Between 2015 and 2016 the most extensive inquiry of its kind ever held in Australia took place in Victoria. The cross-party Victorian Parliamentary Inquiry into End of Life Choices received over 1,000 submissions and heard hundreds of hours of evidence during public hearings. The Victorian Inquiry is directly relevant to the Tasmanian situation. There were also many similar submissions made during the public consultation and debate in the lead up to the 2013 Tasmanian Voluntary Assisted Dying Bill.
Probably the most shocking evidence heard by the Victorian Parliamentary Committee was the testimony of the Victorian Coroner, John Olle, who detailed the horrific ways in which desperately ill Victorians are taking their own lives to end their suffering. You’ll find the first of his submissions here, a second one here which “comprises an expanded and updated overview of the Victorian suicide data described in the 26 August 2015 submission”, and the transcript of the evidence provided in a public hearing here.
The Committee found:
Family members, the Coroners Court of Victoria and Victoria Police gave evidence about how people experiencing an irreversible deterioration in health are taking their own lives in desperate but determined circumstances.
… While some argue that the needs of such people can be addressed with appropriate palliative care and mental health services, the Coroner said, ‘people who have invariably lived a long, loving life surrounded by family die in circumstances of fear and isolation’ and that, ‘The only assistance that could be offered is to meet their wishes, not to prolong their life.’
The Committee concluded:
The Committee rejects maintaining the status quo as an inadequate, head-in-the-sand approach to policy making and the plight of the Victorians discussed in this Report. (pxxvii)
The Victorian Coroner’s evidence
The Coroner estimated the number of Victorians dying in this way – by suicide to escape the ravages of disease “when suffering an irreversible decline in physical health” – at 1 a week, or 8.6% of the total suicides examined by the Victorian Coroner in the 4 year period, from 1 January 2009 and 31 December 2012.
The individual cases that the Victorian Coroner referred to in his evidence make harrowing reading but they are important to show the adverse effect of current laws on the community and the need for a law that takes into account the people who have come to the end of a life that is free of terrible suffering, due to an incurable and irreversible medical condition and with no chance of recovery. For many of these people, their death is not foreseeable. As a DwDTas analysis of the Victorian Coroner’s evidence has found, in probably 60% of the suicides, the person’s death was unlikely to be foreseeable, and they would be unlikely to get a doctor’s prognosis they had only of months or weeks to live.
The analysis was taken into account in the preparation of the Tasmanian Voluntary Assisted Dying Bill 2016, as it should be for all proposed Bills. Consequently, the Tasmanian Bill has as one of its aims the prevention of such suicides and prevent the harm being caused to the people most at risk of terrible suicides because of the lack of a voluntary assisted dying option, the people who love them and the people in our community who have to respond – coroners, police and medical personnel.
It goes on and on …
As the Victorian Coroner said in the public hearing:
I have other cases still before us. The tally is not ending: a lovely lady who had the ability to step off the platform in front of a train; a man with the ability to tie a hessian bag full of sand around his waist and step off a pier. It goes on and on. … This is the information we are privy to.
Five cases of suicide presented to the Victorian Inquiry into End of Life Choices by Coroner John Olle
The first individual is a 59-year-old man. He had a wife of 38 years, survived by his children and his wife, with whom he shared close and loving relationships. He had no mental health documented, a medical history of metastatic colorectal carcinoma, multiple confirmed colorectal and liver metastases. About two years before his death he underwent a liver resection for confirmed liver metastases and was subsequently treated with chemotherapy. He underwent 22 cycles of treatment, and unfortunately a CT scan performed not long before his death showed evidence of progressive disease with a new liver lesion, which resulted in the cessation of his trial treatment. His GP informed the court that the cancer had now spread to his liver and his prognosis was not good.
He was admitted to hospital with a fever, dry cough, ultimately he wished to go home. He would inform his son and family members he would rather take his life than live a life dying in a bed. He was well aware of his suffering and what was ahead of him. So he would rather die than stay in a ward. Ultimately he was observed by a motorist on a major freeway in Victoria hanging from a bridge. A note indicated his intention to take his own life.
Another case I have seen was an 82-year-old lady. She lived on her own and was survived by her children, again with whom she shared a loving lifelong relationship. Her documented medical history: hypertension, insomnia, arthritis, gastro-oesophageal reflux disease, gout and on and on and on it goes. She was feeling very poorly about it and depressed about her lot. Her vision was nearly gone. Her love of reading books, her quality of life was greatly diminished. She was described by her doctor as lonely, isolated, frustrated, impatient. Her daughter was informed by a neighbour who had told her she could not read anymore. It was the most important part of her life. She also informed her on a number of occasions she wanted to die.
She was found on the couch in her lounge room. This 82-year-old lady had a stained towel wrapped around her left hand. There was a knife on the floor in front of her, an open wound on her left wrist. There was a white-handled knife that measured 14 centimetres on the floor beside her. In the bathroom was found two pairs of scissors, and another white-handled serrated knife, about 30 to 40 centimetres in length, was located on a table. There were traces of dried blood on all of these items. She died of exsanguination — she bled to death.
Another, 89-year-old. Again, a man. He lived with his wife of 61 years and enjoyed a long and loving relationship with his family. He had a very lengthy medical history — no hint of mental illness. His son stated his dad’s lucidity, memory and eyesight were failing. He could not listen to music, watch TV or read, which he was known to enjoy. He ended up alone, grinding various tablets with either a mortar and pestle or food processor and died of drug toxicity.
Another, 75-year-old. He lived with his wife, with whom he maintained a good relationship despite their divorce. He is survived by his daughters, with whom he shared close, loving relationships. He had no documented mental health history, and again a very long, complex medical history. Not long before his death, some years, he was diagnosed with prostate cancer, treated — radical treatments — sadly without improvement and increasing pain with poor prognosis. He expressed to others his belief that his life would be so much easier if someone could help him die. He could not face his lot. He ultimately obtained a firearm which he discharged by holding the tip of the barrel against his chest and reaching for the trigger. He was found by family.
Finally, a 90-year-old man, survived by his family, again with whom he shared close, loving relationships. He was described as a delightful gentleman. He was extremely fit for his age and a proficient iPad user. He had no documented mental health history. A very lengthy history included back pain, chronic obstructive pulmonary disease, asbestos exposure and the like. Not long before his death he was diagnosed with a solitary brain metastasis in a setting of metastatic melanoma. He expressed his wishes very clearly to his treating clinicians; he did not wish to have any invasive procedure done. His main priority was quality of life.
In the final four weeks of his life, his doctor explained, he remained frail. He had lost approximately 6 kilograms in the previous four weeks. He had a poor appetite. He looked malnourished and had nausea. His family stated that from about mid-December 2014 his wellbeing deteriorated. He felt generally unwell. He was dehydrated and had diarrhoea. He was vomiting uncontrollably. He had fevers. He was wobbly on his feet, even with the assistance of walking aids. He was diagnosed with likely viral gastroenteritis and was commenced on IV fluids for rehydration therapy. He improved as a result of the rehydration therapy markedly and was discharged home to the care of his grandson in January this year.
The family explained that when he learnt of his cancer he went downhill emotionally. He was depressed and angry that there was no cure. He often told his family he would rather do something to end it straightaway and that if he could no longer drive, he might as well be dead. He mentioned a nail gun. He was subsequently found dying with nail gun wounds to his head and to his chest. He died ultimately from the injuries sustained from the nail gun.