Donald Rumsfeld, Secretary of Defense during the administration of George W. Bush, famously spoke of different kinds of knowns and unknowns. He was speaking of military intelligence, and about what informs decision-making at a strategic level. The same kind of talk could be used for public policy.
With the imminent passing of the Voluntary Assisted Dying Bill in Victoria, there are some things we know. We know that there are tired politicians. They debated long and hard. People on both sides of the argument worked tirelessly toward their legislative goals. We know that once the amended bill passes the Legislative Assembly (which it is almost certain to), and it is signed into law, some people will choose to end their lives legally rather than face the prospect of suffering due to life-threatening illness. This outcome will be applauded by some, and not by others. Euthanasia and assisted suicide are divisive issues.
We also know that the bill, which originally passed the Legislative Assembly without amendment, will return to that chamber with some changes. Some crucial ones include a reduction in the medical prognosis limit from twelve months to six months and changes in how the cause of death will be recorded. All in all, these are good amendments.
But they are, ultimately, good amendments to a bad bill—a bill which reduces the value we place on human life as a society. We know that doctors will now be able to administer lethal drugs to their patients given the right circumstances, something that would have been unthinkable for a medical professional in the recent past. We know that people who might otherwise have lived for years, and whose medical condition might even have improved, will now choose to kill themselves, albeit legally.
We know that the potential for coercion and elder abuse is greater once there is medically assisted suicide and euthanasia. The government would not accept quite sensible amendments to guard against this and to ensure doctors check for depression and undue influence. Likewise, they wouldn’t countenance including a VCAT review prior to prescribing lethal drugs.
We also know that in jurisdictions where euthanasia and assisted suicide is legal there is often a slippery slope toward liberalising the laws. People often call out slippery slope arguments as fallacious. But I suspect someone moving rather quickly down an incline wouldn’t be persuaded by that kind of logical analysis.
And here is where Donald Rumsfeld’s “known unknowns” come in. Here is what we know that we don’t know. We don’t know if the law will be amended in the future to lower the minimum age from eighteen years to include minors. We don’t know if medical professionals, health insurance companies, and even governments, will start promoting euthanasia as preferential to palliative care.
We don’t know if the law will be amended to include people suffering from incurable mental illnesses or for people who are tired of living. We don’t know if Victoria will become a destination state for those wanting to access legal assisted suicide.
These are just some of the many “known unknowns” which are attached to this bill. The policy debate has finished. The parliament is close to rubber-stamping the legislation. Victorians will soon start living with the reality of legal medically assisted suicide.
Those on both sides of this debate have tried to think through the outcomes of legalising assisted suicide and euthanasia. For those who argued for assisted suicide, we understand that there are legitimate, compassionate, thoughtful reasons for doing that. For those of us who argued against it, we can say that we tried to warn you of the problems and potential outcomes.
People will look back and make their own minds up about assisted suicide laws in Victoria after seeing the real outcomes. People in favour of assisted dying will assure you that the outcomes will be, on balance, positive for people’s well being and quality of life. Others have insisted that they will be detrimental to fundamental human rights, the medical profession, and to the most vulnerable in our society.
Donald Rumsfeld is quoted as saying: “Those who made … decisions with imperfect knowledge will be judged in hindsight by those with considerably more information at their disposal and time for reflection.” He is right. The “known unknowns” combined with the gravity of the issue in question seem to indicate that not legislating assisted suicide would have been prudent.
With time will come more information and time for reflection. Perhaps then Victorians will reverse what looks like a grave mistake.
Mark Sneddon is the Executive Director of the Institute for Civil Society. Simon P. Kennedy is a Research Analyst at the Institute for Civil Society.
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