Compassion and respect

Key reports and resources

The Tasmanian Voluntary Assisted Dying Bill 2016 is based on thorough ongoing research.  These are some of the major resources from independent reputable sources which have been taken into account – 1. websites, 2. reviews, 3. official reports and associated material, 4. Canadian Medical Association material, 5. Academic and respected viewpoints, 6. Material relating to particular issues of importance in the debate on voluntary assisted dying.

We will add to this page as new material comes to our attention.

1. Website

End of Life Law in Australia – an initiative of the Australian Centre for Health Law Research. It is designed to be used by patients, families, health and legal practitioners, the media, policymakers and the broader community to access information about Australian laws relating to death, dying and decision-making at the end of life. These laws are very complex, particularly in Australia where the law differs between States and Territories, and where areas of uncertainty about the law exist. This website provides you with a broad introduction to these laws. It can also help you stay up to date with Recent Developments in the end of life area.

2. Reviews

All major recent reviews by independent reputable bodies have found consistently in favour of voluntary assisted dying legislation.

Australia

  • Victorian inquiry into end of life choices, June 2016.  This link takes you to the site where you can find the Report as well as over 1,000 submissions, transcripts of evidence provided at hearings and the Government’s response.

Canada

UK

3. Official reports and associated material

New 22 May 2017 – Switzerland

Causes of death 2009 – This isn’t a new report but a very useful official Swiss statistics comparing assisted suicide and suicide in that country in 2009.  Assisting a suicide has been legal in Switzerland since 1942 if it is for an altruistic reason.

New 2 May 2017 – Canada

The first Interim Update on medical aid in dying in Canada was released on 26 April 2017 for the period 10 December 2015 and 31 December 2016.  The national legislation was passed and came into operation in June 2016. Quebec has its own provincial legislation, An Act Respecting End of Life Care, which came into operation in December 2015.  It issued a report on the period 10 December 2015 to 30 June 2016 but it is in French.  You can access it here.

The national interim update reports on a total of 970 assisted deaths under the national and Quebec legislation.  This includes 803 for the 6 months period from June to 31 December 2016 under both the national and Quebec legislation, and 167 assisted deaths in the province of Quebec for the period from 10 December 2015 to June 2016.

As the report reveals:

  • Medically assisted deaths accounted for less than 0.6% of all deaths in Canada from June – December 2016.
  • The most common underlying medical circumstances among those receiving assistance in dying were related to cancer (neoplasm), neurological illness (e.g., multiple sclerosis, amyotrophic lateral sclerosis), and cardiovascular/respiratory disease.
  • There were close to equal numbers of men and women and the average age of people receiving assisted dying was 72.
  • Only three were self-administered deaths (meaning the individual took a dose of life-ending medication that was prescribed by a doctor). The rest were doctor-administered. [Note: In Quebec, only doctor-administered assisted dying is legal.  Both self- and doctor-administration of the lethal drugs are legal under the national legislation.]

Oregon

  • Annual Reports,  including the latest report for 2016, the 19th year of operation
  • Data collection form.  This is the form completed by the Attending Physician and provides the data for the Annual Reports.  Please note: data is not collected from patients.  Please also note Question 15 on page 3.  Physicians do not provide information that patients “feel a burden” and claim that is why they have requested an assisted dying prescription, but whether the patients have expressed “a concern about … the physical or emotional burden on family, friends, or caregivers”.  See more information in point 6, Common Fallacies and misunderstanding about existing legislation, in Current situation – Voluntary assisted dying overseas.

The Netherlands

  • Annual Reports  – the latest report in English is for 2013.
  • Latest report in the five-yearly longitudinal academic study on end of life decisions including euthanasia. The latest report is for the year 2010 and includes comparisons with 2005, 2001, 1995 and 1990.

Belgium

See also Assisted Dying Practice in Benelux; White Paper 1. 

4. Canadian Medical Association

The Canadian Medical Association has demonstrated responsible, professional and principles-based policy and action on voluntary assisted dying, in consultation with its own members, academic experts and the wider community.  It has played an active and positive role in the development of Government policy and legislation and in community education and awareness.  Its policy, reports and other publications are of very high quality, soundly based on principles, facts and thorough analysis.

Principles-based Recommendations for a Canadian Approach to Assisted Dying,  December 2015

The Tasmanian Voluntary Assisted Dying Bill 2016 is probably closest to this approach to assisted dying, including consistency with foundational principles: respect for persons, equity, respect for physician values, clarity, dignity, protection of patients, accountability, solidarity, and mutual respect.

