Australian territory considers assisted dying law with few protections

When Australia’s Medical Oncology Group surveyed its members the year after lawmakers in Victoria passed a state law permitting assisted suicide, only 47 percent of responding members disagreed with assisted suicide. But an overwhelming 94 percent supported conscientious objections for physicians. Ninety-five percent thought patients should undergo palliative care consultation before choosing assisted suicide, and 86 percent of responders said a psychiatry specialist should be consulted before a physician approved someone for assisted suicide.

But as Australian states and territories have approved euthanasia in quick succession, state laws have steamrolled possible checks and balances on the practice. Last month, the Australian Capital Territory human rights minister, Tara Cheyne, introduced the Voluntary Assisted Dying Bill 2023 to the Legislative Assembly. Under the proposed law, conscientiously objecting doctors would be required to refer inquisitive patients to doctors who have no qualms about assisted suicide or are at least willing to comply.

After committee inquiry, the proposal is expected to become territory law and go into effect in 2025. Euthanasia supporters in the territory say it will have the most liberal laws in Australia, a perceived advantage of being one of the last areas in the country to legalize it. Laws allowing euthanasia took effect in New South Wales on Tuesday after the region became the last Australian state to pass “voluntary assisted dying” legislation last year.

Only the states Victoria and Tasmania allow doctors to opt out entirely from assisting in someone’s purposeful death. In Western Australia, objecting doctors must provide an assisted dying pamphlet to patients who want information. The ACT version would be most like Queensland, where the conscientiously objecting doctor must refer the patient to a doctor who supports assisted dying.

“I think that’s problematic,” says Xavier Symons, a postdoctoral research fellow at the Human Flourishing Program at Harvard University. He wrote Why Conscience Matters: A Defence of Conscientious Objection in Healthcare, which was published last year, and said his Roman Catholic faith informs his views.

Symons said the ACT referral requirement ethically qualifies as “formal complicity in wrongdoing.” It’s not just looking away while someone else does the deed, he added. It’s more like being an Uber driver for a hitman.

In June, the ACT government took over the Roman Catholic-run Calvary Public Hospital Bruce in Canberra and promptly began performing abortions, which were legal in the ACT but not practiced at the facility. At the same time, Little Company of Mary Health Care turned over control of its palliative care home, Clare Holland House, where practitioners will offer euthanasia after the bill’s passage enables it.

Besides the law being problematic for doctors who disagree, Symons said that once a euthanasia law is passed, it becomes a slippery slope. “Look at what’s happening in Canada,” he said, referring to a failed bill that would have put a check on expanding medical assistance in dying. Instead, starting in March 2024, people can apply for assisted suicide because of mental illness.

The ACT measure comes near the end of a long line of euthanasia bills in the country. The Northern Territory will be the last Australian province to legalize euthanasia, even though it was really the first. In 1995, the Northern Territory became the world’s first jurisdiction to pass a euthanasia law. Nine months after the law was enacted—after four people had used it to commit assisted suicide—the region also became the first to have the federal government repeal its law. Since 2017, each of Australia’s states has passed legislation allowing euthanasia.

When lawmakers in Victoria passed its assisted suicide law, the measure allowed doctors to completely opt out for conscience reasons. “They were very happy for it to be a tightly circumscribed euthanasia regime that they were ushering in, as long as they got something through,” Symons said, adding that it would be easier for euthanasia supporters to remove protections once basic laws are in place.

But due to concerns that demand would outpace doctors willing and able to participate in assisted suicide, ACT lawmakers did not limit the practice to licensed doctors. Instead, the bill includes nurse practitioners, counselors, and social workers. No other state law allows providers to be the first to bring up assisted suicide to a patient. But they will be able to in the ACT, effectively circumventing a patient’s own conscientious objections.

Many doctors warn that assisted suicide flies in the face of their responsibilities to their patients. “We live in a death-denying, youth-obsessed culture and have lost touch with the normal process of dying and spiritual issues,” Dr. Megan Best, a palliative care doctor and an associate professor of bioethics at the University of Notre Dame Australia, told me last year. “The Church should be at the forefront, leading conversations about the end of life.”

Those conversations will likely become more common. “The challenge now becomes defending the conscience rights of healthcare practitioners and helping society to see that we’re creating a world where we are putting our most vulnerable at risk of exploitation,” Symons said.

He added that the ACT bill and other Australian laws make it clear that euthanasia will be present in Australia at least for now. “Just looking at it from a very pragmatic point of view, I think this is a disaster,” he said.