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The final report by the WA Ministerial Expert Panel on End of Life Choices, chaired by Malcolm McCusker, has recommended a WA assisted suicide bill that has less protections than Victoria.

Unlike in Victoria, their WA model permits doctors to raise the subject of euthanasia with their patients.  FamilyVoice WA Director Darryl Budge has highlighted the high risk of patients being steered into assisted suicide, in a recent media release.

A patient whose death is “reasonably foreseeable” within 12 months can apply, whereas it is six months in Victoria. The panel has thus rejected the advice from AMA (WA) about prognosis: “Death must be imminent within 6 months, as the outcome of the medical condition.  Further, all measures must have been exhausted to remediate the person’s suffering.”

A doctor and a senior clinical nurse may assess a patient for approval, to determine if they have “decision-making capacity”. In Victoria, it is two doctors. More concerningly, the Panel recommended that “neither doctor [nor the senior nurse] is required to be a specialist regarding the person’s disease or illness.” Rather than recommending more palliative care in regional areas, the panel justified these decisions by referring to “the scarcity of medical practitioners in many country districts and towns of Western Australia.”

The panel recommended that mental illness (assuming “decision-making capacity) is not a barrier, but did not set any requirements for expert psychological or psychiatric care in these situations.

Regarding the Victorian assisted suicide law, the former AMA vice-president Stephen Parnis said the fact that 68 “so-called safeguards” were a central pillar of Victoria’s assisted suicide legislation affirms the clear risk of wrongful deaths.

“In order to satisfy the needs or demands of a number of people to be able to take their own life when they choose, we are putting many more frail, vulnerable, dying people at risk. The word ‘dignity’ is bandied about here, as if dignity at the end of life hasn’t existed until this day,” he said. “I’ve assisted thousands of people at the end of their life over 27 years of medical practice. Dignity does not require a lethal potion.”

Legislation is expected to be introduced into the WA Parliament after it resumes from its winter recess on 6th August 2019.

The following is the full open letter by a number of WA palliative care specialists published in May 2019:

The McGowan Government has invited public comment on its discussion paper Ministerial Expert Panel on Voluntary Assisted Dying.

We write as WA palliative care specialists whose vocation is caring for those who are dying. Between us, we have been privileged to care for tens of thousands of patients and their families. We would like to explain our position regarding the Government's proposal to legalise euthanasia. In our conversations with our patients, their families, politicians, and even our medical colleagues, we are concerned about the confusion and misunderstanding regarding euthanasia and palliative care.

The confusion starts with the language. The discussion paper uses the term "voluntary assisted dying". This term is ambiguous. It could be used to describe palliative care: we provide assistance to people who are dying. It would be less confusing if the discussion paper were entitled Ministerial Expert Panel on Euthanasia and Assisted Suicide. The older term "mercy killing" has fallen out of use, but is actually a more accurate description than "voluntary assisted dying".

The proposal to legalise euthanasia and assisted suicide involves a massive change in the ethics of our society. "Do not kill" is a foundational ethical principle which has been observed by every civilisation for thousands of years.

Euthanasia and assisted suicide are not medical treatments, and most emphatically not part of palliative care.

We agree with the World Health Organisation statement on palliative care:

  1. Affirms life and regards dying as a normal process;
  2. Neither hastens nor postpones death;
  3. Provides relief from pain and other distressing symptoms;
  4. Integrates the psychological and spiritual aspects of patient care;
  5. Offers a support system to help patients live as actively as possible until death; and
  6. Offers a support system to help the family cope during the patient's illness and bereavement.

We support the patient's right to:

  1. Refuse treatment (such as surgery and chemotherapy);
  2. Cease treatment deemed unnecessary (such as kidney dialysis, ventilators and admission to ICU);
  3. Control symptoms (including pain, breathlessness and agitation); and
  4. Choose where they will die.

Most people want to die at home. In Perth we are blessed with an excellent range of palliative care services, whether the patient is in a hospital, a Palliative Care Unit or at home. Sadly, many Western Australians do not have access to these services.

