Today (24th November 2016) the Australian Medical Association released its new policy on euthanasia and assisted suicide.
The policy review is a five-yearly process that involved significant consultation and surveying of members ahead of the development of the final document released today.
The two page document changes the focus somewhat by opening with various affirmations about the AMA's commitment to making quality end-of-life care available to all Australians:
1.4 All dying patients have the right to receive relief from pain and suffering, even where this may shorten their life.
1.5 Access to timely, good quality end of life and palliative care can vary throughout Australia. As a society, we must ensure that no individual requests euthanasia or physician assisted suicide simply because they are unable to access this care.
The AMA rightly calls for action by all Australian governments:
1.6 As a matter of the highest priority, governments should strive to improve end of life care for all Australians through: ï‚· the adequate resourcing of palliative care services and advance care planning; ï‚· the development of clear and nationally consistent legislation protecting doctors in providing good end of life care; and ï‚· increased development of, and adequate resourcing of, enhanced palliative care services, supporting general practitioners, other specialists, nursing staff and carers in providing end of life care to patients across Australia.
The statement includes a clear direction to doctors on their responsibility should a patient ever ask for euthanasia or assisted suicide:
2.1. A patient's request to deliberately hasten their death by providing either euthanasia or physician assisted suicide should be fully explored by their doctor. Such a request may be associated with conditions such as depression or other mental disorders, dementia, reduced decision-making capacity and/or poorly controlled clinical symptoms. Understanding and addressing the reasons for such a request will allow the doctor to adjust the patient's clinical management accordingly or seek specialist assistance.
The key paragraph that retains the AMA's opposition:
3.1 The AMA believes that doctors should not be involved in interventions that have as their primary intention the ending of a person's life. This does not include the discontinuation of treatments that are of no medical benefit to a dying patient.
The statement acknowledges that there are divergent views in the medical fraternity just as there is in Australian society. They acknowledge, correctly, that law and public policy in this area is the preserve of our parliaments and they insist on being consulted and included in any debate on the matter.
This last observation, though a general principle no doubt, could just as easily be a reflection on the lack of consultation with the AMA and other medical bodies evident in the recent South Australian debate.
The AMA was clearly intent upon using the release of this new policy as an opportunity to educate the public. From the press release:
"Dr Gannon said the AMA recognises that good quality end of life care can alleviate pain and other causes of suffering for most people, but there are some instances where it is difficult to achieve satisfactory relief of suffering.
"There is already a lot that doctors can ethically and legally do to care for dying patients experiencing pain or other causes of suffering," Dr Gannon said.
"This includes giving treatment with the intention of stopping pain and suffering, but which may have the secondary effect of hastening death. This is known as the principle of double effect," Dr Gannon said.
While the statement is exceptionally clear, the media reporting has been very shabby.
The Australian ran with the headline: Most doctors would help terminally ill die: AMA. The Fairfax Press: Four in 10 doctors want voluntary euthanasia, Australian Medical Association survey shows.
The Fairfax headline is at least accurate. Indeed, as the story states 38% of the doctors who completed the AMA survey said that doctors should be involved in euthanasia or physician assisted suicide. But, according to Fairfax, 50% said that doctors should not be involved.
The survey, according to AMA President Dr Michael Gannon, will not be made public until the membership has seen the results. It would seem that some of the references in the articles may well be to slightly different questions.
For example, The Australian says that 55% of doctors were in favour of retaining the existing policy; that's not the same result and probably not the same question referred to above. The Australian calls the results on the policy question 'relatively close' at 55-45. Not so. Only 30% of doctors, according to the same article were in favour of a policy change to 'neutral' on euthanasia while 15% were undecided.
The Australian's headline: Most doctors would help terminally ill die, is misleading. The article explains:
"Crucially, an even clearer majority of AMA members said if voluntary euthanasia were made legal at the state and territory level, doctors should be involved in helping terminally ill people die rather than dig in on principle and boycott the process."
That's a far more nuanced position than the headline suggests.
It tells us that while doctors don't want a change to the law, that if it is changed they think they have a role. This may be because they see no problem with patient killing but it may also indicate, for those not ethically or morally opposed, that better that doctors do it rather than cowboy operators. It suggests, as Dr Gannon confirms, that doctors see that they have a role in protecting their patients.
This is also borne out by the fact that the variation in results to the two questions on retaining opposition to euthanasia and assisted suicide and whether a doctor should be involved suggests that some doctors who opposed any change in policy still thought that doctors had a role. This, it seems, reflects the understanding of the second question that it is not about doctors who are keen and willing to kill, but something much more than that. As Dr Gannon summarised:
"What did surprise me is that our members have made it very clear that if society moves, they want doctors involved in euthanasia. A conservative view might be that this is not medicine, that ending patients' lives is not what doctors do and that role should go to another group in society, maybe a new professional group."
I could go on about The Australian's new-found enthusiasm for euthanasia. That's annoying enough but sloppy journalism really gets me going. Here's a classic example (The Australian):
"The replacement policy states that a failure by doctors to initiate or continue life-prolonging measures for a dying patient does not constitute euthanasia."
Failure? That implies negligence; the doctor 'failed' to do his or her job. What rot! The policy says nothing of the sort:
2.2 If a doctor acts in accordance with good medical practice, the following forms of management at the end of life do not constitute euthanasia or physician assisted suicide: ï‚· not initiating life-prolonging measures; ï‚· not continuing life-prolonging measures; or ï‚· the administration of treatment or other action intended to relieve symptoms which may have a secondary consequence of hastening death.
Doesn't sound like 'failure' to me.
In closing, we welcome the AMA's policy statement and its affirmation that 'doctors should not be involved in interventions that have as their primary intention the ending of a person's life.' We also welcome the educational initiatives and the call for better access to quality care for all Australians.
The survey recorded something like 4000 responses from a membership of some 30,000 doctors Australia wide.