Important note: This post refers to Geoff Bullock of Family Voice Australia. It does not refer to the Australian songwriter of the same name.
You may recall that at the recent Your Death, Your Choice forum in Maroochydore we had a particularly animated discussion on voluntary euthanasia, during which I promised to send you evidence of my claim that your pronouncement on involuntary euthanasia was not only false, but mischievous. (OK, I said ‘evil’, not mischievous.)
You may be surprised and discomfited that rather than replying to you privately, I have chosen to do so publicly. Let me explain my reasons.
I took some time to debate the ethics of this in my own mind. Ultimately, I determined that it was fair for the following reasons:
- You are not just a private citizen, you are a senior member of a political lobby group.
- In asking me to contact you, you did not hand me a private card – you handed me your political lobbyist’s business card.
- You made your statement in a public forum. It seems fair that my response should also be public.
- Writing, researching and editing this response has taken me three days – because I care about proper research and accuracy. I know intuitively that you will reject every piece of evidence presented to you in this letter or, if you deign to accept that I am right on this one point, you will scurry away to find other things from the Christian blog-o-sphere that seem to suggest that voluntary euthanasia is dangerous/evil/out-of-control/about to bring in Nazi-style eugenics/will result in little old ladies being knocked off for the inheritance, etc.
In other words, I know that writing to you privately is almost certainly a complete and utter waste of my time. I might borrow from the Bible and say ‘casting pearls before swine’ , but that would be unkind.
So, Geoff, this letter isn’t really for you. It’s to expose people like you and it’s to inform people who may come into contact with people like you that Christians are not always to be believed. They do not always represent “The Truth” as one might expect. In fact, sometimes, Christians stand up in public forums, misrepresent their level of expertise and spew out a great deal of absolute nonsense on subjects about which they know very little.
That is why I am writing this letter; not with any faint hope that you have any genuine interest in “The Truth”.
So, let’s get down to specifics. At the Your Death, Your Choice forum you stood up in a forum of around 200 people and declared that after voluntary euthanasia was legalized in The Netherlands, the rate of involuntary euthanasia increased.
When you were told by a number of experts that this was completely untrue, you insisted that you had researched this, giving the impression that you, yourself, were some kind of authority.
After the forum, you will recall that I challenged you. You see, Geoff I have researched the academic literature on voluntary euthanasia. I don’t claim to be an expert – that would take years – but I’ve spent months on it, researching, reading, writing, speaking to doctors and nurses and to those whose loved ones have suffered because people like you pollute the public debate with lies, misinformation and propaganda.
You may care to read some of my articles:
Activist Dead Wrong on Voluntary Euthanasia (written with Dr David Leaf)
I knew you had not done your research because:
a) what you were saying was bollocks and
b) I had actually read the reports whose findings you were so blatantly misrepresenting.
I promised I would send you the evidence which contradicts what you said at the forum and you assured me that you were only interested in “The Truth”. I doubt this is true, Geoff. I suspect that you are only interested in “The Truth” when it accords with your narrow, Biblical world-view. When it challenges that view, it seems you are quite happy to opt for the lies and misinformation which appear to support it.
Let me begin by telling you what Dutch academics, John Griffiths (Emeritus Professor of Sociology of Law), Heleen Weyers (Lecturer in Legal Theory) and Maurice Adams (Professor of Law) have to say about how academic research on voluntary euthanasia in The Netherlands is distorted by those with ideological agendas.
“Imprecision, exaggeration, suggestion and innuendo, misinterpretation and misrepresentation, ideological ipsedixitism, and downright lying and slander (not to speak of bad manners) have taken the place of careful analysis of the problem and consideration of the Dutch evidence.”
Make no mistake, they’re talking about you and yours. Yes, Geoff, unwittingly you identified yourself as one of those base religionists to whom ideology is more important than the facts. That’s how I picked you out as ‘religious’ at the Your Death, Your Choice forum. You checked all the boxes.
I hope you have the grace to be embarrassed by the fact you can be so easily identified as a fundamentalist Christian because your public pronouncements (and not just those at the YDYC forum) fit the description given above.
I didn’t even need to meet you to know you were a Christian, but you confirmed the type of Christianity even before you gave me your business card. Do you know how ?
When I asked you directly if you had done your research from a ‘religious’ perspective you spluttered, “I’m not going to tell you that! That’s irrelevant!”
