Confusion in Tasmania debate over the role of doctors

In March, at the time of the euthanasia & assisted suicide discussion paper in Tasmania, The President of the Tasmanian Branch of the Australian Medical Association condemned the move in the Australian Media.  MP Nick McKim - a prime mover in pushing the agenda forward, responded.
 

Mr McKim says Dr Davis's comments are disgraceful and do not represent the views of Tasmanian doctors.

"Dr Davis has just abandoned his members who currently are performing euthanasia in hospitals," he said.

"We have doctors who are motivated by compassion and respect for human dignity who currently euthanase patients and the AMA has just come out and sold those doctors down the river."

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In what sense doesn't the AMA represent doctors?  AMA Tasmania's vice President, Tim Greenaway, on a radio show last Sunday, pointed out that both the northern and southern sub branches of AMA Tasmania met, discussed the issue and the motion to endorse the opposition to euthanasia & assisted suicide was unanimous - with one abstention.
 
It's a little difficult to assess McKim's understanding of what happens at the end-of-life from this and other comments; particularly in respect to the notion of the double effect doctrine and the administration of pain relief. It's not exactly clear. But McKim uses highly-charged rhetoric when he suggests that Davis is abandoning doctors, selling them out.
 
There are only two possibilities here. He could be referring to the principle of double effect wherein, to manage pain and other symptoms a doctor may be required to gently increase the level of medication even though such increases may hasten death. The intention is not to kill; the action is licit and lawful.
 
The second possibility is the delivery of pain medication in doses well above what is needed to relieve pain with the deliberate intention of hastening death. This is a situation of intentional killing. It is an act of homicide.
 
Some wrongly call the first situation 'slow euthanasia'. This is a patently false description, euthanasia being an act with deliberate intent to kill. It may be that McKim understands the practice in that way, but this is an errant view.
 
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However, if there are doctors who are deliberately ending the lives of their patients, then they are acting outside the law and should be brought to account for their actions. If Mr McKim knows of any such cases he should report them to the authorities. It is perhaps an obvious point, but if there are doctors who are currently intentionally killing their patients in breach of the law, then we can have little confidence that, should the Tasmanian euthanasia law pass, that they would not continue to do so for cases that do not fit within the law's structure.
 
The trouble with the 'it's happening already so let's create a legal framework' is obvious from the previous comment. However, it also casts a shadow over the medical profession as a whole and Tasmanian doctors in particular. This is simply not fair.
 
This was exacerbated this week when Mr McKim told reporters that, "There is evidence from palliative care doctors in Tasmania that the practice of hastening the death of patients is occurring." Again I ask: what does he mean by that? The context of the comment makes it all the more problematic.
 
"The problem is it's occurring without legal protection for those doctors and it's also occurring without a regulated framework of safeguards for their patients." There we have it - falsely conflating intentional killing with sound medical practice that does not have that intention - draws the false conclusion that doctors are at risk of legal action. Ergo, we need to regulate!
 
The media report goes on to say:
 

His (McKim's) legal advice says that could leave a doctor open to a charge of murder.

"Just because a complaint hasn't been made or an inquiry hasn't been held doesn't mean that it won't be held in the future," Mr McKim said.

But it is not murder if the intent and the practice are focused on the relief of pain. Those that should be in fear of the law will have intended death and acted upon it.
 
Doctors are protected under law for the legitimate use of double effect. In most states this protection is codified within respective palliative care legislation. The Tasmanian Parliament does not have a dedicated palliative care act; regardless, doctors would still be protected under common law.
 
AMA spokesperson, Dr McGushin spelt this out in the media.
 
 

"Doctors are not asking for legal protection with this legislation. We actually know where we stand and we realise that we're not above the law." Adding, "We acknowledge there is some issue of double-effect when you're trying to palliate some symptoms," Dr McGushin said. "But that is not your intention. The intention is to palliate their symptoms to allow them to die a natural death."

If doctors did need extra protection under law so that they could continue sound medical practice, then a palliative care bill would be the best way to achieve this. Creating a cause for the protection of doctors and championing a euthanasia bill as a solution is not a reasonable response - especially when the media is awash with such confusing statements.
 
Nor does this kind of talk help patients. People often talk about the damage that the advent of euthanasia and assisted suicide would have on the doctor patient relationship. Creating such confusion provides a small but potent example. At a time of uncertainty and fear over a poor diagnosis, such confusion can only add to a patient's anxiety.

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