New euthanasia/assisted suicide law in Australia

Victoria’s Voluntary Assisted Dying Act 2017

Sean Murphy*

Introduction
On 19 April, 2018, the legislature of the State of Victoria, Australia, passed the Voluntary Assisted Dying Act 2017, which will come into force in June, 2019.  It is currently the most restrictive euthanasia/assisted suicide (EAS) legislation in the world, running to 130 pages.  In brief, the law authorizes physician assisted suicide for terminally ill adults, but permits euthanasia by physicians only when patients are physically unable to self-administer a lethal drug.  In both cases a permit must be obtained in advance.  The main elements of the law are set out below, followed by consideration of its protection of conscience provisions. . .  [Full Text]

Why I will be a conscientious objector to Victoria’s assisted dying law

A palliative care specialist laments the unrealistic individualism and elitism of the euthanasia movement

MercatorNet

Adrian Dabscheck

During a recent period of enforced rest, I had time to reflect on my attitude to the recently enacted voluntary assisted dying legislation in Victoria and consider my response.1 I will detail my reaction to the Act and why I have chosen to become a so-called conscientious objector.

In his essay Western Attitudes Toward Death,2 French historian Philippe Ariès illustrates the evolution of our attitudes to death.

Initially, and for millennia, there had been a general resignation to the destiny of our species for which he used the phrase, Et moriemur, and we shall all die. This was replaced in the 12th Century by the more modern concept of the importance of one’s self, and he used the phrase, la mort de soi, one’s own death.

Ariès then notes that in the 18th Century man gave death a dramatic and disquieting meaning. Man became concerned with the death of the other person, la mort de toi. Death was no longer familiar, nor were the dead. The dead had been torn from life; death had become an important event. By the 19th Century mourning had become difficult and thy death, la mort de toi, is more feared than la mort de soi, one’s own death.

Following this slow evolution in Western attitudes towards death, from being ubiquitous and familiar, with industrialisation, came the concept of the forbidden and shameful death. Life was now meant to be happy and this happiness was interrupted by the emotional disturbance of death and dying. Death was not spoken of, as illustrated by Tolstoy in “The Death of Ivan Ilyich”.3 Death was moved from home to hospital, from the care of one’s family to the sanitised, technical care whereby it is difficult to tell when the dying process actually began due to the interference of modern medicine. Death became part of the medical industrial-movement.

In a 2013 article reviewing the situation in Flanders where euthanasia is embedded in palliative care,4 it was noted:

Healthcare professionals note that family members and proxies tend, much more than before, to consider the dying process as undignified, useless and meaningless, even if it happens peacefully, comfortably and with professional support. Requests made by family members for fast and active interventions from healthcare professionals regarding elderly parents are often very coercive, with little nuance or subtlety. End-of-life interventions such as euthanasia are seen as an instrument to end a process of disease (or old age) that is demanding and difficult to bear, instead of letting it follow its course.’

We could not be further removed from Ariès’ phrase, Et moriemur, and we shall all die. Happiness is now the ultimate goal; we can no longer accept the place of death in our life. Ariès wrote in L’Homme devant la mort:5 “Death must simply become the discreet but dignified exit of a peaceful person from a helpful society. A death without pain or suffering, and ultimately without fear.” Thus the idealised ‘good death’.

Unfortunately, for most, society is unable to achieve such utopian goals, hence the need for the modern palliative care movement. As David Roy noted in the third edition of the Oxford Textbook of Palliative Medicine,6 it is up to society to allow the palliative care movement to flourish, to remove barriers to care, to develop the broad tapestry of interconnected people, resources, services and institutions to care for those who suffer in the face of death.

For this to be successful there must be an effective ethic of care. An ethic that allows relationships to flourish, an ethic that acknowledges the vulnerability of people and views autonomy from a relational rather than an atomistic perspective. Autonomy is a product of our personhood, our development of interests and values gained by interactions with others. None of us can make decisions which are free from influence. Our decisions relating to ourselves are made in the context of relationships. We commence our life completely dependent on others to sustain us. We depend on the non-judgemental love of others to care for us, to allow us to become independent, to become autonomous in the context of family, friends and society.