The ‘eligible medical condition’ requirement in the Tasmanian Bill is similar to the CMA recommendation on the medical condition of the person for eligibility for assisted dying.  However, the Tasmanian Bill has some important additional requirements to ensure that eligible people are at the end of their lives:

Section 11 of the Tasmanian Voluntary Assisted Dying Bill 2016 – “For the purposes of this Act, an eligible medical condition –
(a) is the advanced stages of a serious incurable and irreversible medical condition, whether caused by illness, disease or injury, as diagnosed by a medical practitioner who has specialised qualifications, or experience, in diagnosing and treating the medical condition; and
(b) the person’s medical condition, or associated medical treatment, or complications resulting from the medical condition or treatment –
(i) is causing persistent suffering for the person that is intolerable for the person; and
(ii) there is no reasonably available medical treatment or palliative care options that would, having regard to both the treatment and any consequences of the treatment, relieve the person’s suffering in a manner that is acceptable to the person; and
(c) there is no reasonable prospect of a permanent improvement in the person’s medical condition.

There is also the ‘last resort’ provision in S22 (2) and (3). S22(2) states that the person’s doctor (the primary medical practitioner)

must discuss with the eligible person whether there are any relevant treatment options available that may adequately and to the satisfaction of the eligible person – (a) improve the eligible person’s medical condition; or (b) relieve the eligible person’s suffering”.

S22(3) requires the doctor to provide assisted dying only “If the eligible person and the eligible person’s primary medical practitioner are satisfied there are no relevant treatment options available as discussed [under S22(2)]”.

The CMA recommendation is based on the Canadian Supreme Court decision but adds some details.  The recommended requirements are that it has to be serious or severe, constant and enduring, not able to be cured, causing severe physical or psychological suffering that is intolerable to the patient, is not amenable to further treatments or interventions that are acceptable to the patient, or it is not remediable by other means acceptable to the patient, and that patients and doctors make a joint decision about assisted dying in a deliberative process of decision-making, supported by the physician’s disclosure of all available standard of care interventions or possible therapies.

The CMA supported the Canadian legislation which ended up with a more restrictive approach to eligibility with the additional requirement that the person’s death “has become reasonably foreseeable taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining“.

Other CMA documents:

A Canadian Approach to Assisted Dying:  CMA Member Dialogue, Summary Report, 2015

Euthanasia and Assisted Death policy, update 2014

End-of-life Care: A National Dialogue – CMA Member Consultation Report, July 2014

End-of-life Care: A National Dialogue, June 2014

5. Academic and respected viewpoints

Added 8 May 17 Current AMA policy adopted after a review including a survey of members.  The AMA indicated last year that the report of the review of the policy and details of the survey would be made available to the public but it is still available online only to AMA members.  DwDTas has been able to access the report through members. 

Professor Michael Ashby, How We Die: A View from Palliative Care , QUT Law Review Vol 16, Issue 1, pp 5-21.  This was also part of Professor Ashby’s submission to the Inquiry into Palliative Care being conducted by the House of Assembly Standing Committee on Community Development and available with other submissions here. His evidence in a public hearing in the transcript of the afternoon of 8 August 2016.

Dr Neera Bhatia, Professor Ben White and Professor Luc Deliens, How should Australia respond to media-publicised developments on euthanasia in Belgium?, Sept 2016, Journal of Law and Medicine, Vol. 23, p. 835, 2016 (also Deakin Law School Research Paper No. 16-34)

Hal Swerissen and Stephen Duckett, Dying Well, Grattan Institute, September 2014. Professor Swerissen also gave evidence in a hearing for the Victorian inquiry into end of life choices on 25 July 2016.

Assisted Dying Practice in Benelux; White Paper 1 : This paper includes very valuable empirical data and graphs on the practice of assisted dying in Belgium, The Netherlands and Luxembourg.

6. Material relating to particular issues of importance in the debate on voluntary assisted dying.

The Impact of Increased Cost of Death with Dignity MedicationsThere are major problems occurring in the US because of poor accessibility of affordable and suitable drugs for self-administration by those whose doctors have decided they are eligible for an assisted dying prescription.  This has been caused by the US medical system in which the patients must bear all the costs and the profiteering action of pharmaceutical companies increasing the cost of relevant drugs to over 7 times what the cost was in 2010.

 

DwDTas

Dying with Dignity Tasmania

P O Box 1022,
Sandy Bay,
Tas 7006,
Australia

Tel. 0450 545167

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