Friday, July 23, 2021

Eight questions about the New South Wales 'Assisted Dying' Bill

This article was published by Mercatornet on July 23, 2021

Michael Cook
By Michael Cook

NSW MP Alex Greenwich is circulating a draft bill which would legalise what his supporters call “assisted dying” and what his opponents call assisted suicide and euthanasia. He believes that there is strong support for change in the state Parliament now that “assisted dying” laws have passed in Victoria, Western Australia, and Tasmania. In Queensland a change will come soon.

But even a quick look at Mr Greenwich’s bill reveals that it is full of holes. Here are eight questions that need answers before MPs could possibly vote for it.

Why will doctors be forced to lie when they fill out death certificates?

The draft bill states very clearly: “The medical practitioner must not include a reference to voluntary assisted dying in the cause of death certificate for the person.” In other words, they are required, under law, to falsify the death certificate. If a patient suffering from cancer died after being hit by a truck, would you record the cause of death as “cancer”? If a patient with both Covid and a toothache dies, would you record the death as “toothache”?

Not only will this distort health statistics, one of the principal reasons for death certificates, but it bakes a lack of transparency into the process of “assisted dying”.

How many are going to die?

Like the legislation in Victoria, Western Australia, South Australia and Tasmania, the bill proposed by Alex Greenwich for New South Wales is modelled on Oregon’s Death With Dignity Act. “Assisted dying” deaths in Oregon have grown very slowly, from 16 in 1998 to 245 in 2020. Supporters of “assisted dying” in NSW believe that only a few people will take advantage of the law.

But from the time “assisted dying” became legal in Victoria on June 19, 2019 until December 31, 2020, 224 people died. It took more than 20 years for deaths in Oregon to rise to that level. For some reason, “assisted dying” is more popular in Australia, perhaps because euthanasia is included as an option.

Perhaps a better comparison is to the province of Quebec, which has about the same population as NSW – 8 million. From legalisation in 2016 to 2020, there were 6,453 deaths. In 2020, 2,268 people died. Will this be repeated in NSW?

The provisions for gathering statistics are crap. What is Mr Greenwich going to do about it?

In Oregon there have been well-founded complaints about a dearth of information. In Oregon’s figures for 2020, in more than half the cases, complications with dying were “unknown”. In about half the cases, the times elapsed between ingestion and unconsciousness and between ingestion and death are “unknown”. You would expect that a bill written 25 years later would improve on Oregon’s deficiencies. This is no small matter: what isn’t measured can’t be managed.

The proposed NSW bill does not fill these gaps. Doctors are required to gather some of this information if they are present – but, based on the Victorian experience, doctors will only be present in about one in five cases. In any case, the proposed Voluntary Assisted Dying Board is not required to publish even this meagre information in its annual report.

Again, lack of transparency is baked into Greenwich’s bill. Voters in NSW will be worse informed about how people die through “assisted dying” than voters in Oregon – even though they can draw on a quarter-century of experience.

Isn’t it true that residential facilities will be forced to host “assisted dying”?

Many aged-care facilities are run by religious groups which object to cooperating with “assisted dying”. They see their job as caring for people, not killing them. And Mr Greenwich seems to accommodate them. The bill provides that “A health care establishment or residential facility may decide that it will not provide services relating to voluntary assisted dying at the establishment or facility.”

But this is smoke and mirrors. What the bill says is that the facility cannot be forced to provide “assisted dying”. But if a resident requests it, the facility must not stop people from entering to advise them of their options and to administer lethal medications. Section 97 states very clearly that the facility must “allow reasonable access” and may not “hinder access” to doctors and witness when the appointment for the death is set.

The same draconian requirements forced a palliative care hospice in British Columbia to close. Its staff and its residents wanted to have an environment where “assisted dying” was not an option. The government insisted and shut it down.

It was tragic. “This is about the B.C. government destroying a sanctuary for dying patients who want the choice to stay in a palliative care facility where [assisted dying] is not offered,” said the chair. Will NSW hospices which object to “assisted dying” be forced to close their doors?

How can we be sure that people will die quickly and painlessly?

That’s the promise of “assisted dying”, isn’t it: a quick, controlled, and painless death? But in Oregon, they know better.

Its 2020 annual report on its Death with Dignity Act covers the 23 years of the Act’s operation, from 1998 to 2020. In that time 1,905 deaths were reported.

In a substantial number of cases there were complications: 33 people had difficulty in ingesting the lethal drugs or regurgitated them; 3 had a seizure; and 16 had “other” difficulties. In 8 cases, the patient “regained consciousness”. It’s hard to imagine how horrific it must have been for a person who expected to die peacefully – but suddenly found herself alive, awake … and possibly in great pain.

The interval from ingestion of lethal drugs to unconsciousness has been as long as four hours in Oregon – and that was in 2017. The time from ingestion to death has been as long as 104 hours (4 days and 8 hours). In 2020 one person took 8 hours to die.

It’s a huge fudge to promise people a no-fuss death. Is that why the bill gathers so little information?

No one is required to witness self-administered death. How can we be sure that there has been no physical or psychological pressure?

People may choose to die in two ways in this bill: self-administration or practitioner administration. No one is required to be present when a person self-administers the poison. How can we be sure that an impatient relative did not browbeat them to hurry the inheritance along if they haven’t died on time –“within a period of 6 months”?

How can we allow people who are seriously depressed to die?

The bill says that if a person is depressed or showing signs of dementia, a doctor must refer them to someone with professional expertise, such as a clinical psychologist, a neurologist or a geriatrician to see if they have decision-making capacity.

But a seriously depressed person, unlike a demented person, could often pass that test. In Canada, Belgium, and the Netherlands, for instance, psychiatrists argue that depression should not disqualify some from seeking “assisted dying” because it does not necessarily rob a person of their autonomy. Even if this were true, depression is hard to diagnose and not predictable. A person might recover enough to want to live.

In any case, the experience in Oregon is that referral is ineffective. According to research published in a leading medical journal, the BMJ, one in six people who died under Oregon’s law had clinical depression. Last year, only 3 out of 245 of those who died in Oregon had been referred by the prescribing doctor for a psychiatric evaluation.

Is the ‘slippery slope’ really a myth?

Supporters of “assisted dying” claim that dire predictions about abuses have not eventuated in jurisdictions where it has been legalized. That’s not true, but in any case, the slippery slope is not about abuses; it’s about gradual changes in the law.

In Canada, where “assisted dying” has been legal for a mere five years, there have already been significant changes to allow people to allow people with chronic but not terminal conditions to be euthanised. Doctors are exploiting the law to combine euthanasia with organ donation.

“The law you enact is the law you get” is a great slogan for supporters, but it’s just a slogan. Laws are amended by Parliament and laws are interpreted by judges. They change. Will a “Voluntary Assisted Dying Act 2021” survive legal challenges by people who want to access “assisted dying” even if they are mentally ill? Even if they are not adults? Even if they are not mentally competent at the time of their death?

Lawyers will argue that some of the vaunted safeguards are arbitrary, discriminatory, and harmful. That is what has happened in Canada and there is little doubt that it will happen here.

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