The Hon. C.M. SCRIVEN


The Hon. C.M. SCRIVEN (20:08): I rise tonight to speak on the Voluntary Assisted Dying Bill, and I would like to thank everyone who has made contributions and particularly those who have made contributions about their personal circumstances, which I think for most of us is never easy to do.

I think, however, it is very important that we look first of all at foundational principles when we are thinking about legalising euthanasia. Australia is a member of the United Nations and therefore has bound itself to the Universal Declaration on Human Rights. Articles 3 and 4 of that declaration describe the rights to life and liberty as inalienable rights. These are rights that cannot be alienated, a right of which the individual may not be deprived and of which the individual may not even deprive himself or herself.

As an example, it follows that one cannot give up one's freedom by selling oneself into slavery, even for a compellingly compassionate reason. If the state permits individuals to sell themselves into slavery, this would impede the state in protecting impartially the right to freedom of all other citizens and especially the most vulnerable. It is the same with the right to life. If the state allows some people to voluntarily seek the assistance of others to kill them, even for what is considered a merciful reason, then this impedes the state from protecting impartially the rights of other citizens not to have their life taken from them voluntarily.

In general, as a society we recognise that this right to life is inalienable and that we do not kill each other. A government's first duty is to protect each one of us impartially. Euthanasia fatally compromises that first duty of parliament. I know that some members do not accept the premise that euthanasia puts some people at risk but there is empirical evidence to prove that it does, some of which I will outline later in this contribution.

Legalising euthanasia or voluntary assisted dying involves important threshold questions. Former Primer Minister Paul Keating said this:

The justifications offered by the bill's advocates—that the legal conditions are stringent or that the regime being authorised will be conservative—miss the point entirely. What matters is the core intention of the law. What matters is the ethical threshold being crossed.

In both practical and moral terms, it is misleading to think allowing people to terminate their life is without consequence for the entire society. Too much of the…debate has been about the details and conditions under which people can be terminated and too little about the golden principles that would be abandoned by our legislature.

These are principles that affect us all. Palliative care specialist Professor Odette Spruijt voices similar principles. She has worked in palliative care for over 25 years and says:

To regard those who are at the end of life as if they come within a different category of human, that the sanctions on deliberate ending of life that we (so far) accept in other stages of life no longer apply, is to fundamentally change our value system at its core. It is not enough to talk about patient choice as if autonomy means only me. Autonomy is also relative, we are relational beings, we depend on each other, and what we do affects each other.

Paul Keating noted the reluctance on the part of proponents to confront the essence of what they propose in this type of legislation, permitting physicians to intentionally end the life of patients or assisting patients to do so. He said:

Opposition to this bill is not about religion. It is about the civilisational ethic that should be at the heart of our secular society. The concerns I express are shared by people of any religion or no religion. In public life it is the principles that matter. They define the norms and values of a society and in this case the principles concern our view of human life itself. It is a mistake for legislators to act on the deeply held emotional concerns of many when that involves crossing a threshold that will affect the entire society in perpetuity.

There are two reports that are particularly worthy of note on the issue of voluntary euthanasia. The first is the report of the House of Lords Select Committee on Medical Ethics, which concluded:

We believe that the issue of euthanasia is one in which the interest of the individual cannot be separated from the interest of society as a whole.

One reason for this conclusion is that we do not think it possible to set secure limits on voluntary euthanasia. Some witnesses told us that to legalise voluntary euthanasia was a discrete step which need have no other consequences. But as we said in our introduction, issues of life and death do not lend themselves to clear definition, and without that it would not be possible to frame adequate safeguards against non-voluntary euthanasia if voluntary euthanasia were to be legalised. It would be next to impossible to ensure that all acts of euthanasia were truly voluntary, and that any liberalisation of the law was not abused. Moreover, to create an exception to the general prohibition of intentional killing would inevitably open the way to further erosion whether by design, by inadvertence, or by the human tendency to test the limits of any regulation. These dangers are such that we believe that any decriminalisation of voluntary euthanasia would give rise to more, and more grave, problems than those it sought to address.

