If I stay lucky I should live another 20 or 30 years. I will be dead within the next 40 years.
If I stay lucky I will have a good death. Where I live, as of 1st January 2023 good deaths don’t need to rely on luck alone. Voluntary assisted dying will become a sanctioned option for those who meet the legal criteria [here].
If I stay lucky my death will be a bit like Queen Elizabeth’s recent death. I’ll be incredibly wealthy, I’ll die at a place of my choosing, I’ll be with people I’m related to, like or employ, and I will spend my last days doing things I value and enjoy.
If I stay lucky, when I see health professionals in my last year of life they’ll believe me when I say I’d rather choose the time and manner of my death than leave it to chance. If they look unsure or quizzical, I’ll use one of 2022’s favourite rejoinders and say, “Google it, mate.”
If I stay lucky, when the health professionals search “is paul mcnamara fair dinkum about voluntary assisted dying?” (or words to that effect) they’ll land on this blog page (archived here and here), and see the evidence below:
It’s a little bit funny…
I hope, like me, you enjoy the delicious paradox of becoming a life member of two organisations that focus on the right to die. It’s not hilarious, but it’s a little bit funny.
To make the information clear/overt: – I became a life member of Exit International in 2013 – I became a life member of Dying With Dignity Queensland in 2018 – I wrote this open letter in support of voluntary assisted dying legislation in 2021 – I published the blog post you’re reading now in 2022 My convictions are not transient or ambiguous. It would be a little bit funny if my values were not respected. No need to agree with me. Just believe me.
Also, it would be a little be funny (funny peculiar, not funny ha-ha) if anyone confused this obviously personal blog post with anything to do with my job or employer. That would be a malevolent misrepresentation of the facts. Don’t do it. Be sensible. Be kind.
Google it, mate.
Exit International and Dying with Dignity are similar in that they both strongly advocate that the locus of control re end of life decisions should rest with the person, not any one else. However, the two well-established organisations have different views on how this should look. Want to know more? Google it, mate.
That’s it. I only wrote this blog post to archive something personal somewhere public so it’s searchable/googleable in future. It should be clear that – apart from ensuring my choices are known and respected – this blog post does not seek to influence the opinions or actions of others.
Normally I invite feedback via the comments section below, but on this occasion I’m a bit wary. If, like me, you have a personal opinion that you feel compelled to make public, the comments section may serve that purpose. I agree to making all comments public, but have no intention to reply, mediate or elaborate.
Just a quick blog post to reassure those alarmed by the dodgy “voluntary should mean voluntary” scaremongering campaign. Please see the corrected version below.
Of course neither patients or health professionals will be pressured into voluntary assisted dying under the proposed Queensland voluntary assisted dying legislation. The word “voluntary” in “voluntary assisted dying” makes it pretty clear, but don’t just take my word for it.
Let’s look at some key sections from “A Legal Framework for Voluntary Assisted Dying”, published by the Queensland Law Reform Commission (QLRC) in May 2021 [PDF]. This is the document Queensland politicians will be reviewing next week, prior to casting a conscious vote.
“Voluntary assisted dying is an active and voluntary practice… It is a voluntary practice in that it is undertaken at the person’s request. More than one request is required. The decision to access the process must be made freely and without coercion.”(QLRC, May 2021, section 1.48, page 7)
“In summary, we recommend that the right to refuse to participate in voluntary assisted dying on the grounds of conscientious objection should apply to registered health practitioners (such as doctors and nurses) and to speech pathologists.”(QLRC, May 2021, section 14.96, page 437)
The proposed Queensland voluntary assisted dying law is similar to the existing legal framework for termination of pregnancy, in that neither patients or clinicians are forced into dong something they object to. The proposed Queensland voluntary assisted dying law has additional safeguards.
For example, a patient safeguard includes: “The process of request and assessment involves three separate requests that are clear and documented. The process has a waiting period of at least 9 days between the first and final request.” (QLRC, May 2021, section 8.477, page 248)
An example of a safeguard for health practitioners includes provision for “conscientious objection” (QLRC, May 2021, section 8.103, page 200) and, “The practitioner must have completed the approved training before they accept a transfer of the role of administering practitioner.”(QLRC, May 2021, section 13.187, page 412) To my way of thinking, this is a generous safeguard in that it allows health professionals who are unsure or ambivalent to simply not-get-around-to completing the training. This also safeguards the patient from enduring a clinician who is unsure of their own beliefs, or passively resistant to the patient’s wishes.
There is strong support for voluntary assisted dying (VAD) legislation in Queensland: ~77% of the public support VAD ~87% of nurses support VAD Source: Queensland Nurses & Midwives Union (QNMU), June 2021, Submission into the Voluntary Assisted Dying Bill 2021 [PDF]
It is interesting to reflect on why nurses have a higher rate of support for voluntary assisted dying than the general public… What do nurses see and know that others don’t see and know?
It is also important to reassure the 13% of Queensland nurses and midwives who did not support voluntary assisted dying in the QNMU February 2021 survey [PDF], that they will not be pressured or compelled to participate. Just as is the case with pregnancy termination, only a very small percentage of the nursing workforce are in roles where they will be directly exposed voluntary assisted dying. Not only is there no pressure to become involved if you do not want to, you can not be involved unless you choose to complete specific voluntary assisted dying training.
Voluntary does mean voluntary. Scaremongering means scaremongering.
Obviously, I’m part of the 87% of Queensland nurses who support voluntary assisted dying legislation. I’ve written about it previously in July [here], and wasn’t intending to write about it again. However, the scaremongering campaign can not go unaddressed. I’m realistic. I know the Catholic church has a much bigger audience and budget than me. All I have to counter their scaremongering is integrity and social media (it’s my loudest voice).
Thanks for visiting my blog. As always, your feedback is welcome via the comments section below.
Paul McNamara, 7 September 2021
Short URL: meta4RN.com/Voluntary
Addit on 08/09/21
This makes the same argument as me, but in a more articulate manner:
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.
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.
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.
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.
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.
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.