Setting the agenda on the End-of-Life debate

Setting the agenda on the End-of-Life debate

Dr Katharine Noonan
Policy and Research Lead Clinical

Thursday 31 May 2018

It is an issue that will dominate political, medical and ethical debate in Western Australia over the next year, if not longer.


And the Australian Medical Association (WA) is determined to have the voice of the medical profession heard – and heard loudly.


Whether we call it End-of-Life Choices, palliative care or a term that is sometimes thrown around indiscriminately, euthanasia, it is clear that virtually every West Australian has a view on the matter.


In fact, this subject is one that invariably drives strong, and sometimes extremely strong and diverse, views.


The AMA (WA) has already played a major part in the discussion around this subject on the back of legislation passed by the Victorian Parliament last year.


From articles, comments and a range of TV and other media interviews, the AMA (WA) has ensured that its voice is heard on this most complicated of subjects.


At the same time, the AMA (WA) has been taking it further by organising a symposium to discuss the issue from a range of directions and to determine future directions and advocacy.


The AMA (WA) End-of-Life Choices & Palliative Care Symposium – A SMALL CHANGE OR A SEISMIC SHIFT – was held on Saturday, 5 May 2018 at the University Club of Western Australia. Almost 250 members registered to discuss and debate the complex and occasionally delicate issues.


The event was a successful one on a number of levels. Members engaged in frank, open and respectful discussions throughout the day. An excellent symposium program, supported by eminent keynote speakers, presenters and panellists, was instrumental in assisting members to consider these sensitive yet vital issues.


It was clear throughout the symposium that improving the care of patients at the end of life extends far beyond the narrow scope of a euthanasia debate. There was extensive discussion of the shortcomings and potential for improvement in the way palliative care is currently delivered in WA.


The members who attended agreed that there should be a greater focus on capacity building in the health system as a whole. This includes educating medical practitioners and healthcare workers about the principles of palliative care, as well as greater awareness around what is required to deliver effective palliative care.


We heard about the gap in palliative care experienced by Indigenous communities, who often need to travel to receive specialist treatment. The first panel of the day highlighted the fragmentation of palliative care between General Practice, tertiary and community services, as well as the need for recognition of the time required to effectively communicate and engage with patients.


The importance of effective communication in palliative care resonated with the audience, acknowledging that the impact reaches beyond simply patient understanding, into family and community.


To assist the discussion and to provide a firm foundation of debate, we were extremely fortunate to have two international guests speak to us about their experience and insights around assisted dying.


Professor Ilora Finlay, the Baroness Finlay of Llandaff is a Professor of Palliative Medicine at the University of Cardiff and an Independent Crossbencher in the House of Lords. She spoke about the complexities and concerns around assisted dying, particularly the notions of capacity and autonomy.


Dr Gord Gubitz, a stroke Neurologist from Nova Scotia, Canada, offered a unique perspective as a provider of Medical Assistance in Dying (MAiD).


The audience also heard from three international experts via recorded video interviews. One of them, Prof Theo A. Boer, discusses the Netherlands’ experience.


Key learnings ranged from the practical implications of implementing assisted dying, the crucial role of the medical profession in the legislative process, and the societal impact of assisted dying in countries where there has been expansion of eligibility criteria.


From our panel discussion on advocacy going forward, it was clear that capacity and competence are key issues to be addressed by any potential legislation.


Throughout the day, delegates actively participated in Q&A sessions and provided their opinions via interactive polls using their phones. A set of recommendations from the sessions were put to the delegates and voted on at the conclusion of the day. The outputs of these discussions
will be invaluable going forward, as the AMA (WA) actively considers and advocates for end-of-life issues.


As a first step, the outcomes from the symposium will be discussed at a special AMA (WA) Council meeting, and potentially endorsed.


AMA (WA) President Dr Omar Khorshid is also due to present to a public hearing of the WA Parliamentary Inquiry into End of Life Choices to inform Committee members of the outcomes of the symposium and to answer further questions.


The findings and recommendations of the WA Parliamentary Inquiry into End of Life Choices – its final report is expected to be issued in August this year – and any subsequent legislative changes are yet to be determined.


Whatever the outcome, and whatever course the government and Members of Parliament decide to take, the AMA (WA) will continue to be vocal in its advocacy – on behalf of doctors, patients and the most vulnerable in society.

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