Last month, I was a participant in a Q&A panel on “Voluntary Assisted Dying” at the Australian Medical Association Victoria Congress 2017. I was pleased to have been invited and hopeful that there would be a balanced discussion, but also somewhat concerned that might not be realized in practice, given the membership of the panel.
The panel participants included the well-known advocate of the legalization of doctor-assisted suicide Andrew Denton and the leader of the Greens, Senator Richard Di Natale, who also supports its legalization in certain circumstances. The chair was Dr Sally Cockburn, another supporter of the legalization of doctor-assisted suicide. I oppose legalizing both doctor-assisted suicide and euthanasia.
Unfortunately, my concerns materialized.
First, my participation in the discussion was limited in several ways. The chair told me that the question of whether or not legalizing doctor-assisted suicide or euthanasia was a good or bad idea, ethical or unethical, was not open for discussion.
She explained that the only topic to be discussed was the conditions which should apply for access to assisted suicide and how it should be regulated. In short, the panel was based on an assumption that legalizing assisted suicide was inevitable in Victoria, even though legislation has not yet been tabled in the Victorian Parliament, let alone debated or enacted. This assumption is a pro-assisted suicide/euthanasia strategy as it leads people to believe there is no point in discussing views opposing legalization.
Legislative bodies only regulate conduct that they and the community consider to be ethical under certain conditions and they regulate to set out those conditions. We prohibit conduct we believe to be inherently unethical, as those who oppose euthanasia believe it to be. Consequently, discussing regulation affirms the ethical acceptability of assisted suicide and euthanasia.
On more than one occasion, I was told by the chair that I had been invited as a lawyer and not an ethicist, despite the fact that the latter has been my main professional role for 40 years. Given this proviso, it was not unexpected that the questions addressed to me from the chair were purely legal ones; for instance, I was asked to define mental capacity and dignity. This gave me speaking time and an appearance of fair time allocation among panellists, without opening up an opportunity for me to present the anti-assisted suicide/euthanasia arguments I wanted to propose.
A theme developed by the panellists who agreed with legalizing assisted suicide was that being absolute on the issue of its legalization is “not helpful” and that the voices in the public square debate should be those of reasonable people who were not absolutists. This, in fact, amounts to another pro-euthanasia strategy, because if one is not against the legalization of assisted suicide or euthanasia, one is necessarily for it in some form. While some people might be uncertain where they stand, and many people say they are, there is no entirely neutral position.
At the beginning of the event, that chair told the audience that they should text questions to her and that she would collate and present them; those who did not have an iPhone were told they should raise their hand and ask the question in person. She added that if the questioner spoke for too long or was presenting commentary or policy, rather than a question, the audience could shout “No, no, no!” and she would cut off the person.
It seems reasonable to assume this invitation was offered only in relation to an audience member asking a question. But when I prefaced an intervention by saying that I wanted to describe a case of euthanasia that showed its risks and harms, the chair interjected and said “No stories please”, and a substantial percentage of the audience immediately joined in to shut me down, shouting, “No, no, no, no stories”.
In 40 years of giving speeches on average around 25 to 30 times a year, I have never encountered such an incident. Moreover, bear in mind that I was an invited guest speaker sought out by the AMA to be a Q&A panellist at the congress and the audience were all, or almost all, medical doctors.
This behaviour does not fulfil the requirements of respectful discussion. Indeed, it is designed to stifle, rather than facilitate, debate on an important social and medical issue, and can be characterized as bullying.
A positive aspect of the panel was that Andrew Denton – one of the very few people present who was not a medical doctor – did behave respectfully with regard to my anti-euthanasia arguments and towards me. And a positive and important message, delivered by the gerontologist and psychiatrist on the panel, was that we shouldn’t even be talking of legalizing euthanasia until we have fully adequate palliative care available to all who need and want it, which is far from the case at present in Australia.
In summary, my experience can be characterized as involving silencing and intimidation and a failure to respect freedom of speech.
Many people with traditional or conservative values, especially young people, when they encounter such experiences respond by self-censoring. They tell me, privately, that they share some of the values I present, but would never say so publicly for fear of being ridiculed or shamed or, even, not being employed or promoted. The same is true of many conservative politicians who fear losing votes.
Indeed, I had initially decided not to publish this article for fear that I and the case against doctor-assisted suicide and euthanasia would be discredited by being characterized as extreme and summarily dismissed.
But then I realized that I, too, was falling prey to self-censorship.
We should also always keep in mind in the euthanasia debate that whether we are pro- or anti- legalizing doctor-assisted suicide and euthanasia, we have a common goal of relieving suffering. Where we disagree is the limits on the means we may use to do this. As I’ve written elsewhere, I believe we should kill the pain and suffering, not the person with the pain and suffering.
The vignette that I describe has wide moral and ethical implications in relation to the quality and character of public debate, which is essential to a healthy democracy and maintaining a society in which reasonable people would want to live.
Perhaps one of the most disturbing aspects of this event is that it was an Australian Medical Association Victoria congress and, as I’ve noted already, almost everyone present, whether as speakers or in the audience, was a medical doctor. In secular, democratic, pluralist, multi-cultural societies like Australia, medicine is a major values-creating and values-carrying institution for society as a whole, because it is one of the few institutions to which we all personally relate. That means it must be open to taking into account the full range of people’s commitments and values systems.
We need to ask whether, in the organization and conduct of this doctor assisted suicide-euthanasia panel, the AMA Victoria lived up to its responsibilities in this regard.
Margaret Somerville is Professor of Bioethics in the School of Medicine at the University of Notre Dame Australia. Until recently, she was Samuel Gale Professor of Law, Professor in the Faculty of Medicine, and Founding Director of the Centre for Medicine, Ethics and Law at McGill University, Montreal. Her most recent book is Bird on an Ethics Wire: Battles about Values in the Culture Wars.