In Both Sides Now, author and ethicist Leslie Cannold presents two sides of an argument. Then it’s over to you: what do you think is true, and what do you think Cannold really believes?
Today: have Victoria’s much-vaunted voluntary assisted dying (VAD) laws made a significant impact on alleviating suffering of the terminally ill?
No: Despite assurances it wouldn’t happen, the numbers of suicides in the state have risen since the law came in. Yes: After specialised training and safeguards, reports show that many terminally ill Victorians have been able to end their suffering without resorting to suicide.
No
The statistics are shocking. In 2017 Victoria recorded 694 cases of suicide. In 2020, that number had jumped to 842. That’s a 21.2% increase — what’s going on?
The answer is simple. Almost two years ago, the first Victorian wanting medical help to suicide took delivery from the Statewide Pharmacy Service of enough pentobarbital to put down a horse, swallowed the dose and died. Ever since then, more than 224 Victorians have become victims of state-sanctioned killing.
While advocates of euthanasia claimed during the debate about the contentious new laws that assisted dying would lower Victoria’s suicide rate, we now know this is untrue.
It’s not the pro-death brigade’s first lie. While Aussies may trust themselves to manage their own deaths, they are rightly worried about others. Especially the vulnerable. What about the greedy grandchildren desperate to inherit Nana’s estate? What about the enormous rates of depression in elderly populations who could easily be made to feel, by an overwhelmed spouse or a society that despises dependence and disfigurement, that it’s time for them to go? As US legislator Nancy Elliot reminds us, “euthanasia is a prescription for all types of abuse of people at the most vulnerable times of their lives”.
Australians also know that encouraging doctors to cross the line set down by Hippocrates — who famously said, “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect” — is a slippery slope. Today, the state says it’s OK to put down the terminally ill. Tomorrow, they could be coming for you.
Which is why holding elites to account on their promises matters. If the new law is actually driving up the state’s suicide rate, rather than deflating it, what else would a thorough investigation of Victoria’s assisted dying regime reveal about what the law really does and doesn’t do?
Yes
Last month, Safer Care Victoria and the Victorian Agency for Health Information released the fourth report of the operations of Australia’s first VAD law, the Voluntary Assisted Dying Act. Currently, such reports are issued every six months.
While Victoria’s VAD law passed in 2017, it took a full 18 months to establish the processes and provide training to healthcare providers that would ensure that when terminal and suffering patients started to use it to legally end their lives in mid-2019, the care they obtained would be safe, compassionate and compliant with what is regularly referred to as the strictest VAD law in the world.
How many terminally ill Victorians used the law in the second half of 2020 rather than — as the Victorian coroner John Olle put it during the 2015 cross-parliamentary inquiry into end-of-life choices — stepping in front of a speeding train or tying a hessian bag of sand around the waist and walking off a pier? The answer: 144 (or 175 if you include those whose medication was administered by a doctor).
What does this number have to do with the suicide rate? Literally nothing because voluntary assisted death isn’t suicide.
But even if you insist that it is, only a second grader adds that figure to the raw suicide numbers for 2020 and calls it a statistical jump. Yet that’s what the “no” side has done.
If you do the numbers properly, comparing suicide case rates (not raw numbers) from the full year before the law was in effect, which was 2018 (11.4%) with suicide rates in 2020, the first full year the law was operational (10.8%), you can see that the predictions of VAD have come to pass. In 2020, suicide rates are down against those seen in 2018. By 0.6%.
Sadly, this is how the anti-choice do business. Whether they are fighting the liberalisation of abortion laws or control over one’s own dying, their MO is the same: say whatever you must to get your way. As US anti-assisted dying politician Nancy Elliot puts it:
We have to be flexible … When you have lots of arguments, if one argument gets blown out of the water, you still have more. And each argument will reach somebody else.
The emotive use of the phrase “put down” is just one misleading strand of spaghetti in a frothing pot full of them: each one designed to turn back long-overdue reforms with high levels of popular support by using what Andrew Denton calls FUD: fear, uncertainty and doubt.
