Caring for the dying is our greatest challenge

Caring for the dying is our greatest challenge

Dr Omar Khorshid

Wednesday 6 December 2017

With the passing of euthanasia and physician assisted dying legislation by the Victorian Parliament earlier this week, the issue is now sure to travel West. In fact, this subject is likely to dominate public and medical debate next year. Already the WA Parliament has an inquiry underway about the issue and a report is expected to be tabled in August next year from which draft legislation will almost certainly follow.


The medical profession has a longstanding opposition to euthanasia born in the Hippocratic tradition and further codified after the horrors of World War II. The Declaration of Geneva states ‘I will have the utmost respect for human life’ and to this day the declaration is read out at the beginning of many medical events, including every National Conference of the AMA.


Doctors share the end of life journey with patients and their families and although the majority are opposed to euthanasia and physician assisted suicide, most would understand why there is public support for so called ‘end of life choices’.


It is certainly possible for people to die with dignity without access to euthanasia, but we cannot ignore the reality that there is inadequate access to quality palliative care for many West Australians. There are a number of people for whom palliative care does not provide adequate symptom control or the death that they hope for.


I believe that we need to refocus the debate to end of life care rather than the narrower issue of euthanasia. Before any proposed legislative change it is important to ensure that our community and our politicians fully understand the reality of the end of life issues that face our community, the risks associated with change and the experience of other countries that have had this debate or have already gone down this path.


There was a detailed report prepared in Victoria over a 12 month period that was used as part of the debate on this issue which carried 49 recommendations. Unfortunately the subsequent debate has ignored all but one of these important recommendations. We must ensure that this mistake is not repeated in WA.


There is significant misinformation in the community regarding end of life care as it stands at the moment. Every day, in consultation with patients and family members, futile care is withdrawn that results in the death of the patient. Every day, pain and symptom relief is provided to patients with terminal conditions that speeds up their death, and doctors are not prosecuted for delivering that treatment. Every day, common sense decisions are made around whether or not to commence care for patients who are nearing the end of life or who suffer dementia.


We don’t always get these decisions right, but the options are there for the vast majority of patients without any discussion around physician assisted suicide or euthanasia. Legally binding advanced care directives are already available, so that our wishes are captured and must be respected in the event that we are unable to communicate.


Many people in the community and many doctors are concerned about the ‘slippery slope’ of change. Whilst initial legislation must include adequate safeguards to protect the vulnerable, it is easy to see how these safeguards could be removed over time as our community becomes worryingly accepting of the easy concept of ending the lives of those who request it.


The AMA considered this topic in 2016 and surveyed its members in the process of developing a position statement on Euthanasia and Physician Assisted Suicide. That statement reaffirms the AMA’s opposition to the involvement of doctors in treatment that has the primary objective of ending a patient’s life. The results also reflected the view that decisions around the law in this area is a matter for the community and for our elected representatives, not the medical profession.


The AMA will continue to advocate for better end of life care, including access to palliative care and for an informed debate around the topic of euthanasia in WA. In the event that the WA Parliament decides to legalise euthanasia and physician assisted suicide, we will ensure that the vulnerable are protected and that this step is only available to those at the end of life who are unable to benefit from palliative care.

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