THE FACTS ABOUT DYING WITH DIGNITY
The Roy Morgan national poll carried out in November 2017 shows that more than 80% of Australians in every state support Voluntary Assisted Dying (VAD) to allow for better choice at the end of life. This poll reflected support in Western Australia of 88%, and in December 2019 the Voluntary Assisted Dying Act 2019 was finally passed after nearly 40 years of advocacy by Dying with Dignity WA. There are however still no VAD laws in any other states apart from Victoria, which led the way with its legislation in 2017.
Here's our guide to some of the facts that surround the debate for voluntary assisted dying laws. Misinformation and distortion of these facts have encouraged politicians in many states not to act in the way voters clearly want them to.
FACT: "PALLIATIVE CARE CANNOT 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 that small number of patients suffering at the end of life can be intolerable.
The legalisation of voluntary assisted dying gives patients experiencing such suffering another choice. It should be used here just as it is used overseas: an option of last resort, when all other treatments have failed.
FACT: "THERE IS NO 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’ - including the extensive cross-party parliamentary inquiries in Victoria and Western Australia. Both inquiries found high levels of compliance with safeguards and monitoring procedures in overseas jurisdictions where VAD is lawful and no evidence of institutional corrosion or the often cited ‘slippery slope’. The rare changes that have been made have either been as a result of a Supreme Court decision or introduced and debated in accordance with due parliamentary process. This is otherwise known as democracy.
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 a prognosis of 6 months or less to live. Since the law in Oregon was passed in 1997, many states have followed Oregon by adopting similar laws. In more than 23 years of operation in the USA the laws relating to VAD have been changed only once.
FACT: "THE DISABLED WILL NOT BE VULNERABLE..."
Some opponents have suggested that people with disabilities or mental illness will be placed at risk if assisted dying is legalised. This is not true. Voluntary assisted dying laws come with strict eligibility criteria and strong safeguards to protect the vulnerable from coercion or abuse. A disabled or mentally-ill person would be eligible for VAD only if he or she satisfied all the eligibility criteria, including the capacity to make an informed choice. Disability of any kind does not of itself make a person eligible under VAD laws in either Victoria or Western Australia.
Exhaustive, peer-reviewed evidence about how these laws operate overseas has not shown any increased threat to people with a disability, a fact confirmed by leading disability rights groups in those countries. In Australia, VAD is supported by People with Disabilities WA and the Australian Federation of Disability Organisations.
FACT: "THE ELDERLY ARE NOT AT RISK OF ABUSE AND COERCION..."
Some opponents have suggested that family members or carers could pressure an elderly patient to request assistance to die, for instance so that they may access an inheritance or the family estate sooner.
It is a sad reality that elder abuse and coercion occur in any event in our society. Having the strong regulatory framework provided by voluntary assisted dying laws that come with strict eligibility criteria and strong safeguards will help create a safer environment for these vulnerable people.
The requirements for access to VAD in Victoria are very similar to the law in WA, which stipulates that the person seeking access must be a mentally competent adult Australian citizen or permanent resident who is ordinarily resident in the relevant state. He or she must also have at least one disease, illness or medical condition that is advanced and progressive and is likely to cause death within a specified time, and is causing suffering to the person that cannot be relieved in a manner that the person considers tolerable.
Two independent medical practitioners who are appropriately qualified must certify that in their opinion the person satisfies these requirements, and has been given information about all their end of life options, including palliative care. The person must make three requests for VAD, including one in writing, witnessed by an independent witness.
To circumvent these safeguards the doctors would need to collude with family members and in doing so risk prosecution with serious consequences, including losing their licence to practice and going to gaol.
As with the slippery slope argument, research in jurisdictions where voluntary assisted dying is legal demonstrates no evidence of elder abuse as a result of these laws, a fact confirmed by leading rights groups for the elderly in those countries. In fact, the only evidence of pressure has been in the other direction, namely relatives expressing the wish that the patient not avail themselves of a VAD option.
FACT: "SUICIDES DO NOT INCREASE..."
Some opponents have suggested that the legalisation of voluntary assisted dying will lead to an increase in suicides, referred to as 'suicide contagion'. Suicide is entirely distinct from voluntary assisted dying.
Suicide is often an act of desperation where there is no alternative. In the lead up to the VAD debate in Western Australia the head of the WA police union came out in support of voluntary assisted dying for this reason. In his own words: “People experiencing an irreversible deterioration in their health are taking their own lives, often in horrific circumstances. We need a compassionate assisted dying law to give people in certain circumstances a choice to die in a dignified way”.
This is what is will soon be available in Western Australia, when the Voluntary Assisted Dying Act 2019 comes into operation in or about June 2021. This law will enable those who satisfy the eligibility criteria to make a rational decision in consultation with their doctors and family to die a peaceful and dignified death at a time of their choosing. The WA Act provides that VAD is not suicide, and suicide is not recorded on the death certificate as the cause of death.
There is no credible evidence of increased suicide rates as a result of assisted dying laws overseas.
FACT: "CHILDREN ARE NOT AT RISK..."
Opponents of VAD sometimes refer to Belgium, which does have legislation allowing a child in a 'medically futile condition', and who is experiencing constant and unbearable suffering that cannot be alleviated, to request voluntary assisted dying. However, this law carries even greater safeguards, and stricter criteria, than the already strict laws relating to adults. Along with two doctors, a child psychiatrist has to confirm that the child knows what they are requesting. The child’s parents must also participate in, and approve of, the request. Passed into law by a two-thirds majority of the Belgian parliament, this is a recognition that even children can die from illnesses which, in spite of the best treatment, cause terrible suffering. Use of this law is extremely rare.
All the laws being proposed in Australia apply only to competent adults. References to Belgium are nothing more than red herrings.
FACT: "MANY DOCTORS SUPPORT VAD..."
In WA there was support and opposition from doctors. A number of high profile doctors in WA were outspoken ambassadors for the introduction of voluntary assisted dying in the state, including Professor Fiona Stanley. In October 2019, 150 doctors from WA signed an open letter to members of parliament in support of VAD.
Although the hierarchy of the current WA Australian Medical Association (AMA) strongly and publicly opposed assisted dying law reform, the membership of the AMA is divided. Ultimately the AMA worked constructively with the Labor Government in discussing possible amendments, and finally reached an agreement to support the Bill. The AMA represents about 30% of all doctors in Australia.
The national organisation Doctors for Assisted Dying Choice has always strongly supported VAD and other medical organisations came out in support during the campaign in 2019, including the WA Primary Health Alliance and the Royal Australian College of GPs.
FACT: "DOCTORS WILL NOT BE FORCED TO COMPLY..."
Voluntary assisted dying is voluntary and is about choice, and this applies to medical professionals as well as to patients. By law, there is no mandatory requirement for any doctor to participate in VAD, and there is a specific conscientious objection exception for anyone who is ethically or morally opposed to voluntary assisted dying. Everyone involved, including the person requesting help and the doctors and nurses involved in the process, has the right to opt out at any time.
FACT: "A MAJORITY OF CHRISTIANS SUPPORT VAD..."
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 voluntary 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 and Anglican Church hierarchies are opposed to voluntary assisted dying, they do not speak for the majority of their parishioners or believers.
FACT: "ASSISTED DYING IS NOT WHAT THE NAZIS DID...”
During World War II, amongst many other atrocities, the Nazis conducted a program, described as euthanasia, 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.