Should we introduce Voluntary Assisted Dying?

In Queensland, Australia, the government has introduced into Parliament a bill that will give terminally ill people the right to request medical assistance to end their life. This is variously known as Voluntary Assisted Dying (VAD), Physican Assisted Suicide (PAS), and voluntary euthanasia. The bill will be considered by Parliament’s Health and Environment Committee, and the public can make submissions until 9 am on Friday 2 July 2021. It is expected to be voted on in September 2021.

I do not support VAD. Although I am a Christian, my opposition to VAD is not primarily based on religious grounds. There are good reasons for us all to oppose legalising VAD.

One of the most fundamental ethical principles humans have is that we should not kill the innocent. This is why laws such as those proposed in Queensland are rare – only five US states, Australia, Colombia, Canada, Luxembourg, Belgium and the Netherlands currently permit assisted dying. Once this violation is legalised, the inevitable result will be that the law is, at times, abused. Some people who do not wish their lives to be ended this way will not have their wishes respected.

An important principle in healthcare is the notion of consent. We require that patients provide informed consent to treatment. This means they understand the procedure, its consequences, and are not subject to duress or coercion. It can be very difficult to ensure that people are genuinely consenting to VAD. All kinds of pressures are exerted on those who are terminally ill, especially the elderly. People can be persuaded to consent because they don’t wish to burden their family or the healthcare system. Family members with ulterior motives can try to influence their decision. If VAD is legalised, people will be killed who do not wish to die at that time.

Legislation such as VAD that violates a longstanding taboo also generates concerns about a slippery slope. Once we legalise killing of terminally ill patients, the scope of the practice is likely to widen over time. This can happen in several ways. Usually, this kind of legislation has strict criteria for qualifying – usually a terminal diagnosis of no more than six months to live (in the Queensland case, it is 12 months, which is unusually long). However, in Canada, the Netherlands, Belgium and Luxembourg, killing people with psychiatric conditions is now permitted. In 2014, Belgium changed the law to allow children of any age to request euthanasia, provided they are capable of understanding it. Although instances are very rare, the youngest child so far was 9 years old. Promises by politicians that the proposed legislation will have strict criteria are therefore of little value, as legislation or guidelines can always be amended later.

A crucial provision for terminally ill people is suitable palliative care. Palliative care is not intended to hasten death, but rather to optimise someone’s quality of life. Unfortunately, palliative care is widely acknowledged to be underfunded in Queensland. If the government was as concerned about improving palliative care as they are about promoting VAD legislation, terminally ill people would be far better off. However, legalising VAD is unlikely to improve palliative care services. If someone is terminally ill and in unbearable pain and VAD is available, why should valuable healthcare resources be wasted on them? Most professionals involved in provision of palliative care oppose VAD.

Finally, having VAD available means that there needs to be healthcare professionals willing to actively participate in killing their patients. Unsurprisingly, the majority of those who have dedicated their lives to improving people’s health are reluctant to do so. For example, the Australian Medical Association (AMA) states that they believe ‘doctors should not be involved in interventions that have as their primary intention the ending of a person’s life’. Yes, there are conscientious provision objections included in the proposed bill, meaning healthcare professionals will not be required to be part of VAD. However, these can always be modified once the practice is normalised. There are also concerns about hospitals run by religious organisations may be forced to provide VAD, against their religious beliefs.

Most people are scared of the process of dying, and it is natural to want to exert as much control over it as possible. However, if we had excellent palliative care provided to all, this would go a long way toward alleviating people’s concerns. VAD is superficially attractive as an option to give us greater control over our deaths, but will inevitably result in vulnerable people having their lives ended against their will. This is a high price to pay, and is one of the reasons why most countries have been extremely hesitant to introduce it.

There’s still time to make a submission if you want to comment on the proposed legislation. Feel free to use any of the thoughts provided here to help you do so.