Strange, isn’t it, that when I asked directly if you were coming from a religious perspective you repeatedly refused to confirm it. A bit like Peter’s denial of Jesus, isn’t it Geoff?
As several people have said to me, “Why didn’t he just say, ‘Yes, I’m a Christian, and that’s why the truth is important to me!’?”
But I know why. I’ve become very familiar with fundamentalist Christians trying to hide their religious affiliations in order to seem more authoritative. It’s why your political lobby group is called “Family Voice” instead of a more transparent “Christian Voice”. It’s why the Family First Party isn’t called the God First Party and it’s why Doctors for the Family isn’t called “Doctors willing to make shit up for Jesus”.
All those names would be far more accurate, but you guys aren’t about truth and accuracy are you, Geoff? It’s all about ‘spin’.
“Don’t make it obvious we’re coming from a religious perspective – no-one will believe us!”
Isn’t that a sorry indictment of the depths to which fundamentalism has brought Christianity?
The thing is, Geoff, you know and I know, the moment you admit you’re a Christian – especially a Christian of a certain conservative, fundamentalist type – your credibility is shot.
Because your lot are doing such a fabulous job of destroying the reputation of your religion by trying to prop up the unsupportable, widely debunked rationales for your narrow minded prejudices with a world-wide litany of: ‘“Imprecision, exaggeration, suggestion and innuendo, misinterpretation and misrepresentation, ideological ipsedixitism, and downright lying and slander (not to speak of bad manners)” – and not just on voluntary euthanasia!
Research, Geoff, is not reading Bill Muehlenberg’s blog and stopping by at a few other Christian websites.
You may not have picked this up when you were doing your unaccredited licentiate in theology (Th.L) at the Australian College of Theology, Geoff, but to call what you did, ‘research’ is either blatant misrepresentation or pitiful self-delusion. (I fear that, in your case, because you did seem like a very nice man, it’s the latter.)
Nevertheless, you are an adult in a position of authority and you have to take responsibility for your words. You also have to take responsibility for those you associate with.
Too often your co-religionists stand up and utter absolute rot and are never held to account. You, Geoff – nice as you may be – are today’s sacrificial lamb.
Christopher James Ryan MBBS, FRANZCP (note the post-nominals, Geoff – just a tad more authoritative than ThL, CDec) has this to say about the slippery slope meme you so artlessly invoked at the Your Death, Your Choice forum:
“The slippery slope does not try to argue its case by drawing conclusions from carefully constructed premises, nor does it rely upon a systematic review of empirical evidence. Any sort of formal argument for the slope’s predictions would be quickly bogged down in detail and uncertainty …
Those who make use of the slippery slope … do not concern themselves with [empirical evidence]. They do not need to because, the slippery slope is not really an argument at all.
Rather, it is a stern and knowing warning – an ethical “beware the Ides of March”.
The slippery slope is what Daniel Dennett has termed an intuition pump. Intuition pumps bypass the uncertain and exhausting path of convincing readers with careful and detailed argument in favour of a more easily travelled byway that speeds readers to a conclusion based upon their gut feeling. Intuition pumps replace argument with slogans and telling images. They are designed to convince readers of the truth of what they already suspected.
Although intuition pumps do not depend upon empirical evidence, they will utilise such facts as are available to further their cause.”
“The sky is falling! The sky is falling!” she clucks frantically, and is soon joined in her panic by all her friends, who never think to ask if her interpretation of the ‘evidence’ is sound.
Of course, Henny Penny and her friends met a rather gruesome end. Gullibility is unsustainable in the long term.
This is a bit long-winded, I know, and it gets worse. But I really want you to understand what a very, very bad reputation you fundamentalist Christians have in the mainstream world where “The Truth” you say you so ardently seek is defined as ‘that which is’ not ‘that which one wants to believe’.
You are entitled to your own opinion, Geoff. You are not entitled to your own facts*. Facts are things which are independent of what you’d ‘like to believe’. They are not things which can or should be reformulated in order to be shoe-horned into your narrow ideology.
One of the academics at the conference sought me out after the forum and said to me, “You know, there are some people who will never be convinced by evidence.”
They had you summed up, too.
I said, “I know.”