The New York State Task Force on Life and the Law, called 'When death is sought: Assisted suicide and euthanasia in the medical context', said:

Some Task Force members do not believe that assisted suicide is inherently unethical or incompatible with medical practice. On the contrary, they believe that providing a quick, less prolonged death for some patients can respect the autonomy of patients and demonstrate care and commitment on the part of physicians or other health care professionals. Nonetheless, these members have concluded that legalizing assisted suicide would be unwise and dangerous public policy.

What these are both referring to, essentially, is the concept that is sometimes referred to as the slippery slope. There are two meanings of this. The allegation of a slippery slope is proved if one can show either, one, that despite the presence of legal safeguards, the practice of euthanasia always involves alongside it the practice of non-voluntary euthanasia; and/or, two, that legalisation of voluntary euthanasia for some cases will lead to calls for euthanasia for increasing types of cases and especially for those who are not terminally ill, such as those with dementia.

Both of these propositions are capable of being tested empirically. The evidence is worth some time and attention. First, the issue of non-voluntary euthanasia. The Netherlands allowed euthanasia from 1984. The number of cases reported to the authorities in accordance with the law was 454 in 1990, and 424 in 1994. However, these numbers do not account for the total number of cases of euthanasia, only those reported to the authorities and considered for prosecution.

In most cases, doctors had stated the cause of death as being due to natural causes, despite the fact that they were not. Doctors said the reasons they had falsified the cause of death were, one, to avoid the fuss of a legal investigation; two, a desire to protect a relative from a judicial inquiry; and, three, a fear of prosecution.

However, the government conducted a survey under the supervision of the Attorney-General, Professor Jan Remmelink. The report is referred to as the Remmelink report. It showed that voluntary euthanasia was in fact accompanied by non-voluntary euthanasia. The number of physician assisted deaths estimated by the 1991 Remmelink committee report was 25,306, all of which involved intentional killing by act or by neglect, some voluntary and others non-voluntary.

They were made up of 2,300 euthanasia on request; 400 assisted suicides; 1,000 life-ending treatments without explicit request; 4,756 patients died after request for non-treatment or the cessation of treatment with the intention to accelerate the end of life; 8,750 cases in which life-prolonging treatment was withdrawn or withheld without the request of the patient, with the intention to terminate life; and 8,100 cases of morphine overdose, with the intention to terminate life. Of those, 61 per cent were carried out without consultation with the patient.

I appreciate there were quite a number of figures there, so I will just summarise: it included withdrawal of treatment as well as active euthanasia. To pull out the particularly relevant points: more people were intentionally killed by physicians without their consent than with their consent. The Dutch evidence shows us that in 1990 there were 10,558 cases where there was an explicit intention to hasten the end of life by act or omission, and 55 per cent were non-voluntary. This justifies the conclusion that it is impossible to quarantine non-voluntary euthanasia from voluntary euthanasia, and that where voluntary euthanasia is practised, more are killed without their consent than with their consent.

The Dutch report in 1991 concluded that the Dutch guidelines for carrying out euthanasia by a doctor 'are incapable of preventing abuse'. The survey bears out this conclusion by indicating the cardinal safeguards requiring a request which is free and voluntary, well-informed and durable and persistent have been widely disregarded. The relevant point there is that, regardless of what the law is saying, the safeguards are widely disregarded. Paul Keating puts it this way:

An alarming aspect of the debate is the claim that safeguards can be provided at every step to protect the vulnerable. This claim exposes the bald utopianism of the project - the advocates support a bill to authorise termination of life in the name of compassion, while at the same time claiming they can guarantee protection of the vulnerable, the depressed and the poor.

