Voluntary Assisted Dying (a nurse’s open letter to their state member of parliament)

Dear Michael Healy MP

Thank you for being my local member to the Queensland parliament. I am not in the habit of writing to politicians, but feel compelled to do so on the matter of voluntary assisted dying. 

It is important to acknowledge the Premier’s advice that the matter be debated respectfully, it is a matter above politics, and that all members of the Queensland parliament will have a conscience vote. 

If you have already made a firm decision on how you will vote regarding Queenslanders having a choice to access voluntary assisted dying I do not expect to change your mind. 

If you have not made a firm decision I am hoping to leverage my experience and credibility as a Registered Nurse to influence you to vote in favour of the voluntary assisted dying laws.

My Context

I do not talk about death every day at work, but I can’t remember the last time a week at work passed without it being part of my conversation with patients and colleagues. Death is a part of life. Not the best part, but an inevitable part. Despite the social conventions to the contrary, it’s good to talk about death. 

Most of the patients I speak with have multiple comorbidities. The conversations I have with these people nearly always focus on quality of life, not quantity. The things they dread most tend to be loss of dignity, pain, and loss of control.

When these people say they would rather be dead than suffer unnecessarily I tell them that I understand and, if Queensland laws allowed, would be happy to support them in their choices. 

This stance is in keeping with the position statement of Australia’s largest trade union: the Australian Nursing & Midwifery Federation. 

I understand that there is some opposition to Queensland introducing voluntary assisted dying laws similar to those passed in Victoria, Tasmania, South Australia, Western Australia, the Netherlands, Belgium, Switzerland, Canada, New Zealand, Luxembourg, Colombia and some states in the USA. I would like to address some of these concerns below.

The Catholic Context

I see from your parliament profile that you identify as Catholic. I used to too.

I’m guessing, like me, it was a religion you were born in to. That’s the way religions work. There is not a high percentage of Lutherans in India. There is not a high percentage of Hindus in Germany. In the last couple of hundred years there have been lots of white Catholics who have arrived or been born in Australia. That’s an outcome of colonialism, not faith or truth.

It’s an accident that you and I were born into Australian Catholic families. It’s a choice on whether, as adults, you and I continue to subscribe to Catholic doctrines.

As the Archbishop of Brisbane, Mark Coleridge, said in February 2019, “I think we have to accept that our [the Catholic Church’s] moral authority and general credibility has been massively damaged.” I concur with the Archbishop.

Just as the Catholic church backed the wrong horse when they covered-up priests raping children, they’re backing the wrong horse when they say that competent adults who are within weeks or months of inevitable death can not decide to leave life in a way and a manner of their own choosing. The Catholic Church has form: in my lifetome they backed the wrong horse when it came to access to birth control, access to termination of pregnancy, and access to same sex marriage. You’d think a church with a congregation that has a reputation for gambling would be better at backing the right horse, wouldn’t you?

The AMA Context

The Autralian Medical Association is often the loudest doctor voice in Australia. Like the Victorian branch before it, the Queensland branch opposes voluntary assisted dying, but if the law is passed they want to be in charge of it. No, really, read the third paragraph here for yourself – it’s hilarious:

“The AMA’s position is that doctors should not be involved in interventions that are intended to end a person’s life but, if the government decides to legalise Voluntary Assisted Dying, the medical profession must be involved in developing legislation, regulations and guidelines which protect doctors, vulnerable patients and the health system as a whole.”

The Queensland AMA surveyed more than 1250 members. An overwhelming majority supported voluntary assisted dying, but the AMA Queensland President Professor Chris Perry said the survey was not a referendum on VAD.

Please do not rely on the AMA as the voice of doctors, please also be infomed by Doctors for Assisted Dying Choice.

I see from a recent speech of yours that you have a mate who is a surgeon. It would be worthwhile checking-in with your mate to see what they would think about operating on a patient who is terminally ill. My guess is that they’ll think it’s only a good idea if it improves quality of life.

Nearly every doctor I work with would support a competent adult to make their own informed treatment decisions, whether they agreed with the decision or not. That is the ptofessional, pragmatic and compassionate thing to do. That existing framework can accomodate patients who wish to discuss or access voluntary assisted dying.

The Nurse Context

Nurses are often excluded from public conversations about health matters, despite being the majority of the health workforce (344,941 of 625,228 using 2019 data, ie: nurses and midwives compromise over 55% of the clinical workforce).

This exclusion from the public conversation is even more surprising when we consider who the public trust. Australians have rated Nurses highest for ethics and honesty for 24 consecutive surveys (1994 to 2021).
Higher than doctors.
Higher than ministers of religion.
Higher than members of parliament.

