Beware the scare campaign against voluntary assisted dying
Those who oppose voluntary assisted dying ignore the wealth of evidence that shows the laws are safe and effective and routinely resort to strained hypotheticals and misinformation.
The aim? To unfairly sow fear, uncertainty and doubt in the minds of politicians and the public. Opponents would have you believe they want to help draft a better law, when the reality is they are morally opposed to Voluntary Assisted Dying (VAD) in any form. For them 'Not This Bill' is really 'Not Any Bill'.
Former New Hampshire politician Nancy Elliott belled the cat on the strategy in 2015. Addressing an anti-euthanasia symposium in Adelaide, Elliott spoke about the multiple tactics that can make people hesitate:
“When you have lots of arguments,” she said, “if one argument gets blown out of the water, you still have more, and each argument will reach somebody else.”
For instance, Elliot enthused, one way to oppose assisted dying is to suggest it is a threat to disabled people: “Right now the disability argument is really kicking it. It's very powerful. Will it always be powerful? We don't know. Two, three, four years from now that may have holes kicked in it, just for different reasons, so we have to be flexible.”
Citing elder abuse and suicide contagion as other possible arguments, she went on to say: "You only have to convince legislators that they don't want this bill. You don't have to win their hearts and minds; all you have to do is get them to say, ‘Not this bill’, and then you have got your win.” [i]
In keeping with Elliott’s 'Not This Bill' playbook, anti-assisted dying campaigners have redoubled efforts to sink proposed assisted dying laws in Australia and New Zealand.
Recognising the scare campaign is easy. At its heart are three pervasive myths.
Myth 1: “Assisted dying laws are unsafe”
Reality: Australian and NZ assisted dying laws are some of the safest in the world.
They have strict eligibility criteria and multiple safeguards that protect the vulnerable. [ii]
Among them: the person must be an adult, terminally ill, suffering intolerably and in the end stages of life. They must have decision-making capacity. The request for assistance to die must be voluntary and enduring, and be made at least three times to two independent doctors who must be convinced the request is not the result of coercion. Under the law in Victoria and the proposed law in NZ, doctors are forbidden from raising assisted dying as an option with their patients. A mental illness, disability, dementia or simply being elderly are not sufficient reasons on their own to warrant access. All the steps in the process are strictly regulated by an oversight body.
These safeguards work. Repeated, independent and exhaustive reviews of assisted dying regimes around the world have shown no abuse. These include investigations by Canada’s High Court [iii], Australian Palliative Care Physician Dr Linda Sheahan in her Churchill Fellowship [iv], the Journal of the American Medical Association [v], the Victorian [vi], Western Australian and Queensland parliamentary inquires, and the Victorian Review Board. [vii]
Most tellingly, representatives of disability and elderly communities also report no abuse of their members under the laws. [viii]
Myth 2: “Assisted dying laws are unwise”
Reality: Assisted dying laws are well thought-through and are some of the most scrutinised legislation in the world.
Opponents like to claim that introducing an assisted dying law would destroy the doctor-patient relationship and put at risk the very foundation of medicine.
However, in countries where assisted dying laws have existed for more than two decades, research shows that the opposite is true. The latest OECD report on the Netherlands, where assisted dying has been legal since 2002, notes that satisfaction with health care there is high – 86% – compared to 70% across the OECD. [ix] In Belgium, where a similar law operates, citizen satisfaction with the medical profession is among the highest … at 90%. [x]
In the US, the former President of the Oregon Medical Association, Dr Leigh Dolin, stated that the work of doctors in end-of-life care has been better since VAD was legalised in that state in 1997: “I think we do a much better job because of this law ... The dire fears that doctors would become less trusted, or worse, just hasn’t happened.” [xi]
Opponents also misleadingly claim that assisted dying sends the wrong message about suicide, and could lead to higher rates of self-harm. Assisted dying is NOT suicide and conflation of the two is dangerous and unhelpful. Even so, there is no evidence assisted dying leads to higher rates of self-harm. After reviewing all the international data, the WA Parliamentary Inquiry committee (among others) concluded: “Suggestions of suicide contagion are not supported in the evidence.” [xii]
In Oregon, where Voluntary Assisted Dying has been legal for 23 years, State Health Officer Katrina Hedburg says “We have not seen any change in the statistics around rates of suicide in Oregon before or after the Death with Dignity Act took place.” [xiii]
In Victoria, after a year of VAD, the same is true. Attorney General Jill Hennessy told a UK All-Party Parliamentary Group in July 2020: “None of the fears have been realised”.
