Rhetoric: Slippery slope

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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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Catholic Archbishop of Canberra/Goulburn Christopher Prowse. CC: Bart-1011

Last month, the Catholic Archbishop of Canberra & Goulburn, Christopher Prowse, published an opinion piece about VAD in the Canberra Times. Naturally, Prowse's views were opposed, which is fine. A range of views is always welcome. Misinformation, however, is not.

It would be unreasonable to expect that the opinion editor of the Canberra Times, Andrew Thorpe, would be intimately versed in the empirical evidence about voluntary assisted dying (VAD). So, it was reasonable that he publish an opinion piece on the topic offered by Archbishop Prowse. What is not reasonable, however, is that the counter-opinion I promptly submitted, pointing out several points of significant misinformation, was not published. A month later, still nothing.

A critical feature of high-quality, mainstream media journalism (which includes editorialism) is to ensure that the public can be exposed to a range of views on important topics, and that those views are generally devoid of significant misinformation. I argue that the Canberra Times has profoundly failed in this instance, and could profitably reflect on improving its conduct.

Here's the op-ed I sent, which they failed to publish.

 

Archbishop Prowse sadly misinformed on assisted dying

Catholic Archbishop Christopher Prowse’s recent editorial against voluntary assisted dying (VAD) (Canberra Times, 11 Aug) contains numerous items of misinformation about the practice. While a range of views is welcome, misinformation is not an acceptable standard in public debate about such an important topic.

Unsurprisingly, Archbishop Prowse argues that more palliative care is “the answer” to end-of-life suffering. This ignores formal statements by both Palliative Care Australia and the Australian and New Zealand Society for Palliative Medicine acknowledging that even the best palliative care can’t address all extreme suffering. It’s not like he wouldn’t know: the Catholic church is the largest single institutional provider of palliative care services in the nation.

His editorial also paints VAD deaths as “fearful”, “depressed” and “lonely”. This not only contradicts evidence published in peer-reviewed scientific research and official reports from lawful jurisdictions, but is a slap in the face to those who have chosen a VAD death, and to their families.

For example, the second person to use WA’s VAD law was Mary-Ellen Passmore. Her family and friends gathered to say farewell and sang Hallelujah together during her final moments. Loved ones of those who have accessed VAD in Victoria have described the experience as “peaceful” and “beautiful”.

Ms Passmore was also an indigenous community leader. This is relevant because Prowse argues that indigenous Australians would be fearful of VAD law, avoiding needed medical services.

This old chestnut has been rattling around since the Northern Territory VAD days in the 1990s, but was dismissed as false after a formal investigation found no change in indigenous medical service attendance. Indeed, a parliamentary inquiry heard that it was church members [not referring to Prouse or his diocesan colleagues] who were causing any indigenous fears.

Prowse also enlists “elder abuse” into his supposed army of the “vulnerable”. But a key feature of elder abuse is that it’s commissioned in secret, while VAD has numerous points of assessment, referral, review and documentation by trained professionals.

Perhaps the most egregious misrepresentation is his claim that “reasons for euthanasia quickly expand once legalised”, levelling specific claims about the Netherlands.

In fact, the Netherlands made VAD lawful by regulation in the mid-1980s. Several test cases in following years clarified that certain conditions (like extreme and unrelievable mental suffering) qualified under the regulations. These were formalised (not changed) in legislation in 2001. And that legislation hasn’t changed since. Not. One. Word.

One could be forgiven for thinking that the archbishop represents the views of Catholic Australians. But this isn’t true either. ANU studies show that some three quarters of Catholic Australians support lawful VAD.

I analysed the major 2019 data set of VoxPop — the academics who run VoteCompass — about VAD attitudes in the archbishop’s own archdiocese. It comprises the ACT and the NSW electorates of Bega, Cootamundra, Goulburn, Monaro, and about a third of Wagga Wagga.

