Three wise monkeys

In the final three days of consideration in detail of Western Australia’s Voluntary Assisted Dying Bill 2019, from 17 to 19 September 2019, like the three wise monkeys, the Minister for Health, Roger Cook would see no evil (ignoring real risks of wrongful deaths); the Attorney-General John Quigley would hear no evil (ridiculing members asking probing questions) and the Premier, Mark McGowan would speak no evil (inadvertently admitting taking a poison under his bill IS suicide).

The Minister for Health while admitting that “it was technically possible” for the medical practitioner or nurse practitioner who is to administer the lethal poison to a person to be in “a commercial arrangement or relationship”– such as being an employee or business partner – with one or both of the coordinating medical practitioner and the consulting medical practitioner. The coordinating medical practitioner could first suggest euthanasia to a person as the person’s best or only option, then assess the person as eligible for euthanasia – possibly using Skype or Facetime – get this eligibility confirmed by his business partner and then send their nurse practitioner employee out bush to administer the lethal poison.

Welcome to Euthanasia Inc. wild west style!

But Minister Cook insists this is not a problem because despite this cosy, commercial relationship “the assessment still has to be independent”.

Despite having made much of the safeguards provided by the oversight of the Voluntary Assisted Dying Review Board, the Minister admitted that:

“it was technically possible” for a person to be assessed as eligible for euthanasia and put to death by the administration of a lethal poison before the paperwork is received by this “oversight” Board.

Clearly any oversight will be too late! But the Minister for Health sees no evil in this.

What about steering – described by the Hon Nick Goiran as the elephant in the room?

Sean L’Estrange, the Member for Churchlands, asked the Minister “if a medical practitioner was incredibly supportive of” euthanasia “as a medical option for a patient” and “they were able to introduce into the conversation between themselves and the patient the option of” euthanasia, “how would that be assessed or tested to determine whether opening up that conversation was in and of itself a form of subtle coercion?”.

The Minister saw no evil:

“This is the matter of bedside conversation, and this is what our medical workforce is there to do— discuss people’s options at the end of life. This is the reason that we place so much trust in our medical workforce.”

So, a medical practitioner can both steer a person towards euthanasia and then assess that same person as not being subject to any coercion – including from that practitioner’s own enthusiastic promotion of euthanasia to the person!

Minister Cook confirmed fears that with the much looser criteria for euthanasia rather than assisted suicide in the Western Australian bill compared to the Victorian bill it is quite likely that the overwhelming majority of cases will involve medical or nurse practitioner administration of lethal poison rather than assisted suicide:

“95 per cent of patients in Canada have chosen a practitioner-administered” lethal poison, “That might potentially give … an indication” of what will happen in Western Australia.

The Minister for Health also confirmed that:

a person could request euthanasia rather than assisted suicide by a “hand gesture” to the medical practitioner, with no witness present.

In regard to self-administration of a lethal poison – or assisted suicide – the Minister dismissed concerns about the lethal poison losing its effectiveness if not used before its expiry date: “I can assure the member that, by definition alone, they would not delay it by a year.”

This is a breathtaking refusal by the Minister for Health to acknowledge a real problem.

The eligibility test under his assisted suicide bill is that two medical practitioners, neither required to have any special qualifications or experience in the relevant condition, say that “on the balance of probabilities” that condition “will cause death within a period of 6 months” or in certain cases “will cause death within a period of 12 months”.

The Minister seems not to know what “balance of probabilities” means – namely that while 51% likely to happen there is a 49% chance it may not!! - and so misleadingly gives a completely baseless assurance that no person will outlive the 6- or 12-month period.

He also completely ignores the known error rate of over pessimistic prognoses as well as the evidence from Oregon and Washington of persons assessed as having a condition that “will, within reasonable medical judgment, produce death within six months” (a much stricter criterion than the “balance of probabilities” in the Western Australian bill) not ingesting the prescribed lethal poison until up to nearly 3 years later after being assessed as eligible.

See no evil!! My Bill is perfect!!!

In response to concerns, based on evidence from other jurisdictions that suicides using prescribed lethal poisons can go wrong, the Minister insisted that there was no need for a medical practitioner or anyone else to be present with the person at the time of ingesting the poison. “We are honouring the wishes of the patient who may wish to do this in the privacy of their own home not surrounded by medical practitioners.”

The Minister assures us that “the type of poison that will be” used “will not have any other side effects for the patient. In the event that the medication does not result in the patient’s death, evidence indicates that the patient will awaken without otherwise being affected. That is the nature of the sedatives or things of that nature that ultimately will be used.”

He refuses, like the first of the wise monkeys, to see the evidence from Oregon and Washington regarding seizures, regurgitation, profound burning in the throat, and taking over 4 days to die.

But the Minister isn’t worried. See no evil!!

In response to reasonable questions from the Member for Churchlands, Sean L’Estrange, about the lack of qualifications, including no requirement for a criminal record check for a contact person who must take charge of any lethal poison left after a person prescribed it has died – whether from using the poison or otherwise – the second of the wise monkeys refused to even hear the question and instead just verballed the member in a very derisory manner:

Attorney-General the Hon John Quigley said:

At least the member has planted his flag in the mound. Come his day, he will not even be considering VAD [assisted suicide] and he will not even be considering a contact person; he will go the full distance. He has made that clear, and all pain to him. He has made that clear. He is against these contact people. He is against people handling this drug, so at least in the presence of the Lord he has said, “This is not for me. I will go the full distance.

Yes, the Attorney-General wished a member of parliament “all pain” because he dared to ask a question about the operation of the assisted suicide bill.

The final wise monkey, speaking no evil, inadvertently spoke the truth “It would not be prudent to allow the public to know which … poisons may be used for voluntary assisted dying as this may encourage persons who are not subject to a voluntary assisted dying process to stockpile their supply for the purpose of suicide or assisted suicide outside the protections contained within the voluntary assisted dying legislation.”

You heard it:

the very same poisons may be used for suicide either “outside the protections” of the legislation or under the legislation!

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