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This letter is a response to Catholic Health Australia’s Open Letter

Some might be impressed by the intransigence reflected in Catholic Health Australia’s response to law reform to allow voluntary assisted dying.  Nevertheless it is consistent with the Catholic Church’s attitude to contraception, its attitude to women’s rights to termination of pregnancy and medical rather than surgical means to achieve that, its opposition to health promoting stem cell research, and its vigourous opposition to same-sex marriage.  All of these health issues have had majority community support and parliamentary approval, as has voluntary assisted dying.

Yet all these matters are in conflict with Catholic bio-ethics, a form of ethics which differs significantly from normative secular bio-ethics because it is controlled by man-made religious dogmas that are central to the beliefs of the Catholic Church.  I have no problem with Catholics holding to these beliefs, but am concerned that they are able to impose these beliefs on non-believers through their significant position in the provision of health care as described by Suzanne Greenwood .  She writes that Catholic Health Australia member organisations form the largest non-government grouping of hospitals, aged care and community care services in Australia.  She does not repeat George Pell’s proud claim that 57% of palliative care in Australia is provided by the Catholic Church.

Catholic Health Australia’s statement is replete with references to palliation and palliative care (8) and compassion (4), love (3) and dignity (3); these are not values that are unique to catholic care, whereas its references to hope (3) and faith (2) are typically Catholic – the concept of hope when one is dying is related to a belief in an after-life in heaven, not a commonly held concept today.  It also holds the view that their God will determine when people will die.  Yet that is the milieu in which people needing care will find themselves within Catholic Health Australia’s institutions.

Expansion of palliative care is fulsomely recommended as the solution to the intolerable suffering that leads to requests for medical assistance to die.  To palliate means to diminish, not to eliminate symptoms – it can diminish pain quite well in many cases, but unrelieved pain alone is not a common reason for requests.  It is the symptoms which cannot be palliated such as paralysis, breathlessness, fatigue and dependency, and the associated psychological and existential distress, which can lead to requests.  We do need more palliative care, but we also need better palliative care, care that is not constrained by faith, hope and dogma.

The most glaring absence from CHA’s statement is any recognition of the views and values of those it cares for- it is all about the beliefs of the Catholic church and how they are to be applied in care.  Nowhere is autonomy or choice of the individual mentioned.  Yet this is the fundamental element of the Voluntary Assisted Dying Act, which allows competent people who are dying with intolerable suffering to request a doctor’s assistance to die with dignity, security , at a time and place of his or her choice, surrounded by family in order to say goodbye and share in the end of their life.  But CHA objects to this, and despite receiving public funding for its services, will obstruct such assistance.   I fully support the moral right of any doctor to refuse to provide assistance, but it is a different ethical question where institutions receiving public money are concerned.  They need to develop clear policies to demonstrate how they will respect the rights of patients under the law.

As yet it has not determined what its reaction to the law will be except to obstruct people’s legal rights.  In my view, they must make it very clear in public statements and notices, and in clear information to all patients whom they admit that they will not respond to requests for assistance to die, and immediately refer any such request to another doctor who will acknowledge such a request.  They should not prevaricate and obstruct the dialogue in the good faith that is required.

CHA cannot have it both ways – deny people their autonomy under the law, and continue to receive public money to provide end of life care… they must either acknowledge personal autonomy or publish their views at the front doors of their institutions and provide very clear alternative options for their patients.  Will they allow supportive doctors to visit patients in their institutions or will they discharge suffering patients to find their own way?

Faith, hope and love are comfortable concepts for Catholics but CHA has to acknowledge that many people using their facilities do not adhere to their faith or share their hope in an afterlife in heaven, nor may they share the faith in a Catholic God who will determine when they will die.  People with different views must not be discriminated against simply because CHA “does not think voluntary assisted dying is good clinical care”.

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