Another expert on voluntary euthanasia emailed me, warning me about wasting my time on “fruitcakes you are never EVER going to convince.”
I said, “I know.”
They are both right. Sad to say, I could drive up to your house today with a semi-trailer full of academic research which confirms that, where voluntary euthanasia or physician assisted suicide has been legalised it is operating safely and efficiently with widespread community support (80 per cent in the Netherlands, for instance). I could bring with me a bus load of experts from medicine, science and academia to say– as the experts told you on Saturday – there is no ‘slippery slope’. You would still not believe what they told you, because it conflicts with your religious convictions.
Your ‘research’ into voluntary euthanasia was so poor that you didn’t even realise the ‘evidence’ you were parroting is a gross misrepresentation of a statistic from the Remmelink Report, published in 1991. You hadn’t even heard of Remmelink!
Remmelink has been superseded by two major research projects, commissioned by the Dutch government – both of which follow the format of Remmelink. I suspect you didn’t stumble across them in your research, either, Geoff.
But, first, let’s get our terms right.
You stated that your research showed that the incidence of involuntary euthanasia increased in The Netherlands after euthanasia was legalised. I suspect that what you were talking about was non-voluntary euthanasia also known as ‘euthanasia without explicit request’. Basic research would have clarified this for you, but you will find the two terms commonly used interchangeably on Christian websites.
Voluntary euthanasia means a patient has explicitly asked a doctor to help them end their life and that this request has been properly formalised with all the appropriate paperwork.
Non-voluntary euthanasia means that a doctor, almost always in consultation with her colleagues and the patient’s family, makes the sad decision that the best thing for the terminal patient is to hasten their death. This doesn’t mean the patient was never consulted about their wishes. It may simply mean that their wishes were not formally recorded and, at the time of their death, they were not in a position to confirm their request.
There is certainly an argument for tightening up administrative practices – but it is a long way from suggesting a patient has been killed against their will.
Have you ever considered why it might be impossible to gain the consent of the patient at the time a lethal dose of medication is administered?
Perhaps the disease has progressed too far, perhaps the patient is brain damaged, perhaps they suffer from some kind of ‘locked in’ syndrome like ALS (Lou Gehrig’s Disease), or perhaps the patient is a child or a baby who cannot practically give consent for themselves. The patient may well have spoken to their family or doctor previously about their wishes, but if their wishes were not filled out on the appropriate forms, their death will be recorded as ‘without explicit request’.
Involuntary euthanasia occurs only when a terminal patient has explicitly said, “I do not want to receive assistance in dying” and the doctor proceeds to hasten their death against their will; or, when a doctor decides to kill someone whose death is not imminent and who has not expressed a wish to have their death hastened. In every country and jurisdiction where voluntary euthanasia is legal, this is, if proven, a criminal offence attracting a jail term.
The Remmelink Report, is the foundation report for research into euthanasia. Undertaken in 1990, it is, of course, now way out of date. But, as a document against which we can measure the trajectory of voluntary and non-voluntary euthanasia, it is invalauble.
It is important to note that the Remmelink study was undertaken before voluntary euthanasia was legalized in the Netherlands. (Up until then, voluntary euthanasia was tolerated under certain circumstances but was not yet legal.)
Even taking all this into account it is absolutely untrue to say that the Remmelink Commission found widespread involuntary or even non-voluntary euthanasia. In fact, the Remmelink Commission found no cases of involuntary euthanasia in the Netherlands during the period of their review. None. Not one.
It did find (and this is where all the Henny Pennys and Turkey-Lurkeys start clucking and gobbling!) 1000 cases where a doctor deliberately ended the life of a patient without a clear and explicit request from the patient. This represented 0.8 per cent of all deaths.
Yes, it’s a tiny, tiny percentage isn’t it? I wonder if you knew how small this figure was as a percentage of total deaths before you stood up and spruiked about all the research you’d done, Geoff?
But still, 1000 people killed against their will! That’s barbaric!
But this was not involuntary euthanasia, Geoff. It was non-voluntary euthanasia.
Ryan (1998) provides some important clarifying information on these 1000 cases of non-voluntary euthanasia (please remember, this figure is not current, it reflects the situation in The Netherlands two decades ago, before VE was fully legal):
“[Remmelink’s] detailed analysis of the instances of life terminating acts without explicit request revealed that in 59% of cases the physician did have information about the patient’s wishes through discussion with the patient and/or a previous request. In all other cases discussion with the patient was no longer possible. In 86% of cases life was shortened by a few hours or a day at most and no instances of involuntary euthanasia were discovered.”
