Surveys show that around 75% of Australians support the legalisation of voluntary assisted dying to allow for better choice at the end of life, but despite this there’s still no law. Here's our guide to some of the myths and misinformation that surround the debate for voluntary laws. This misinformation has encouraged politicians not to act in a way voters clearly want them to.
MYTH: PALLIATIVE CARE CAN ALLEVIATE ALL SUFFERING
Australia has one of the best palliative care systems in the world, and we should be proud of it. But even Palliative Care Australia admits that it “cannot relieve all pain and suffering even with optimal care". For an estimated 5% of patients who they can’t help, the suffering at the end of life can be savage, as testimonies from families, doctors and nurses have shown.
Voluntary Assisted Dying is not intended to replace palliative care. It is adding one more option alongside palliative care for doctors and patients to explore at the end stage of incurable physical illness.
MYTH: CURRENT LAWS PROTECT US SUFFICIENTLY AGAINST UNNECESSARY SUFFERING
Under our existing laws, it is legal, if you are dying and suffering beyond medical help, to end your suffering by committing suicide, often violently and alone.
It is legal to refuse all medical treatment, food and water, and to die slowly of starvation and dehydration while your disease takes its course.
It is legal for a doctor to slowly drug you into a coma while your family waits for days, or weeks, for you to die. This can happen without your consent.
But it is not legal if you are dying and suffering beyond medical help to end your suffering painlessly and quickly with the help of a doctor.
As a patient, you do not have any legal right to insist that a doctor gives you more, or faster, pain relief. That decision is entirely up to the doctor whose personal beliefs you may not share.
This is why we need a law. So that we all have a legal right to be protected from unnecessary suffering at the end of life – so doctors have a legal right to help us - and so there can be more compassionate choices if we’re dying and suffering than starving ourselves to death, being slowly drugged into a coma, or taking our own lives, violently and alone.
MYTH: A VOLUNTARY ASSISTED DYING LAW WILL LEAD TO A "SLIPPERY SLOPE"
Opponents argue that once voluntary assisted dying legislation is introduced, it will inevitably be broadened to apply to those for whom it was never intended. They call this the ‘slippery slope’.
Over the last decade, numerous, wide-ranging, official inquiries into these laws have rejected allegations of the ‘slippery slope’ - most recently, a cross-party Victorian parliamentary inquiry. In its June 2016 report, handed down after 10 months of investigation, they found “rigorous safeguards, monitoring procedures and high levels of compliance” and “no evidence of institutional corrosion or the often cited ‘slippery slope’”.
Often opponents refer to the European laws, especially in Belgium and The Netherlands, to suggest that laws written to apply only to the terminally ill have since been broadened to provide access to those without terminal illness. This is incorrect – the laws in Europe were never written purely for the terminally ill, but for those with a ‘medically futile condition that causes unbearable suffering’. The overwhelming majority of people who use these laws have cancer, but they also allow people with degenerative and chronic illnesses, such as Motor Neurone Disease, Multiple Sclerosis, and Chronic Rheumatoid Arthritis, to ask for help to die. In very rare instances, people with long-term and extreme psychiatric suffering have also been helped. All of this is consistent with how the laws in Europe were written. In the USA, access to voluntary assisted dying is restricted to people with a terminal illness and 6 months or less to live. In almost 20 years of operation this law has never changed. All these laws were passed as Acts of Parliament with the strong support of the public and medical profession. No attempt has been made to repeal or rewind them. What opponents call a ‘slippery slope’, we refer to as ‘democracy’.
MYTH: A VOLUNTARY ASSISTED DYING LAW THREATENS THE VULNERABLE
Some organisations, like Right to Life and others, assert that Voluntary Assisted Dying laws are not safe. They warn of vulnerable people being coerced to end their lives for other peoples’ gain.
Numerous independent inquiries have found no evidence that this has occurred.
Australian palliative care physician Dr Linda Sheahan whose 2012 Churchill Fellowship study of how these laws work overseas concluded: ‘The slippery slope in terms of risk to vulnerable groups has not been demonstrated by the data.’
The Victorian parliamentary inquiry in 2015: ‘We found no evidence of institutional corrosion or the often cited ‘slippery slope’.
The Journal of the American Medical Association in 2016, which concluded: ‘In no jurisdiction was there evidence that vulnerable patients have been receiving euthanasia or physician-assisted suicide at rates higher than those in the general population.’
Representatives of peak elderly and disability groups in Belgium, The Netherlands and Oregon also report no abuse of their members under these laws.
Victoria’s proposed law is designed for those at the end stage of a terminal illness whose suffering is beyond meaningful medical help. It has stringent safeguards and is the most conservative of its kind anywhere in the world. The key safeguards – of independent examination by two doctors and strict eligibility criteria – work because it is very hard to coerce a vulnerable person into a terminal illness they don’t have. Even harder to coerce two doctors, whose work will be subject to review, to agree with them.
MYTH: DOCTORS CAN BE TRUSTED TO ‘DO THE RIGHT THING’ WHEN THE END COMES.
Not all doctors will help a dying patient to end their suffering, even if that patient sincerely and repeatedly requests such help. Sometimes this can be for fear of breaking the law. Often it is because doctors, and the institutions they work for, have a core moral objection to hastening death.
However, as the Victorian cross-party inquiry found, there are also doctors who do practice unlawful assisted dying, but they do so ‘without regulation, support, transparency or accountability’.
For those doctors currently faced with the agonising choice of helping a patient to die and breaking the law - or abiding by the law and leaving that patient to die with great suffering - a Voluntary Assisted Dying law provides protection. More than protection, it provides guidance and the opportunity to consult with colleagues and also the family of the person who is dying.