No law and no process can achieve that objective. This is the point. If there are doctors prepared to bend the rules now, there will be doctors prepared to bend the rules under the new system. Beyond that, once termination of life is authorised the threshold is crossed. From that point it is much easier to liberalise the conditions governing the law. And liberalised they will be. Few people familiar with our politics would doubt that pressure would mount for further liberalisation based on the demand that people are being discriminated against if denied. The experience of overseas jurisdictions suggests the pressures for further liberalisation are irresistible.

He quotes the former President of the Australian Medical Association, Dr Michael Gannon, who explained that the formal position of the AMA was opposition to interventions that have as their primary intention the ending of a person's life. Dr Gannon said:

Once you legislate this you cross the Rubicon [meaning a point of no return]. The cause for euthanasia has been made in a very emotional way and this is the latest expression of individual autonomy as an underlying principle. But the sick, the elderly, the disabled, the chronically ill and the dying must never be made to feel they are a burden.

Paul Keating further said:

Palliative Care has issued the most serious warnings. It says at least one in four Victorians who die each year (about 10,000 people) do not have access to needed palliative care, [that is one in four do not have access to needed palliative care] that access in aged residential care is 'very low', that between 2 and 10 per cent of older Australians experience abuse in any given year and that its funding is inadequate to meet growing demand.

Keating went on to state:

More people in our community will be put at risk by this bill than will be granted relief as its beneficiaries. This is the salient point.

The issue is not how many people will choose to die under this proposed law. It is how many people may die when otherwise they wouldn't…

Once this bill is passed the expectations of patients and families will change. The culture of dying, despite certain and intense resistance, will gradually permeate into our medical, health, social and institutional arrangements. It stands for everything a truly civil society should stand against. A change of this kind will affect our entire community not just a small number of dying patients. It is fatuous to assert that patients will not feel under pressure once this bill becomes law to nominate themselves for termination.

Dr John Keown has recently summarised the evidence of euthanasia as it is practised in the Netherlands today. He stated:

Despite the legal requirement that physicians end life only at the explicit request of the patient and report all cases, six large-scale official Dutch surveys have disclosed that since 1984 physicians have, with virtual impunity, failed to report thousands of cases, and have given lethal injections to thousands of patients without request. Dutch assurances when the law was relaxed in the 1980s that euthanasia without request would not take place, and would be prosecuted as homicide if it did, have long rung hollow. In 2016, Professor Boer, a former euthanasia review committee member, observed that of 45,000 cases reported to the review committees since 2002 only 75 had been referred to the prosecutors for breaching the criteria and none had resulted in prosecution.

I note that those being referred were those who were expected to need investigation. It continues:

The Dutch government's proposals in 2016 to extend the law to allow elderly people with 'completed lives' to access assisted suicide promises to lead to a further substantial increase in numbers, involving many people who could live [healthy lives] for years.

We see similar evidence in Belgium. The Federal Control and Evaluation Commission in successive reports 'confesses to feeling powerless' because:

…it does not have the ability to assess the number of reported euthanasia cases versus the number of euthanasia cases actually performed.

Evidence discovered in recent research carried out in Belgium suggests that around 50 per cent of euthanasia cases are not in fact reported. Why is this so? Research indicates the following reasons specified by physicians who do not report who are able to give multiple answers to the questions put.

The answers they gave as to why they did not report included that they did not perceive their acts as euthanasia, that reporting is too much of an administrative burden, that the legal due care requirements had possibly not been all met, that euthanasia is a private matter between physician and patient, and that they did not report the case because of possible legal consequences.

One of the arguments used in favour of the change in law in 2002, and indeed that we see now in regard to this proposed law, is that the illegal practice of euthanasia would be brought out into the light and controlled. Clearly, the law has not done that. Legislation alone does not seem capable of doing that.

In May 2010, another set of Belgian scholars reported their research on the use of life-ending drugs in the Canadian Medical Association Journal. These scholars asked Belgian doctors to fill out a questionnaire to see whether these drugs were ever administered to patients who had not requested them. Of the deaths reported to them where the administration of life-ending drugs was involved, we see that in nearly 32 per cent of cases, doctors admitted to administering life-ending drugs without the consent of the patient.

