Rodney Syme has been lobbying for voluntary assisted dying for more than three decades. On Tuesday afternoon Victoria’s state parliament will debate legislation that is the closest advocates such as Syme have come to seeing patients being granted the legal right to medically end their life.
“On the first day of the debate I’m going to play golf,” Syme, a urologist, says. “Then I’ll come home and find out what has happened. You can’t get yourself too wound up in this, because whatever happens I’ll know that I’ve done my darndest for 30 years to advocate for change.”
But the 82 year-old, the vice-president of Dying With Dignity Victoria, admits that if the legislation passes, he will be “pleased to see it over with”.
“It will help a very small group of people who need help and will allow people to have an open, honest talk about death to their doctor,” he says. “It will encourage dialogue about end-of-life care, and improve the quality of palliative care, as has happened in other countries with assisted dying legislation.”
This is not a private member’s bill, as in attempts to pass similar legislation in other parts of Australia, but a law with government backing and the personal support of the premier, Daniel Andrews. Politicians will be given a conscience vote. More than 60 safeguards are built into the legislation, making it the most conservative in the world.
It is the lower house where the debate is likely to be most rigorous and where supporters have had to work the hardest to persuade politicians. Dying With Dignity has been encouraging its members to contact their local MPs in recent weeks to get those who remain undecided over the line. The group is more confident of upper house support, but Syme thinks the legislation will pass both chambers.
Who can apply?
- Victorian adults, with a progressive, advanced terminal illness and 12 months or less to live
- Suffering must be deemed 'intolerable'
- They must be of sound mind
How will it work?
- Patients must make three, clear requests
- They will be assessed by two experienced doctors
- Those approved will be granted permits for lethal medications, which must be self-administered
- A permit will be granted for doctors to administer medication only in cases where the patient physically cannot
- Doctors do not have to be present when patients administer the medication
- The process to apply and receive medication cannot take less than nine days
- The Department of Health and Human Services will approve applications
- An assisted dying review board will oversee each step of the process
What are the penalties?
- Potential life imprisonment for a breach of the self-administration permit
- Five years' jail and substantial fines for inducing someone to request the scheme
- Doctors who suggest the assisted dying scheme to patients face a professional misconduct investigation
Source: Victorian government
“In recent weeks I think more and more MPs from around Victoria are coming out in support of the legislation, particularly younger MPs,” he says. “Now you never know what politicians will do with a conscience vote. Is it their own values and beliefs they will express, or the values and beliefs of their constituents, or the values of their leader?
“But I think if you look at the debate over the past couple of weeks there has been a momentum for change, and I am just quietly confident that it will pass.”
In July the assisted dying advocacy group Go Gentle Australia surveyed 500 Victorians and found that public approval for voluntary euthanasia laws was stronger than support for same-sex marriage or abortion rights. And 55% of those who identified as Coalition votes supported change.
Syme said momentum had grown to the point where he did not believe politicians could be justified in voting against change. Syme became involved in the issue in 1972 when he treated a woman with incurable cancer of the spine. Her nerve and bone pain was persistent and unbearable, he says, and at the time there was no effective way to relieve her pain.
Intolerable suffering began to weigh on his mind.
But he did not come out publicly in support of voluntary assisted dying until 1987, when he wrote a letter to the Age in support of a medical colleague who believed laws were needed. A journalist subsequently rang him to press him further.
“I was very naive with journalists back then and I waffled away and just in the course of conversation indicated I’d helped a number of people at the end of their life with medication. The next thing I knew the front page of the Age on a Saturday morning was plastered with the headline; ‘Doctor helps people to die’. I’d specifically given people medication they could use to end their life. So I was in the deep end then, and that was really when this all started.”
Two important things have changed in the debate since then, Syme says. First, a lot of empirical evidence has emerged from countries to have passed the laws which has helped to inform Victoria’s bill.
Second, he points to the “beating” the hierarchy of Catholic Church has taken for their “dogmatic positions”, which have “got nothing to do with Jesus Christ”.
Nonetheless, Catholic priests were asked by the church hierarchy to read out a message during weekend services declaring the proposed legislation “unsafe”.
Syme wants to make it clear that he is a supporter and advocate for pain relief and quality palliative care. He urges those concerned that passing voluntary assisted dying laws would result in watered-down laws to look at the evidence from other countries, such as the state of Oregon in the US, which has had legislation in place for 20 years. Victoria’s legislation, though unique, is more closely modelled on Oregon than laws in Europe.
But there were some cases where pain and suffering simply could not be relieved, Syme said.
“The studies showed that the availability of palliative care was very high in Oregon and that the use of opioids for pain relief was very high in Oregon, and it also showed of those provided with drugs to end their life, 30% did not use them, a very significant figure,” he said.
“Just 0.4% of people end their lives with voluntary euthanasia in Oregon. It’s not going to be a lot of people who use the Victorian laws if they pass, but we are talking about people for whom suffering is such that palliative care can’t help them, unless they are put into a coma and given a combination of drugs like sedatives and morphine, which has the effect of hastening their death anyway.
“So in a sense, assisted dying happens now and it’s just not regulated or monitored, and we don’t know if patients have given consent. If legislation is passed in Victoria, we would have a situation that would be open, transparent and reported.
“That seems much safer.”
St Vincent’s private hospital in Melbourne , one of Australia’s largest private Catholic hospitals, has said it would not carry out requests for voluntary assisted dying should the laws pass. Under the laws, doctors have a right to refuse to be involved. And while high-ranking Catholics have been active in lobbying Victorian politicians, Syme believes they have been largely “distracted by the marriage equality debate”. He said lobbying was not at the level seen during previous attempts to introduce legislation around Australia.
“Our opponents argue from the basis of fear and uncertainty, and the basis of their argument is not factual information, and when it is factual it’s what you might call one-off exceptional circumstances,” he said.
“The Catholic church has been beaten around in a number of areas. “Contraception. Abortion. Stem cell research. Child abuse. And now this. People are leaving the church in droves and if you look at expert polling it shows that between 60% and 70% of Catholics support legislative change. They can’t see why people have to suffer.
“The difference is between the hierarchy of the church and the ordinary Catholic. I don’t think that hierarchy is being influential on Catholics anymore.”
