1. Legislation to legalize the self-termination of life with the assistance of members of the medical profession has now been passed in every Australian State. The same kind of legislation will come into effect in the Australian Capital Territory in November of 2025. I think it was Franklin Roosevelt who once spoke of an “idea whose time has come”. The voluntary self-termination of life is an idea “whose time has come” across Australia and in many other places in the world.
2. Despite the contentious nature of this legislation, my impression is that there has been little publicly expressed opposition to it in Western Australia. I am in fact not aware of any really serious public debate of the ethical issues involved. One notable exception to this was made at the time this proposal came before the Western Australian Parliament (2018-19). when the AMA, the Australian Medical Association, to its credit, voiced its reservations about it. Given the traditional adherence of members of the medical profession to the Hippocratic Oath’s requirement that they must act at all times to alleviate pain and try to save lives, it is natural that medical doctors have publicly expressed concerns with the thought of assisting in the active termination of life. Accordingly, at the time of the introduction of WA legislation, the AMA signalled that, as a professional medical association, it did not support VAD. This lack of support was handled by the legislators by ensuring that no medical or health practitioner would be required to participate in the assisted termination of life, but they are nevertheless required to refer patients on to a medical practitioner who is prepared to do so, if the issue is raised with them by a patient.
3. By and large, however, apart from the AMA, (and I think I recall that a nurses’ association may also have expressed a negative view as well), there has not been any really notable resistance to the legislation of which I am aware. My impression is that the Churches have been surprisingly compliant or mute. Perhaps the Churches have had enough on their plate in recent times in relation to the mishandling of child sexual abuse, and have even been shamed into comparative public silence. The on-set of COVID and multiple lockdowns in 2020 probably did not help. By-and-large my perception is that the proponents of this wave of legislation across the country have tended to be allowed to prosecute their cause relatively unchallenged.
4. On the other hand, crusaders for it have been publicly vocal and enthusiastic in their support of it - very notably, the former physician Philip Nitschke, now the Director of Exit International, and the TV personality Andrew Denton, for example. However, the level of rational debate has not been high.
5. The result is, that even the use of the term VAD to signal “voluntary assisted dying” has not really been publicly examined or challenged. This is despite the fact that the acronym “VAD” has already been in use amongst members of the medical profession for the purpose of referring to “ventricle assist device.” If you Google VAD you will get information on that device rather than on the self-termination of life.
6. In fact, however, the term “voluntary assisted dying” is problematic to many, because, as conventionally used in normal English language “dying” is something that happens to us, we are necessarily passive; it is not something we actively do or accomplish ourselves. The voluntary and positively deliberate self-termination of life which has become legal in this country is correctly speaking a form of suicide; by contrast with dying, it is something in which those who resort to it are active agents.
7. Strictly speaking, then, in talking of the self-termination of life we are speaking of VAS – voluntary assisted suicide, though I would myself prefer to speak of STL – the self-termination of life. In fact, it would be more accurate to say that it is the palliative care of a dying patient either at home or in a hospice that properly speaking can be described as providing access to “assisted dying.” But the proponents of VAD understandably prefer to use the euphemism of voluntary assisted dying - presumably because they are well aware that they should not be supporting or normalizing suicide in the community as a good thing. This is particularly so in contemporary Australian society, where death by suicide is clearly a serious problem. Hence, the WA Legislation says: “For the purposes of the law of the State a person who dies as the result of the administration of a substance in accordance with this Act does not die by suicide.” (Sec 12 ). Hence, a person cannot be charged with an offence of attempted suicide or assisting in a suicide. In normal English, however, as distinct from “the purposes of the law” it is, of course, suicide.