With a VoxPop respondent count across the archdiocese of more than 34,000 people, four out of five voters favour lawful VAD with just 9% opposed. Not only that, but more than three out of four Catholic voters (76%) in the archdiocese favour lawful VAD, with just 13% opposed.

canberravadattitudes2019.gif
Voter attitudes toward VAD in the Canberra-Goulburn Catholic Archdiocese
Source: VoteCompass/VoxPop 2019.
~ Archdiocese totals weighted by elector count per district, Wagga Wagga weighted as 1/3 of.

Thus, not only does Archbishop Prowse seem unfamiliar with VAD facts, he seems remarkably unacquainted with the real views of his own flock.

Prowse argues that we are all “made in the image of God so we have dignity”. As an agnostic I’m happy for him to believe such things, though I say that everyone has dignity and life is precious regardless.

But when the archbishop proclaims that allowing VAD is “abandonment” of the person and that his views must prevail over all Australians, I call out hubris. “Abandonment” is to deliberatively seek to quash the deeply-held values and beliefs of others.

Most Australians, including Catholic ones, agree.

 


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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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'HOPE' is pedalling assisted dying misinformation to politicians again.

The Catholic-backed anti-assisted-dying ginger group, HOPE, was represented for years by Paul Russell. He's retired and Branka van der Linden is now at the helm. But its penchant for pedaling egregious misinformation hasn't changed. Van der Linden recently sent an email to all WA members of parliament, containing three points.

Van der Linden's email reads:

 

Dear [MP salutation],

Did you know that the WA majority report that recommended assisted suicide for WA either dismissed or failed to report on the following statistics?

  • In the Netherlands in 2015, 431 people were euthanised without their explicit consent.
  • In Belgium, 8 per cent of all deaths were without explicit consent from the patient.
  • In Oregon in 2017, the ingestion status of 44 (out of 218) patients was ‘unknown’, making it impossible to ascertain if these 44 patients ended their lives voluntarily and without coercion.

Yours faithfully,

Branka van der Linden

Director, HOPE

 

The trouble is, all three claims by van der Linden are either directly false or egregiously misleading. Here are the actual facts:

FACT: Peer-reviewed scientific research shows that the non-voluntary euthanasia rate of both the Netherlands and Belgium has dropped significantly since their assisted dying Acts came into effect in 2002, consistent with more careful end-of-life decision making across the board.

Fiction 1: van der Linden improperly cherry-picked a single year’s statistic for each country (and, incoherently, a raw count for one but a percentage for the other), implying that lawful voluntary euthanasia increases non-voluntary euthanasia, when the opposite is true.

Fiction 2: van der Linden claimed Belgium’s non-voluntary euthanasia rate is 8%. It has never been anywhere near that figure: the most recent figure is 1.7% and it was 3.2% before Belgium’s euthanasia law.

FACT: Oregon’s health department actively matches death certificates with prescriptions issued for assisted dying. At any time some prescriptions have not been taken and the person may still be alive, and for the deceased, death certificates are still being processed. This naturally means that some prescription/death statuses will temporarily be ‘unknown’ to authorities, even though they will be later determined.

Fiction 3: van der Linden comically implies that this proper process is sinister.

It's curious how 'HOPE' likes to repeatedly demonstrate how HOPElessly uninformed it is about the actual facts and that its methods include cherry-picking data which it thinks supports its anti-assisted dying case, but which don't.

Western Australians deserve better than HOPE's silly propaganda campaign.


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The Age reports on the three AMA dcotors' appearance at Spring Street

As reported in The Age, on Tuesday this week three AMA doctors fronted the Victorian Parliament to spread the word about their perceived horrors of an assisted dying law. Their arguments don’t hold water and politicians should see them for what they are: utter nonsense.

Doctors Stephen Parnis, Mukesh Haikerwal and Mark Yates say they will continue to lobby politicians.

With what?

Here is the ‘substance’ of their arguments — a sticky blomonge of the same old confected and discredited claims.

The vulnerable will be at risk

Dr Parnis said that such a law “puts the most frail and vulnerable in our community — the dying — at profound risk,” pointing to coercion, and patients not getting the medical care they need.

As I’ve explained before, the claim is flapdoodle — circular nonsense.

