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Doctors for Assisted Dying Choice (Drs4ADC) http://drs4assisteddyingchoice.org/
Queensland Convenor Group
Dr Sid Finnigan MBBS, FRANZCO
Professor Malcolm Parker MBBS, M Litt, M Hlth & Med Law, MD Dr Heather McNamee MBChB, MRCGP (UK), FRACGP, DFFP Dr Jenny Brown MBChB, MRCP(UK), FRACP
Dr Peta Higgs MBBS, FRANZCOG, CU
Dr Peter Stephenson MBBS (Lon.)
Dr Sid Finnigan E: S&S Finnigan firstname.lastname@example.org PO Box 3218 BIrkdale Q 4159 M: 0402 798 440
We have read the response from the Religious Leaders to the prospect of the legalisation of voluntary assisted dying (VAD) in Queensland. All will agree with their introductory commitments to human dignity and freedom, the importance of Queenslanders feeling valued, and the ability of all to live meaningful, purposeful and fulfilling lives, including through access to high quality health care and end-of-life care. In particular we agree that “Dying well is an important part of what it means to flourish as individuals and communities”.
Nevertheless, we strongly reject the Religious Leaders’ contention that providing assistance in dying is to fail those with terminal illness who are experiencing the level of suffering that would motivate them to request VAD. Below we paraphrase and refute key claims made by the Religious Leaders.
Claim 1. High quality specialist palliative care ensures that no Queenslander need choose VAD in order to avoid a horrible death. All Queenslanders do not have universal access to high quality specialist palliative care, and this should be provided.
The implication is that once everyone has access to high quality palliative care, requests for VAD would cease. There is very good evidence from around the world that this claim is false. Where VAD and high quality palliative care coexist eg in Belgium and Oregon, there is evidence that not all suffering can be avoided and a small but significant percentage of people request VAD. Parliamentary inquiries in Victoria, Western Australia and here in Queensland have all heard medical expert testimony confirming not all suffering can be managed by high quality palliative care. In addition, some terminally ill people do not wish to utilise palliative care, even if it is of high quality. Insisting that everyone would do so is to abridge the freedom that the religious Leaders claim to support.
The implied insistence that VAD should not be legalised until every citizen is assured of access to high quality palliative care is a false, self-serving strategy. While we strongly support increasing access to high quality palliative care, the aspiration to universal access can function as an unattainable goal that remains forever beyond reach. Use of this argument to oppose VAD Legislation is devoid of compassion for those whose suffering is unable to be relieved despite high quality palliative care.
Claim 2. VAD legally enshrines the idea that some human lives are not worth living. This puts vulnerable people at risk of coercion and abuse. People who feel their lives are worthless are particularly vulnerable. VAD undermines the caring for others and being cared for that contributes to our flourishing.
Like many others, the Religious Leaders conflate the ideas of feeling worthless and feeling that one’s life is no longer worth living. Just like those who request that life-sustaining treatment be withdrawn or who refuse further active treatment (lawful requests), people who request VAD do not feel worthless. The Religious Leaders fail to acknowledge or perhaps simply don’t understand that rational terminally ill people have heightened insight into the value of their life and are certainly capable of determining for themselves if their symptoms and quality of life are no longer adequately managed. In the setting of terminal illness with irremediable suffering, the feeling that your life is no longer worth living and the feeling that you are a very worthy and valued person, are, in fact, perfectly compatible states of mind.
There is no evidence from jurisdictions that have legalised VAD that people who consider that their lives are no longer worth living – in either of the two groups described above – have been either vulnerable or subjected to abuse.
People who choose VAD where it is lawful, and their families and friends, would strongly deny that the availability and the process of VAD undermines the flourishing that comes from caring and being cared for. They would insist on the opposite – that provision of VAD in their case constitutes being cared for in a way that they place great value in. For the Religious Leaders to claim otherwise is to project their own particular view of flourishing on to those who do not share it.
Claim 3. VAD undermines human freedom because it seems to offer the misleading choice of dying a horrible death or taking your own life.
This choice currently operates, even in the setting of high quality palliative care. In Queensland between 2106 and 2017, 168 terminally ill people died as a result of self harm. VAD would offer terminally ill people a choice to peacefully end their lives if they wish rather than being forced to choose a painful or violent and lonely death. What is misleading is the Religious Leaders’ willingness to omit mention of palliative care when they believe it suits their argument. Supporters of VAD are on record as being consistent supporters of the provision of high quality palliative care, improving access to palliative care, and ensuring that people are aware of all end-of-life choices.
Claim 4. VAD undermines efforts to address the crisis of suicide in Queensland. We should not affirm the idea that some lives are not worth living.
Aside from repeating the error of VAD affirming the idea that some lives are not worth living, the claim about suicide is false. There is no evidence that suicide rates have increased in jurisdictions that have legalised VAD. Nor is there any evidence that in these jurisdictions, efforts to address the problem of suicide (other than lawful assisted suicide) have been weakened.
Sid Finnigan is a recently retired Ophthalmic Surgeon with subspecialty interest in Ocular Oncology, having previously spent four years in Queensland Country Hospital Service followed by ten years in General Practice prior to specialist ophthalmic training.
Malcolm Parker is Emeritus Professor of Medical Ethics at the UQ and Adjunct Professor at the Australian Centre for Health Law Research at QUT. He was in general medical practice for over thirty years. He has published widely in medical education, philosophy of medicine, medical ethics and law and bioethics, including end-of-life ethics and law.
Heather McNamee is a GP in regional Queensland with special interests in reproductive health, adolescent and HIV medicine and telehealth. She has prior experience in paediatrics including paediatric oncology.
Jenny Brown is a specialist physician in internal medicine with over 30 years’ experience. She set up the palliative care service at Mater Health Services Brisbane, where she was Director of Medicine and Chief of Medical Staff. Dr Brown was previously Clinical Associate Professor of Medicine at UQ, training many medical students and junior staff, and was an examiner for the Royal Australasian College of Physicians.
Peta Higgs is a Subspecialist Urogynaecologist in private and public practice on the Sunshine Coast. She is the immediate past Chair of the Urogynaecology Subcommittee for RANZCOG and an examiner in Urogynaecology.
Peter Stephenson has been a family doctor since 1977 in the Moreton Bay Region,
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