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Address to Synod of the Diocese of Melbourne

Friday, 20 October 2017  | Denise Cooper-Clarke & Gordon Preece

Dr Denise Cooper-Clarke - First Speech

Mr President, members of Synod. Denise Cooper-Clarke, SRC.

Given recent developments in Victoria, I seek leave to move the motion in amended form. It now reads:

That this synod, noting the Voluntary Assisted Dying Bill currently before the Victorian Parliament:

  1. Urges the Victorian government to better resource palliative care in Victoria, to improve access to palliative care in the community, including regional and remote communities, aboriginal communities and nursing homes, and to provide more training in palliative care for health professionals.
  2. Encourages the Victorian Government to clarify the legal status of Advance Care Directives and to encourage Victorians to undertake Advance Care Planning.
  3. Opposes the introduction of a legal framework to provide for ‘assisted dying’ (medically assisted suicide and active voluntary euthanasia).

This week, the Voluntary Assisted Dying Bill is being debated in the Victorian Parliament. Similar bills have been introduced in the past year in other Australian States and been narrowly defeated. A similar Bill is currently before the NSW parliament.

We need to be clear exactly what is being proposed. ‘Assisted dying’ is a euphemism. What it means is a doctor prescribing a lethal drug which the patient may then take without further assistance- that is doctor-assisted suicide. Or, if the patient is physically unable to take a lethal drug, the doctor would administer the lethal drug. That is voluntary euthanasia. It is proposed that this be available for adults (over the age of 18), who are competent to make decisions about their own medical treatment, who have a terminal illness and have pain or suffering which is unacceptable to the patient.

We also need to be clear, when considering the recommendation to legalise such ‘assisted dying’, exactly what question we are addressing. The question is not whether, in some extreme circumstances, one might be justified in helping to end patient’s life in order to end their suffering, but whether this should be legalised.

There is no denying that some people (a small minority of patients) in the last stage of their life experience pain or other symptoms which are difficult to manage. Access to skilled palliative care services (by no means always available, especially in rural areas) reduces the proportion of patients in this distressing situation and is known to decrease requests for help to end people’s lives. And so the first part of our motion concerns palliative care. No one should be forced by the lack of availability of quality palliative care services to ask for their life to be ended.

 Still, for those (very small number of) people whose physical symptoms even the best palliative care cannot alleviate, we might think that if there is no other option, doctor- assisted suicide or euthanasia could be morally justified. But that is not the same question as whether these practices should be legalised. Nor will proposed assisted dying legislation cover only this small number of extreme cases. It will apply to a much broader range of circumstances, where the suffering of the patients may not involve sever pain or physical symptoms at all. And overseas studies in jurisdictions where assisted suicide and/or euthanasia are legal have shown that pain is not the primary reason for requests for assisted dying. Rather what motivates such requests are psychological factors: ‘depression, hopelessness, being tired of life, loss of control and loss of dignity’. Many patients who ask for ‘assisted dying’ will be depressed or demoralised. But the presence of mental illness in itself will not disqualify a person who otherwise meets the criteria from accessing VAD, unless it is so severe that their decision making capacity is affected. Psychological suffering can often be relieved by psychotherapy and/or antidepressants, but patients may not have this option.

The moral principles which are relevant to Christians in considering this are the sanctity of human life, justice, the alleviation of suffering, and respect for individual autonomy. The pain and suffering of many who are dying is real and their desire for meaningful choice in their medical management must be respected. But how these principles are balanced will determine one’s response. Different people will weigh them differently, but I believe the first two principles outweigh the other two.

The sanctity of human life is a core Christian doctrine that derives from the Genesis 1 account of humankind being created in the image of God. Humankind is the image or ikon which represents God: every human being regardless of gender, race, sexual orientation, age, or state of health. This is the basis of the prohibition of murder in Genesis 9: 5-6 and in the Ten Commandments. The incarnation of Christ and his redemptive death affirms the extraordinary value He places on each human life.

Justice, from a biblical perspective, has a strong emphasis on advocating for and protecting the vulnerable and the powerless, which includes the elderly, the sick and the disabled. It is unjust to put at further risk those whose lives are already difficult and often devalued. There are good reasons why so many jurisdictions have rejected attempts to legalise euthanasia or physician-assisted suicide. The criteria for eligibility for ‘assisted dying’ will inevitably be expanded, either in practice or by legislation. Overseas experience shows that initial safeguards become eroded in time. In the Netherlands, what began as a measure for exceptional cases has become so normalised that one in 25 deaths in the Netherlands is now a case of ‘assisted dying’.

Even when doctors conscientiously seek to observe the criteria, it would be very difficult if not impossible to ascertain that a patient has not been subtly or not so subtly coerced into requesting ‘assisted dying’. Elderly, frail and sick patients are especially vulnerable to implied or explicit messages from relatives that they are a burden and that they would be ‘better off dead’. It is naïve to assume that people always have the best interests of their relatives at heart. Elder abuse is prevalent in our society.

Many people support assisted dying because they believe it is a compassionate response to suffering. But how is it compassionate to agree with someone who is so distressed that they wish to end their life that yes, their life is not worth living, and yes they would be better off dead? How is that more compassionate than getting alongside them and providing the best care and support so that they are able to find hope and meaning and even joy in the life that is left to them?