It’s a circular argument (a logical fallacy) because “the vulnerable” are by definition those “at risk” and vice versa. While the circularity makes the claim about assisted dying risks seem true, it's a false imputation.

By way of comparison, we could equally say that “the vulnerable will be at risk if we wear yellow socks on Wednesdays,” so we should outlaw that as well. Or anything else of which we disapprove and make our argument seem valid by attaching it to “the vulnerable being at risk.”

Let’s not talk about it

Dr Yates argued that the Parliament should not be pursing “divisive legislation.” That’s also a false argument because it's merely an appeal to emotion: avoiding legislating anything upon which there is any disagreement and discomfort. The consequence of this argument is to not legislate at all.

Patient trust in doctors

They also argued that assisted dying legislation would “change the doctor-patient relationship” — by which they mean “damage the relationship,” or they wouldn’t have mentioned it.

Again, as I have shown before, the empirical evidence from around the world is consistent with improved, not damaged, patient trust in doctors where assisted dying is legal.

The massive AMA flip-flop

But, as I’ve also pointed out before, the real telltale of the AMA doctors’ farcical representation to the Victorian Parliament is this: while opposing assisted dying legislation because patients might be pressured, subtly or otherwise, to choose death, the AMA officially endorses the right to refuse medical treatment, which includes life-saving treatment.

The hypothetical risk of patients being encouraged to refuse life-saving medical treatment is identical in kind to that of assisted dying. Yet in Victoria, the right to refuse is protected by just three statutory safeguards, while the assisted dying legislation is founded on no fewer than 68 safeguards.

So the AMA incoherently promotes one hypothetical pressure-to-die pathway with only three protections, while cruelly opposing a parallel path with an armada of protections. Let's award 10 out of 10 for the impressive flip-flop manoeuvre.

Conclusion

The AMA doctors’ claims are without merit and advancing them does no favours to their professional credibility.


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Another Catholic 'academic' spreads more misinformation. Photo: donaldytong

It’s very disappointing that Catholic theologian Dr Joel Hodge’s recent editorial in Fairfax media about assisted dying law reform contained misinformation: the same old tired and discredited story trotted out as though it's true. Dr Hodge also repeated an old and curiously one-sided (Catholic) examination of the hypothetical slippery slope.

Unhappily, the kind of misinformation that Dr Hodge advances muddies the waters and cruelly stands in the way of legislative action, which most Australians want.

An impeccable national survey conducted by scholars at Australian National University last year found 77% of Australians in favour of assisted dying law reform. Strong support (43%) outweighed strong opposition (4%) by more than ten to one. In the two states whose Parliaments are currently considering reform, NSW and Victoria, support stands at 75% and 79% respectively.
 

Non-religious support is 91%, and it’s high amongst Catholics (74%) and Anglicans (79%) as well. Bishops are jarringly out of step with the views of their flocks. And across the political spectrum, 87% of Greens, 80% of Labor, 77% of Coalition and 69% of minor party voters also want reform.

The electorate’s desires couldn’t be clearer. But politicians — who have little time to fact-check what they’re told — are fed the kind of misinformation Dr Hodge advances.

The false 'non-voluntary euthanasia slippery slope' argument

He quotes details from a medical journal article by Dr José Pereira, a Canadian Catholic physician. Like others who cite this article, Dr Hodge fails to mention that it was thoroughly debunked in a surgical deconstruction by expert scholars. They found Pereira’s claims variously unsupported by any evidence, unsupported by the sources he cited, or false, concluding that the article was “smoke and mirrors.”

Like other Catholics, Dr Hodge relies heavily on a thoroughly debunked journal article by Catholic Canadian doctor, José Pereira.A significant source of smoke, which Dr Hodge fans from this debunked article, is the claim regarding “900 Dutch deaths hastened without explicit request”: that is, non-voluntary euthanasia or NVE. Such figures are cited as ‘proof’ of the hypothetical slippery slope from legalised voluntary euthanasia to NVE.

