Friday, June 05, 2015

The dangers of assisted suicide – making a mountain out of a mole hill

I recently came across this piece by an Australian psychiatrist, John Buchanan, published in Australia's only quality broadsheets, Melbourne's The Age and Sydney's Sydney Morning Herald. Much as I am flattered by being described in Australia as an influential bioethicist, he got it badly wrong in his commentary. Here's a reply to Buchanan's analysis (I did, of course, send it to the paper's OpEd editor but didn't receive so much as an acknowledgment that they received it, much less do they apparently want to publish this response - so far for the influential bioethicist thing :-).
John Buchanan argued in this paper (May 27) that Victoria’s Parliament should reject a motion by the Greens to review the state’s assisted dying prohibitions. His main concern is that assisted dying legislation could not protect against abuse. Buchanan is primarily worried about assisted dying legislation’s impact on disabled patients, the mentally ill, and other vulnerable people.  
As an Australian making a living as an academic in Canada I have been privileged to chair on behalf of the Royal Society of Canada an international expert panel drafting a report on end-of-life decision-making. Among our recommendations was that Canada ought to decriminalise assisted dying. In a unanimous decision the country’s Supreme Court came recently to the same conclusion. On the face of it, it is quite unlikely that the expert panel that I chaired as well as the honourable Supreme Court justices would have missed existing evidence of the abuse of vulnerable people in jurisdictions that have decriminalised.

This perhaps is a good indication as any, that doomsday sayers such as Buchanan have got it wrong on this issue. His arguments are all too familiar to those of us who have been involved in these debates. Let me address some of them.
Among his evidence is a reference to a Dutch ‘medical ethicist’ who changed his mind on euthanasia. Said ethicist’s views are presented as a quote from a notorious British newspaper not known to feature quality content. It turns out, this ‘medical ethicist’ is Theo Boer, a Christian theologian employed at a Dutch Protestant university. Boer cuts a pretty lonely figure on this issue in the Netherlands. The existing assisted dying regime is overwhelmingly supported both by Dutch clinicians as well as the Dutch people. Clutching at straws is a familiar theme when it comes to anti-choice activism.

Buchanan serves another staple of anti-choice campaigners, personal anecdotes. He mentions hospital administrators getting all fired up about assisted dying so that they can empty hospital beds. There’s naturally also a fair bunch of greedy relatives and whatnot else. It is odd indeed that we must take his word for it. In a case currently windings its way thru the courts in New Zealand, similar anecdotes have been presented by the handful of clinicians travelling the globe to prevent legal assisted dying from coming about. Unsurprisingly, actual peer reviewed scientific literature does not support these claims. Perhaps anti-choice campaigners are drawn in strange ways to abusive hospital administrators and greedy relatives. A recent survey of permissive jurisdictions concluded that the average patient requesting assistance in dying is a late-stage middle-class male cancer patient. At no time has it been demonstrably shown that in permissive jurisdictions vulnerable disabled or mentally ill patients have been disproportionately affected by assisted dying. If anything, the existing evidence could be interpreted as showing that they have trouble accessing assisted dying.
There is something deeply troubling about the trope of alleged abuse meted out against disabled people, beyond the mere absence of credible evidence to support it. Disabled people have often been at the forefront of attempts to decriminalised assisted dying, because they often are least able to end their lives on their own accord, precisely due to their disability. A case in point is Canadian Steven Fletcher, a quadriplegic Conservative Member of Parliament. Paralysed from his neck down, a result of a car accident involving a moose in 1996, it was Fletcher who introduced assisted dying legislation in the Canadian House of Commons. 

Buchanan also claims darkly that Belgium and the Netherlands have widened access criteria. For that to be of concern we would already need to have concluded that there is something wrong about assisted dying. That, however, is what is in dispute. If I lived in a jurisdiction that had decriminalised assisted dying, I would want my government to monitor carefully how the existing regime works out and to adjust it in response to societal need. That might well entail changes to access criteria. Any such change as such is not evidence of something gone awry. 
Buchanan further makes the suggestion that we should improve the quality and availability of palliative care. He is right, we suggested that much in our Canadian report. He is wrong to assume that this is an either-or type situation. We know that even with the best palliative care there will be a fair number of patients who want an assisted death regardless. Study after study produced by palliative care specialists opposed to assisted dying comes to this very same conclusion. Palliative care will never be a panacea to resolve everyone’s suffering to their satisfaction.

Buchanan ends with the conclusion that ‘the risks of assisted suicide legislation are too great.’ His whole piece provides no evidence to support that conclusion. The problem for Buchanan and others like him is that we do not live in the 1970s any longer. We actually know what happened over many years in jurisdictions that have introduced assisted dying. Precisely the lack of evidence of abuse is the reason for why an increasing number of jurisdictions are decriminalising assisted dying. It is time for Australia to follow suit. Leaving things as they are condemns many of us to a death that is disrespectful of our final considered choices.

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