The oversight regime hopes to find out nothing, investigate nothing and report nothing
As the House of Commons approaches the crucial vote on the Terminally Ill Adults (End of Life) Bill, members should be aware that many misleading statements have been made about the so-called “safety” of assisted suicide in Australia.
Merely labelling assisted suicide as “Voluntary Assisted Dying” does not make it so. There need to be effective checks and oversight that make sure it truly is voluntary, and it is here that the Australian regimes fail abysmally.
It is always going to be very difficult, if not impossible, for doctors to recognise whether an assisted suicide request has been motivated by factors such as domestic violence, elder abuse or other coercion or undue pressure, or to detect mental illness or lack of capacity.
Yet minimal attention is given to these major risk factors in the training Australian doctors receive to qualify to dispense assisted suicide. In Victoria, for example, one study has found that of the six to eight hours of the mandatory online training course, only five minutes cover voluntariness and detection of risk factors such as coercion, and just over three minutes cover other eligibility requirements, such as diagnosis or time to death. Most of the training is about how to follow the required procedural steps and get the paperwork right.
In Victoria in the last two years not a single application for an assisted suicide permit has been refused
For a decision to be truly voluntary, it also needs to be fully informed by well qualified practitioners. Yet the Australian regimes fail that test as well. In Victoria, for example, there is no requirement for either of the assessing doctors to be a specialist in the patient’s condition, or for either doctor to have any particular level of knowledge about palliative care.
In fact, it is possible in Victoria for a patient to be assessed simply by two GPs, only one of whom has had any prior experience of patients with similar conditions, and there is nothing in the legislation to stop the two GPs being in the same clinic or other practice.
For a regime to be safe also requires thorough and impartial oversight. However, this is yet another failure of the Australian regimes; perhaps the most serious failure of all.
Approval permits for an assisted suicide in Victoria are issued by civil servants and almost exclusively on the submitted paperwork alone, with virtually no investigation. There are, moreover, no audits of actual compliance, no random case reviews and no requirements to report adverse events.
To make matters worse, the Voluntary Assisted Dying Review Board is not an impartial and objective regulator. Instead, most of its members are strongly committed to VAD and thus have a strong interest in ensuring that any problems are not made public.
In fact, the design of the Australian oversight regimes can be summed up in the maxim: “Hear no evil, see no evil, speak no evil” — find out nothing, investigate nothing and report nothing that could suggest that assisted suicide has been anything other than an unblemished success.
Thus, in Victoria in the last two years not a single application for an assisted suicide permit has been refused. This is not, however, due to 100 per cent practitioner understanding of and compliance with the legislation. Rather, as the Review Board’s latest annual report makes clear, it reflects the fact that applications are not being formally determined until the initially submitted paperwork has been got into order by interaction between civil servants and the submitting doctors. As long as the paperwork is in order, there seems to be scant regard for the underlying reality.
The role of the Review Board itself has been little more than that of a cheerleader for the assisted suicide regime, assuring the public how well it is all working regardless of the facts, avoiding publication of any contrary evidence, and lobbying for further expansion of the law.
Given all this, the decision of the Westminster Public Bill Committee to replace High Court review and Chief Medical Officer oversight with Assisted Dying Review Panels and a Voluntary Assisted Dying Commissioner imports into the Bill the single worst regulatory design failure (of many) in the manifestly unsafe Australian model.