I continually ask myself, how have we allowed our ethical boundaries to move to such a degree that a law allowing doctors to take life as a way of relieving suffering has been passed by our state legislature? How have we allowed our view of the individual to become so individualistic and self-gratifying, so removed from an acknowledgement of our dependence on others, so self-centred or dare I say narcissistic?

Perhaps we can learn for the world of art and aesthetics. Hans van Meegeren was an accomplished forger of Vermeer, such that Vermeer experts accepted as originals what are obvious from our current perspective as forgeries. David Roy asks:6 “What process was at work that could so distort the faculties of aesthetic perception and poor judgement? It was a process of incremental adaption to incrementally poor forgeries.”

The Netherlands introduced the Termination of Life on Request and Assisted Suicide (Review Procedures) Act in 2001. In 2005, of all deaths, 0.4 percent were the result of the ending of life without an explicit request by the patient.7 In 2013 euthanasia was performed for 97 patients with dementia and 42 patients with psychiatric diseases (percentages not reported).8 Have ethical perceptions been distorted such that incremental creep allowed this to happen, as it did with aesthetics and van Meegeren?

In an article published in May 2017 in the New England Journal of Medicine discussing the experience of the University Health Network in Toronto after the introduction of medical assistance in dying (MAiD) in Canada,9 the authors noted:

[T]hose who received MAiD tended to be white and relatively affluent and indicated that loss of autonomy was the primary reason for their request. Other common reasons included the wish to avoid burdening others or losing dignity and the intolerability of not being able to enjoy one’s life. Few patients cited inadequate control of pain or other symptoms.

I would like to question if the possible consequent good of allowing a highly selected population of privileged people the ability to request and be administered medical assistance in dying is sufficient to overturn millennia of accepted medical practice. Medicine has long been perceived by society to be beneficent and is trusted to avoid actions which would deliberately hasten death. The intent of palliative medicine is the relief of pain and suffering, not the taking of life. Should we risk the incremental creep of our values for the sake of a privileged few?

Do we wish to allow our society to become similar to Belgium, where we are so removed from the human experience that we consider the dying process useless, meaningless and undignified?

In my own city, Melbourne, we can all witness the inadequate provision of palliative care and other health services to more economically challenged sections of our society. A similar picture emerges in rural settings. Can we as a society justify allocating resources to voluntary assisted dying, when basic palliative care and health care are so lacking?

Should we really allow the values of our society to be so radically altered for the few who are so removed from an acceptance of the frailty of the human experience, from an acceptance that we are all dependent on others and vulnerable?

It is for the above reasons that I will be a so-called conscientious objector when the Voluntary Assisted Dying Act comes into operation on 19 June 2019. I will continue to practise medicine as it has been practised for millennia, for the relief of pain and suffering. I would encourage all doctors to in Victoria to do likewise.


Adrian Dabscheck is a Palliative Care Consultant from Victoria

References

1.  Voluntary Assisted Dying Act 2017 (Vic).

2.  Ariès P. Western Attitudes Toward Death from the Middle Ages to the Present. Johns Hopkins University Press, 1974.

3.  Tolstoy L. The Death of Ivan Ilyich. Published in 1886.

4.  Vanden Berghe P, et al. Assisted Dying – the current situation in Flanders: euthanasia embedded in palliative care. European Journal of Palliative Care 2013;20(6):266-272.

5.  Ariès P. L’Homme devant la mort (The Hour of Our Death). Published in 1977.

6.  Doyle D, et al. (eds.) Oxford Textbook of Palliative Medicine. 3rd Edition. Oxford University Press, 2005.

7.  Van der Heide A, et al. End-of-Life Practices in the Netherlands under the Euthanasia Act. New England Journal of Medicine 2007;356:1957-1965.

