To legalise so-called voluntary assisted dying is to legalise a practice that predictably and inevitably expands. There is plenty of evidence of bracket creep already in Australia and overseas.
From 2017 in Victoria through to this year in Queensland, the circumstances in which this service has been made available have widened as bills have been debated in state jurisdictions.
So, too, in NSW from 2017 when the state parliament debated the Khan Bill to this year when it debates the Greenwich Bill: once again the conditions under which the service is to be available have expanded. And there’s plenty of evidence of the same phenomenon from Europe and Canada.
Expansion should not surprise us. More important, however, than acknowledging these empirical facts is understanding why they have occurred.
There are, I think, two forms of pressure that cause this by-now familiar expansion of the laws. I will call the first pressure “choice will not be necessary” and the second pressure “choice will be the only thing that’s necessary”.
The “choice will not be necessary” pressure works like this. The patient chooses VAD. Then two doctors assess the person’s eligibility: a medical condition from which the patient will likely die soon, from which the patient is suffering intolerably. The doctors must judge whether these criteria are met. But, if someone else meets these criteria, why will choice be necessary? Why not expand the availability to people who meet these eligibility criteria but who cannot choose?
The pressure to expand availability in this direction can be seen in the arguments of those who say euthanasia should be made available for newborn babies (as in The Netherlands) and/or to people with dementia (as in Canada).
Indeed, years ago the late Dr Rodney Syme, a proponent of these laws, predicted that once the service was legally available to those who could choose it, society might come to think that it would be unfair if it were not available to people who could not choose it. His reference was to people with dementia. Thus the “choice will not be necessary” prediction.
The “choice will be the only thing that’s necessary” pressure goes in the other direction. A patient chooses VAD. Then the doctors must assess the patient’s eligibility. But the doctors, understandably, are likely to shy away from making what is mostly a medical judgment (that the patient meets the eligibility criteria) and prefer to rely on the actual choice of the patient.
The pressure to expand availability in this direction to anyone who chooses can be seen in Canada, where the requirement that death must be reasonably foreseeable has been dropped on the grounds that requirement discriminates against people with serious disabilities who are not terminally ill. Thus the pressure towards “choice will be the only thing that is necessary” prediction.
These two forms of pressure, which seem to go in opposite directions, in fact share an assumption: that we can know when a life is not worth living.
In the former case, that assumption is made “objectively” by others. In the latter case, that assumption is made “subjectively” by the person themselves.
This is why most of the debate about adequacy of the safeguards in these bills misses the point. However humane one’s motives in supporting these laws, the likelihood of the criteria of eligibility being expanded cannot be set aside as though it were mere panic-mongering.
Parliamentarians, in framing laws for the wellbeing of everyone in the community, have a responsibility to deepen and widen their thinking.
The social policy before them is not simply a matter of how best to ensure that people do not die in unrelieved suffering. It is also a matter of how to protect the lives of those who, on their own or at the behest of others, have come to think their lives are not worth living. Their existential demoralisation is a challenge to us all.
Yes, I’m a Catholic, so it will be said I’m trying to impose my religious beliefs on those who don’t share them. Well, any reasonable religion holds out its social teachings as matters that are apt for rational assessment.
But, that said, there is nothing religious in the claim that expansion of these laws is predictable and inevitable.
This article first appeared at www.theaustralian.com.au