HLR Interviews Greg Bondar

Australia and Canada are the two English-speaking jurisdictions where the legalization of euthanasia has made the greatest inroads. Critics charge that Canada follows an expansive and permissive approach to promoting “medical assistance in dying,” leading to increased numbers of dead with almost no oversight to check abuse even of the stated rules. As of May 2022, all six Australian states now allow some form of “voluntary assisted dying” (VAD), while pressure to extend killing to Australia’s territories grows. In some ways, Australia is just “getting used to” its newfound pro-euthanasia status. Greg Bondar, the National Director of Family/Voice Australia,* based in New South Wales, spoke with John Grondelski for the Human Life Review about the situation down under.

Human Life Review (HLR): Euthanasia is a confusing term to many people. Many different ideas fall under its umbrella: removal of extraordinary means to preserve life, removal of food and fluids if provided artificially, directly bringing about death, whether self-administered or by involving other people. How is the debate shaping up in Australia, and what is the legal situation in your country?

Greg Bondar: Last year’s introduction by Independent New South Wales (NSW) Member of Parliament (MP) Alex Greenwich of his Voluntary Assisted Dying Bill (2021) (the “Bill”) is a momentous shift in medical practice and community expectation. It marks the final abandonment of one of the cornerstones of Western civilization: the sanctity of life.

First, let’s differentiate between “euthanasia” and “voluntary assisted dying” (VAD) or “government-sanctioned assisted suicide,” as the Christian community in Australia refers to it. Physician-assisted suicide is where a doctor assists a patient to commit suicide by prescribing the lethal drugs to take when he or she chooses. Euthanasia is where a doctor administers a lethal drug to a patient to end his or her life. “The main difference between euthanasia and assisted suicide is who performs the final, fatal act,” said Richard Huxtable, professor of medical ethics and law at the University of Bristol.

Australia’s debate is currently skewed heavily in favor of proponents of euthanasia, who have support from the pro-death Australian media, celebrities, politicians, and even some in the church.

In Australia, euthanasia is a state—not federal—issue. Every state and territory has some form of VAD in place. Voluntary assisted dying began in Victoria in 2017 and Western Australia in 2019. Tasmania and South Australia both legalized VAD in 2021, the latter on the 17th attempt after a three-decades-long campaign. Queensland introduced VAD in September 2021. NSW ceased to be the last state holdout, adopting a VAD law on May 19, 2022, by a 23-15 vote.

The Northern Territory legalized VAD in 1995, the first jurisdiction in the world to do so. Its law came into force in mid-1996, when federal Liberal MP Kevin Andrews introduced a private member’s bill in the federal Parliament to ban the territories from legislating for VAD. The Andrews bill passed in 1997. Both the Northern Territory and the Australian Capital Territory are again calling on the federal government to restore their ability to enact VAD laws, a campaign likely to intensify after the change in government following the May 2022 federal elections.

HLR: Help to effectuate one’s death—whether through “physician-assisted suicide” (PAS) or “medical aid in dying” (MAID)—is making advances in many Commonwealth countries. Can you provide a rundown of where PAS/MAID stands in Australia?

Greg Bondar: Suicide and attempted suicide were originally crimes but are now legal in Australia. Though it is not a criminal offense for a person to take his or her own life, assisting or encouraging (i.e., aiding, abetting, procuring, counseling, commanding, or inciting) another person to commit suicide is illegal in all Australian states and territories. This is so even where the person requested assistance to die, and regardless of whether the assistance is provided by a relative, friend, or medical professional. It is also an offense to take active steps to bring about the death of another person, even where the deceased requested the action causing death. That’s the distinction between VAD and euthanasia.

Motive for assisting or causing another to die—even if to alleviate pain— is irrelevant to determining whether a crime has been committed. Even if the person asks another to end that person’s life, the one causing the death may still be charged with and found guilty of murder or manslaughter. There have been numerous prosecutions against family, friends, and medical practitioners for aiding and abetting suicide, murder, or attempted murder.

