It’s just not right - NSW’s voluntary assisted dying bill has myriad flaws

A/Prof Richard Chye (St Vincent’s Hospital Sydney’s Director of Supportive and Palliative Care) - SMH 12 Nov 2021 

Most readers will know that a new euthanasia bill has been introduced in the NSW Parliament.

If we believe the narrative of its barrackers, those opposed to it are driven by religion, ideology, or an absence of compassion. I am strongly opposed to euthanasia – or voluntary assisted dying (VAD) – and yet, I am neither political nor hold any faith.

I am also someone who has spent more than 30 years caring for terminally ill people. And it’s my deeply held view that VAD is a step we should not take.

As St Vincent’s Hospital Sydney’s Director of Supportive and Palliative Care, I have had the privilege of caring for thousands of people in their last years, months and days.

I entered this specialty after experiencing the painful death of my father. VAD’s supporters tell me it would have made his death better. I believe the opposite, not only for him, but for my family.

What would have alleviated my father’s suffering more meaningfully and consequentially would have been more family support, and clinicians who were better educated and trained in symptom and pain management; who understood the value and benefits of accessing quality palliative care early in the arc of a patient’s life-limiting illness.

VAD proponents say it’s only to be accessed by the small percentage of people who experience distress beyond the reach of palliative care.

It is true – and there’s no point not being honest about it – that there is a small handful of people who experience distress at death that no drug can fully address. Only if allowed can palliative care reduce that distress.

But let’s be equally honest. With VAD in place, far more than this number will choose a hastened death as has happened in Victoria. I also fear many of my fellow clinicians are more likely to talk about VAD in the first instance, rather than focusing on relieving distress.

This is exactly the experience in Canada, where VAD has been available since 2016. More than a third of people dying via Canada’s VAD system cite a desire not to be a burden as a reason for their choice, while a further 13% cite loneliness and a lack of social support.

Separate research has found that the fear of ‘becoming a burden’ is a problem for up to 65% of terminally ill people, and is a contributing factor in the selection of death-hastening pathways.

These people aren’t choosing assisted dying because of untreatable pain. They are choosing it out of fear and anxiety, or because they don’t believe they have the love and support of family or friends.

This is the real ‘absence of compassion’.

At a time when mental illness, social isolation and loneliness are on the rise, a NSW VAD system will similarly draw some terminally ill people down the same unnecessary path.

If there are gaps in people’s end-of-life care, or in existing interventions, we should address them in the same way we approach any other area of health: through community and social education, research, and innovation. Throughout COVID-19, our community has demonstrated its extraordinary capacity to meet acute need when we put our minds and resources to it.

In contrast, VAD proposes alleviating suffering by handing a patient a box of lethal drugs.

That is not the way we have ever achieved long-term solutions to health issues in this country, and to think VAD will provide one for end-of-life is fiction.

For example, it is a very real problem that many health professionals fear talking about dying. Many others don’t know how to, so they avoid it. The result is that some terminally ill patients reach their end-of-life horribly unprepared, with all the awful consequences that go along with that. It’s a real failure and it needs addressing.

But will VAD solve it? Of course it won’t.

For me, the rush to VAD is consistent with our society’s ever-growing appetite to achieve unrealistic quick fixes for wicked and complicated problems.

We might achieve an illusory result, but at what cost? It is a huge blind spot for us, and not just in the area of end-of-life. Easy doesn’t mean good. Simple and quick doesn’t mean right.

VAD’s proponents mean well and act out of compassion. I know that many of them have been touched by a poor experience of a terminally ill loved one.

But in terms of the complexities of end-of-life, VAD offers nothing but a mirage, and one that risks sweeping the lonely and vulnerable up with it.