8.  Radbruch L, et al. Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care. Palliative Medicine 2016;30(2):104-116.

9.  Li M, et al. Medical assistance in dying – implementing a hospital-based program in Canada. New England Journal of Medicine 2017;376:2082-2088.


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Poll: would you dispense Voluntary Assisted Dying drugs?

Debate about Victoria’s Voluntary Assisted Dying legislation is dividing the country… but what do pharmacists think?

AJP.com.au

Megan Haggan

Victoria’s controversial Voluntary Assisted Dying bill – which would introduce legislation that would be the most “conservative” of its type in the world – has passed the State’s lower house, bringing the process one step closer.

Under the legislation, pharmacists would be part of the process, supplying lethal medicines in a locked box to eligible patients. . . [Full text]

 

Victoria, Australia: Voluntary Assisted Dying Bill 2017

Comment

Sean Murphy*

euthanasia and assisted suicide bill introduced in the Parliament of Victoria, Australia, includes several provisions that pertain to legal protection of freedom of conscience.  Concerning these:

  • Freedom of conscience provisions concern only individual practitioners, not health care facilities.  Freedom of conscience presumably includes acting upon moral or ethical beliefs grounded in religious teaching.
  • Statements of principles that require encouragement and promotion of an individual “preferences and values,” that people should be “supported” in conversations about treatment and care and “shown respect” for their beliefs, etc. can be interpreted to require affirmation of moral or ethical choices.
    • While the principles may have no direct legal effect, they could be cited by professional regulatory authorities against those who refuse to encourage, promote, or affirm the acceptability of euthanasia and assisted suicide.
  • Registered medical practitioner is not defined, but all would be encompassed by the definition of health care practitioner.
  • All health care practitioners are protected by Section 7.
  • Section 7(b) allows for refusal to participate in the request and assessment process and Section 7(c) protects refusal to be present when lethal medication is administered, but Section 7
    • does not include protection for refusal to participate in the administration of lethal medication, by, for example, inserting an IV line in advance, or by other means
    • does not include protection for refusal to participate in dispensing lethal medication
  • “Participate” in Section 7(b) is broad enough to encompass referral.  However, the bill would be improved by providing protection against coerced indirect participation in administering or dispensing lethal medication.
  • The bill does not require falsification of death certificates, but does require the falsification of the cause of death in the registration of deaths.  The bill includes no protection for a registrar who, for reasons of conscience, is unwilling to falsify a registry entry.

116 Victorian patients refuse lifesaving treatment

The Advertiser

Grant McAurthur

FOUR Victorians a week are taking legal action to prevent doctors giving them lifesaving treatment, with the number expected to multiply next year when new regulations make refusing care easier.

As the Victorian parliament prepares to debate voluntary euthanasia laws in coming months, the Herald Sun can reveal 116 patients have already used legally binding certificates to ban hospitals prolonging their lives this year; however, the measures stop short of assisting them to die.

The issue arose last month when a failed suicide pact saw emergency doctors at Monash Medical Centre forced to save an elderly patient against her wishes because no legally binding Refusal of Treatment Certificate had been lodged to reinforce the demands. . . [Full text]

 

Politicians wrestle with doctors’ consciences in Victoria

Conscientious objection needs to be protected

MercatorNet
Reproduced with permission

Paul Russell*

As the Victorian Ministerial Advisory Panel on “assisted dying” makes ready to release its interim report sometime in April, The Age newspaper turned its attention to the matter of conscience whether a doctor may refuse to take part in any action that would bring about the premature and deliberate death of a person.

Conscience – or the ability to draw upon one’s own personal belief system in making a decision about an action – plays out at different levels in any debate on euthanasia and assisted suicide. . . [Full text]

 

Victorian Premier and Opposition Leader pledge to allow conscience vote on forcing doctors to participate in abortion

News Release

Australian Christian Lobby

The Victorian Premier and Opposition Leader will allow a conscience vote if a private members’ bill is introduced to restore freedom to doctors to decline to participate in abortion.

