GP on Assisted Suicide Debate: 'We Have Not Been Fully Engaged'

Picture2.pngDespite the fact that the medical community plays an intrinsic part in the administration of end-of-life measures, Victorian politicians have failed to involve them in the debate on the Voluntary Assisted Suicide Bill. There is a callous assumption that physicians will automatically perform such procedures if legalised.

But in reality, most doctors and nurses are resisting assisted suicide, not only on an ethical basis, but because administering a lethal injection directly contradicts their role as a healer and life-saver. In the past month, the AMA released a statement opposing the Assisted Dying Bill, and nurses such as Annmarie Hosie have also stepped into the public eye to make their voice heard on the issue.

In the past week, GP Jane Barker, who has been practicing medicine for over 30 years, joined her fellow medical professionals in taking a stand, writing an editorial emphatically arguing against physician assisted suicide.

THIS euthanasia debate is our debate and we have not yet been fully engaged in it. This is our debate because we will be the ones expected to write the scripts, to administer the medications and to make the final decision within the boundaries of the law. We will be the ones to be considered lacking in compassion if we refuse a patient’s request or to feel pressurised by patients when nobody else is available. How do we feel about this?

What troubles me is that I feel that there is a presumption that euthanasia and physician-assisted suicide (PAS) are a doctor’s role – indeed, could it morally, ethically and legally be performed by any other professional? – but that somehow the question of whether we would want to play this role and how it should be regulated has not been fully discussed with us.

Dr Barker points to both national and international statistics, proving that her attitude towards physician assisted suicide is predominantly shared among the medical community.

Internationally, surveys of doctors’ attitudes to voluntary euthanasia and PAS have found that a higher percentage of the general public agree to euthanasia compared with doctors interviewed. They found a different attitude among doctors working in different specialties. Importantly those working in palliative care, perhaps at the coal face of dying, were least likely to agree. In a German survey of palliative care specialists only 5.3 % said they would be willing to carry out euthanasia and this number decreased when asked about assisting patients who were not terminally ill. One hundred and seven of 109 national medical associations affiliated with the World Medical Association have statements opposing PAS.

She also makes it clear that there are superior alternatives to assisted suicide which are more compassionate, and allow doctors and nurses to adhere to their roles as healers, instead of forcing them into the role of executioners. 

One of the other important ethical problems facing medicine currently is the so-called “futile treatment”, where life is prolonged for inappropriate reasons. There are times as doctors when we share in hard decisions to withdraw care and allow the dying nature has decreed. Debates on euthanasia and ways of reducing futile treatment may both have their answers in effective, accessible palliative care.

The science of palliative care increasingly understands ways to effectively treat pain and other symptoms associated with dying, which in the past have had the potential to cause untold suffering and generate fear for both the patient and their careers.

Pain control in palliative care is not euthanasia. It aims to improve the quality of life experienced in the process of dying and to help patients to retain their dignity. In my experience, doctors are not afraid to give increasing levels of pain relief or sedation to reduce suffering. Doctors are grateful if there has been discussion in the form of advanced care directives that can assist in their decision making, but these need to be more effective, universal and readily accessed, perhaps through a central, controlled and confidential data bank. Priority needs to be given to researching and funding effective symptom control for people who are dying, so that some of the fear may be removed, making euthanasia less needed.

As Jane Barker concludes in her article, euthanasia and assisted suicide cannot be the ultimate solution to end-of-life suffering. Not only does it pose serious risk of premature death for vulnerable Australians, but it forces the hand of the medical community. Despite what politicians may tell us, that is not compassion.