Thursday, June 9, 2016

Australian Assisted Dying Report - A sugar coated poison pill.

“vulnerable people—the elderly, lonely, sick or distressed—would feel pressure, whether real or imagined, to request early death” House of Lords.
Paul Russell
y Paul Russell

The Legal and Social Issues Committee of the Victorian Parliament handed down its Report into End-of-Life choices in Victoria today.

The extensive report makes some valuable comments and recommendations in respect to improvement in palliative care.

It acknowledges that access to palliative care is patchy, is overburdened and needs improvement. In a country rated recently as second in an international table for end-of-life care, it still remains that the availability of such care is more closely related to postcode than it is to need.

The committee heard from many individuals whose family members had passed away in circumstances that were clearly far from what all Victorians would want and certainly far from best practice. The committee seems to take it as read that such cases are compelling proof that Victoria needs a regimen of ‘assisted dying’ – euthanasia or assisted suicide. Few, I contend, are that clear.

While family members submitting their stories to the committee often (but note: not always) called for legislative change, the submissions and stories may well have been evidence of poor care, lack of care options or, indeed, refusal of good care options; we simply do not know. For the committee to seem so easily to have accepted that poor deaths require the State of Victoria to help people to suicide is a travesty as much as it is the potential abandonment of people in great need.

Certainly, the admission that palliative care is still not able to meet the needs of Victorians is an important one and we welcome all policy and planning decisions that bridge the gap between need and availability. Sadly, however, the committee seems intent that, for those who cannot access such care, being made dead is an option. This is a failure of the committee’s stated aims to improve choice; suicide in such circumstances is no choice at all.

Of course, when the committee talks about ‘assisted dying’ they really mean euthanasia or assisted suicide, or both. That they seem so reluctant to call a spade a spade is rather telling. The reality is that they are recommending suicide:

At the end of life (final weeks or months of life). Suffering from a serious and incurable condition which is causing enduring and unbearable suffering that cannot be relieved in a manner the patient deems tolerable.
It remains for the government to respond to this report within six months, so any legislative framework may not necessarily follow the suggested framework. Still, there will be many who made submissions calling for law reform who will be disappointed; who, indeed, would not qualify.

How any doctor can accurately predict that the person is in the ‘final weeks or months of life’ is not stated. Nor is it easy to predict. While the intent seems to be to provide a minimalist approach, perhaps in an attempt to appear moderate and thoughtful, the reality is otherwise.

In the described framework the person does not need to be actually dying from a condition. In April this year a Quebec man who had been partially paralysed for a number of years but who was not dying, starved himself to the point where he was actually dying from starvation so that he could fulfil the criteria for assisted suicide. He was living with a disability. Death for disability may well be an accepted reason for suicide under the proposal, just as it was an acceptable reason to want to die according to the Supreme Court of Canada.

No more potent example of disability discrimination exists currently than the new Hollywood movie, Me Before You that sees a quadriplegic young man commit suicide in a Swiss clinic. Disability advocates across the globe are outraged by the depiction of disability as being ‘worse than death’ going so far as to call the movie ‘disability snuff porn’ and asking people to boycott the film. That the makers of this film simply don’t get the problem speaks to the reality that many in the disability community talk about; being made to feel that death is better than disability. The Victorian Parliament has, perhaps unwittingly, only reaffirmed those concerns.

The committee seems to be claiming a mandate for action when no mandate exists. Approximately 78% of substantive submissions (submissions of detail and from health providers, institutes, lobby groups etc.) were either against euthanasia and assisted suicide or were neutral and preferring to focus on end of life care more generally. Overall, the total submissions were about 56% in favour with the remainder either being opposed (approx. 35%) or neutral (approx. 7.3%).

The clear mandate is for better care.

There is much more to be said about this report, not all of which is unacceptable.

Failing to gain any publicity are the two dissenting reports by members of the committee. They are appended in the table of contents under one line, yet they comprise a far more robust analysis of available evidence than the entire Majority Report.

The Hon Inga Peulich MLC summarizes the concerns about human destruction via assisted suicide well:

"Any accidental loss of life – even the loss of one life, means such a regime cannot be justified, just as the loss of life, due to capital punishment, deliberate or due to a possible miscarriage of justice, cannot be justified and was the reason for its abolition."

Daniel Mulino MLC’s analysis should be read first, before the Majority Report. It forms not only a sound academic and rigorous approach but also, by implication, is damning of the narrow, outcome focus of the Majority Report:
“Moreover, the rapid growth in documented cases of euthanasia and assisted suicide probably materially understates the actual prevalence of the practice. There is a widespread failure of safeguards and procedures across jurisdictions, including low rates of reporting. 
“While legalisation was supposed to bring what was occurring in the shadows into the light, legalisation has simply pushed the boundary of what is legal out further and may have increased the amount of activity that occurs beyond the sight of regulators.”
Even tempered and thorough, Mulino concludes:
"The Majority Report asserts that the evidence is “clear” that safeguards work in jurisdictions with legalised euthanasia and assisted suicide. A balanced reading of the evidence would lead one to conclude that such an unequivocal statement is not true."
The Majority Report in its conclusions and recommendations on assisted suicide, have presented the Parliament and the people of Victoria with a sugar-coated poison pill. We hope that the government of the day will see through this charade and act at all times to protect vulnerable people while prioritizing palliative care.


Ak Rhodes said...

Demand your rights, ignore the social, downplay the opposition and want it your way. This is a typical response to the situation. What is really desired: palliative care, is ignored. Options are obscured in the glare of death on demand for any reason at any time without apology or explanation. And that will become the only option recommended or noted, which creates a self-fulfilling prophecy.

Jule Koch said...

Isn't there a song?
"Just a spoonful of sugar makes the poison go down, the poison go down, the poison go down.
Just a spoonful of sugar makes the poison go down, in the most delightful way."