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On assisted dying

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The AMA National Conference hosted a special policy session on the highly contentious issue of assisted dying as part of an on-going AMA policy review.

The session, moderated by ABC presenter Tony Jones, brought together a panel of doctors, ethicists and lawyers with a range of views on whether doctors should be involved in assisted dying.

The debate began with an account of the death of an elderly patient who had had a breathing tube removed without anaesthetic because the treating doctor was fearful that if they administered a drug they might be charged with causing their death.

The scenario prompted discussion of the degree to which doctors were uncertain about the law around assisted dying and the so-called double effect doctrine.

Professor of Ethics at the University of Queensland, Malcolm Parker, said it was “widely understood the doctor knowledge of the law in all sorts of areas is not particularly good,” and many doctors were worried that if the treatment they provided had the effect of causing death, “they will get into trouble”.

Avant Head of Advocacy, Georgie Haysom, said the issue hinged around intent: “If you intend to cause someone’s death, that is murder”.

Dr Karen Hitchcock, who works in acute and general medicine at Melbourne’s Alfred Hospital and last year wrote a Quarterly Essay on caring for the elderly, said there needed to be much greater education around the double effects doctrine, under which the death of a patient is a side effect of treatment.

“Double effect is the bedrock of medicine, which is to treat symptoms,” Dr Hitchcock said. “We never treat life, we treat symptoms. So hastening death is not an issue. [Doctors] do not set out to kill; alleviating symptoms is the aim.”

Associate Professor Mark Yates, a geriatrician at Ballarat Health Services, said the double effects doctrine “is used on a day-today basis”, and rather than changing its position on assisted dying, the AMA should devote its efforts to promoting good palliative care.

But Emeritus Professor Bob Douglas from the Australian National University said the double effects doctrine was “a nonsense”, and was causing serious concern for both doctors and the broader community.

Professor Douglas agreed that there needed to be greater investment in palliative care and advance care planning, but said patients should have the choice of assisted dying.

“From the perspective of a patient, my concern is that when I get to the point of incurable illness and inevitable death, I don’t want to put all my relatives through the pain and suffering of an unnecessarily elongated process,” he said.

Professor Douglas said laws similar to those enacted in the US state of Oregon, which allow terminally ill adults to obtain and use prescriptions from their physicians for self-administered, lethal doses of medications, would “give a lot of people comfort”.

Dr Hitchcock said, however, that Oregon-style laws were unnecessary and could actually be harmful, by making the elderly and disabled feel pressured into seeking assisted dying, such as because of the fear of being a burden to their relatives.

“Every patient [already] has a right to choose to have treatment withdrawn,” she said. “The main reason people request physician-assisted suicide is because of feelings of uselessness and hopelessness. If we give people the choice, it will influence them.”

Dr Hitchcock disputed claims that Oregon-style laws put doctors at arms’ length from killing their patients, arguing it was “ridiculous” to pretend that writing a prescription for a lethal dose of medicine was not an act.

“What we are proposing is that instead of [a palliative care team], doctors can give a patient a prescription to go ahead and kill themselves,” she said. “We are talking about replacing the palliative care team with a script.”

But Professor Douglas countered that just knowing assisted dying was an option could bring people enormous comfort, and experience showed that far from all who acquired a prescription for lethal medication went on to use it.

Figures published by the Oregon Public Health Division show that from the time the laws were introduced in 1997 and the end of 2013, 1173 had obtained prescriptions and 752 had used them. During 2013, 122 people were provided a prescription, and 71 had killed themselves.

AMA President Dr Michael Gannon, who initiated the policy review as Chair of the AMA Ethics and Medico-legal Committee, said the National Conference session would, along with 3500 responses to an AMA member survey, be used to help inform the AMA Federal Council’s deliberations on the issue.

Adrian Rollins

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