Other opponents of assisted dying variously put the figure at 500 or 1,000. For the sake of argument, let’s say the 900 figure is equivalent to 1,000. Both the 500 and 1,000 figures, also repeatedly promoted by Catholic ethicist Professor Margaret Somerville and others, have been true. But here’s the thing.

What they don’t mention is that the 1,000 rate is from the 1990s when Dutch assisted dying was conducted under a general regulatory framework. In 2002 the Dutch euthanasia Act came into effect. Amongst the Act's many details was the establishment of a Commission which examines every reported case of assistance.

Since then, the Dutch NVE rate has dropped to 500, and even further. It has stayed low and is now similar to the NVE rate in the United Kingdom, the world’s gold standard for palliative care, and where assisted dying remains illegal.

There was a significant drop in the NVE rate in Belgium, too, after its euthanasia Act came into effect, also in 2002.

It is absolutely unconscionable that yet another Catholic commentator has trotted out the same old lie as though it's true. Dr Hodge is an academic and it is incumbent on him to check the facts before sounding off.By cherry-picking a single figure, opponents argue the opposite of the facts, implying or even directly claiming that NVE rates are caused by or have risen as a result of legalised assisted dying. I’ve comprehensively exposed this nonsense before, yet it comes up repeatedly.

It’s similar to other lines of Catholic argument against assisted dying, like the claim that Dutch elderly supposedly travel to Germany for healthcare because they fear being euthanised by their Dutch doctors — an outrageous falsehood. There’s also the faintly desperate claim that Dr Els Borst, the architect of the Dutch euthanasia Act, later regretted her reform — a fake claim she’s firmly corrected.

Consider too a Catholic bishop’s claim, without reservation and in formal evidence before an official Parliamentary inquiry, that Oregon’s general suicide rate was very low prior to its assisted dying Act but very high afterwards — contrary to the facts. Or a report cherry-picking just half a sentence from a journal paper to claim that a significant proportion of assisted-death patients in Oregon had symptoms of depression, when the other half of the very same sentence clearly stated that none of them had.

As Professors Griffiths, Weyers and Adams wrote in 2008, “imprecision, exaggeration, suggestion and innuendo, misinterpretation and misrepresentation [and worse] took the place of careful analysis.” Sadly, the same still seems true today.

Major Catholic flip-flop on choosing death

Now let’s turn our attention to the core of Dr Hodge’s thesis. His plea for “the vulnerable” leads his argument and is heavily egged throughout the polemical pudding.

A comparison is moot: Australians have the right to refuse any unwanted medical treatment, even if it’s life-saving.

In my home state of Victoria, this right to refuse is enshrined in statute. The statute contains just three ‘safeguards’ for checking a refusal, and those only apply if the refusal is formally documented in writing but not if it’s only oral.

As I’ve explained in detail before, the consequence is that a person can refuse life-saving medical treatment with few if any checks and balances. In theory, just as Dr Hodge argues in regard to assisted dying, the person might feel pressured by greedy relatives, resource-poor doctors or others, to so refuse.

In this case, where is the Catholic call for protections? Where is the moral outrage on behalf of ‘vulnerable patients’? There is none. In fact, the Catholic Church’s call is quite the opposite. In a directive to all Catholic healthcare institutions in the USA, the Conference of Catholic Bishops make the Church’s position abundantly clear. They direct that there is no obligation for patients to use “disproportionate means of preserving life.”

The Catholic church's rhetoric against assisted dying is a major flip-flop when compared to its cosy attitude towards refusal of life-saving medical treatment: both might result in hypothetical pressure to choose death, yet only assisted dying has adequate safeguards.They define disproportionate means as “…those that in the patient’s judgement do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community.”

So, under two identical hypothetical possibilities of inappropriate persuasion to choose death, Dr Hodge’s argument bristles against an assisted dying reform containing — as he acknowledges — no fewer than 68 safeguards, while his Church argues that patients may refuse life-saving medical treatment if the patient feels it’s “hopeless,” entails “excessive burden” or imposes “excessive expense” on others, with hardly any, or no statutory safeguards at all.