Voluntary assisted dying in Victoria and Western Australia are an exception. In those states the legislation protects authorized health practitioners who provide VAD in accordance with the Act, and also protects others (including other health practitioners, family, or care providers) who assist or facilitate a request for VAD.

It should be noted that a person with capacity can lawfully refuse ordinary food and drink, as well as artificial nutrition and hydration (for example, given through a tube into the person’s stomach). This is not suicide in Australian law.

Terminology differs around the world. “Physician assisted suicide” (PAS) is used in Oregon and other American states. “Medical Assistance in Dying” (MAID) is the term of art in Canada. “Euthanasia” is used in Belgium and the Netherlands. People of good conscience, including many physicians, are sharply divided on the ethics of MAID/PAS. Unfortunately, much of the support for this practice is founded on several myths and misconceptions regarding existing MAID laws and practices.

Voluntary assisted dying (VAD) continues to be a major legal, ethical, and social policy issue that has been enacted by all of Australia’s six states. The term “voluntary assisted dying” has been evolving in Australia in recent years following inquiries and parliamentary debates about laws enabling a terminally ill person to seek medical assistance to die. This term, rather than euthanasia or physician-assisted suicide or dying, is now the term commonly used in Australia.

In Australia, there have been studies investigating Australian pharmacists’ views about their role in physician-assisted suicide (PAS), their ethical and legal concerns, and overall thoughts about PAS in pharmacy, which found that their role in PAS highlighted the need for a sound ethical and legal framework to support PAS, as well as the need for training and budgetary considerations.

HLR: All six Australian states now allow some form of active euthanasia, although the federal government does not, and has turned away efforts to legalize it in places directly under its jurisdiction (e.g., the Northern Territory or the Australian Capital Territory). Why this difference between the states and Canberra?

Greg Bondar: Australia’s Constitution limits what states can and cannot do. The Australian states existed even before Australia’s federal government was created in 1901, so these states have their own state governments, whereas territories are under the control of the federal government. The Northern Territory (NT) and the Australian Capital Territory (ACT) remained under the control of the Commonwealth parliament, including for matters of euthanasia/VAD. Both the NT and ACT have campaigned for repeal of the 1997 federal law banning them from adopting VAD, and will likely renew that effort. 

HLR: What’s driving state efforts to legalize euthanasia? Is euthanasia broadly gaining public support, or are these efforts due to the well-coordinated efforts of an aggressive lobby?

Greg Bondar: The shift in the exponential growth of support for euthanasia/VAD in Australia has been fueled by both a gradual departure away from a Christian worldview and, unfortunately, a lack of understanding of the benefits of palliative care as an alternative to VAD.

Proponents of euthanasia and PAS identify three main but misleading benefits to legalizing death: (1) individual autonomy, (2) reducing pain and suffering, and (3) providing psychological reassurance to dying patients. What the proponents fail to disclose is the fact that the main motivations for seeking VAD support are (1) loneliness, (2) the stigma of being a burden, and (3) the pressure from relatives to fast-track inheritance windfalls, as was shown in recent studies of the “no” side of the New South Wales VAD debate.

There is no doubt that the efforts of various pro-euthanasia/VAD organizations have been so aggressive that they make pro-life organizations sound as if they promote pain and suffering, when in fact research shows that VAD techniques can also result in pain. The pro-VAD lobby has used celebrities and media spokespersons to push the cause for euthanasia/VAD through testimonials and endorsements.

The other major driving force in all the states in Australia to legalize euthanasia/VAD is political. Many local MPs are situated in anti-Christian proLGBTIQA+ and left-wing progressive electorates, which means that MPs are electorally forced to support euthanasia/VAD in Parliament to secure the vote of constituents. In NSW for example, the Independent MP Alex Greenwich’s Voluntary Assisted Dying Bill (2021) (the “Bill”) was prompted by the pro-LGBTIQA+ and left-wing progressive voters who live in the innercity electorates of Sydney.

