reform and so cannot have been caused by such a law.
  4. The NVE rates of the Netherlands and Belgium have both decreased significantly since their assisted dying statutes came into effect in 2002.

References

  1. High Court of Ireland 2013, Fleming v Ireland & Ors - Determination, [2013] IEHC 2, Dublin.
  2. Boudreau, JD, Somerville, MA & Biller-Andorno, N 2013, 'Physician-assisted suicide: should not be permitted/should be permitted', New England Journal of Medicine, 368(15), pp. 1450-1452.
  3. Somerville, M 2016, 'Killing as kindness: The problem of dealing with suffering and death in a secular society', The Newman Rambler, 12(1), pp. 1-26.
  4. Keown, J 2014, 'A right to voluntary euthanasia? Confusion in Canada in Carter', Notre Dame Journal of Law, Ethics & Public Policy, 28(1), pp. 1-45.
  5. Pijnenborg, L, van der Maas, PJ, van Delden, JJM & Looman, CW 1993, 'Life-terminating acts without explicit request of patient', Lancet, 341(8854), pp. 1196-1199.
  6. van der Heide, A, Deliens, L, Faisst, K, Nilstun, T, Norup, M, Paci, E, van der Wal, G & van der Maas, PJ 2003, 'End-of-life decision-making in six European countries: descriptive study', The Lancet, 362(9381), pp. 345-350.
  7. Bilsen, J, Cohen, J, Chambaere, K, Pousset, G, Onwuteaka-Philipsen, BD, Mortier, F & Deliens, L 2009, 'Medical end-of-life practices under the euthanasia law in Belgium', New England Journal of Medicine, 361(11), pp. 1119-1121.
  8. Rietjens, JA, Bilsen, J, Fischer, S, Van Der Heide, A, Van Der Maas, PJ, Miccinessi, G, Norup, M, Onwuteaka-Philipsen, BD, Vrakking, AM & Van Der Wal, G 2007, 'Using drugs to end life without an explicit request of the patient', Death Studies, 31(3), Mar, pp. 205-21.
  9. Seale, C 2009, 'End-of-life decisions in the UK involving medical practitioners', Palliat Med, 23(3), pp. 198-204.
  10. 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.
  11. Chambaere, K, Vander Stichele, R, Mortier, F, Cohen, J & Deliens, L 2015, 'Recent trends in euthanasia and other end-of-life practices in Belgium', N Engl J Med, 372(12), pp. 1179-1181.
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