Denis Napthine and Daniel Andrews were responding to questions from Christian leaders at the Australian Christian Lobby’s Make it Count forum at Queens’ Hall, Parliament House last night.

Their commitments come following sanctions imposed on Melbourne Doctor Mark Hobart, who declined to assist a couple who wanted their baby girl aborted so they could try again for a boy.

“If a private members’ bill was introduced then we would certainly allow a conscience vote,” Dr. Napthine said.

“My position would be to afford a conscience vote,” Mr Andrews said.

ACL Victorian Director Dan Flynn welcomed the leaders’ commitments to allow a parliamentary vote on whether or not doctors should be forced to participate in abortion by making a referral for an abortion.

“No one should be forced to go against their conscience on an issue which involves the taking of a human life,” Mr Flynn said.

The leaders were asked about a range of issues including domestic violence, freedom of religion, poker machine reform and the ice epidemic.

Asked whether “your Government (would) commission independent research into whether there are features in poker machines that lead to gambling addiction”, Mr Andrews committed to examining “the best research, the best evidence”.

On family violence, Dr. Napthine said: “Men particularly need to stand up”.

Mr. Andrews said family violence was the leading cause of death or disability for women aged 45 and under and was “national disgrace”.

On religious freedom, Mr Flynn expressed disappointment about Labor’s election policy, reiterated last night by Mr Andrews, to amend Equal Opportunity laws to diminish the freedom of faith-based schools to employ staff who share their ethos.

Dr. Napthine was called away from the forum to deal with last night’s terrorism-related shooting of an Islamic extremist just moments before Mr Andrews concluded taking questions.

The pre-election Make it Count event was attended by 150 Christian leaders from a wide cross-section of denominations and churches.

Fundamental freedoms

 Why the right to conscientious objection must be restored

Presentation to the Life Dinner
Melbourne, Australia

David van Gend*

I feel a little out of place coming from Queensland to speak about the wretched situation in Victoria: coming from a State where it is always sunny, where the people are always nice, and where we don’t have oppressive laws that try to compel the conscience of free citizens.

But we are all in this together: an assault on fundamental freedoms in one State will become a precedent for similar abuses in other States.

Uncivil society

It was a Melbourne man, Julian Savulescu, now an ethics professor at Oxford, who declared that doctors who will not provide abortion should be “punished through removal of license to practice”. He wrote in the British Medical Journal in 2006:

A doctors’ conscience has little place in the delivery of modern medical care. What should be provided to patients is defined by the law… If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors.1

Crucial to his argument is that, “when society has already decided that a service is legal”, it is not for doctors to “compromise the delivery of services”. When Savulescu’s article was discussed in 2006 in the medical newspaper Australian Doctor, I was given as an example of the sort of doctor who, in his view, “should either get out of the specialty or the profession altogether.”2  I gave a different angle to Australian Doctor: that abortion as commonly practiced is not a medical service; it is a “medical abuse” which doctors are bound by their Hippocratic principles and humane conscience not to commit.

And no law, no professional board, has the authority to compel any doctor to violate the principles of their vocation or mutilate their own conscience by collaborating in intentional killing.

Yet in Victoria, under section 8 of the Abortion Law Reform Act 2008,3 that compulsion by the authorities is exactly what doctors and nurses face.

Not long ago society was a little more civil and did not contemplate using the force of law to compel the conscience of fellow citizens. . . [Full text]

Abortion law changes eyed as Dr Mark Hobart probed

The Sydney Morning Herald

Henrietta Cook

The Napthine government is not ruling out changes to Victoria’s abortion laws ahead of an investigation into a doctor who refused to give a couple an abortion referral because they wanted a boy.

The state government said it was interested in the outcome of the Medical Board of Victoria’s investigation into Mark Hobart, a pro-life doctor who has been accused of breaking the state’s abortion laws.

It comes as pro-life advocates run a concerted campaign to repeal a section of the Abortion Law Reform Act, which requires doctors who have a conscientious objection to abortion to refer a woman to someone with no such objection. [Full story]