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AUSTRALIAN MEDICAL ASSOCIATION (WA)
Statement by AMA (WA) President Dr Andrew Miller
9 August 2019
The Australian Medical Association (WA) stands for high quality end-of-life care for all – and for compassionate and open discussion.
We commit to listen to all and respect the decision of Parliament and doctors involved on both sides of the current debate about the Voluntary Assisted Dying Bill 2019, recently introduced into State Parliament. The medical profession, like the community, is in two minds on this important Bill.
The independent Chair of the Medical Expert Panel, the respected jurist Malcolm McCusker AC, CVO, QC was quoted in The West Australian on 8 August 2019 (page 13) as saying:
“This involves the ending of agony in many cases for a person who is reaching his or her end of life and is certainly going to die,” McCusker said. “It’s simply a matter of putting an end to the extreme pain and suffering which that person finds intolerable.”
The community rightly takes very seriously the quoted comments of Mr McCusker.
In the view of the AMA, a reasonable reader may think from these reports that VAD would only be available for people in extreme pain who are certain to die, and that this is a small group. They may take some reassurance from this and therefore be more likely to support the Bill.
The AMA respectfully asks Mr McCusker whether a patient who has no pain problem but has, for example, anxiety or fear, who has been judged by a doctor as probably, but not necessarily, going to die in the timeframe, could also qualify for VAD?
We ask because the VAD Bill does not mention “extreme pain” or indeed pain at all, and because this may mean a lot more people will qualify for VAD than the media report implied.
The Bill does require that the patient have a terminal disease that is causing “suffering to the person that cannot be relieved in a manner that the person considers tolerable”.
The AMA believes the definition of suffering includes many alternatives to pain, and this therefore widens the scope enormously. This may mean that some people will not support the Bill as they see it as too permissive, so it is important to clarify.
Suffering could include, for example, mental anguish, emotional distress, loss of enjoyment of life, fear, anger, humiliation or anxiety. If one of these is causing suffering that cannot be relieved tolerably in the patient’s view, at the time of two brief assessments, they may qualify. There is no requirement that various treatments be tried first to see if the suffering can be improved.
There does not seem to be any requirement to even try treatment for a curable terminal disease to see if this suffering can be alleviated, before VAD is permitted.
The reported comment also refers to patients who are “certainly going to die” which implies that the prognosis is definite, whereas the Bill seems to require only that the patient is probably going to die within six or 12 months. This estimate of survival – notoriously unreliable – does not have to come from a specialist in the disease they have.
Again, this will result in a much bigger group than those for whom death is “certain”.
CLEAR VIEW FROM EXPERT PANEL REQUESTED
While the community and Parliament may upon consideration support a wide scope and a large number of patients being involved in VAD, we must at least get a clear view of the number and type of people affected from the Expert Panel.
Is this “big permissive open door” access, or “small restricted definitely dying despite having had lots of care” access?
It would be very useful also, for all in this important discussion, to see an expert panel analysis of the differences between the WA Bill and the Victorian legislation so we can all understand why they seem to be so different.
Especially because there is currently limited access to high quality end-of-life care, more so for the many people who live outside the western suburbs of Perth. As a community, we need an accurate idea of how many vulnerable people could fall into the scope of euthanasia, and why.
We urge the Government to allow enough time for all these issues to be fully explored, and look forward to any clarification Mr McCusker and the Expert Panel wish to provide on his reported comments with gratitude.
For further enquiries, contact Robert Reid: 0422 553 877