Tumbling down a deadly slope to the ultimate solution

In just six months, safeguards in states’ euthanasia laws are already being whittled away or dispensed with altogether.

This week the Victorian Voluntary Assisted Dying Review Board put out its report on the operation of the law so far.

The report has been released amid a renewed clamour from the pro-euthanasia lobby to change the so-called “gag” laws in Victoria, which prevents physicians from raising the subject with patients to counter concerns vulnerable people could be pushed into euthanasia.

Along with this there are demands, referred to in the report, that video link and online consultations be legalised, despite federal laws prohibiting online promotion of suicide. It comes as a draft bill in Tasmania would make euthanasia virtually an on-demand practice.

So, after only six months, the vociferous advocates of this practice are trying to whittle away the safeguards we were told would prevent euthanasia on demand.

We were told the slippery slope was a myth, but recent developments in various jurisdictions prove we are seeing the cascade down the slope. The passage of laws with seeming “strict safeguards”, as we were assured would be the case in Victoria, is just a way of getting a foot in the door.

In Victoria, rather than the projected dozen or so who would want this procedure, the number in six months has been 52. And it is set to increase by another 30; that is more than 80 deaths. This could be because of a “lag” effect, but it is noticeable that despite the early estimates, the positive language of the conclusions and the reassuring quotes from family members throughout the report, there is no explanation for this high number.

And this is despite the small number of medical practitioners who have undertaken the online training for this — 134 across the whole state, and most in regional areas. Apparently not many doctors are willing to kill someone, even with self-administration.

Consequently, the report touches on the thorny issue of video link consultation: “The commonwealth law means that it is an offence to use a carriage service … for suicide-related material (which may include voluntary assisted dying).” The report speaks of a significant impact to rural and remote Victorians unable to use telehealth technology.

It is not hard to see that along with abandonment of the gag laws, another of the lobby group’s aims will be nullification of the federal law which would then allow teleconferencing for euthanasia. The exquisite irony of this is that on the one hand we have a law that is trying to strengthen prevention of suicide, but on the other a powerful lobby is wanting it to be made more available.

Another problem with this report is that it is short on detail about those who used the euthanasia laws. Were they young or old? Were they male or female? What was their psychiatric status? Was there any real in-depth investigation of how they came to ask for assisted suicide?

All this report tells us, reassuringly, is that there was 100 per cent compliance with the requirements of the law. This is hardly a full story. It is a feel-good report.

It contrasts markedly with a recent report from the US state of Oregon, which legalised euthanasia in 1994, where there is a much clearer idea about who the people are who want to access euthanasia. It is accompanied by a full profile, which sets out age, sex, marital status, education, health insurance, underlying illnesses and psychiatric consultations.

It also sets out the patients’ reasons for their decision and, in contrast to Victoria, the length of the relationship between the patient and the physician.

This type of information is important when weighing up the efficacy of safety nets around the practice. However, not only is none of this available in the Victorian report, Health Minister Jenny Mikakos has specifically declined to gather or reveal any such information, saying “she didn’t want to go into detail”. In fact the only information in this report is the number of people euthanised and the number of doctors who are registered or awaiting training.

However, despite its deficiencies, Victoria’s laws and the practice of euthanasia are relatively limited and cautious compared with Western Australia and proposed legislation in Tasmania.

There is no prohibition on doctors initiating conversation in Western Australia. There is no requirement that the person be seen by a specialist, which is the case in Victoria. However, in Tasmania just the one doctor who has completed online training can prescribe a lethal injection. But that’s not the worst of the proposed Tasmanian bill.

In Victoria and Western Australia, a person has to be terminally ill and have six to 12 months to live. The Tasmanian bill does not include a requirement that a person be terminally ill.

If passed, the bill will allow for people who are injured or chronically ill to access euthanasia. There is no requirement that the person undergo any psychiatric assessment; the only requirement is that the doctor be satisfied with the patient’s decision-making capacity. Nor is there a prohibition on providing lethal drugs to a person suffering depression or anxiety, and the period between the first and last request is only 96 hours. The consultation can be done by video link despite federal law, which is fairly indicative of the poor drafting of the bill from the state that introduced gender-neutral birth certificates.

But the most horrific thing about this bill is that it includes a review process to be done two years after the legislation comes into force to examine extending the law to minors.

There are children who endure suffering but it goes against the most fundamental ethics of medicine to end the life of a child. However, this has already happened in Belgium and The Netherlands, which makes the claim that it will be used only to voluntarily terminate life, because a child has no agency. Euthanasia in these countries also has been broadened to allow doctors to help kill patients who have “intolerable psychiatric” conditions.

All these things are now proposed in the Tasmanian draft bill, and one must ask how far the euthanasia lobby is prepared to go in applying the ultimate solution to all life’s miseries.