Unlike euthanasia, palliative care aims to provide total care (body, mind and spirit) for patients and support for their families.

With modern medications and procedures, we can almost always control symptoms. In extreme cases, at the request of a dying patient and his or her family, we have occasionally used deep sedation to control symptoms that did not respond to the usual treatment.

Rarely, a patient will say to us, "doctor, I just want to end it all". Contrary to popular opinion, the reason for such requests is not pain, but despair and loneliness also called "existential suffering". Euthanasia is not a treatment for despair and existential suffering. Provision of holistic care by a skilled interdisciplinary team of health professionals enables patients and families to acknowledge and attend to distress within themselves and their relationships. The time before death offers unique opportunities for psychospiritual growth and allows for healing even without a cure.

We agree with the discussion paper that, "too many Western Australians are experiencing profound suffering as they die. This is, in part, due to inequitable access to palliative care".

According to the parliamentary records of 3rd April this year, Western Australia has the lowest proportion of specialist palliative care doctors of any state in Australia. We have 15 full-time equivalents for the state, less than one third the number required to meet national benchmarks.

According to the Honourable Jim Chown, whose motion was supported unanimously, WA needs at least another $100 million per year spent on palliative care for staffing and education, in addition to funding for infrastructure such as palliative care wards and beds.

We do not believe euthanasia or assisted suicide are solutions to suffering. We reaffirm our commitment to our patients: we will continue to care for you to the best of our ability, guided by your choices, but we will not kill you. Although we work in a variety of institutions, these opinions are our own and not necessarily those of our employers.

Prof Douglas Bridge. BMedSc (Hons). MBBS. FRACP, FRCP (UK). FAChPM. DTM&H; Dr Anil Tandon, MBBS, FRACP; Dr Derek Eng, MBBS. FRACGP. FAChPM; Dr Ashwini Davray. MBBS, MD, FRACP. FAChPM; Dr Mary McNulty, MBBS. FAChPM; Nurse Practitioner Giuliana Duffy, MN; Dr Paula Moffat MBBS, FRACP, FAChPM; Dr Alice Phua, MBBS, FAChPM; Nurse Practitioner Lou Angus. MN: Dr Andrew Hart, MBBS. FRACP, FAChPM: Dr Shannyn George, MBBS, FRACP, FAChPM: Dr Sampath Kondasinghe. MBBS, FRACP; Dr Kevin Yuen.MBBS, FAChPM; Nurse Practitioner Natalie Panizza, MN: Penelope Tuffin, Adv Prac Pharm; Dr Ellen Knight. MBBS, FAChPM; A/Prof Alison Parr. MBBS. MSc, FRCP (UK), FRACP, FAChPM; Dr Lisa Cuddeford. MBBS, CCT, MRCPCH, FRACP: Dr Ranbir Dhillon, MBBS, FAChPM; Dr Carolyn Masarei. MBBS, MRCP (UK). PGDipMed(PC), FAChPM; Dr Scott Lee, MBBS, FRACP. FAChPM; Nurse Practitioner Claire Doyle. MN

 

Felix Ngole

In a landmark judgment, the Court of Appeal has upheld the rights of UK Christians to freely express their faith by handing victory to former student social worker Felix Ngole.

Overturning a High Court decision to uphold Felix’s expulsion from Sheffield University, the crucial outcome represents a major development of the law. It is now clear that Christians have the legal right to express Biblical views on social media and elsewhere in public without fear for their professional careers.

This is the first Court of Appeal judgment regarding freedom of expression of Biblical views which sets limits on the rights of professional regulators to limit free speech on social media. The ruling is an authoritative statement of the law, likely to be relied upon in hundred of current and future cases.

Expelled for quoting the Bible

Felix was expelled in 2016 from his social work course at the University of Sheffield after quoting Bible verses on Facebook that were deemed critical of homosexuality.

In 2015, he had entered into a discussion on Facebook over the imprisonment of Kim Davies, the Kentucky marriage registrar jailed for refusing to issue marriage licenses to same-sex couples. During a vigorous online political debate, many views were exchanged on the Christian faith. A devout Christian, Felix quoted Bible verses affirming the traditional Christian opposition to same-sex marriage and of the sinful nature of homosexual activity.