The incoherence, and repetition of misinformation, is indefensible. Civil debate on such an important matter deserves better.


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The terminally ill are not choosing between life and death, but between two ways of dying, according to their own beliefs and conscience. Photo: Andrew Drummond/AAP

In Monday’s Herald Sun, Victorian Archbishops Philip Freier and Denis Hart, and Bishops Ezekiel, Suriel, Lester Briebbenow, Bosco Puthur and Peter Stasiuk published a half-page advertisement admonishing the Victorian government for its initiative to legalise assisted dying for the terminally ill, an ad similar to the one published by religious figures in 2008.

I have no quarrel with individuals of faith regarding their own private beliefs. However, the bishops’ attempt at public “leadership” through the advertisement is deserving of redress for its multiple fallacies.

The ‘abandonment’ fallacy

The bishops claimed that assisted dying “represents the abandonment of those who are in greatest need of our care and support”. On the contrary: to ignore the deeply-held beliefs and rigorously-tested wishes of people at the end of life is to abandon their values and critical faculties in favour of the bishops’ own religious dogma.

The ‘competition’ fallacy

The bishops demand there should be more funding for healthcare rather than assisted dying, fallaciously pitting one option against the other. The Victorian government is indeed increasing funding for palliative care. It’s also aiming to provide lawful assisted dying for when even the best palliative care can’t help – which Palliative Care Australia has acknowledged – giving lie to the faux competition.

The evidential fallacy

Contrary to the bishops’ false presumption that legalised assisted dying will decrease trust in “the treatment and quality of care” from doctors, scientific studies into attitude change show that more people trust doctors when assisted dying is legal. Patients can then talk openly about options, even if they decide against assisted death. The bishops have abandoned facts in favour of religious assumptions.

The equivalence fallacy

The bishops refer to assisted dying as “government endorsed suicide”. They fallaciously equate a reasoned, tested and accompanied decision for a peaceful assisted death in the face of a terminal illness, with the impulsive, violent, isolated and regrettable suicide of individuals (many of whom have mental health and substance abuse issues) who are failing to cope with problems that can be addressed.

However, while the latter are choosing between life and death, the terminally ill are choosing not between life and death, but between two different ways of dying, according to their own beliefs and conscience. Rigorous 2016 research from Australian National University shows that the vast majority (79%) of Victorians support assisted dying choice for the terminally ill (with just 8% opposed), clearly distinguishing it from general suicide.

Shame on the bishops for disrespectfully equating the two.

The inconsistency fallacy

They also argue that assisted dying ought to remain prohibited because within healthcare, “mistakes happen and the vulnerable are exploited,” and “that in spite of our best efforts, our justice system could never guarantee” no one would die by mistake or false evidence. However, as I’ve pointed out before, an identical hypothetical problem exists under the refusal of life-saving medical treatment, a statutory right that Victorians have enjoyed for nearly 30 years. The statute has only three “safeguard” requirements, yet even those only apply if the refusal is formally documented, but not if it’s verbal.

Further, the United States Conference of Catholic Bishops directs that patients may refuse treatment if it imposes “excessive expense on the family or community,” yet makes no mention of the hypothetical “vulnerability” of the patient to be persuaded so, nor directs any requirements to assess the veracity of the refusal.

In stark contrast, the Victorian proposal for assisted dying legislation contains more than 60 safeguards and oversights.

The bishops are at risk of ridicule for such a gargantuan flip-flop: supporting the refusal of life-saving treatment with little or no oversight, while vocally opposing assisted dying legislation that mandates an armada of protections.

The not-so-hidden agenda

The bishops’ methods are rather unsubtle – hoping that these arguments, erroneous but carefully crafted to avoid any religious connotations, will be accepted as non-religious. Yet religion is writ large across their plea: as signatories to the letter they are all clerics employed directly and centrally in the promotion of their religions.

The authority fallacy

They might also rely on their religious status to convey gravity and authority to their pleas. Yet as people paid to do a job, like anyone else, their titles grant them no special privileges in lecturing Victorians about how they should die in the face of a terminal illness.