8. That it would unwittingly contribute to the development of a culture of suicide was one of the concerns that was raised by the AMA. I will return to this a little later. For the moment, it is sufficient to signal that this language - VAD - for the self-termination of life is misleading and confusing and perhaps even offensive to those who support assisted dying in the form of the palliative care of those facing the existential challenge of a life threatening diagnosis to make their dying as comfortable and pain-free as possible. The hijacking of this language and applying it to camouflage voluntary assisted suicide needs to be recognized. I have recently noted that Australia’s most notorious euthanasia campaigner Philip Nitschke, in his promotion of the “suicide pod” in Switzerland recently, at least spoke candidly and honestly of it as “rational suicide”.
9. Another problematic assertion regularly made by proponents of the self-termination of life in the course of their active public support of recent legislation is that it would be lacking in “care and compassion” to oppos it. In other words, it has often been suggested that not to allow access to the self-termination of life to those in the sad predicament of having to face a sinister terminal illness is to be lacking in care and compassion. (Nitschke himself says that “what people need is care and compassion, not a lethal dose”). It is as though the procedure that is now regularly referred to as VAD is the only caring and compassionate course of action. This language has tended to be intimidating and to silence the expression of an alternative point of view, whereas those of us who support palliative care at home or in a hospice would also claim to be equally motivated by care and compassion. In other words, the concept of care and compassion has also tended to be hijacked in way that is intimidating to those who have reservations about it for fear of being said to be uncaring or lacking in compassion.
10. The same may be said of the use of the slogan “dying with dignity”. In the State of Washington in USA the relevant Act of Parliament is in fact called “Dying with Dignity.” It is as though other modes of assistance and care for the dying, let us say in a hospice, only offer a form of “dying without dignity.” Once again, I think the use of this kind of emotive language in corralling public support for what the supporters euphemistically call VAD has to be called out.
11. Why is it that this kind of emotive language rather than rational ethical argument has been a feature of the public crusade in support of assisted self-termination of life prior to and in the course of the passing of recent legislation, while there has been so little rational public debate of the relevant ethical issues?
12. Basically, I think the answer to this question has to do with, what for the last 70 years or so now, has been identified as a flaw in thinking that is fundamental to all liberal democratic societies of the Western World. Generally speaking since the eighteenth century (under the influence of such thinkers as Immanuel Kant in Germany, followed by Jeremy Bentham, and John Stuart Mill in Britain in the nineteenth century) liberal democratic societies such as ours have been based on the contention that human individuals should be autonomous and free to determine their own individual moral attitudes and behaviours, so long as they do not encroach on the equal right and freedom of others to determine their moral attitudes and behaviours: “You do your thing and I’ll do mine; and so long as I do not tread on your toes and you do not tread on mine, we will get along just fine.” There is thus an implicit divide between public and private morality. In his essay On Liberty, (1859) John Stuart Mill famously declared: “The only purpose for which power can rightly be exercised over any member of a civilized community, against his will, is to prevent harm to others.... Over himself, over his own body and mind, the individual is sovereign.” Ideally, in our kind of society the human individual is free and autonomous: over him or herself he or she is self-determining, “over his (or her) own body and mind, the individual is sovereign.’
13. This basic principle of western liberal democratic societies is most clearly defined in the American Constitution, where a basic and inalienable right of individual freedom and autonomy in personal decision making is established in the cause of securing “life, liberty and the pursuit of happiness”. We currently see this principle operating in US debates in which the NRA (the National Rifle Association) regularly upholds the alleged individual constitutional right to possess and carry firearms to defend themselves; or conversely the individual right of individual freedom and personal autonomy not to be obliged to have compulsory health insurance. Hence opposition to the health insurance package of Obamacare. Immediately, the fact that Americans want the freedom to decide for themselves whether to have guns and the freedom not to have health care insurance probably signals that there may be something wrong with this basic alleged individual right at the expense of the more communitarian value of the public good.
14. The stand-out critical work in relation to this basic principle of Western liberal democratic societies is that of Alasdair MacIntyre in a book called After Virtue, published in 1981, which I obviously can’t unpack in detail today. But MacIintyre argues very persuasively that the so-called inalienable rights which individuals are said to acquire at birth in Western liberal democratic societies are actually a myth, with no more reality than witches and hobgoblins. Rather, he argues that rights to social and moral freedoms are never absolute, and have to be balanced with the good of the community. They do not somehow come through the air to individuals at birth but are actually worked out in community with others in rational debate.