When life-ending treatment was carried out without explicit request, the matter had only been discussed—even discussed—with 22.1 per cent of the patients. The reasons given as to why the ending of life decision was not discussed with the remaining 77.9 per cent of patients were that the patient was comatose, the patient had dementia, the decision was clearly in the patient's best interests, discussion would have been harmful to the patient, and others.

The evidence that we should not just trust doctors and nurses is also revealed in Australian scenarios. In their report of a sociological survey on the attitudes and practices of medical practitioners and nurses in South Australia, Christine Stevens and Riaz Hassan found that 19 per cent of medical practitioners and nurses had at some time taken active steps to bring about the death of a patient.

Their most striking discovery, however, was that 49 per cent of those who had done so had never received a request from a patient to take such active steps; that is, in our jurisdiction, South Australia, where euthanasia is legally prohibited, 19 per cent of the medical profession agreed they had been involved in euthanasia but half of those 19 per cent had done so without reference to the patients.

Dr Stevens, who was involved in conducting the study, revealed on radio and in private correspondence that at the time she conducted the study she was neither in favour of euthanasia nor was she opposed, saying, 'I was entirely neutral and impartial in my views, neither in favour nor opposed, until completion of the analysis of the survey results.' She formed her judgement to be opposed to legalised voluntary euthanasia because of her finding of views, albeit minority ones, that:

…poor quality of life, mental disability and physical handicap should be valid circumstances for active euthanasia, whether this was requested or not.

That was what she found in terms of attitudes here in South Australia. She continued:

Advocates of euthanasia often argue in its favour from the perspective of individual rights, autonomy and dignity, but the research demonstrates that these very principles are abused by its practice.

The very principles of rights, autonomy and dignity are abused by the practice of voluntary euthanasia. She said:

There is a danger that legalisation of active euthanasia, voluntary or involuntary, may expand the potential for further abuses. Further, I consider legalisation could undermine the value placed on human life, and erode our sense of security. We need to ensure that the state continues to protect people.

Yet, we hear arguments that the very fact euthanasia exists and is being practised now despite its illegality is a reason to make it legal. As stated by a number of earlier speakers in this debate and also those I have quoted tonight, why on earth would we expect that those who are already willing to break the law would cease doing so if we have legalised euthanasia and safeguards? Those safeguards would not be respected.

The second meaning of the slippery slope refers to the calls to extend the provisions. The evidence I have mentioned from the Netherlands and Belgium shows that, whatever the law actually says, euthanasia will expand beyond the original confines in the law. There will also be calls to extend the law. The contribution earlier tonight from the Hon. Frank Pangallo has already outlined various jurisdictions where euthanasia has been extended to include children, people with disability, people with depression or other mental illness and so on.

The Canadian government is seeking to make it legal for doctors to directly kill or assist the suicide of vulnerable people who are not terminally ill. If passed, the bill known as C-7 will remove the requirement for a person's natural death to be 'reasonably foreseeable' and let people with a disability, including those suffering from mental illness deemed to be incurable, access medical assistance in dying (MAID).

Heidi Janz is an ethics professor at the University of Alberta and chair of the Council of Canadians with Disabilities' Ending-of-Life Ethics Committee, and she called the plans irresponsible and extremely unethical. Having grown up among other children with disabilities, Professor Janz said:

…we all knew that some of us would live longer than others. But we also knew that all of us would live with the best quality of life possible…

But she confessed that she worries about the effect that expanding euthanasia will have on kids and youth with disabilities. She added:

What keeps me up at night is knowing that this is not the message the current generation of kids with disabilities is getting. Instead, they're hearing about parents requesting [medical assistance in dying] for their disabled kids.