When senior doctors, such as AMA Federal President Michael Gannon, argue against a voluntary assisted dying law what they are actually arguing against is protection for their members – and what they are arguing for is that it’s OK for doctors to keep breaking the law. Bizarrely, they argue this on the grounds of ‘safety’.
MYTH: VOLUNTARY ASSISTED DYING IS NOT ‘ASSISTING’ A DYING PERSON TO DIE, IT IS ‘PATIENT KILLING’
Those who oppose this law refer to Voluntary Assisted Dying as ‘patient killing’ or ‘state sanctioned killing’.
This dishonestly avoids the central fact that the law is to help those already being killed by an incurable disease. Being voluntary, it is entirely up to the patient whether or not they choose to end the suffering caused by that disease.
Neither are doctors being asked to ‘kill’ a patient. In reality, what they’re being asked to do is what they already do - make a careful diagnosis that a patient’s condition is terminal and their suffering intolerable and go through with them their treatment options.
If the patient meets the legal requirements for assistance to die, they write them a prescription for a life-ending medication. After that, it is up to the person whether or not they use it.*
Only one person is being asked to make a life and death decision. The person who is dying.
*The only exception to this, under Victoria’s proposed law, is in the rare circumstance where a dying patient cannot digest or swallow the lethal medication (this can happen, for instance, with gastro-esophageal cancer and Motor Neurone Disease). In that instance – if the patient requests it (a request that must be witnessed) and the doctor receives a special permit from the Department of Health and Human Services, then a consenting doctor may administer lethal medication.
MYTH: VOLUNTARY ASSISTED DYING BREAKS A DOCTOR’S OATH TO ‘DO NO HARM’
According to the AMA’s code of ethics, doctors are obliged to:
“Respect the right of a severely and terminally ill patient to receive treatment for pain and suffering, even when such treatment may shorten a patient’s life”
Some doctors object to Voluntary Assisted Dying on the basis of the Hippocratic Oath which instructs ‘do no harm’. Others see leaving a dying patient to suffer as the opposite of ‘do no harm’.
A Voluntary Assisted Dying law is voluntary for everyone. It respects and protects the rights of those doctors who object. Just as it protects and respects the rights of those doctors with a different ethical view.
MTYH: VOLUNTARY ASSISTED DYING AFFECTS SOCIETY’S CORE BELIEF IN THE SANCTITY OF LIFE.
The Victorian Charter of Human Rights enshrines the right to freedom of thought, conscience, religion and belief.
It is important to acknowledge that people of religious faith have a right to their deeply-held views in opposition to voluntary assisted dying. The proposed law acknowledges and enforces this right by allowing anybody to conscientiously object to participation in it. However, The Victorian Charter of Human Rights also enshrines The right to protection from torture and cruel, inhuman or degrading treatment.
By using extreme rhetoric such as ‘patient killing’ and ‘murder’ to inflame emotions, Right to Life and other faith-based objectors do not acknowledge, or address, the clear evidence of suffering happening across the community that was accepted by the Victorian cross-party inquiry.
Surveys consistently show that these objectors are in a very small minority, even within their own religions.
A 2012 Newspoll survey showed that 88% of Anglicans and 77% of Catholics agreed that a doctor should be allowed to meet a request from a hopelessly ill patient for help to die. The 2013 ABC Vote Compass policy tool found that out of 1.4 million Australians, 75% supported the legalisation of assisted dying for the terminally ill.
It also provided a breakdown based on religion, and the rate of support among Catholic respondents was 69.8%.
While the Catholic Church hierarchy is opposed to voluntary assisted dying, it does not speak for a majority of Australian Catholics.
MYTH: VOLUNTARY ASSISTED DYING ENCOURAGES SUICIDE
Opponents often cite a phenomenon called “suicide contagion’, which suggests that the legalisation of voluntary assisted dying will lead to an increase in suicides.
This is a deliberate, and false, conflation of two very different acts.
Suicide is entirely distinct from voluntary assisted dying. The first – suicide - is an irrational impulse, acted on in secret, in response to a problem that, with treatment, could most likely be fixed. The second - – voluntary assisted dying - is a rational response, taken in consultation with doctors and family, to a condition that cannot be fixed.
This difference was clearly understood by the Chief NY medical examiner, Charles Hirsch, when investigating the deaths of office workers who jumped from the Twin Towers on 9/11. Faced with a terrible choice – a slow, agonizing death by fire, or a quick death by jumping – many chose to jump. Seeing this as a rational choice to avoid needless suffering, Hirsch refused to classify their deaths as ‘suicides’.
There is no credible evidence of increased suicide rates as a result of assisted dying laws overseas. Neil Francis wrote an in-depth article in April 2017 in response to claims by Margaret Somerville, which you can read here.
MYTH: VOLUNTARY ASSISTED DYING THREATENS TO LEAD TO ATROCITIES SIMILAR TO THOSE IN NAZI GERMANY.
During World War II, amongst many other atrocities, the Nazis conducted a program, described as euthanasia, and known as the Aktion T4 program. It was not voluntary, nor does it have anything to do with voluntary assisted dying legislation.
Voluntary assisted dying is voluntary, and is about giving better choice to those who are suffering beyond meaningful medical help. This choice can only be granted to a person found by medical professionals to fit strict criteria, who is mentally competent, and who has made the request themselves.
There is no link between voluntary assisted dying and what happened in Nazi Germany. To compare people who are needlessly suffering and seeking the choice of a compassionate end to their life to the thousands of souls who were murdered in the Aktion T4 program is not only a lie, it is also highly inflammatory and offensive to the memory of those who died and their descendants.