15. Now, the interesting thing for us today to note, is that when you think about it, the individualism of modern liberal democratic societies of the Western world is right from the outset not conducive to rational ethical and moral debate. if you are autonomous and free and do your thing and I do mine, and if your view is as good as mine, the concept of moral truth actually goes out the window. Hence the lack of rational ethical debate, and the recourse to emotive language in expressing a particular point of view. Instead of rational argument in search of moral truth, modern Western liberal democratic socities tend to opt for a kind of Emotivism. Emotivism is a theory of ethics which holds that ethical statements “are neither true nor false but express emotions, desires or attitudes….To affirm, for instance, that an action is morally right is, according to emotivism, to show a favourable attitude towards the action.” (Dictionary of Philosophy, ed. Thomas Mautner, London: Penguin, 1996, p.184, entry under “Emotivism”). As a consequence, in modern Western liberal democratic societies, the standard way of registering a moral point of view is less by rational debate and more characteristically by placards and public protests. Indeed, I happen to think that the deficit in the ability to conduct a rational ethical debate means that the societies of the Western world are probably in big trouble. Only time will tell whether modern America, for example, is at present a nation in decline.
16. To these arguments of McIntyre about the problematic nature of so-called autonomous individual rights, those of us who come from a Christian tradition distinguish clearly between an individual and a human person. An individual is considered in separation from others, a person by contrast is understood in relation to others. A person is one who is addressed by another and who may be expected to make a similar response. That is why an ATM machine is necessarily impersonal. Between persons there is inter-personal give-and-take. Furthermore, we get our identity as persons from our relationships with others - as a son or daughter in relation to a father or mother. or as an employee in relation to a boss, or in our relations with friends in community. In fact, the concept of a person as distinct from an isolated individual was actually discovered in the context of the life of the Christian Church in the fourth century as it worked out the distinctive understanding of God as three Persons in one indivisible communion of love. As persons we are accordingly made in the image of God, addressed by him and called to newness of life; to this personal God we respond in prayer and worship as Persons in communion. The idea that we somehow flourish as autonomous individuals is a myth of modern secular liberal democratic society.
17. Let us look at some of the difficulties that we are experiencing in western liberal democratic societies, given the individualism that actually inhibits rational community debate of ethical issues.
I happen to be a supporter of Karmala Harris, and hoped earnestly that she would defeat Donald Trump in the recent US election, but I had enormous misgivings during the course of the recent US electoral campaign when she so often declared that American women have a basic right of autonomy over their own bodies and thus the freedom to pursue what amounts to abortion on demand, because, as Karmala Harris often said, “they have the freedom to do as they will with their own bodies” (possibly without knowing it, almost directly echoing John Stuart Mill). This is understandable given the characteristic American insistence on individual autonomy and freedom. But the obvious question is: do American women have a basic freedom or an autonomous inalienable right to put their bodies behind the driving wheel of a car and then drive on the wrong side of the road? Or the freedom to do what they like with their own bodies by driving when drunk? Or even the freedom to put their bodies in a car without wearing a seat belt? Or to put their bodies on a motor cycle without wearing a safety helmet? Clearly, in an ordered and civilized society individual freedom is never absolute; it has to be balanced and often modified in the communitarian interests of the public good.