It is these kinds of subtle messages that imply that some people's lives are not worth living, and it is the most vulnerable who will be affected by them. In Victoria, despite the short time that their voluntary assisted dying laws have been in place, we see that the Voluntary Assisted Dying Review Board has already recommended changes to the act to provide for the legal right for medical practitioners to initiate a conversation about voluntary assisted dying. That provision of course is constrained by legislation in this bill, and yet in Victoria they are already seeking to change that after only 18 months of operation.

Associate Professor Spruijt, who I mentioned earlier—and I remind members that she is a palliative medicine specialist and affiliated with the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne—says this:

True to expectations, the results of the first 12 months of Victoria's voluntary assisted dying laws have been presented in the media as an argument for the removal of some of the safeguards of the initial act. The narrative provided is one of unrelieved suffering unless more people are able to access this option more easily. This narrative would have us believe that 'if not voluntary assisted dying, then devastating deaths are the only alternative'.

As a palliative care specialist with over 25 years of practice, mostly in Victoria, I have found the institution of the Victorian law to have a devastating effect on my practice of palliative medicine. I have witnessed the devastating impact of this law on the cohesion of teams, on the relationships within clinical units, and as a cause of deep moral distress among many of my medical colleagues, for whom this law, and its accompanying narrative, is anathema to the very core of our sense of what it is to be a doctor.

She continues:

While I try to avoid the slippery slope terminology, I see so much evidence of this in the attitudinal creep associated with the implementation of VAD that I find it hard to not adopt this metaphor. The slippery slope refers to the normalisation of these practices as much as to numbers of people who are assisted to die. I have seen this in my workplace, as those of us who express objection to VAD are challenged as uncaring, dogmatic and confrontational, as our views as conscientious objectors are not respected. I have seen it in the documentation of 'consider VAD if appropriate' in a clinical note on a patient…That note was written by a junior inexperienced doctor—

which means that he would not have been able to actually implement that—

but it echoes the growing sentiment of normalisation and acceptance of this practice for the relief of suffering.

She says:

I feel deep distress when I see junior doctors respond to patients' expressions of a wish to die by [simply] beginning the VAD process. There is no longer the mental health review, no longer the palliative care pathway, now there is just the simplistic acceptance that a wish to die in a person with life-threatening illness can be taken at face value and acted upon. And that those of us who express a different response to end-of-life suffering are berated as obstructing the patient's free choice. If we follow…[the] narrative, our duty now is to grant this wish with expedition, without question or exploration of the many and often complex factors leading to this request.

Previous speakers have referred to remarks from the Chair of Victoria's Voluntary Assisted Dying Review Board, who said she has not found evidence of coercion. She is quoted as saying:

…it simply can't be done under this legislation, the safeguards are too rigorous and there are criminal penalties for any coercion.

Firstly, these comments were made after only 18 months of the Victorian laws operating, which is far too short a period to make meaningful conclusions. Secondly, the nature of coercion is such that it will almost always be incredibly difficult to pick up, for example, talking about how badly the person's illness is affecting family members, how crowded the hospital is with people awaiting beds, how difficult it is to get time off work to visit the sick person, how a relative is losing income because they are staying with the sick person.

Any of these and a hundred others can be a form of coercion and pressure and be incredibly difficult to pick up. One-on-one conversations with no-one else present will, of course, never be picked up by a review board. In the event that it ever made it to court, how can a court determine beyond reasonable doubt whether the intent was to coerce the sick person or the person making the comments was merely incredibly insensitive.

It is nonsense to claim that legislation can prevent coercion which is one of the compelling reasons why this legislation should not pass. Of course, after the act of euthanasia, how can it be verified that the request was fully voluntary, well thought out and not due to external pressure. The people who may exert pressure suggest family members are hardly going to admit to the fact when the subject of that pressure is now dead.

As we see from the various other jurisdictions however many safeguards are in place, they can be and are ignored. Again, it would be irresponsible of us to pretend that changes in attitudes will not occur as the normalisation of ending others' lives develops. One person wrote to me saying this:

We have seen with the release of the Royal Commission report into the care of the elderly that this vulnerable group to our horror have not had their wishes for good and dignified care leading up to end of life respected. What sort of subtle pressure from institution or relative could be brought to bear upon this vulnerable group if assisted suicide were an option instead of them taking up limited health resources to remain alive until their natural time of death.