So, Geoff, while technicaly, 1000 deaths are categorized as ‘without explicit request’, the wishes of 590 of those patients were known to their physician. They were not killed against their wishes, they were euthanized in accordance with their wishes.
But what of the other 410?
Let’s jump forward to Agnes van der Heide’s (and colleagues) 2007 follow-up on Remmelink, because she clearly sets out how we might understand this category of euthanasia ‘without explicit request’.
Van der Heide tells us that, in 2007, requests were not received from 10.4 per cent of the patients because ‘they were unconscious’ and in 15.3 per cent of cases there were ‘other factors’ which made an explicit request impossible. A further 14.4 per cent of patients were unable to give consent because they were children or babies – their parents gave consent on their behalf. In 80.9 per cent of cases, the decision to hasten death was discussed with the patient’s relatives. In 65.3 per cent of cases, the decision was made in consultation with other health professionals.
In other words, Geoff, euthanasia ‘without explicit request’ does not mean involuntary euthanasia, nor does it necessarily even mean the patient was not consulted or that their views were not taken into account.
But, my goodness cry all the Henny Pennys! Why would someone’s family want to hasten the death of a loved one – unless, of course, there were nefarious motives. Rushing to reap the rewards of a rich aunt’s will, perhaps?
Sanctimoniously, Geoff, you, yourself have written on Bill Muehlenberg’s blog that ‘the sanctity of life is far more important than the quality of life’.
Have you ever seen how a cancer patient’s life might end, Geoff? Where is the sanctity in a beautiful young woman, in the final hours of her life, uncontrollably vomiting faeces from her mouth?
If it were your daughter or wife, would you be piously prattling about the wonderful ‘dignity’ and ‘sanctity’ of her last hours?
What would be most compassionate, Geoff; to leave her in her indignity, or for her loved ones and her doctor to consult and decide that the kindest thing to do, what she would have wanted, would be to hasten her inevitable and imminent death?
What of an old man with uncontrollable gangrene in his foot? Would you have been able to wax lyrical about the sanctity of his life as he lay in a palliative care ward for months begging to be released from his suffering as the gangrene, slowly and excruciatingly spread, rotting him to death?
If I was angry with you on Saturday, Geoff, I was not as angry as I should have been, because these are the kinds of people I was speaking up for. These are the kinds of people who continue to suffer because, what is more important to you and other anti-euthanasia lobbyists is that terminally ill patients, with their own views on what is right for them, should be required to abide by YOUR particular view of what is right and what is wrong. Who died and made you God, Geoff?
It’s not enough, for you, is it Geoff, that you could refuse to have your own death hastened?
No! God-like, you seek to push your views on to others – lobbying your little heart out without even stopping to think of the suffering your stance causes, or the possibility that you might be wrong. Without even bothering, I may add, to spend the time doing some accurate, unbiased research.
But, it is inconceivable to you that you may be wrong, there is no need for you to do any serious research into the rubbish you’ve read on Christian websites. You just take it as ‘read’.
As a senior member of a Christian lobby group I don’t doubt you’ve made similar representations to polticians on euthanasia, on abortion, on stem-cell research, on homosexuality – in the firm conviction that you’ve ‘researched’ them.
Sadly, like Henny Penny’s followers, they probably believed what you told them – a Christian wouldn’t lie or misrepresent their level of expertise, would they, Geoff?
Since Remmelink, there have been two, major, official and widely accepted peer-reviewed reports which you don’t seem to have stumbled across in your ‘research’ on voluntary euthanasia. They are:
Van der Maas et al (1996) “Euthanasia, Physician-Assisted Suicide, and Other Medical Practices Involving the End of Life in the Netherlands, 1990–1995”, New England Journal of Medicine.
And, as previously mentioned:
Van der Heide et al (2007), “End-of-Life Practices in the Netherlands under the Euthanasia Act”, New England Journal of Medicine.
Both of these are available on the internet for anybody who takes a modicum of interest in reading the actual key source documents for research into voluntary euthanasia in The Netherlands.