Data Source: Roy Morgan Image of Professions Survey 2021. Finding No. 8691. Country: Australia. Available via http://www.roymorgan.com

So, what do nurses think about voluntary assisted dying?

“We support legislative reform so that competent adults who have an incurable physical illness that creates unbearable suffering shall have the right to choose to die at a time and in a manner acceptable to them and shall not be compelled to suffer beyond their wishes.” Australian Nursing Midwifery Federation (ANMF) (November 2019) Voluntary assisted dying position statement, page 2, no. 14 [PDF].

Naturally, as is the case with termination of pregnancy, the proposed framework entitles nurses and other clinicians who oppose voluntary assisted dying to decline participation. See 14.96 in Queensland Law Reform Commission (May 2021) A legal framework for voluntary assisted dying [PDF].

Nevertheless, this provision has not stopped some nurses speaking out stridently, eg: “Voluntary Assisted Dying is simply a euphemism for assisted suicide, or what Adolf Hitler called mercy killing.” Margaret Gilbert, Treasurer, Nurses’ Professional Association of Queensland (NPAQ), The Courier-Mail, March 23, 2021. Open access version here. This comment should be read in conjunction with Godwin’s Law. As with the Catholic church, it should be noted in NPAQ has form: in 2019 they advocated for paramilitary forces to be installed in hospitals instead of security guards, and in 2018 were aligned with the opinions of Cory Bernadi and Peta Credlin when they misinterpreted cultural safety with an obligation for white nurses to apologise to each of their Aboriginal and Torres Strait Islanders. The NPAQ does not represent the majority of nurses in Queensland, the Queensland Nurses and Midwives Union (QNMU) does.

In February 2021 the QNMU (the Queensland branch of the ANMF) asked members if they support in principal the legalisation of voluntary assisted dying in Queensland. Approximately 87% of respondents said ‘yes’. QNMU (10 June 2021) News.

Nurses have the unique role of caring for the person in life and in the first few hours of death. Nurses are at the bedside 24 hours a day, 7 days a week. Other professionals flit in and out, but nurses are the ones on the floor. We see life and death up-close and personal.

As Joseph Heller said in his classic 1961 novel Catch-22: “People knew a lot more about dying inside the hospital, and made a much neater, more orderly job of it. They couldn’t dominate Death inside the hospital, but they certainly made her behave. They had taught her manners. They couldn’t keep death out, but while she was in she had to act like a lady.”

Heller was only half right. When we can, nurses make death act like a lady, but there are times when death is beyond the control of nurses and the rest of the clinical team. Sometimes death acts like the cruelest sadist you can imagine. Many nurses, like me, would have heard patients with a terminal illness say words to the effect of, “Please help me die. You wouldn’t let a dog suffer like this.”

There is no empathy in denying the patient relief in those circumstances.

It is only an outdated law that prevents us helping these patients.

It is only our parliamentarians who can change the legislation to be more humane. That’s where you come in Mr Healy.

End Notes

Sorry for publishing my letter online. Doing so is a bit shouty. However, the opponents of voluntary assisted dying (eg: the Catholic Church, the AMA, and NPAQ) have argued their case online. In 2021 online = the village square. This is too important an issue to ceed the village square to those who seek to control the life choices of others.

I do not seek to impose my beliefs on others, I only wish that people with a terminal illness have a choice. Whether people access voluntary assisted dying or not is none of my business. I would like to support them no matter their decision.

You can probably tell by the tacky website that I am not representing any organisation, and these opinions are my own. For elaboration on this division between employee and professional, please see number 13 on my 2012 introduction to this website: meta4RN.com/about.

Do you want to send your local Queensland MP an email on this topic? This link via Dying with Dignity Queensland will help you find the right person/email address, and – if required – give some tips

You are welcome to leave feedback via the comments section below.

Paul McNamara, 2 July 2021

Short URL meta4RN.com/VAD

Addit 3 July 2021

A postscript:
Michael Healy gave a very thoughtful and encouraging response to this open letter on his Facebook page. It’s worth reading: www.facebook.com/healycairns
Thank you Michael.

1 thought on “Voluntary Assisted Dying (a nurse’s open letter to their state member of parliament)

  1. Mark Aitken

    Excellent post Paul and so many valid arguments made.

    Hope you are well.

    Cheers

    Mark

    Mark Aitken RN

    Deputy Director

    P: (03) 9415 7551 M: 0427 714 805

    E: mark.a@nmhp.org.au

    W: http://www.nmhp.org.au

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