So let us not delude ourselves that if this bill passes it will be the last we hear of this issue for years to come. There will be more attempts to expand the criteria or reduce what will be called the 'bureaucratic burden' or the 'barriers to access' or discrimination.

Allowing physicians to help patients end their lives also changes the practice of medicine and our entire culture. Our laws impact society as a whole and not just the small number of terminally ill individuals. Physician assisted suicide changes the culture in which medicine is practised. It corrupts the profession of medicine by permitting the tools of healing to be used instead as techniques for killing. It reduces patients' trust of doctors and doctors undivided commitment to the life and health of their patients.

VAD advocates argue instead that it increases the trust that doctors have compassion, although no evidence is offered for this. But the change in the doctor-patient relationship will have occurred. A person will go to a doctor knowing that the doctor thinks that some people's lives are not worth living which must beg the question, consciously or unconsciously, does he or she think my life is not worth living? Can I therefore really be confident that she or he will do everything to preserve my life and health?

We are told that the safeguards are rigorous. Whilst I will make some further comments at clause 1 and during the committee stage elsewhere on these, I will reflect on a couple now. The first is that doctors must consult a second practitioner and yet we know from the recent debate on abortion law changes that the requirement for two doctors to personally examine the woman seeking an abortion was easily circumvented.

Doctors reported that they just had a pile of papers on their desk at the end of the day that they signed as the second consultation without personally examining the woman at all. Indeed, we were told at briefings that the removal of the second practitioner provisions was changing the law to reflect what was actually happening in practice. Once assisted dying practices become normalised, there is no reason to think that a similar dilution will not happen.

The latest push for physician assisted suicide is opposed by many of the medical associations. I am advised that includes the World Medical Association, the Australian Medical Association, and the Australian and New Zealand Society of Palliative Medicine. The World Medical Association Declaration on Euthanasia and Physician-Assisted Suicide states:

The WMA reiterates its strong commitment to the principles of medical ethics and that utmost respect has to be maintained for human life. Therefore, the WMA is firmly opposed to euthanasia and physician-assisted suicide.

The AMA states:

The AMA believes that doctors should not be involved in interventions that have as their primary intention the ending of a person's life. This does not include the discontinuation of treatments that are of no medical benefit to a dying patient.

And there are many others. Some are silent, but those that are silent say 'this statement should not be taken as explicit or implied support of the legalisation of physician assisted suicide'.

We are told that SAPOL supports voluntary assisted dying because there are currently suicides of people with terminal illnesses. Clearly, the support for VAD rests on an assumption that suicides will decrease if VAD was available. However, international studies offer no evidence of such a decrease. One of the few studies that has tested this theory, Jones and Paton's 'How Does Legalization of Physician-Assisted Suicide Affect Rates of Suicide?', published in the Southern Medical Journal, found:

Legalizing PAS [physician assisted suicide] has been associated with an increased rate of total suicides relative to other states and no decrease in nonassisted suicides. This suggests either that PAS does not inhibit (nor acts as an alternative to) nonassisted suicide, or that it acts in this way in some individuals but is associated with an increased inclination to suicide in other individuals.

Similarly, Victoria has not seen any decrease in the number of suicides since its introduction of legislation. However, given it has only been in effect for 18 months, I want to be consistent in suggesting that that is not something we can draw a conclusion from.

There is also the problem of the so-called Werther effect. This is the theory that hearing about suicides and the reasons for them can cause others with similar dispositions to have suicidal ideation and possibly attempt suicide. Members will be aware that this is why we have strong guidelines for media on how to report on suicides. Supporters of VAD argue that suicide is not the same as VAD. However much we may use language such as 'voluntary assisted dying' instead of 'suicide', the reality is that many people will see it as the same.