Some months later, Felix was reported anonymously to the University of Sheffield by a fellow student and was subsequently disciplined in a Fitness to Practice hearing. He was informed that he had brought the social work profession into disrepute and was then expelled from the course, losing the career he had worked so hard for.

'Lacking insight'

In the court hearings, the University argued that Felix had ‘lacked insight’ into the effect of his posts on social media. During his Fitness to Practice hearing, the University had told him that the expression of his Christian views was unacceptable and was effectively told either to renounce his faith or stay silent on pain of losing his career. Yet Felix says he felt he could not surrender his faith.

In some shocking exchanges from the High Court hearing, the University of Sheffield implied that Felix was not allowed to express the Christian viewpoint on same-sex marriage or homosexuality on any public forum, including in a church.

However, the Court of Appeal held that it was the university that was ‘lacking insight’ in not understanding a Christian viewpoint.

In addition, the Court of Appeal lavished praise on Christian Concern co-founder Pastor Ade Omooba MBE for urging that the university sought caution and compromise.

Sharing faith is not discriminatory
The Court of Appeal condemned the position of the university whereby people would live in fear if private expressions of views were overheard and could be reported anonymously.

The Court ruled that: “The mere expression of views on theological grounds (e.g. that 'homosexuality is a sin') does not necessarily connote that the person expressing such views will discriminate on such grounds.” It was further recognised that Felix had never been shown to act in a discriminatory fashion.

The outcome of this case will have significant implications not only for Christian freedom of speech, but in relation to all free speech. For example, comments made by people on social media (often many years ago) have recently been arbitrarily used to silence viewpoints that people dislike or disagree with.

“My personal loss is gain for future Christians”

Commenting on his win, Felix said: “This is great news, not only for me and my family, but for everyone who cares about freedom of speech, especially for those working in or studying for caring professions. As Christians we are called to care for and serve others, and publicly and privately we must be free to express our beliefs, especially when asked, without fear of losing our livelihoods.

“"I have suffered tremendously as a result of how I was treated by the University of Sheffield and I feel that four years of my life have been taken away from me. Despite all this, I feel overwhelming joy that what I have lost will be so much gain to Christians today and in the future as a result of this important ruling for freedom.”

A message of freedom

Andrea Williams, Chief Executive of the Christian Legal Centre, which supported Felix, said: “This is a watershed case for Christians and a resounding victory for freedom of speech.

“We are delighted that the court of Appeal has seen the importance of this case and made a ruling that accords with common sense. It is shocking that the university sought to censor expression of the Bible in this way, and we hope this sends out a message of freedom across all universities and professions that Christians and others should be allowed to express their views without fear of censorship or discipline.

“Due to Felix's sacrifice, Christians and others now know that it is their legal right to express Biblical views on social media or elsewhere without fear for their professional careers. This is a major development of the law and must be upheld and respected in current and future Christian freedom cases.

“Despite this victory, this is not the end of Felix’s fight for justice. He must now go back to a University of Sheffield panel who will judge, in light of this outcome, his fitness to practice as a social worker. Full justice must be served and the University held to account so that this kind and compassionate man can finally work in a job that reflects his qualifications and his ability, professionally and as a person. Our communities and the most vulnerable in our society need more Christian professionals like Felix, not less.”

Scott Morrison for website

Prime Minister Scott Morrison plans to introduce legislation to protect religious freedom by the end of the year.

“The first step is to consult with our colleagues, our parliamentary colleagues and then I'm very keen to engage the Opposition in that process as well,” the Prime Minister said.

Religious freedom entered the spotlight after Rugby Australia sacked Israel Folau for paraphrasing the Bible on social media.

Folau’s cause has gained widespread support. He has fundraised over $2 million for his legal defence even after GoFundMe shut down his fundraising page because of his Christian view of human sexuality.