If you had bothered to read these reports, Geoff, you would have found that van der Maas makes it very clear that:
“Further scrutiny of the case histories in the interview study showed that decisions to end life without the patient’s request covered a wide range of situations, with a large group of patients having only a few hours or days to live, whereas a small number had a longer life expectancy but were evidently suffering greatly, with verbal contact no longer possible.”
In other words, van der Maas and his colleagues didn’t just jump to the uninformed conclusion that you did. They took the time to ask, “What are the particular circumstances of these patients whose deaths were hastened without explicit request? Is there a reasonable explanation why this was done?”
Having done this, van der Maas and his researchers found no cause for alarm. The sky was not falling.
Not only that, when comparing the numbers of cases categorised as ‘without explicit request’ with the Remmelink Report, they found, “The frequency of cases in which life was ended without an explicit request by the patient has decreased somewhat since 1990.”
In the second follow-up report (2007), van der Heide confirms that deaths ‘without explicit request’ further decreased from 0.7 per cent in 2001 to 0.4 per cent in 2004 – a factor of almost 50 per cent.
This lays to rest the ‘slippery slope’ argument in terms of euthanasia ‘without explicit request’.
Van der Heide also found that, rather than escalating, the overall number of deaths due to voluntary euthanasia decreased slightly. Legalising euthanasia did not lead to an explosion of euthanasia deaths – either with or without explicit request.
I know this is long, and I apologise to my regular readers – but not to Geoff who has probably long, since left us. I must continue as there is more that needs to be said on this subject.
The charge is that legalising euthanasia is what leads to a high incidence of involuntary or non-voluntary euthanasia. It’s implied that legalising euthanasia is the causative factor; that whatever is happening prior to legalisation, will inevitably get worse afterwards. Again, studies have shown this charge to be completely unfounded.
A 1997 comparative study by Helga Kuhse et al found that, in Australia, 1.8 per cent of deaths were the result of voluntary euthanasia – the same rate as in the Netherlands. According to this study, euthanasia occurs at more or less the same rate whether it is legal or not.
While voluntary euthanasia was not yet formally legal in the Netherlands in 1997, the Dutch Supreme Court had ruled three years earlier that it was acceptable, provided doctors followed strict guidelines. So, the comparison here is between the Netherlands, which had a ‘high tolerance’ for voluntary euthanasia, and Australia, where it was then and is now, uncompromisingly illegal.
This (and other similar studies) tells us that, in countries where voluntary euthanasia is illegal, it is being performed anyway – with and without ‘explicit request’.
But, here is the difference that you and your fellow anti-euthanasia propagandists ignore, Geoff. Where voluntary euthanasia is not legal, it is being performed without regulation. You heard that for yourself at the Your Death, Your Choice forum. If you’re ‘in the know’ you can make a phone call to a doctor who ‘does that sort of thing’ (on the ‘sly’ of course) and get him to pop over and ‘oblige’. (Please note, I am not suggesting the obliging doctor would agree to this for just anyone. My point is that that because voluntary euthanasia is illegal, they have to make an assessment on only their own judgment.)
Is that really what you want, Geoff? Because that is what your opposition to regulated voluntary euthanasia is perpetuating.
Kuhse et al found that, in Australia, cases where the patient’s life was ended without their explicit request comprised 3.5% of all deaths – around 5 or 6 times the number in the Netherlands. Overall, they found, “Australia had a higher rate of intentional ending of life without the patient’s request than the Netherlands.”
Speaking of Kuhse’s research, Ryan confirms that:
“If the slippery slope were a reflection of reality, the rate of non-voluntary euthanasia in Australia should have been lower than that in the Netherlands. The results indicated that exactly the opposite was true. The rate of non-voluntary euthanasia in Australia was 3.5% (+_0.8%), far higher than the 0.8% and 0.7% reported in the two Dutch studies.”
And this holds for other countries as well. A comparative survey, published in the Canadian Medical Association Journal explains that:
“Opponents of euthanasia often argue that legalizing the procedure will lead to a rise in the use of life-ending drugs without a patient’s explicit request, especially in vulnerable patient groups. Thus far, however, no indications of this have been found in studies of physician-assisted deaths before and after legalization in Belgium and the Netherlands. In Belgium, the percentage of deaths in which life-ending drugs were used remained stable, and the proportion without an explicit request from the patient decreased.
