For the past three weeks, Kim Leadbeater's Terminally Ill Adults (End of Life) Bill, which seeks to legalise assisted suicide in England and Wales, has been at the committee stage. There is mounting concern over the selection of witnesses, who have been drawn largely from those in favour of assisted suicide.
In this interview, Dr Anthony McCarthy speaks with Hon. Robert Clark, a former Attorney General in Victoria, Australia, to discuss the slanted evidence given by Australian witnesses to the Parliamentary Committee inquiring into the assisted suicide bill and why it is so misleading.
No, not if the aim was to enable Committee members to get a full and balanced account of how assisted suicide is operating in Australia.
Every Australian witness who has given evidence is a prominent supporter of assisted suicide, and most have been heavily involved in implementing it. Dr Clare Fellingham, for example, is described on the website of euthanasia lobby group Go Gentle Australia as a “high-volume VAD practitioner”, while Dr Greg Mewett was a member of the Victorian Voluntary Assisted Dying implementation task force, and Dr Cameron McLaren is the founder and inaugural president of Voluntary Assisted Dying Australia and New Zealand (VADANZ), of which Dr Chloe Furst is a board member.
As far as I am aware, none of the many Australian palliative care specialists, other practitioners, or even MPs who have opposed assisted suicide have been invited to give evidence.
It is hard to see how the recommendations of a committee that has taken this approach to the selection of its witnesses can have any credibility with either MPs or the public.
For a start, in his evidence, Alex Greenwich MP claimed that palliative care was “baked into” the New South Wales legislation and that MPs “came together” to ensure “any access issues were addressed”.
Yet just a year after the NSW VAD legislation was passed, a leading Sydney newspaper reported that $150 million of palliative care funding had been cut from the state budget as a cost-saving measure—at the same time as an additional $97 million was provided to implement VAD.
The Australian Medical Association in NSW warned in March last year:
<em>Waitlists to see a palliative care doctor for patients who are rapidly approaching the end of life in Western Sydney are taking multiple weeks. To force people to wait longer is heartless and inhumane.</em>
The human face of this lack of palliative care is illustrated by the harrowing account on the Palliative Care Australia website of the painful and distressing death of a family member in NSW in 2024 due to delayed and inadequate palliative care availability, coupled with a lack of understanding by many hospital staff of the patient’s palliative care needs.
This account is yet another example of the sort of suffering endured by dying patients and their families that is cited in Parliamentary debates as justification for assisted suicide. Yet, when looked at more closely, it is in fact an example of the continuing inadequacy of palliative care.
Despite the legalisation of VAD in every Australian state, and despite assurances such as those of Mr Greenwich, the fact remains that, according to Palliative Care Australia:
<em>Each day around 400 people die of a terminal illness, yet more than three in five (62%) do not receive specialist palliative care at any stage. … Without action, our future is one of diminishing care for people and families living and dying with terminal illness.</em>
Also highly misleading was a claim made by Dr McLaren about oversight. After outlining the process in Victoria by which two doctors assess the patient and a written application for VAD is made, Dr McLaren went on to say blandly:
<em>“That process then goes to our review board, to ensure that it is compliant...”</em>
In fact, this review by Victorian public—i.e., civil—servants does not ensure that the process for assessing the patient has been complied with; it simply ensures that the paperwork is in order. In one notorious case, where a doctor falsely certified that the patient had signed a statement in the presence of two witnesses, the public servant reviewing the application noticed that the two witnesses had signed but not the patient. Instead of rejecting the application, the public servant simply asked the doctor to obtain the missing patient signature. The doctor did so, and the application was approved—even though it was plain that the two witnesses had signed the form without actually witnessing the patient’s signature.
The lack of proper oversight in the Victorian regime goes even further. There is no programme of random case reviews, either before or after death, to ensure that what occurred actually complied with the legislation. The Act provides no process by which anyone with relevant information can flag concerns prior to a decision to authorise VAD, and the coroner is excluded by the legislation from investigating any case where a substance was taken in accordance with the Act—even if there is evidence that something went terribly wrong in the dying process.
All this is compounded by the fact that Victoria’s Voluntary Assisted Dying Review Board (VADRB) is made up of members, each of whom has a strong personal commitment to VAD, and thus a strong interest in ensuring that nothing comes to light that could result in VAD being seen as anything other than an unblemished success.
Another misleading statement to the Committee was the claim by Dr Clare Fellingham that before doctors can take part in assisted suicide in Australia, they have to undergo stringent training, including on how to assess capacity, how to detect coercion, and how to assess voluntariness.