In addition, skewed surveys and opinion polls have shown, incorrectly, that most Australians support voluntary euthanasia due to the prominence of several overseas jurisdictions (such as Switzerland, Belgium, the Netherlands, and Oregon) that have legalized voluntary euthanasia. On the other hand, polls undertaken by pro-life groups have shown that when opinion polls include questions/statements such as “(1) Would you support euthanasia/VAD if alternative palliative care were available?” and “(2) Would you support euthanasia/VAD if your medical condition could be treated to extend your lifespan…?,” support for euthanasia/VAD drops by over 35 percent.

HLR: Is there any organized or effective opposition in Australia to staunch, if not roll back, the advances euthanasia has made in Australia?

Greg Bondar: Yes. There is currently a campaign by organizations such as FamilyVoice Australia, Right to Life Australia, and the Catholic Church to revisit the euthanasia/VAD legislation in place in the various states through new research and through the lobbying of parliaments to undertake “reviews” of existing legislation.

For example, more than 50 people died under Victoria’s euthanasia scheme during its first six months, with the state’s VAD Review Board confirming 52 deaths under the scheme between June and December 2019. Nine of those died using medication administered by a practitioner, while 43 self-administered. Medication has been dispensed for 66 people. The VAD Review Board chair and former Supreme Court justice Betty King said at the time that because some family members of those who chose to die have not agreed with their decision but supported them nonetheless, a review must be undertaken as access to VAD becomes more readily available.

On 24 November 2021, the Minister for Health, Roger Cook, told the Legislative Assembly that 50 people had “completed the process under voluntary assisted dying,” by which he means that 50 people had died by assisted suicide or euthanasia using a lethal poison prescribed and supplied under the Voluntary Assisted Dying Act 2019.

This equates to a rate of 0.82 percent of all deaths being deaths by assisted suicide or euthanasia. This is already 64 percent higher than the Victorian rate for the period of January to June 2021—after the Act had been operating for two years—and 34 percent higher than Oregon after its Act had been operating for 23 years.

Total figures from around the world are hard to collate. Figures from Switzerland show that the numbers of those living in the country who underwent assisted suicide rose from 187 in 2003 to 965 in 2015.

According to the 2017 Regional Euthanasia Review Committees (RTE), in the Netherlands there were 6,585 cases of voluntary euthanasia or assisted suicide—4.4 percent of the total number of deaths. About 96 percent of cases involved euthanasia, with less than 4 percent involving assisted suicide; the largest proportion of cases involved people with cancer.

The trend worldwide is that euthanasia and assisted dying rates are soaring. It must be remembered that euthanasia was originally intended for severe cancer patients, and this has now been abused by others with less severe medical conditions seeking VAD options. This indicates signs of a “slippery slope,” with the practice being applied too widely.

As the Dutch laws were designed with cases like terminal cancer in mind— but with cancer patients still making up the majority of requests—the proportion of requests related to other conditions is growing, as it becomes more widely known to both physicians and patients that they could also apply VAD to other categories.

Under these circumstances, pro-life groups in Australia have sought provisions for “review” clauses in legislation that would allow submissions on the failure and/or abuse of VAD.

HLR: What protections exist in Australia to protect people from being pressured/coerced into euthanasia? How effective and well-enforced are they? Are there efforts to undermine or weaken them?

Greg Bondar: The various state VAD legislations in Australia do vary in terms of the protections that exist to protect people from being pressured/coerced into euthanasia. Victoria stipulates that people will only receive access to the VAD drugs if they meet all of the following conditions:

1. They must have an advanced disease that will cause their death and that is:

a. likely to cause their death within six months (or within twelve months for neurodegenerative diseases like motor neurone disease).

b. causing the person suffering that is unacceptable to them.

2. They must have the ability to make and communicate a decision about voluntary assisted dying throughout the formal request process.

3. They must also:

a. be an adult 18 years or over,

b. have been living in Victoria for at least twelve months (aimed at stopping euthanasia tourism), and

c. be an Australian citizen or permanent resident.