The euphemism ‘assisted dying’ aims to mask the fact that euthanasia and assisted suicide are actually forms of suicide. It is incongruous that there are moves in Australia to legalise these practices at the same time as there is so much emphasis on suicide prevention. Suicide is a major social problem, and we rightly spend resources aimed at reducing the suicide rate. If ‘assisted dying’ were legalised, we would on the one hand be promoting suicide prevention, and on the other, promoting suicide as a legitimate choice. Suicide is a tragedy whether a person is old or young, sick or healthy, disabled or not. To approve suicide for some but not others indicates that some lives are considered of more value than others. As Christians we should value the lives of all people, even, perhaps especially, the most vulnerable among us.

I commend the motion to you. It is seconded by the Rev. Dorothy Lee.

Dr Denise Cooper-Clarke - Second Speech

Assisted dying synod motion 2017 reply speech. Denise Cooper-Clarke.

We should oppose the legalisation of ‘assisted dying’ for these reasons:

  1. The proposed ‘safeguards’ are inadequate
  2. This Bill will fundamentally change the nature of our society in relation to attitudes to suicide
  3. The legalisation of assisted suicide and euthanasia (which is what is meant by ‘assisted dying’) is inherently discriminatory
  4. Improved palliative care services are a much safer and more compassionate way to address the issue of ‘bad deaths’ in our community.

Attitudes to suicide, inherently discriminatory

The proposed legislation is inherently discriminatory. It creates a class of people (those with terminal illness, many of whom will be disabled in some way or have a mental illness, and many of whom will be socially isolated without community or family support; in other words some of the most vulnerable in our society) for whom suicide is seen as appropriate, whereas for everyone else it is rightly seen as a tragedy. The legislation will also discriminate against people in rural and remote areas where psychological and palliative care services are not readily available.

Inadequate safeguards

The safeguards in this Bill are not, as has been claimed, the most stringent or conservative ever proposed.

(First, assisted dying would be available to patients who would not be likely to die for 12 months. This far out from death, any doctor’s prediction of life expectancy is little more than a guess, and is only based on averages.

Second, the ‘cooling off’ period of 10 days is too short. There is evidence that people who make requests in a moment of distress or at a low point in their illness often, given time and the opportunity for counselling and /or a palliative care consultation, withdraw their request. 10 days is too short to give them the opportunity for such counselling or consultation to take place.)

But even if the safeguards were more careful, many have concluded that adequate safeguards are simply impossible. In 1993 a Select Committee of the House of Lords concluded, after investigating the practice of euthanasia in the Netherlands, that ‘it would not be possible (in the UK) to frame adequate safeguards against non-voluntary euthanasia’. In a judgement on September 7 this year, New York’s Court of Appeals said that the state had legitimate reasons to outlaw doctor-assisted suicide, including to protect vulnerable patients from pressure to end their lives. Recently a group of 101 Victorian oncologists wrote to the Victorian parliament opposing assisted dying because there is ‘no safe system possible to protect vulnerable populations’.

This is the reason so many jurisdictions have repeatedly rejected the legalisation of ‘assisted dying’- lawmakers were not convinced that the so called safeguards would prevent vulnerable people dying unnecessarily.

This was admitted by pro-euthanasia advocate British neurosurgeon Henry Marsh when he wrote in The Sunday Times, ‘Even if a few grannies get bullied into it (assisted suicide) isn’t that the price worth paying for all the people who could die with dignity?’

Do we think that this is a price worth paying?

Thursday 19th October 2017

Speech by Rev. Dr Gordon Preece

Gordon Preece, PiC Yarraville, Chair of the SRC.

Mr President, Synod members, I rise to support the motion, partly to clarify that despite no longer seconding it, I still strongly support it in its entirety. But I’d like to personally accent certain aspects and make an additional economic point which I communicated in person to health minister Hennessy.

  1. Despite the euphemistic and deceptive redescription of what is actually assisted suicide and voluntary euthanasia, this bill will inevitably legitimise suicide, a massive social problem. Why else, when tragic cases of end-of-life suffering and thinly disguised advocacy of assisted suicide & VE appear in our media, do they attach contacts for Lifeline & Beyond Blue? It’s because the framing of such sad stories inadvertently legitimise suicide. Mental illness, depression & anxiety disorders are predicted to be the main health crisis in Australia, if not already. Much of my family is involved professionally in caring for people with mental illness. My wife has a wonderful phrase for the role of carers - ‘Holding the hope’. This legislation, though well-intended, is a counsel of despair. Next Thursday I preach at the funeral of a close friend whose wedding I took in our home and who lived in our flat. Our society should not do anything that further encourages people in mental or physical pain to die alone in despair.
  2. The legislation so focusses on absolute individual autonomy that it cannot be limited by safeguards as the avalanche of autonomy increases demands through various ages and conditions, physical and mental, as the Dutch, Belgian and Canadian experience shows.
  3. The legislation fundamentally shifts the foundational institutions and professions of medicine and law away from their anchoring in and guarding of a sacredness of life and care ethic, to one of killing in the name of curing, at all costs.
  4. While the legislation’s emphasis on palliative care is commendable, it is utterly undercut by the cheap option of assisted suicide and VE. Note the truisms ‘follow the money’, and 'it’s the economy, stupid’. In a rapidly privatising and profit-based health (hospitals and nursing homes) and welfare systems labour intensive and relatively expensive palliative care will be short-changed. And we will become a less caring society.

I urge you to support the motion.

Thursday 19th October 2017

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