If I am having suicidal ideation am I not seeking to die voluntarily? If we support ending of life because of suffering, including mental suffering, for someone who has a terminal illness, why would we argue against the ending of life of someone who is also suffering, including mental suffering, and who after all will also die at some point in the future? However carefully we choose our words, the message is confusing and conflicts with our attempts to combat the rising rates of suicide in our state. Palliative Care said the bill 'sends the wrong message to people contemplating suicide and undermines suicide prevention efforts'.

There are also claims that assisted suicide is better for the family and loved ones of the person who takes advantage of it. There has been one significant study called 'Death by Request in Switzerland: posttraumatic stress disorder and complicated grief after witnessing assisted suicide'. The Journal of European Psychiatry study examined the impact that witnessing assisted suicide has on the mental health of family members or close friends.

The study surveyed family members or close friends who were present at an assisted suicide, with assessment of full or partial post-traumatic stress disorder and complicated grief. They were assessed at 14 to 24 months post loss. The results showed that 13 per cent met the criteria for full post-traumatic stress disorder, 6½ per cent met the criteria for subthreshold PTSD and 4.9 per cent met the criteria for complicated grief. The prevalence of depression was 16 per cent; the prevalence of anxiety was 6 per cent. The study concluded this:

A higher prevalence of PTSD and depression was found in the present sample than has been reported for the Swiss population in general. However, the prevalence of complicated grief in the sample was comparable to that reported for the general Swiss population. Therefore, although there seemed to be no complications in the grief process, about 20% of respondents experienced full or subthreshold PTSD related to the loss of a close person through assisted suicide.

We have been told essentially that this legislation is inevitable. The implication is that it is sweeping the world and somehow we are being left behind. In fact, it has been introduced in only 10 countries—10 out of 195. The debate also tends not to concentrate on medical advances.

We heard at a briefing recently some heartbreaking stories, but several of them were from 40 years ago. I acknowledge of course that there are other more recent ones, but medicine has come a long way in both preventing and treating illness and disease as well as palliative care. We as a society are becoming better equipped to reduce pain and suffering and not less so. At a time when we are able to do more and more to relieve suffering, it seems it is almost counter to then be introducing voluntary assisted dying.

One person said to me, 'We often hear it said by people who support VAD that we treat dogs better than we treat those at the end of life,' referring of course to putting animals down when they are suffering from sickness or injury. Apart from the objection that some of us might have to comparing people with animals, I will continue the quote:

This simple statement seems appealing on face value, but it is worth reflecting that we also put animals down when we no longer wish to pay for their treatment and medical bills.

I would like to extend my sympathy to all who have experienced the death of a loved one, which is, after all, most of us. It is always painful to see. Every person is different and every circumstance is different. No-one wants to experience suffering themselves or to see suffering in others.

My own dear sister-in-law, Mary, died less than two years ago from ovarian cancer, a particularly painful disease. It was about three years from diagnosis to her death, and she left behind a large family, who were of course devastated by their loss. Her illness and deterioration was painful for her and painful to watch for all of us who loved her. She received wonderful palliative care. One of the nursing staff who cared for her in the days before her death told us how, despite Mary's own suffering, she had been a joy to care for.

I mention this as a tribute to Mary, an amazing and loving woman who I feel very privileged to have known. I mention it also because it is frequent that people who do not support voluntary euthanasia are accused of lacking compassion and told that they will feel differently when someone they love has experienced a painful disease, illness or medical condition.

Most, if not all, of us have experienced a loved one suffering in that way. In many ways, we would dearly love to be able to relieve that suffering, and voluntary assisted dying seems like a simple answer, but if we cross the threshold of legalising the killing of another, we abandon fundamental principles to the detriment of our community overall. That detriment includes putting the most vulnerable at risk. The evidence shows us that roughly half of those who die through voluntary euthanasia legislation have not requested it. We cannot take that risk. It is not fair to those we love. It is not fair to those who have suffered and died. It is not the appropriate move for our society.