In fact, the evidence from Victoria is that the training for VAD, which consists of an online course that can be completed in about six to eight hours, is mainly about how to follow the required steps in the process and how to fill out the paperwork correctly—rather than about how to identify and protect patients against risk factors, or how to counsel patients in ways that avoid implicit practitioner recommendations of VAD. One study found that the part of the training that covers voluntariness, including assessing the absence of coercion, totals five minutes, consisting of a two-minute, 10-second video and slides that take a further two minutes, 50 seconds to read.
This claim was made by Alex Greenwich MP in his evidence to the Committee, and similar claims were frequently made ahead of VAD being legalised in Victoria.
The reality is that, according to a recent study, there has been no reduction in general suicide in Victoria compared with other Australian states since the commencement of the VAD regime. Indeed, there is some evidence of an increase in suicides among those aged 65 and over.
Non-medical suicides by terminally ill people largely consist of those who end their lives impulsively, such as by jumping from a multi-storey car park after receiving adverse test results from their oncologist. Legalising assisted suicide is not likely to avert such suicides. Others who end their lives by non-medical suicide do so in circumstances of loneliness and lack of support. An emblematic example of this in Victoria was the suicide of a person who was alone and whose condition had deprived her of her lifelong pleasure of reading. Surely, rather than this showing the need for VAD, the compassionate community response should be to make it easier for people in such situations to receive more home visits or for someone to sit and read to them.
<strong>One Australian witness told the Committee that conscientious objection is respected where voluntary assisted dying (VAD) is practised. Is this not the case?</strong>
Regrettably, this claim is directly contrary to the experience of many Victorian doctors who disagree with VAD, either in general or in its manner of implementation. Assisted suicide has been institutionalised throughout the Victorian hospital system. The Victorian government and health department have driven all public hospitals that may have terminally ill patients to make VAD readily available and to tolerate no dissent from their practitioners, to the point where many practitioners working in public hospitals now feel unable to raise concerns about VAD—including about the ways in which VAD is being implemented within their hospital—for fear of suffering adverse career consequences. Others are leaving the Victorian hospital system altogether.
<strong>The witnesses made much of the need to respect the autonomy of patients, with most stressing autonomy rather than pain. What did you make of their arguments?</strong>
Yes, it is striking that while Alex Greenwich MP repeatedly grounded his support for the legalisation of assisted suicide on it being the alternative to a “cruel and painful” death, the remaining Australian witnesses almost exclusively based their support on grounds relating to autonomy.
A painful death is usually the main reason given in public and Parliamentary debates by MPs who support legalising assisted suicide. In contrast, the main rationale given by advocates for and practitioners of assisted suicide concerns their views about personal autonomy.
Avoiding painful deaths is not a valid reason for legalising assisted suicide, because almost without exception, pain and other physical symptoms can be resolved by proper palliative care. Presumably, however, MPs who support legalising assisted suicide nonetheless emphasise painful deaths because appealing to a desire for autonomy is far less likely to convince undecided colleagues to vote for a Bill with such far-reaching consequences.
Furthermore, the conception of autonomy evidenced by the Australian witnesses and many other advocates of assisted suicide is flawed and simplistic, overlooking medical practitioners’ broader responsibilities.
These responsibilities to a frightened and distressed terminally ill patient extend far beyond simply giving them the facts about their options and leaving them to make up their minds.
Medical practitioners have a duty to provide both emotional support and practical guidance to the patient. In particular, they must not only present the facts about any unfounded concerns regarding what might happen towards the end of their life, but also offer emotional reassurance that such concerns need not materialise and that the doctor and others will be there all the way to help overcome them.
When a patient tells a doctor they want to die because they are a burden on their family, the doctor’s first reaction should be: <em>“What can I do to help you with the reasons you are thinking that way?”</em> rather than simply thinking to themselves (as law professor Meredith Blake seemed to imply in her <a href="https://hansard.parliament.uk/Commons/2025-01-30/debates/895ba091-38d0-4162-8f79-40df9fae7e38/TerminallyIllAdults%28EndOfLife%29Bill%28SixthSitting%29%23contribution-63D7DCF4-CF36-466E-B584-A264241089C6%20)">evidence</a>): <em>“Well, just because they feel they are a burden doesn’t mean their decision isn’t voluntary, so let’s go ahead with assisted suicide if that’s what they want.”</em>
As I have detailed on a previous occasion, legalising assisted suicide involves profound changes to a country’s health system and to how doctors’ responsibilities to terminally ill patients are perceived. These changes will introduce systemic risks of inadequate or erroneous advice and insufficient support for thousands of terminally ill patients. Parliament should not do anything that will compromise doctors’ sense of responsibility or diminish the care and support that patients receive.
No individual’s desire for autonomy can be absolute when that autonomy unavoidably means that multiple others will suffer unfairly as a result. The desire for autonomy for some should not come at the expense of harm to many.