But Karmala Harris repeatedly spoke of the freedom of women to choose what they do with their own bodies, as though there is no need to consider the rights to care and protection of the unborn bodies of conceived human children in utero. No rational consideration in ethical debate was given to the scientific advances that have been made over the last one hundred years in monitoring the in utero development of human life – the fact that an unborn child has a heart-beat of its own, independent of that of the mother, a blood circulation system of its own, and fact that the beginning of a central nervous system of its own shows up embryonically as a build-up of cells to form what is called “the primate streak” right from the time of conception, 14 days or so after the fertilization of an ovum. You are free to disagree about this, but, my point is there can be a rational scientifically informed debate about the rights of the unborn child. It is not just a matter of a woman’s autonomy and freedom to do what she likes with her own body. There can be a rational ethical debate about these things as we seek for moral truth.
But apart from the assertion of an alleged individual right to personal autonomy and freedom, the language ends to become emotive. Often in the recent US electoral campaign, tragic examples were cited of hospitals refusing treatment to women seeking a therapeutic abortion that have resulted in the death of the mother. Alternatively access to abortion was said to be needed in the case of rape. In both these cases there can be a rational ethical debate also – in the case of the justification of therapeutic abortion in the interests of saving the life of the mother, based on well accepted ethical principle of self-defence, for example. Therapeutic abortion dictated by the need to protect the health and well being of the mother does not warrant abortion on demand. On the other hand, in the case of rape most people know when they have been raped and can immediately seek a curette, a flushing of the womb in order to prevent conception, in the 14 day period between the possible fertilization of an ovum and its implantation in the womb, which signals that a human being has been conceived, This is surely a better possibility than to wait to see if a conception has resulted and then turn to abortion. Prior to this talk of abortion is inappropriate for there has not even been a human conception. There is now such a thing also as the “morning after” pill to inhibit conception. So talk of abortion in the case of rape is inappropriate and does not warrant abortion on demand.
18. Now, our purpose is not to debate abortion this morning, but this problematic principle of individual autonomy and freedom as an absolute inalienable individual right in liberal democratic societies that we have often seen asserted by Karmala Harris in relation to abortion rights as though it were some kind of absolute, is of interest to us this morning because this very same principle is regularly cited as the basic justification for giving terminally ill patients the autonomous freedom legally to access the self-termination of their own lives with the help of the medical profession. The Western Australian Joint Select Committee which paved the way for local legislation, produced and published a Report in 2018, significantly entitled “My Life, My Choice”. This committee was Chaired by Amber Jade Sanderson, the current Minister for Health.
On the assumption of the validity of this alleged basic right the Report concludes: “Individuals exercise independence and autonomy in their daily lives and want to be able to make autonomous choices when they are dying. One of those choices should be to manage the place and time of their own death, through voluntary assisted dying.” We should note at the outset that instead of beginning a rational moral argument the Report relies upon a statement of what people want: Right at the outset polling takes the place of rational argument.
19. The ensuing legislation of 2021 then seeks consistently to uphold this principle: At the very beginning of the process of seeking access to VAD the ACT requires that an initial request for VAD must be “clear and unambiguous”. It has to be clearly initiated by the patient. If it is just tentative then it appears to be invalid. The WA ACT itself says that VAD is validly offered if the diagnosed disease is “advanced, progressive and will cause death” and is causing suffering to the person that cannot be relieved in a manner that the person considers tolerable.“ Once again it is up to the autonomous and free individual to assess whether suffering has reached a degree that is intolerable. Then, at the end of the process when the date for self-termination arrives, the patient is encouraged to administer the lethal medication him or herself, rather than relying of a medical practitioner to do it, thus sustaining a distinction between euthanasia and self-termination. In the Victorian legislation this requirement is almost mandatory.
20. The Report’s initial focus upon “absolute individual autonomy” means that little if any ethical consideration is given to communitarian values. In other words, the Report reaches its conclusions independently of the discussion of the problematic nature of the individualism that in recent years has been recognized to have had a noxious influence on ethical discussion since the late eighteenth century, through at least until the second half of the twentieth century.
