The End-of-Life Choices (Voluntary Assisted Dying) Bill 2020 is heading to the Committee Stage in the Legislative Council. A number of MLCs have indicated that they support the bill in principle as long as adequate safeguards can be drafted to protect the vulnerable. But does the theory fit the practice? What can we learn about the experience of The Netherlands and Belgium that legalised euthanasia in 2002. Canada also legalised euthanasia in 2015. What can their experience teach us in Tasmania?
Live and Die Well has developed the “Can safeguards prevent abuse?” brochure to highlight the way in which euthanasia has shifted from being an option of last resort to something that has been normalised. The eligibility criteria in these countries has expanded. Vulnerable people with dementia are now being euthanased based on what they wrote in a form years before they got dementia. This process has taken around a decade in The Netherlands and Belgium but it has taken only 5 years in Canada.
“Safeguards” in these countries have been viewed as barriers to access and scaled back over time. These countries also demonstrate that there is a stark difference between what is in the legislation and what is practiced at the bedside. The legislation establishes the requirements for the bureaucratic process and paperwork that needs to be followed. However this paper trail hides the actual practice that is occurring in the context of the doctor-patient relationship that gets even more complicated when it becomes the doctor-patient-family relationship that is often the case with vulnerable sick and/or elderly people. Hence on the surface of the assisted suicide/euthanasia iceberg, the paperwork that is completed with all the i’s dotted and the t’s crossed creates the impression of due process, however under the surface of the iceberg a host of machinations can be hidden. In the event of this occurring it is rare that justice will be done as the main witness is deceased. The Netherlands and Belgium have only had 1 prosecution each in 18 years and the doctors convicted served no jail time. This is hardly a disincentive for those who are operating under an exemption to the Criminal Code.
Some would say that this slippery slope effect couldn’t happen in Tasmania. However if we look at what Mike Gaffney has said about his bill then we can see that the DNA of the End-of-Life Choices (Voluntary Assisted Dying) Bill 2020 is closely related to its Dutch, Belgian and Canadian forebears.
Mike Gaffney, Second Reading Speech, September 15, 2020
“I travelled to five jurisdictions where VAD currently occurs – the Netherlands, Belgium, Switzerland, Canada and Oregon in the United States. I was introduced through Dying with Dignity Tasmania connections to 11 international experts, all highly regarded in their fields. They included palliative care experts, medical practitioners, university researchers and senior legal counsel; there were current and former politicians and several health practitioners who are directly involved in the assessment and administration of and eligibility for VAD – their collective knowledge of constructing and strengthening legislative frameworks, ensuring adequate safeguards and best practices, legal protections for the person and the practitioners as well as detailed anecdotal evidence of their own experiences with people utilising VAD and working closely with other end-of-life services, such as palliative care, and the families who generously and candidly shared in the interests of trying to help craft a bill absolutely tailored to suit the Tasmanian environment – absolutely tailored to suit our place.
The insights gained through these meetings and discussions have been invaluable to the process and the international experts have all remained but an email or phone call away in the months since my visits. I remain utterly grateful to each and every one of them.” ….
“I did not tell this to Robyn, but at the end of January when her first draft bill was sent to Jocelyn Downie in Nova Scotia [Canada] – and Jocelyn is responsible for the Canadian bill – she was so impressed, she said to me, ‘Would this lady like to come and work for us?’. I just have to say that was the high regard that Jocelyn Downie, who is one of the international experts, had for the craftsmanship of our senior officer of Parliamentary Counsel.”
Mike Gaffney, Second Reading – Summary Address, September 22, 2020
“The EOLC (VAD) Bill is more consistent with other safe and more effective legislation by avoiding a major weakness in the Victorian and WA VAD Acts – the requirement for prognoses of months to live – and focussing instead on end of life suffering and the wishes of people to end that and to choose the way to do so. There is no requirement for suffering under US assisted dying laws – the model is primarily for a “right to die” a bit earlier than you would have done. The model for the Canadian, Netherlands, Belgian and Luxembourg laws is different and has a primary focus on assisting people to end intolerable/unbearable end of life suffering. This is close to the model of the EOLC (VAD) Bill.”