Other studies have shown that euthanasia, physician-assisted suicide and the use of life-ending drugs without explicit patient request are not confined to countries where physician-assisted death is legal.”
Let me just hammer this home Geoff (in case you’re still with me and didn’t stomp off disgusted at the point I said “making shit up for Jesus”).
Credible studies from expert researchers, published in mainstream academic journals, show the rate of non-voluntary euthanasia tends to be significantly higher in countries where it is illegal (e.g. Australia) than in the countries where laws were more liberal (e.g. The Netherlands and Belgium).
The myth that legalising euthanasia causes high rates of non-voluntary euthanasia has been thoroughly debunked; but, of course, that doesn’t stop anti-euthanasia propagandists from trotting it out as ‘evidence’ of the non-existent ‘slippery slope’.
Let me stress this point. Voluntary euthanasia is already happening in Australian hospitals and nursing homes. It happens unregulated, unsupervised and without reporting procedures. Is this what you want, Geoff?
“Do you know how many vials of morphine are ‘accidentally’ broken at 3am in the morning in Catholic nursing homes?” a GP asked me recently.
Legalization brings in stringent procedures and safeguards. It requires multiple checks to ensure that the patient is competent and not being coerced. Such rigour is not possible if the doctor or nurse has to administer the lethal injection alone, and in the dead of night, to avoid conviction.
Because politicians buy the misinformation put about by people like you, Geoff, people are being euthanised without any checks or balances – and often without their explicit request. Not because euthanasia is legal, but because it’s not legal!
Some, who aren’t confident they’ll find someone to euthanize them shoot themselves in the head, or hang themselves, or take an overdose of drugs at home – subjecting their family to criminal investigations.
That’s what happens without legalization. So, if compassion for human suffering and reducing the incidence of euthanasia ‘without explicit request’ is really your concern, may I suggest you should be campaigning for legalization because that is what will reduce both of those things.
But, that’s not your real concern, is it Geoff? No, your only concern is to push your narrow religious view onto the rest of us, through legislation, regardless of the consequences.
I have written a great deal on this. Much more than I expect you will read. But I promised you evidence and I always keep my promises. I promised you “The Truth” and I have supplied it; not a truth biased by ideology, but the kind of truth that comes from proper research and critical analysis.
What you represented at the Your Death, Your Choice forum, Geoff was ideologically biased delusion. Whether you knew that or not is really not important, because you have adopted this as a ‘way of thinking’ and that is your responsibility.
I can see from your comments on the internet, that you don’t confine your ideological bias to euthanasia. You make the same mistake in formulating your views and policies on abortion, homosexuality, same-sex parenting, stem-cell research and a host of other issues. Have you ‘researched’ them, too, Geoff?
What is important is that your ideological bias compels you to be dishonest. You have to get the facts to fit your world view.
If this only affected you, I’d say, “Fair enough.”
But it’s not “fair enough” because this kind of chicanery has real life consequences. It hurts people – badly. It ruins lives. It causes suicides. It is not based on a genuine desire to help people and make their lives better, it is based on a hubristic desire to prove that your Biblical world-view is right – no matter what the real truth might be.
If you’ve been moved or inspired by this article, please join the fight to legalize voluntary euthanasia in Australia.
The most effective thing you can do is join a lobby group in your own state or territory – you can find them here.
If you are independently wealthy, or happen to have a ‘little bit to play with’, please consider making a donation to any of these organisations.
If you are updating your will (I assume you have a will, don’t you???) please consider leaving a bequest to Dying with Dignity. It may not help you, but it may help your loved ones.
And, finally, it is important to note that I speak independently, and not on behalf of Dying with Dignity or Palliative Care Queensland which hosted the Your Death, Your Choice forum at which Mr Bullock and I clashed. My opinions are entirely my own.
However, I would urge you to also look at the magnificent work that Palliative Care organisations do in your state and understand that they are grossly underfunded – particularly in Queensland which, we were told, “is one of the worst places to die in Australia”. If you can manage a donation to Palliative Care, please do so. Here are the links.
*While I’d love to claim it as my own, the statement “Everyone is entitled to their own opinions, but they are not entitled to their own facts” must be attributed to its originator, US Senator Daniel Patrick Moynihan. (Thanks to Hilton Travis for finding the origin of the quote.)