When asked about Folau’s situation, the prime minister referred to faith as merely a private matter, rather than a public activity: “I think it's important, ultimately, that employers have reasonable expectations of their employees, and that they don't impinge on their areas of private practice and private belief or private activity.

“And there's a balance that has to be struck in that, and our courts will always ultimately decide this based on the legislation that's presented.

“Now, that matter [Folau], I'm loathe to make further comment on, because that matter will be finding its way through the courts as well, and that will be done based on the existing legislative framework,” he said.

In his interview with ABC’s 7.30 program on July 1, the prime minister indicated he would protect religious freedom in a narrow way.

“We're looking at a religious discrimination act which… will provide more protections for people because of their religious faith and belief in the same way that people of whatever gender they have or sexuality or what nationality or ethnic background or the colour of their skin - they shouldn't be discriminated against also, and we have discrimination acts that deal with that,” he said.

Faith and family groups are pushing for freedom of religion, association and speech to be protected more broadly.

Euth WA MR inside article

The report by the WA Ministerial Expert Panel on End of Life Choices shows no regard for known risks to the elderly and mentally vulnerable, according to Darryl Budge of Christian advocacy group FamilyVoice.

“Allowing doctors to raise assisted suicide puts the mental health and safety of the most vulnerable at risk,” said FamilyVoice WA State Director Darryl Budge.

“In our state of WA with dire statistics relating to elder abuse, mental health and youth suicide, permitting the WA health system to openly recommend assisted suicide to patients and the general community would be a backward step.

“This report also makes a stunning admission about the lack of patient knowledge on all treatments including palliative care.

“The report states, ‘Up to 60 per cent of Australians have low levels of individual health literacy’ and ‘people may not have the knowledge or confidence to start discussions about specific treatments or options’ which their health practitioner may not have raised.

“Knowledge about palliative care is desperately lacking, and the panel dares to recommend a doctor can steer a patient into choosing assisted suicide, regardless of the patient’s mental health or the risks of elder abuse by other parties.”

Mr Budge added, “Legalising euthanasia before world-class palliative care is properly provided and promoted across WA is putting the cart before the horse.”

“WA has the lowest proportion of specialist palliative care doctors of any state in Australia. There are just 15 full-time equivalents across WA, less than one third the number required to meet national benchmarks.

“Our state needs more than $100 million in annual spending on palliative care for staffing and education, in addition to funding for infrastructure such as palliative care wards and beds. This terrible funding shortfall was raised in a Legislative Council motion introduced by Jim Chown and passed unanimously.”

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Victoria’s Voluntary Assisted Dying bill was enacted today, making Victoria the first Australian state to legalise, and provide for, doctor assisted self-killing of vulnerable people.

Six-hour workshops have been held to provide ‘guidelines’ for medical practitioners willing to assist in the suicides – brief training considering the emotional challenges to staff, doctor or patient, and problems that may arise in administering lethal drugs or ‘safeguarding’ the process.

Many questions are still unanswered.

  • Only registered health practitioners have the right to freedom of conscience not to participate in assisted suicide/VAD. What about all the other staff members involved in the death process?
  • Who is responsible for ensuring the patient stops taking laxatives and other medications, fasts the required number of hours prior to ingesting the lethal dose, and turns off an implantable cardioverter defibrillator (ICD) if they have one?
  • Who will advise the patient on how to use the suspension and sweet syrup, the lethal substances, and the tools?
  • Have aged care services been suitably briefed on storage of the VAD lethal substances in a resident’s possession? What measures are being taken for the security of the substances, especially if unused?
  • Do our overworked health services, residential aged care providers, health practitioners and other staff have time to properly convene the required planning meetings to discuss the 19 key areas of responsibility like ‘staff capacity and willingness to be involved,’ ‘personal preferences e.g. music, clothing, bedside rituals or customs the patient would like in place’ and ‘who will be responsible for assessing and managing risks for bereaved individuals?’

This is bad, ideology-driven, harmful legislation. Once again, Victoria’s legislators have failed to protect the vulnerable and must now live with the consequences of their awful decisions.