So, whilst these conditions exist, people with disability or mental illness who meet the conditions have the same right to ask for voluntary assisted dying as others in the community. However, having only a disability or mental illness is not sufficient reason for a person to receive access to the drugs: They must also have an advanced disease likely to cause death within six months (or twelve months for neurodegenerative diseases) and have the ability to make and communicate a decision about voluntary assisted dying throughout the process. Dementia alone is insufficient to procure these drugs without another condition, but when dementia affects a patient’s ability to make decisions about VAD, the patient will not meet the conditions to receive assistance to die.

It is against the law for a doctor to suggest a person seek VAD. He cannot raise the topic unless the person asks the doctor first. Once someone has chosen to seek VAD, that person works with a physician through the legally established process. The doctor cannot advocate VAD and must remind the person of the right to change his or her mind.

Other states generally follow the Victoria model, but the question remains: How effective and how well enforced are their guardrails? The simple answer to this is that there have been cases highlighted by pro-life groups where a doctor has diagnosed a patient with a terminal illness such as the meningococcal disease. After various enquiries about VAD, a decision has been made to “live on” with treatment, resulting in an extended life of another 4-5 years.

Their law had no regulatory or compliance provisions to ensure that VAD was not incorrectly administered in such cases.

The real and growing issue, as evidenced by overseas developments and proposals by Australian pro-death groups, is to extend VAD to people who are depressed or have Down syndrome, or intellectual disability, or autism spectrum disorders, including babies. The Australian groups are fueled by developments overseas in places such as Belgium, which amended its 2002 Euthanasia Act to extend the rights of euthanasia to minors. All these proposals are in effect undermining or weakening the protection provisions in place.

HLR: In countries where physicians have become involved in euthanasia, there is often pressure to erode professional conscience, either by compelling doctors to provide such “services” or at least to refer people to those who will. What does the situation for health professionals’ conscience rights look like in Australia?

Greg Bondar: The protection for medical professionals in Australia is not as good as it should be. Victoria offers good legal protection for doctors participating in VAD under its laws. If a doctor abstains out of conscientious objection, that’s fine. But if, in following the law, the doctor makes mistakes, the law has clear and strong protections against liability or professional complaints. In short, a doctor has to deliberately flout the law not to have access to these protections.

The laws are very broad as to what one can object to, ranging from information, any part of the assessment, or actual presence at the death. Some doctors will object to voluntary assisted dying entirely, while others may be willing to provide information and referrals.

Current state and common law protections adequately protect doctors when patients are treated palliatively, when the intent is not to kill the patient. According to the group Doctors Opposed to Euthanasia (submission to Victorian Parliament’s Legal and Social Issues Committee, July 29, 2015), both the community and the medical profession need better education in palliative care practices, to improve awareness of current end-of-life treatment and planning options.

In Victoria, South Australia, and Queensland, a person with a conscientious objection can also refuse to provide information about VAD, but in Western Australia and Queensland, a medical practitioner (such as a general practitioner) who refuses to accept a first request for VAD because of a conscientious objection must inform the person immediately and give the person contact details for a service that provides VAD assistance. Providing this information is also a requirement in Tasmania. Clearly, the obligations of health practitioners who conscientiously object to VAD differ in each state.

HLR: The Low Countries were among the first to legalize euthanasia and have progressively expanded the scope of those who can access euthanasia to include minors. What does that situation look like in Australia?

Greg Bondar:: Australia has been closely following the Low Countries. Belgium extended its euthanasia legislation to minors, making their legislation the first in the world without a minimum age limit. There is, however, some qualified support against extending euthanasia legislation to minors, but Australia has yet to delve into this issue. Also, unlike in the Low Countries, euthanasia is generally not regulated by national legislation.