The facts about Victoria’s VAD law are these. That voluntary assisted dying has nothing to do with pet euthanasia or — while we’re here — the eugenics-inspired genocide of the Nazis. Those were choices made for one individual by another, for compassionate reasons or with evil intent.
In contrast, VAD is a choice made by the dying person herself both in theory and — here in Victoria with its 68 safeguards — in practice.
Indeed, if there are any concerns about the law’s delivery on its promise, it’s that it is too restrictive and cumbersome to provide relief to many suffering Victorians.
Fully 239 Victorians had their case withdrawn or died before they could complete the legal process, and another 87 sought assistance from the law but were denied permits. And, as Denton has been documenting in the second series of Better Off Dead, the stresses all the procedures put on a dying person in excruciating pain seem less like protection and more like cruel and unusual punishment.
What side are you on? And where do you think Cannold sits? Send your thoughts to letters@crikey.com.au with Both Sides Now in the subject line.
We’re all in the queue for dying. If someone wants to jump the queue and push in ahead of me then thats OK with me. As an ex-ambo I’ve been to some very messy, desperate suicides. A quiet and dignified departure is definitely the way to go. You shouldn’t usually trust me, but you can on this.
ambos job is to go to messy situations- care providers job is to avoid situations becoming messy – so your perception is very limited by the nature of your job.
Ouch, mate – pretty unnecessary.
I would suggest that all people who disagree with VAD will not have seen someone live for fifteen years with severe dementia …or post stroke condition having been reduced to a total status of total degradation, no speech,no comprehension and no bladder or bowel control. If I am diagnosed with dementia I want the drugs while I am sane enough to take them and so would most people. With the stroke condition please be the medico reduces my food and liquid and saves my family the horrendous situations above. Bring on VAD for the people who want this privilige.
What about the greedy grandchildren desperate to inherit Nana’s estate?
I just want to comment on this one point. I have worked in older persons mental health for the past 20 years – both in community teams and in aged care facilities. Currently I am just finishing a five year stint in a nursing home. I have never, repeat never, in all that time ever met a case where the offspring have in some way suggested, urged, asked for, hinted that Nana be put down, for any reason at all. I have on many occasions experienced the other side of that coin, that is, that families want their oldies to live even when it is clear that there is no quality of life, and no hope they will recover from what ails them. I have seen far too many cases to count, where the children have wanted to send mum or dad (in their 80s and with a long h/o dementia) to hospital, or put on antibiotics in the vain hope they will live a couple of more days or weeks. I think this ‘putting nana down’ argument is a straw man.
On first reading it apeared obvious to me what Cannold thinks. The case against Vic Vad laws was so weak to have me thinking that it was written by a 6th grader. Does anyone still believe the strawman of relatives knocking their grandmum off for the inheritence. In the pro side Cannold burns this strawman down by referencing the 68 laws that dying people have to jump through to take that swig.
Today, the state says it’s OK to put down the terminally ill. Tomorrow, they could be coming for you.
The slippery slope argument. Is there any evidence that there is such a thing as a ‘slippery slope argument’? I would like an example of one. Certainly, why should we think the slippery slop argument would apply in this situation?
Agreed, and we have countries such as Switzerland and The Netherlands to learn from. I personally would choose a dignified VAD if it meant avoiding a painful, inevitable death.
Slippery slope argument shouldn’t be used as it doesn’t happen. What happens, given long enough the statistics uncovers what is happening- I have read that in some European countries in the assisted dying process the about 40% of the deceased had no input into the process – that is because of the culture of the society. In the Netherlands for instance primary school children are taken to zoos to witness euthanasia and dissection of inconvenient animals if they have too many of the same genetic makeup for breeding. Remember the furore a few years ago of the giraffe that they refused to be sent to USA for breeding – so the education system helps buffer the concept of primate death.
I’d love to see some references on that if I may.
Also, on suicide rates. A suicide is not a suicide until the coroner calls it a suicide.
Thus whilst we know how many suicides are associated with physician assisted suicides, we do not know, and have never known the true rates of suicide before this new legislation came in.