21. Unfortunately, the Report “MY Life, My Choice” is a remarkably poorly argued document – par for the course in the context of a lack-lustre public examination and debate of the issues involved in society at large. When it was produced I wrote a piece for my webpage (petercarnley.com) entitled “Light on Logic” (2019). It is still there if anybody want to pursue the argument in detail. Today I can highlight just a few points:
22. First, there is an initial logical failure from the very start in the Report “My Life; My Choice” involving an apparent inconsistency. While insisting on the fundamental value of individual freedom and autonomy in the Report, the recommendations of “My Life, My Choice” and the actual ensuing legislation that is said to enshrine this principle, go to great lengths to put in place safeguards that in fact deny individual freedom and autonomy. Apparently, the implicit self-contradiction in this is not perceived as a problem. For example, the principle of individual freedom and autonomy to access the right of self-termination of life is denied those under 18 years of age. You have to be of voting age. This itself seems fairly arbitrary, for if there were good reasons to allow an 18 year old person the freedom to judge that his or her suffering was intolerable and to self-terminate his or her own life, why should this not apply to a 17 year old in the very same set of circumstances? A 17 year old is also a free and autonomous individual Indeed, the age of discretion when human individuals are said to be competent and responsible enough to be charged with a crime, which used to be 8 years, is now 10 or 12. If 12 year olds are judged to be capable of taking responsibility for their own actions and so can be charged with a crime, (let us say murder) how is it that they are not capable of being responsible for decisions about their own lives? In any event, my point is that the alleged principle of individual autonomy and freedom is circumscribed in the legislation by an age requirement; almost certainly this is to meet the community requirement to avoid self-termination of life amongst children which people somehow sense to be wrong. Autonomous freedom of personal decision making is not an absolute.
23. The alleged principle of freedom and autonomy is also denied to people who are not Australian citizens, and have not been resident in WA for 12 months; further, the exercise of this alleged individual freedom and autonomy is denied unless a person has made an uncoerced request for access to it on two occasions in writing, and has been assessed by two doctors who have to approve the procedure, and so on. The requirement of these “permission givers” further erodes the basic contention that Individuals are free to act autonomously in deciding to terminate their own lives at a time and place of their choosing.
24. However, this unwitting admission that individual freedom and autonomy is not absolute,but needs to be modified by communitarian considerations, unfortunately fails to be carried through so as take seriously other communitarian values. Even though some of these are at least touched upon in “My Life, My Choice”, they tend to be quickly dismissed, while, other communitarian values are not addressed at all.
25. For example, one of the communitarian issues touched upon in the Report “My Life, My Choice” is the issue originally raised by the AMA to which I have already referred: the problem of normalizing suicide generally in the community by signalling approval of it in the circumstance where life no longer seems worth living for reasons related to deteriorating health. The AMA pointed to the social danger that this might lead to increasing numbers of suicides in the community generally. After all, if suicide is thought to be OK here in this circumstance, why is it not OK in other circumstances where life appears not to be worth living? This is especially so when autonomy and freedom is alleged to be an inalienable individual right.
26. When the AMA raised this very concern here in Western Australia, it actually cited anecdotal evidence of increased rates of suicide in places where the self-termination of life had already been legalized. The Netherlands. the State of Oregon in the United States, for example. The argument of the Report “My Life, My Choice”, such as it is, in relation to this is instructive: When it tackled the problem of increased suicide rates in the Netherlands it briefly cited the problem and then said it would return to it in more detail in chapter 5 of the Report. In chapter 5 of the Report there is no mention of the problem in the Netherlands. It is conveniently forgotten. It instead talks about the falling suicide rate in Switzerland (which may have nothing to do with assisted suicide). And then its conclusion is that VAD may not inevitably lead to an increased suicide rate in the community. Obviously, it may not be inevitable, but the problem is that there is a danger that this negative outcome might eventuate. In fact, since the legislation passed in the WA Parliament updated statistics now demonstrate that suicide has in fact certainly increased in the Netherlands, as elsewhere in the world including Australia, where suicides are up from 9 in every 100,000 people in 2019 to over 13 in every 100,000 people in 2023. The AMA appears to have been justified in signalling this concern. So the communitarian problem is that once suicide is approved and made legal because life is deemed not to be worth living for this medical reason, the community mentality can easily come to assume that when life is deemed not to be worth living for other reasons, suicide is an acceptable solution.