This development has caused a lot of angst for the pro-life movement in Australia. The Dutch considered expanding eligibility for euthanasia to children between one and twelve, as children under one were allowed to be killed with their parent’s consent following criteria set out in the Groningen Protocols. Children older than twelve are already eligible. After neighboring Belgium passed legislation in 2014 enabling child euthanasia, doctors and activists in the Netherlands were keen to catch up, so now euthanasia is currently legal in the Netherlands for children older than one, with mandatory consent from the patient and their parents. It is also legal for babies up to a year old with parental consent. The patient must be enduring “unbearable and endless suffering,” and at least two doctors must agree to the procedure. Australia is in a different place and asking different questions. So, while those interested in the issue in Australia should be aware of what’s happening abroad, caution is needed in applying the Belgian experience here—and particularly without careful regard to the scope of those amendments.

HLR: Another area where euthanasia has made advances is, at minimum, discriminatory non-treatment of handicapped newborns, although arguments exist in the bioethics literature justifying the active killing of handicapped neonates. There have been several cases in Britain of handicapped children (for example, Charlie Gard and Alfie Evans) being denied care, even over the objection of their parents. How does this look in Australia?

Greg Bondar: In 1983 the Human Rights Commission was invited by the Australian College of Pediatrics to join with it in promoting discussion of legal and ethical issues related to deciding whether life-sustaining treatment should be given to infants with major disabilities. These issues clearly concern a core area of human rights: the value placed on life. The Human Rights Commission was set up by the Commonwealth Government in 1981 to promote and protect human rights in Australia.

As early as 1985, there was an analytic review of issues relating to the care of newborns with severe disabilities, with particular emphasis on the human rights involved. These derived from the International Covenant on Civil and Political Rights, the Declaration of the Rights of the Child, and the Declarations on the Rights of Disabled Persons and Mentally Retarded Persons.

The Declaration on the Rights of Disabled Persons says that disabled persons have the inherent right to respect for their human dignity. Disabled persons, whatever the origin, nature, and seriousness of their handicaps and disabilities, have the same fundamental rights as their fellow citizens of the same age, which implies first and foremost the right to enjoy a decent life, as normal and full as possible.

Further, disabled persons have the right to medical, psychological, and functional treatment, including prosthetic and orthotic appliances; medical and social rehabilitation; education, vocational training, and rehabilitation; aid, counselling, placement services; and other services which will enable them to develop their capabilities and skills to the maximum and hasten the process of their social integration or reintegration.

Baby M was the pseudonym of an Australian girl named Allison who was born with severe birth defects, whose treatment and eventual death caused significant controversy and international discussion about the medical ethics of disabled newborns. Right-to-life activists accused her parents and the hospital of murdering the infant, leading to a lengthy legal inquest.

The quality of life and the death of “Baby M” highlighted the issue that Australian doctors, like their American counterparts, are frequently making decisions resulting in a severely disabled infant’s death, without public guidance and against the backdrop of laws and traditional ethical precepts which uphold in spirit (although, as we shall see, not always in practice) the traditional “sanctity of life” view. It should be no surprise then, when doctors and parents ready to end a child’s life come up against zealous defenders of an infant’s “right to life” who will invoke the law to try to prevent what they see as immoral and unlawful decisions. That happened in 1989, when a severely disabled infant was born and died twelve days later. The case is still invoked by pro-euthanasia groups claiming children as young as twelve should be able to choose to end their own lives, with civil libertarians citing European laws as a model that could be replicated in Australia.

Pro-life organizations like FamilyVoice and the Australian Christian Lobby have warned of the euthanasia slippery slope as pro-euthanasia organizations like the Queensland Council for Civil Liberties promote access to assisted dying for children as young as twelve. Extending euthanasia legislation to children that young sends a dangerous message on the value of life to very young kids, especially when suicide is currently Australia’s leading cause of death of young people aged 14-17 years.

