The Age newspaper (May 28, 2016), barely a week before the Victorian Parliament’s report into end-of-life choices was expected, foreshadowed that the committee will recommend some form of legislative change. A form of assisted suicide is widely rumoured.
More than one thousand submissions is a huge public response to a vexing and polarising issue for the community. The committee also heard from about 100 witnesses over several months at forums held across Victoria.
Of those 100 or so witnesses, many were from professional bodies such as palliative-care units, regional health centres, institutes of study, public interest groups and academic institutes. The vast majority of these, something like 80 per cent, were either against euthanasia (about 10 per cent) or were focused on other issues, such as improving care, improving regional services, reform and improvement of advanced care planning.
It was a similar situation with the submissions: 78 per cent of substantive submissions (submissions of detail and from health providers, institutes, lobby groups and so on) were either against euthanasia and assisted suicide or were neutral and preferring to focus on end-of-life care more generally.
Overall, the total submissions were about 56 per cent in favour, with the remainder either being opposed (35 per cent) or neutral (7.3 per cent).
If the committee does recommend some sort of assisted suicide legislation, I expect that it will also comment about these professional submissions that point to the need for improved care with a “yes, but …” type of summary. It is the “but …” part that points to the problems associated with assisted suicide and euthanasia legislation, as evidenced in the submission by Victorian Coroner John Olle and his colleagues.
Mr Olle’s evidence before the committee focused on the Coronial data of suicides by people whom they defined as people with ‘“irreversible decline”, so terminal disease; death was foreseeable; incurable, chronic disease but death not imminent; permanent physical incapacity and pain.’
The numbers were defined as “50 cases per year between 2009 and 2012. It is a small cohort, but a significant number. We are looking at 8.6 per cent of suicides that meet this criteria set out in our definition of our cohort.”
Mr Olle responds to a panel question from Daniel Mulino MLC with what I consider to be a counsel of despair:
Mr MULINO: I am just wondering whether, first, even within that subset that you have looked at you feel that there are instances where there is the potential to help people feel less alone and more supported; and, second, whether in the data that you have looked at there is any change over time as palliative care perhaps improves. Have you noticed that that cohort is changing the composition of the overall rate of suicides over time?
Mr OLLE: I do not think it is an issue in this small cohort we are referring to, where very tight criteria are applied. The numbers might be far greater than the numbers we have found – very tight, very conservative. No, to my knowledge the people we are talking about in this small cohort have made an absolute clear decision. They are determined. The only assistance that could be offered is to meet their wishes, not to prolong their life. (emphasis added)
So, the only intervention Mr Olle sees in helping these people who want to suicide is to help them to die. Mr Olle’s colleague, Dr Dwyer, follows, offering support to Mr Olle’s point but then, curiously, seeming to contradict him:
Dr DWYER: On that point, at the time when they have made the decision to suicide, I completely agree that the potential for intervention in a number of these cases would be a long time before that. There are some well-documented issues that coroners have been discussing repeatedly, particularly around the management of pain and the need to get more pain specialists involved earlier rather than it being like the mental health system, which devolved to where you could not get into the mental health system unless you were in crisis. It appears to be that way at the moment with pain treatment, and this has been pointed out by all kinds of organisations involved in pain treatment and so on.
Dr Dwyer makes it clear that there may well be opportunities for intervention – even if it needed to be far earlier.
Mr Mulino follows up with a request for confirmation:
Mr MULINO: So in some cases, by the sound of it, intervention earlier might have been possible.
Dr DWYER: I think so. In a lot of these suicides there is a trajectory over time. It is not like something suddenly happens and they make a decision. There is this trajectory, and there are attempts to engage in treatment. It would be interesting to get some kind of review of whether earlier and different treatment might have made a difference, but by the time they are at the point where they are suiciding, as Coroner Olle has indicated, these are not people where you can say, “Oh, if we just switch medications, everything will be OK”. It is a long way past that.
Setting aside the sad reality that people do and probably always will take their lives in difficult circumstances, as Dr Dwyer makes clear, there are issues of intervention that have not been explored here that may well have made life more bearable for these people.
Mr Olle and Dr Dwyer are clear: this is not about the kind of suicide prevention that we normally think of. Rather, it is about a system that did not care enough earlier on so as to foresee problems and to provide better care.
It is also true that some simply do not want the kind of care on offer, for their own reasons. We all have that choice. But that does not mean that because people refuse effective care options that society has an obligation to provide death as the answer. But it would be a sad day if we did not provide the best of care and timely interventions and people chose suicide for lack of genuine choice; which is precisely the counsel Mr Olle provides.