I thank the committee very much for the opportunity to speak to its members tonight. I am professor of end-of-life law and regulation in the Australian Centre for Health Law Research at the Queensland University of Technology in Brisbane (Meanjin), Australia. I am making this opening statement on behalf of my colleague, Professor Lindy Willmott, as we have been researching the law, policy and practice of voluntary assisted dying together for over 20 years. More information about our work can be found at the end of this statement.
We support law reform to allow voluntary assisted dying in limited circumstances. It is possible to design a safe and effective voluntary assisted dying system that respects autonomy and shows compassion for terminally ill patients who are suffering and want to die, while at the same time robustly protecting the vulnerable in society. Reaching this view required a process of deliberation. First, we reflected on the ethical values that we thought should underpin law in this area: the values of life, autonomy, freedom of conscience, equality, the rule of law, protecting the vulnerable, reducing human suffering, and safe and high-quality care. We balanced and weighed these values and concluded that the ethical case for lawful voluntary assisted dying was very strong, provided it can be done safely.
Whether voluntary assisted dying can be safe involves a shift from ethics to facts and importantly, consideration of the evidence. We reviewed the evidence, including two decades of experience in places overseas which showed, for example, that vulnerable individuals are not more likely to use voluntary assisted dying, and also that voluntary assisted dying can be regulated safely.
This was the view we reached prior to voluntary assisted dying becoming lawful in Australia. Since then, all six Australian states, after careful reviews by committees like this one, and extensive debate in all six parliaments, decided that it was safe to have voluntary assisted dying. So we can now add the experience in Australia to that evidence After reviewing the experience of four years in Victoria, two years in Western Australia and approximately one year in Queensland, South Australia and Tasmania - the New South Wales law has only recently started - our view remains that voluntary assisted dying can be safe, and that this is the case in these systems. The Australian evidence we draw on for this includes the reports of the oversight bodies in these states. It also includes our research with team members across the states of Victoria, Western Australia and Queensland interviewing over 140 people: people seeking voluntary assisted dying, their family members, doctors, nurses, pharmacists, health administrators, medical college members, oversight board members, government officials and others. A key finding from this research is that the voluntary assisted dying systems are operating safely. In fact, a challenge is that the many of the safeguards in these systems have made accessing voluntary assisted dying very difficult for some patients.
I conclude with some reflections on research we have done on law reform deliberations about voluntary assisted dying.
In this research, we make the case for such deliberations to be evidence based and, in particular, that the evidence which lawmakers use be reliable. I mentioned that our own process of deliberation about voluntary assisted dying involved first thinking about the ethical issues and then about the facts or evidence. People can and do reasonably have different views about the ethics and the rights and wrongs of voluntary assisted dying. This is informed by a person’s values. We transparently stated the values that we considered in our deliberations but arguments about facts are different. These are claims about whether or not something is happening in practice. For example, are vulnerable groups in society more likely than others to seek voluntary assisted dying? This question, because it is about facts, is not settled by debating values but rather by looking at the evidence.
A key challenge for this committee is that it has received, and will continue to receive, a lot of information that will conflict. Voluntary assisted dying is said by some to be safe and by others to be dangerous. We make the following point about evidence. Only reliable, trustworthy, high-quality evidence will accurately show what is happening in practice. Drawing on established ways that science uses to evaluate evidence, a reliability pyramid has been proposed by a colleague, Professor Jocelyn Downie, which is figure 1 at the end of this statement. At the bottom of that pyramid are anecdotal claims or opinions, including what people think, what people claim to have seen, or what they believe based on their experience or views. These claims are of limited reliability and are not a safe basis upon which to make laws. An example towards the top of that pyramid is a systematic review, published in a top international journal and subjected to peer review, which analyses all the research on a topic and carefully and critically evaluates it. This is reliable evidence that lawmakers can safely act upon.
I note that this point about evidence is not an argument in favour of or against voluntary assisted dying. It is rather an argument that lawmakers, when considering this important and complex topic, should be supported in their deliberations by high-quality, reliable evidence.