Myth 3: “Assisted dying laws are unnecessary”
Reality: Assisted dying laws are absolutely necessary.
Australia and New Zealand have some of the best palliative care systems in the world. However, the claim that palliative care can help everyone is untrue. The words and statistics from palliative care tell us so. The many testimonies from medical professionals and families of those who have died badly tell us so, too.
These are Palliative Care Australia’s own words, published in their Policy Statement on Voluntary Euthanasia in 2006:
While pain and other symptoms can be helped, complete relief of suffering is not always possible, even with optimal palliative care. [xiv]
Other Palliative Care data reveal that about two per cent of patients in the terminal phase suffer severe distress from pain. This is more than 500 individuals a year in Australia
And pain is only one part of suffering. Data from the Palliative Care Outcomes Collaboration shows that 13.9% of patients who died in Australia under the care of a hospital or home-based palliative care team had severe distress from at least one of the seven symptoms listed in the Symptoms Assessment Scale just prior to their death. In the six months to June 2018, for example, 2.5 per cent of patients, (579 nationally), suffered severe distress from breathing difficulties in their terminal phase. Other difficult-to-treat symptoms include nausea, existential distress, fatigue, incontinence, open sores, diarrhea, recurrent infections and seizures. [xv]
Clive Deverall, former president of Palliative Care Western Australia, said this extreme suffering was the “elephant in the room”.
“I have attended so many palliative care meetings where problems have been discussed in context of the experience of individual terminally ill patients. The term ‘palliative care nightmare’ was used frequently. Even if good, modern palliative care was available for each and every terminally ill patient − we would still have the ‘nightmares’. [xvi]
Even if this extreme suffering never eventuates, forcing a dying person to continue to live against their wishes is itself a form of abuse.
Countless testimonies from patients, doctors, nurses, carers, families and friends attest to palliative care’s limitations.
These stories are on the public record. They cannot be wished away, no matter how much opponents want it to be so.
Go Gentle Australia believes every terminally ill person, no matter where they live, should have the same access to more compassionate end-of-life choices, including Voluntary Assisted Dying.
Join our campaign for a better conversation around end-of-life choices, including VAD laws in every Australian state and territory.
[i] Nancy Elliott in Andrew Denton, “Better Off Dead: #1 The invasion of death”, podcast, Thought Fox and the Wheeler Centre, published online by the Wheeler Centre on 15 March, 2016, (audio) – https://www.wheelercentre.com/broadcasts/podcasts/better-off-dead/1-the-invasion-of-death Transcript at Go Gentle Australia website – https://www.gogentleaustralia.org.au/transcripts1
[ii] NZ End of Life Act 2019, Meaning of person who is eligible for assisted dying or eligible person
http://www.legislation.govt.nz/act/public/2019/0067/latest/DLM7285950.html
Also, Victoria Voluntary Assisted Dying Act 2107 https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/end-of-life-care/voluntary-assisted-dying/vad-overview
[iii] Carter v. Canada (Attorney General), 2012 BCSC 886, paras. 1241 and 1367
[iv] Linda Sheahan, “The Dorothea Sandars and Irene Lee Churchill Fellowship to study the interface between Palliative Care and legalized Physician Assisted Suicide and Voluntary Euthanasia”, The Winston Churchill Memorial Trust of Australia, 30 May, 2013, p.64 – https://www.churchilltrust.com.au/media/fellows/2012_Sheahan_Linda.pdf
[v] J Emanuel Ezekial, Bregje D Onwuteaka-Philipsen, John W Urwin, and Joachim Cohen, “Attitudes and Practices of Euthanasia and Physician- Assisted Suicide in the United States, Canada, and Europe”, JAMA - Journal of the American Medical Association, 316 (1), July 5, 2016, pp. 79-90 – https://jamanetwork.com/journals/jama/article-abstract/2532018
