Who do you trust to tell you the truth about Voluntary Assisted Dying’s impact on the health sector? Nurses, or pro-VAD politicians and lobbyists?
The Nurses Professional Association of Queensland (NPAQ) has unequivocally said euthanasia and assisted suicide laws (so called “Voluntary Assisted Dying”) should not be legislated in Queensland.
Their emphatic “no” was contained in a July 1 submission to the Parliamentary Health Committee of Inquiry, which was obliged to canvass public opinion followed the tabling of the Queensland Law Reform Commission draft legislation in May.
NPAQ President Margaret Gilbert, whose association represents approximately 8,000 nurses, co-authored the submission and objected on the following grounds:
- VAD fundamentally contradicts the right to life.
- Legalisation of VAD will transform the very nature of the profession of nursing away from saving life and doing no harm to the intentional taking of life.
- The legalisation of VAD is guaranteed to make nurses unsafe, subject to abuse and attacks, damage emotional wellbeing and undermine the health of the workplace. In particular, nurses will be vulnerable to abuse from families, general members of the public (due to a lack of privacy), hostile work environments, trauma and distress inherent in the process and additional workplace burdens. This is simply unacceptable.
- The importance of VAD’s impact on nurses has been totally neglected in the debate.
- VAD is being pushed as a cheap alternative to the woefully underfunded palliative care sector. The current VAD proposals will entrench a two-tier system where the wealthy will access palliative care and the average person will be left with no choice but to end their own lives.
- The VAD Bill purports to give patients a choice to access palliative care through mandatory disclosure, but the Government has effectively destroyed that choice.
- The Government has only guaranteed roughly 35% of needed money and that money is going to bureaucrats, not frontline care. Palliative Care needs to be given $375 million per year to meet needs estimated in conjunction with greater training, nurse led palliative care units and accessible homecare provision.
- VAD is inherently ripe for abuse.
- Even if the arguments against VAD are ultimately rejected by Parliament, eligibility requirements must be amended in order to minimise as much as possible the chances of abuse.
- It is too easy to get away with putting to death those with marginal capacity or doing so through financial/economic coercion. This must be changed.
- The Conscientious objection provisions for nurses are not good enough. Emotional, professional or liability concerns are not covered and nurses who are emotionally distraught may be forced to participate in VAD. Nurses with conscientious objections will be compelled by law to still participate in VAD through mandatory referrals and will be strong armed into participation by colleagues or employers. The Bill needs to be changed to reflect these concerns.
There is much to digest, but it is only the tip of the iceberg and shows how deeply the NPAQ have drilled down into the VAD supporters simplistic mantra of “compassion” and “choice”.
Most importantly they see right through the contradiction that palliative care and VAD can co-exist and complement one another.
Their submission is particularly blunt on this point: “VAD is a terrible, ‘cheap’ fix that appears to be driven by the worst impulses in cost cutting and will do nothing to change either resourcing or healthcare system structure and delivery,” they wrote.
“Its legalisation will only encourage the perpetuation of a two tiered system that entrenches income and regional inequality. Those who are unlucky will increasingly opt to end their own lives.
They go on: “…it will become a political excuse to ignore the substantive issues with palliative care, this will happen because it will be seen as the normal, legitimate option for end of life care.”
In spite of the headline catching dollop of an extra $171 million spread across 5 years, they warn “there will be no political impetus or will to ever further reform the palliative care system. Not only is VAD not a fix, it will kill better, alternative efforts to address the same problem.”
The NPAQ also found irony in another self-fulfilling driver of the need for VAD.
The Explanatory notes to the legislation argue a justification because “for some Queenslanders suffering from a life-limiting condition, palliative care is unable to effectively manage their pain, symptoms or suffering.”
That is ambiguous – is it because all pain can’t be managed through palliative care? Is it because there is not enough funding or trained practitioners* around the state? (* something that was red-flagged in a 2013 State Government Inquiry report – 8 years on the entire progress we have to show on this inadequacy is..…VAD)
In either instance they are defying the findings of a study by the well-respected Harvard University.
This study found that (i) adequately funded and well-managed palliative care resulted in substantially less pain, and that pain is well managed (ii) only 2% of patients that receive palliative care in an ICU bed make it through the process and (iii) successful palliative care drastically reduced the need for admission of patients into emergency departments.
Following the learnings from this study would likely produce a ‘win-win’ for both terminally ill patients and cash-strapped governments trying to shore up their massive health budgets.
Its’ wisdom is squandered instead, and to add insult to injury the NPAQ highlight the Government health system processes which only amplify the hospital trauma.
Their submission notes: “…often suffering in public hospitals is a by-product of a lack of rostered on experienced staff. Within a 24 hour week at a public hospital, 70% of the time is filled by junior doctors and staff.”
“Specialist palliative consultants will often only be present 2 days per week, leaving junior doctors with the lion’s share of the palliative work.
“Unfortunately, due to a lack of experience and expertise, patients cannot have their needs adequately met and often suffer.
“This is fixable through increased funding for experienced staff and training.”
So how do ‘progressives’ deal with a problem largely of their own making? They overleap the maxim of ‘prevention is better than cure’ and rush headlong into VAD instead of following the more proven path of better-funding and easily accessible palliative care.
“To put it bluntly, assisted suicide is cheaper,” as NPAQ head Margaret Gilbert felt obliged to apologise in a Courier Mail op-ed piece published on March 23.
The other interesting conundrum the NPAQ shine light on is the fiction that VAD is a private act.
This is patently untrue. If not, why does it rely on the enactment of a new law to legalise it.
There is no criminal offence if an individual currently wishes to end their own life at their own hands.
The legal constraints that exist are directed at the participation of third parties in the process of the person ending their own life, either by killing that person (section 300) or aiding and counselling suicide (section 311).
As legal philosopher John Finnis notes, “VAD is not a private act. It is an act for seeking assistance from someone else, to share the intention to end the life of the person who wishes to end their own life.”
The NPAQ anticipated the implications of involvement in such a ‘private act’ for its members when it submitted “the Conscientious objection provisions for nurses are not good enough.”
“Emotional, professional or liability concerns are not covered and nurses who are emotionally distraught may be forced to participate in VAD.
“Nurses with conscientious objections will be compelled by law to still participate in VAD through mandatory referrals and will be strong armed into participation by colleagues or employers”
By virtue of the Commonwealth laws that prevent the promotion of suicide via a carriage service, nurses also face the added peril of legal risks.
The NPAQ warned “VAD leaves nurses exposed to being criminally prosecuted by the Commonwealth Government and no safeguards exist in the Bill to even notify nurses of this risk, let alone protect nurses.”
“All assurances to the contrary that have been provided are wishy washy and lack substance (relying heavily that the Commonwealth Department of Public Prosecutions will show ‘discretion’ and not pursue cases to help out the Queensland Government).
This article has only focused on three areas of criticism levelled by the NPAQ at the VAD legislation.
There are multiple others we could have pursued but won’t for the sake of brevity.
Ask yourself this simple question.
If you were to present for a major life altering surgery, and the nurses attending provided you with more than three good reasons you shouldn’t proceed, would you trust their advice?
If the answer is yes, then join with the nurses of the NPAQ and contact your local MP to let them know you oppose the introduction of VAD.