According to the 2016 census, just 23% of Victorians identified as Catholic, 9% as Anglican, 0.5% as Lutheran, and the other bishops’ signatory denominations so small as to not appear separately in the government’s statistics. Combined, the bishops’ faiths represent around 33% of the Victorian population, while 32% of Victorians identify with no faith at all. Surely the bishops are not arguing that they’re speaking for these other Victorians, too?

But the bishops don’t represent the views of their own flocks, either. According to the 2016 ANU study, 89% of non-religious Victorians support assisted dying law reform, as do 78% of Victorian Catholics and Anglicans. Indeed, opposition to assisted dying exists mostly among those who attend religious services once a week or more often – that is, those who are frequently exposed institutional religious messages of opposition – yet who comprise just 12% of Australians and 11% of Victorians.

Minding their own flocks

Australians are abandoning religion in droves. For example, when Freier ascended to the top job of Anglican Primate of Australia in 2006, some 19% of Australians identified as Anglican (2006 census). A decade later under his leadership, the 2016 census showed a drop of about a third to just 13%, and in Victoria, his home territory, to just 9%.

Hart’s Catholic church has experienced a drop in affiliation too, and it’s likely to continue and accelerate as Australians react with shock and disgust to the extent of child sexual abuse that the royal commission has exposed from under his organisation’s “pastoral umbrella”.

In conclusion, rather than bishops lecturing the government and Victorians with fallacious and faintly desperate arguments about the choices they shouldn’t have at the end of life, attending to their own flocks may be more useful Christian leadership.

May their God go with them in that endeavour.

 

This article was originally published in The Guardian.


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More Dutch evidence contradicts Margaret Somerville's 'suicide contagion' theory

I’ve previously published an extensive analysis of how Professor Margaret Somerville, of the Catholic Notre Dame University of Australia, cherry-picked her way through select data that seemed to be (but wasn’t) consistent with her ‘contagion’ theory from assisted dying to the general suicide rate. I provided ample evidence from lawful jurisdictions that comprehensively contradicts her claim. I also published the summary in ABC Religion & Ethics.

Yet Somerville still says despite extensive real-world experience to the contrary, that “I believe that my [suicide contagion] statement will prove to be correct.”

She and her Catholic colleagues still hold onto several tenuous threads of information that might — just might — appear consistent with her theory, despite the truckloads of evidence to the contrary.

One of those tenuous threads is that the general suicide rate in the Netherlands has increased from 2008, around the same time that use of the Dutch euthanasia law also increased. (The general suicide rate previously fell as assisted dying rates increased.)

I reported official Dutch government statistics and expert financial reports to show that the unemployment rate explains most (80%) of the variation in the Dutch general suicide rate since 1960, and that the Netherlands was particularly hard-hit by the global financial crisis from 2008 — whereas neighbouring Belgium wasn’t and its suicide rate dropped as assisted dying numbers increased. Unemployment in hard times is a known significant risk factor for suicide.

Now, a detailed and peer-reviewed analysis of Dutch data recently published in the Netherlands Journal of Medicine throws more mud in the face of Somerville’s theory.1

The research looked at the Dutch assisted death and general suicide rates from 2002 through 2014, separately for each of the five Euthanasia Commission reporting regions.

Headline results of the averages for 2002–14 are shown in Figure 1.

netherlandsfiveregionmap.jpgFigure 1: The average assisted death rate (and suicide rate) as a percent of all deaths by region, 2002-14
Source: Koopman & Putter 2016

As you can see, Region 3, which includes Amsterdam, had by far the greatest assisted death rate (3.4%), compared with the other four regions (1.7% – 2.0%). Yet Region 3’s suicide rate at 1.2% was the same as Region 5 which had only half the assisted death rate of Region 3 (1.7% vs 3.4%). (The authors, unusually, expressed suicides as a percentage of all deaths rather than per 100k population.)

The results are the opposite of Somerville’s theory which says that Region 3’s general suicide rate should be much higher than (not the same as) Region 5’s.