27. Even worse once that kind of mind-set takes root in the community it seems very easy for other people than oneself easily to come to the conclusion that life is not worth living for certain classes of people or problems. This is the slippery slope argument and we have to be aware of the danger of slipping from logical possibilities, (from what is thinkable without self-contradiction), to actual possibilities. What is thinkable may not actually turn out to be real. We are inclined to say “that will not happen here”. But that this is a real possibility is suggested by the undeniable fact that this is what people said in the sophisticated culture of Goethe, Beethoven and Mozart from 1933 to 1945. Unfortunately, at the Castle of Hartheim alone in Germany it was deemed, with an apparently entirely complicit medical profession, that life was not worth living for 20,000 people who had mental problems, including simply schizophrenia. The point is that sometimes, even normally rational and civilized society becomes somewhat irrational, especially given the difficulties of ethical debate of Western liberal democratic societies where the concept of moral truth and rational debate so easily falls victim to protest and placards. Witness the recent election of a convicted felon for a financial offence, and a 6 times bankrupt person, as the in-coming economic saviour of the USA, or the appointment of an anti-vaccination/anti fluoride-in-water person to head up the nation’s Department of Health.
In other words, there may be good reasons for exercising caution relating to the legalization of voluntary assisted suicide given the possible long term negative implications for the well-being of the community generally in relation to the preservation of the sanctity of life.
28. Another communitarian concern is the impact of the involvement of members of the medical profession in assisting voluntary suicide on the perception of the medical profession itself in the community. It is hugely important to the community generally that we enjoy a basic trust in members of the medical profession always to do the right thing by us. Hence the importance for centuries of the Hippocratic Oath – since 470BC in fact.. Members of the medical profession must always act in the interests of alleviating pain and of doing everything possible to save life. In other words, when a person approaches my bed and I am very seriously ill, I need to know and trust that he or she is there to care and if possible to help me regain my grasp on life; I don’t want the worry that he or she may in fact be an executioner. The question is, will the involvement of the medical profession in voluntary assisted suicide over time and in very subtle ways, undermine this basic community trust? It is perfectly understandable that the AMA voiced its concerns about the issue.
29. Even worse, if anything, the Report’s commitment to the value of “absolute individual autonomy” itself leads to an unfortunate tendency to disparage the role of the medical practitioner in end-of-life decision-making. It is suggested, for example, that the “absolute autonomy of the individual” means that the patient should ideally be independent, and therefore free even of dependence on the medical profession. The idea of autonomy is thus said to have displaced the idea that “the doctor knows best.” Absolute independence in end-of-life situations is in this way implicitly valued above dependence on the medical profession.
30. On the other hand, the Report “My Life, My Choice” acknowledges a need to ensure that there is no deficit in the behaviour of the medical profession. Apart from an inhibition on members of the medical profession from initially raising the possibility of the self-termination of life with patients, one of the requirements of the current legislation is that those in the medical profession who are asked about it or approached to give permission for it, must also outline the alternative possibility of palliative care. In other words, the raising of the alternative possibility of palliative care at home or in a hospice is mandatory. So the assumption seems to be that there will always be the alternative possibility of palliative care to be considered.
31. Unfortunately, given the comparative lack of rational ethical debate of the issue and the tendency of the supporters of the legalization of the self-determination of life to resort to emotive language to promote their cause, there has been a tendency to suggest that this alternative, palliative care, is at least in some circumstances unsatisfactory and something to be avoided and replaced with VAD. The Report “My Life, My Choice”, on the other hand tends to suggest that VAD is required because palliative care services are not available right across the State. This section of the Report, by the way, is the best part of it, given that it points up the need for more palliative services and for more tax-payers’ money needs to be devoted to their more adequate provision.