HLR: Philip Nitschke is perhaps one of Australia’s most infamous euthanasia advocates. His most recent effort is to try to develop a suicide pod called “Sarco” to allow for do-it-yourself suicide. What’s his standing in Australia? FVA: The concept of a capsule that could produce a rapid decrease in oxygen level while maintaining a low CO2 level (the conditions for a peaceful, even euphoric death) was the idea behind Sarco (short for “sarcophagus”). The company behind a 3D-printed pod that can help carry out assisted suicide has said it is confident it could be used in Switzerland as early as next year. Assisted suicide, in which somebody is given the means to end his or her own life, is legal in Switzerland, with about 1,300 people having died this way in 2020.

The capsule’s creator, euthanasia campaigner Dr. Philip Nitschke, sometimes known as “Dr. Death,” invented Sarco in 2017; he has said he plans to make the blueprints available so anyone could download the design. This will be made available for free to “demedicalize” the dying process.

Nitschke, who embarked on an Australia-wide tour in 2019 promoting his space-like Sarco suicide capsule, no longer practices as a doctor in Australia. He burned his medical registration documents in protest of the restrictions against promoting suicide placed on him by the Australian Medical Association in 2015. He maintains that his still notional death-by-design pod will deliver a “peaceful, elegant, almost-euphoric” ending, yet euthanasia opponents see his death-by-design pod as another false step into a dystopian future.

His general standing in Australia ranges from being seen as a “saint” by some patients to being viewed as “Dr. Death” by pro-life supporters.

HLR: While much of the focus in the Covid pandemic has been on preventing deaths from that virus, the world’s nearly two-year lockdown has also seen an increase in depression and suicides, especially among certain more vulnerable populations. Australia has been among the more rigid jurisdictions in matters related to Covid. What does the “bigger” picture look like in Australia? Michael Cook has argued that voluntary assistance in dying can even become “contagious.” Do you expect it will contribute to further acceptance of euthanasia?

Greg Bondar: No. Covid-19 has indeed presented a dilemma for both pro-life and pro-euthanasia supporters. On the one hand, there are campaigns to preserve life at all costs, whilst on the other hand, legislation supporting deaths is on the increase.

As of the end of April 2022, there were just under 7,000 deaths in Australia due to Covid; whilst it is difficult to estimate the abortion rate in Australia, as most states do not routinely report abortion data and published national data have been incomplete, it is estimated there are over 100,000 abortions in Australia each year.

Likewise, it is difficult to estimate the euthanasia/VAD rate in Australia, given its newness. However, as a guide, the recent VAD Review Board report in Victoria shows that since June 2019 (when the Act commenced) until 30 June 2021:

• 836 people have been assessed for eligibility to access voluntary assisted dying.

• 674 permit applications have been made.

• 597 permits have been issued.

• 331 people have died from taking the prescribed medications.

Applicants were between the ages of 18 and 101 years, and the average age was 72, with around 46 percent of applicants being female and 54 percent male. Extrapolating this nationally, the growth rate for VAD in Australia is likely to exceed Covid fatality rates and mirror those of abortion in a matter of 10 years.

HLR: Any last thoughts?

Greg Bondar: The idea that all human life is inherently precious was not generally affirmed in the world into which Jesus Christ was born. It spread with the growth of early Christianity and finds expression today in the UN Declaration of Human Rights.

For pro-life groups like FamilyVoice Australia, opposition to euthanasia is not just a biblically held view but a moral and ethical view that says life is precious and must be preserved at all costs.

The issue that is rarely addressed is: Who “benefits” from euthanasia/VAD legislation? Suggestions have ranged from the funeral industry to health insurance companies. Is insurance for “voluntary suicide” moral and ethical? Should it be insurable? Likewise, the cost of aged care is skyrocketing worldwide, so is euthanasia/VAD an answer for governments having to care for the aged? There are, it appears, numerous and convincing economic arguments favoring euthanasia/VAD as opposed to the moral, ethical, and social justice arguments that don’t seem to resonate with politicians.

There is simply “no dignity in dying,” regardless of how it is presented.

HLR: Thank you.

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*Greg Bondar is now the national director of Christian Voice, Australia.