[vi] Parliament of Victoria Legislative Council, Legal and Social Issues Committee, “Inquiry into end of life choices: Final Report: ‘Chapter 8 – Victoria Should Legalise Assisted Dying’”, June, 2017, p. 212 – https://www.parliament.vic.gov.au/images/stories/committees/SCLSI/EOL_Report/LSIC_58-05_Text_WEB.pdf
[vii] Victorian Voluntary Assisted Dying Review Board reports https://www.bettersafercare.vic.gov.au/reports-and-publications?f%5B0%5D=agency%3A751&search=voluntary+assisted+dying+review+board&
[viii] A Sanderson (MLA) and Hon. C J Holt (MLC), “Report 1 - My Life, My Choice: The Report of the Joint Select Committee on End of Life Choices: 5:98 ‘What the evidence says’”, 40th Parliament, Parliament of Western Australia, August, 2018, p.176 –
https://apo.org.au/sites/default/files/resource-files/2018/08/apo-nid188761-1227101.pdf
Also, Andrew Denton, “Better Off Dead: #13 Now they’re killing babies”, podcast, Thought Fox and the Wheeler Centre, published online by the Wheeler Centre on 24 March 2016, (audio) https://www.wheelercentre.com/broadcasts/podcasts/better-off-dead/13-now-they-re-killing-babies Transcripts available at Go Gentle Australia website – http://www.gogentleaustralia.org.au/transcripts2
Affirmation of ‘no risk to vulnerable groups’ comes from: Illya Soffer, director of Lederin (Everyone In) representing 250 organizations for disabled people in the Netherlands; Pierre Gyselinck. president of the Catholic Association of Persons with Disabilities, Flanders, and president of the Belgian Disability Forum; Bob Joondeph, executive director of Disability Rights Oregon; Joeri Veen, spokesperson for ANBO,representing about 180,000 senior citizens in the Netherlands; Mie Moerenhout, director of the Flemish Council of the Elderly; Cherrie Brounstein, vice president of the board for Elders in Action, Oregon.
[ix] OECD, “Government at a Glance 2017: Country Fact Sheet - Netherlands: ‘Satisfaction and confidence across public services (2016)’”, 2017 – http://www.oecd.org/gov/gov-at-a-glance-2017-netherlands.pdf
[x] OECD, “Government at a Glance 2017: Country Fact Sheet - Belgium”, 2017 – http://www.oecd.org/gov/gov-at-a-glance-2017-belgium.pdf
[xi] Leigh Dolin in Andrew Denton, “Better Off Dead: #9 Death with dignity in Oregon”, podcast, Thought Fox and the Wheeler Centre, published online by the Wheeler Centre on 17 March, 2016, (audio) – https://www.wheelercentre.com/broadcasts/podcasts/better-off-dead/9-death-with-dignity-in-oregon
Transcript at Go Gentle Australia website – https://www.gogentleaustralia.org.au/transcripts1
[xii] A Sanderson (MLA) and Hon. C J Holt (MLC), “Report 1 - My Life, My Choice: The Report of the Joint Select Committee on End of Life Choices: ‘Suggestion of suicide contagion are not supported in the evidence’”, 40th Parliament, Parliament of Western Australia, August, 2018, p.179 – https://apo.org.au/sites/default/files/resource-files/2018/08/apo-nid188761-1227101.pdf
[xiii] Katrina Hedburg in Andrew Denton, “Better Off Dead: #9 Death with dignity in Oregon”, podcast, Thought Fox and the Wheeler Centre, published online by the Wheeler Centre on 17 March, 2016, (audio) – https://www.wheelercentre.com/broadcasts/podcasts/better-off-dead/9-death-with-dignity-in-oregon
Transcript at Go Gentle Australia website – https://www.gogentleaustralia.org.au/transcripts1
[xiv] Palliative Care Australia, “Policy statement on voluntary euthanasia”, Canberra, 2006, p.2. Quoted by: Neil Francis, “AMA uncovered: How its own review exposed its assisted dying policy as indefensible”, Dying for Choice, 27 March, 2017, p.20 – http://www.dyingforchoice.com/docs/AMAuncoveredFullReport27Mar2017.pdf
[xv] Eagar K, Clapham S, Allingham S. Palliative care is effective: But hospital symptom outcomes superior. BMJ Supportive and Palliative Care 2020;10:186-190.
Also, Palliative Care Outcomes Collaboration, “Patient outcomes in palliative care: National Report January−June 2018”, September, 2018 - https://ahsri.uow.edu.au/content/groups/public/@web/@chsd/@pcoc/documents/doc/uow252855.pdf
[xvi] Noreen Fynn, “Submission to the Joint Select Committee on End of Life Choices (Western Australia)”, 17 October, 2017 –
http://www.parliament.wa.gov.au/parliament/commit.nsf/(Evidence+Lookup+by+Com+ID)/30D73154F4D00AFF48258219000B3C84/$fi le/20171017+-+EOLC+-+Sub+347+-+Ms+Noreen+Fynn.pdf
Noreen Fynn is the widow of Clive Deverall