32. Certainly, the emotive rhetoric of supporters of VAD often leave us with the impression that the only alternative to self-termination is a painful death of unwelcome suffering, of a kind that is lacking in compassion. Indeed, in much emotive rhetoric it is not that the disease is actually causing suffering that is judged to be intolerable in the present (as the ACT requires for granting access to VAD), but an ultimate fear of a future process of dying. This is often presented as the operative reason for choosing self-termination. While people may not fear death itself and may even live in positive hope for eternal rest in the timeless eternity of the love of God, the actual process of dying is presented as a fearful fate to be avoided, even to the point of suggesting that there are hospital wards full of patients suffering in great pain and officiously being kept alive on life-support machines. VAD is then presented as the solution to this problem. Sometimes it is as though there would be no justification for voluntary assisted suicide, if there were not something to be feared.
There is therefore a tendency amongst those who wish to promote and support the legalizing of the voluntary self-termination of life to point to exceptional cases of suffering and pain. Perhaps the Churches have a particular vocation to be vocal about this so as to dispel the fear of the dying process that has tended to develop in the wider community. For it has to be said that there is another narrative.
33. It has been my experience that usually, the actual process of dying is not as it is often represented – as something traumatic to be feared. In most cases palliative sedation with modern pain killing drugs, ensures that the process is peaceful, comfortable and pain free. Sometimes patients have a pump and are able to top up the supply of morphine; perhaps they a given an intravenous cocktail of midazolam and morphine, or a fentanyl patch (fentanyl being said to be 100 times stronger than morphine). The last days of life are often marked by drowsiness and actual sleep, punctuated by precious moments of lucidity. We rightly trust the medical profession to do the right thing by us in such circumstances to relieve pain and suffering. Sometmes the pain killers apparently hasten death (the so-called lethal dose) but the chief intention is to relieve pain. Ethically this is judged to be the right thing to do by appeal to the law of double effect – just as for example, chemotherapy for the treatment of a cancer may have the secondary effect of lowering immunity and lead to a fatal infection. The so-called lethal dose of pain killer is not the intentional taking of life.
34. It has to be acknowledged that there may be exceptions to this norm, but exceptions cannot be made a norm, otherwise they would not be exceptions. Once exceptions become the norm then the remedy (in this case self-termination of life) can be accessed by those in more normal and less exceptional circumstances. I noticed recently a TV clip of a man in the Eastern States who had waited two years for the Commonwealth Health Care plan to be approved who said he was now going to access VAD “because he did not want to be laying around waiting for things to happen.”
35. Once again, the chief reason given for the Western Australian Report is unfortunately that the self-termination of life is justified on the principle of a right of individual autonomy and freedom simple because people “have a right to choose their own place and time of death.” In other words, rather than the avoidance of unnecessary or uncontrolled pain, the legislation is said to be required and justified because of an alleged autonomous right to freedom to choose one’s place and time of death. This is of course a nonsense. There is no right that we somehow have as individuals to choose our own time and place of death; what we enjoy as a right in our kind of society is the right to medical and hospital care if we need it at the time of death; this right does not just come through the air, but is secured by the law of the community and hence provided to its citizens.
36. There is also some confusion in the legislation itself about the distinction between pain and suffering, for these are not synonymous. Pain is a physical sensation, suffering is the psychological reaction to it. The word suffer comes from the Greek pascho, to suffer, to be in the position of having to allow or permit something to happen to oneself. As in the statement: “Suffer in the little children to come to me.” Or “He does not suffer fools gladly” - meaning allow or permit. A person who is patient of suffering is necessarily rendered passive, he or she must passively allow or permit others to bring meals to him or her, medicines are prescribed for him or her, x-rays are arranged, and so on. The enforced passivity of suffering may involve the anguished wish that one’s situation or predicament with other than it is, but it might not necessarily involve pain. One can suffer because of remorse, or embarrassment, or a set of circumstances that one has no power to turn around. On the other hand, a yachtsman may experience physical pain, in pulling on at ropes in a biting cold wind, but he or she does not suffer - for the over-call situation is one which he or she actively embraces and enjoys.