Those figures are the average for 2002–14. It’s possible that the picture is a little different for the more recent years in which the assisted dying rate is higher.

To answer that question, I’ve retrieved official Dutch Government data and calculated the assisted dying rates and general suicide rates for 2014 alone, the most recent year for which all the data is available. I’ve also calculated the general suicide rate per 100,000 population, the more usual way of reporting and comparing suicide statistics. The results are shown in Figure 2.

dutchregionsveandsuicide2014.gifFigure 2: The Dutch assisted death rate and general suicide rate by region for 2014
Sources: Euthanasia Commission annual reports, Dutch Government statistics

While region 1 (the far north) has the lowest assisted death rate (3.2% of all deaths), it has by far the highest general suicide rate (13.6 per 100k population).

The latest Dutch regional data shows the opposite of Margaret Somerville’s ‘suicide contagion’ theory, adding to the already extensive evidence against it.Conversely, region 3 (which includes Amsterdam) has by a very large factor the highest assisted dying rate (6.0% of all deaths), yet it has the second-lowest general suicide rate (10.3 per 100k population).

This latest empirical evidence is consistent with other extensive evidence I’ve published showing an inverse — or no — relationship between assisted dying rates and general suicide rates.

The question is whether Margaret Somerville and her Catholic friends will pay the slightest attention, or continue to rely on invalid, cherry-picked morsels of data that they think support their theory, but don’t.

 

References

  1. Koopman, JJE & Putter, H 2016, 'Regional variation in the practice of euthanasia and physician-assisted suicide in the Netherlands', Netherlands Journal of Medicine, 74(9), pp. 387-394.

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Yet more research contradicts Prof. Margaret Somerville's Dutch NVE claim

I’ve criticised Catholic ethicist Professor Margaret Somerville in the past for promoting misinformation about assisted dying. One of her favourite stories is about supposed non-voluntary euthanasia (NVE) ‘contagion’ from voluntary euthanasia laws.

NVE is where a doctor deliberately hastens the death of a patient without a current explicit request from the patient.

Somerville claims that elderly Dutch citizens fear NVE — a slippery slope claim previously promoted by the Vatican. She stated that:

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.”

She made the claim with certainty and without qualification.

She also stated it under the credentials of Professor, yet has offered not a shred of sound, verifiable evidence. That's unscholarly.

Her claim is premised on two false beliefs, that:

  1. The Dutch assisted dying law causes NVE —extrapolated to mean that elderly Dutch are therefore fearful of NVE in the Netherlands; and
  2. Because assisted dying is illegal in Germany, NVE doesn’t happen there — extrapolated to mean that elderly Dutch are confident in German healthcare and seek it in preference to their own.

Belief 1 is soundly contradicted by the evidence. Researchers have found small but significant rates of NVE in every country they’ve studied (though that to date hasn’t included Germany). They’ve also found that the rates of NVE in the Netherlands and Belgium have dropped (not risen) significantly since their assisted dying laws came into effect in 2002.

Now, new research comprehensively knocks Belief 2 off its perch, too.

In a pilot study just published in the German Medical Weekly, a team led by Professor Karl Beine of Witten/Herdecke University in Germany found that around 3.1% of doctors and nurses surveyed were aware of deliberately hastened deaths (which is illegal in Germany) in the past twelve months, and that 2.4% of them administered it themselves.

A new study has found that of German nurses and doctors who had intentionally administered life-ending drugs to patients (which is against the law), 40% of them had not been asked to do so by the patient: non-voluntary euthanasia. Further, of those who administered it themselves, 40% hadn’t been asked for it by the patient. That's NVE.

While previous evidence strongly suggested that NVE would occur in Germany as everywhere else, this study now factually establishes that it does.

The study authors concluded that “illegal intentional life-ending acts were administered by physicians and nurses in all healthcare areas [hospitals and nursing homes] under investigation.”

So much for Somerville’s second premise.

Now both premises of her misinformed NVE story are soundly contradicted by empirical research evidence.


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