However, the legislation tends to confuse pain and suffering by allowing people to seek permission for self-termination when “suffering is judged to be intolerable” (not when physical pain “is judged to be intolerable.’ I think some thought that this section of the legislation (Section 16 (c) ) probably meant “when pain cannot be relived and is intolerable” but that is not what it actually says.
Certainly, given that the section speaks of suffering rather than pain, suffering might be judged by a patient to be intolerable even when the likelihood of pain is problematic, as in the case of the man on TV who announced that he was turning to the self-termination of his life “ because, as he said, “he did not want to be laying around waiting for things to happen.” I have myself certainly witnessed persons accessing VAD who did not appear to be suffering great pain, if any at all.
37. On the other hand, that the process of dying actually turns out to be not as fearsome as the supporters of self-termination often suggest it to be, explains why it is that so many who go through the bureaucratic process of getting permission for self-termination, in the end do no go through with it. I understand that two thirds of those who go through the process of getting access to VAD do not resort to it. Though numbers seeking access are greater than originally anticipated in Western Australia, only 1.6% of deaths are VAD deaths. But this raises the question about whether many patients need to go through that process in the first place. I also know from recent experience of the operation of VAD that the final months and in one case even a whole year of life can be unnecessarily dominated by the challenging question of whether to get permission for it or not; the stressfulness of this both to the patient and those supporting him or her is not to be underestimated. Admittedly, some say that it is a comfort to know that they could access VAD if the suffering becomes more than they can tolerate. On the other hand, I have certainly had experience of patients in a terminal condition who have received the comforting assurance of their GPs that if suffering and pain threaten to become intense they will ensure that pain-killing medication deals with it in a way that the process of dying can be comfortable and pain-free.
38. So, in conclusion, apart from the attempted justification of this legislation by appeal to the flawed and fictitious principle of individual freedom and autonomy as a kind of absolute inalienable right, and the concerns arising from the failure to take account of the communitarian implications of voluntary assisted suicide, both in relation to the community’s hold on the sanctity of life and the medical profession’s continuing hold on our absolute trust, I am myself yet to be convinced that voluntary assisted suicide and the bureaucratic procedure for accessing it is either pastorally desirable or really necessary. There is an alternative narrative.
39. I think we can be confident in our commitment to the provision of palliative care of the dying, and to be involved in “assisted dying” in this sense. We are not compelled by law to be involved in assisting in the self-termination of life. There is no synodical mandate that I know of to be involved in voluntary self-termination of life. On the other hand, it seems obvious that our vocation should be the provision of quality palliative care with an absolute commitment to the alleviation of discomfort and pain, always delivered with respect and the preservation of the patient’s human dignity, and all informed by loving compassion.
+Peter Carnley Fremantle, WA, 19 November 2024
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HIPPOCRATIC OATH
I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them.[6] Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. …I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein.Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.
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Any registered medical practitioner who receives a request for VAD from a patient has obligations under the Voluntary Assisted Dying Act 2019 (Act) if the request for VAD from the patient is:
Clear and unambiguous
Made during a medical consultation or appointment
Made in person (or, if this is not practical, via audiovisual communication where the patient can be seen and heard)
A request that meets these conditions is known as a first request.
According to the WA ACT Sec 16 (c) a person is eligible for access to VAD:
If the person is diagnosed with at least 1 disease, illness or medical condition that —
(i) is advanced, progressive and will cause death;
(ii) and will, on the balance of probabilities, cause death within a period of 6 months or, in the case of a disease, illness or medical condition that is neurodegenerative, within a period of 12 months;
(iii) and is causing suffering to the person that cannot be relieved in a manner that the person considers tolerable.
(ie. VAD cannot be the subject of an advance health directive).
).
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