Most doctors would help terminally ill die: AMA

The Australian 12:00am November 24, 2016

Jamie Walker

A majority of doctors would help terminally ill people die if ­voluntary euthanasia became law, a landmark survey of GPs and medical specialists by the AMA has revealed.

The Australian Medical ­Association will today unveil a policy rejecting euthanasia and doctor-assisted suicide, but which acknowledges for the first time that right-to-die laws are ­“ultimately a matter for society and government”.

The position statement, previewed exclusively by The Australian, spells out how doctors can ethically give drugs and treatment to dying patients that hasten death, provided the intent is to ­relieve suffering.

The AMA spent a year revising its stance on euthanasia after the hot-button issue was revived by an ultimately unsuccessful cross-party bid in South Australia to push right-to-die legislation through the state parliament and ongoing moves to frame such a law in Victoria with the backing of senior ministers in Daniel ­Andrews’ Labor government.

The AMA review was underpinned by a survey of 30,000 doctors. About 4000 responses came in, AMA president Michael Gannon said yesterday.

Views split narrowly in favour of retaining the AMA’s existing policy that doctors should not take any action primarily ­intended to cause the death of a patient. Doctors could, however, “relieve symptoms which may have a ­secondary consequence of hastening death”, the new position statement says.

Dr Gannon said 30 per cent of the responding doctors favoured a change in AMA policy to endorse or to shift to a neutral position on euthanasia, while 15 per cent were undecided.

The relatively close margin of about 55-45 per cent for and against or undecided on the existing policy underlines that doctors are as divided as the public.

The position statement says: “The AMA recognises there are divergent views within the medical profession and broader community in relation to euthanasia and physician-assisted suicide.”

Crucially, an even clearer ­majority of AMA members said if voluntary euthanasia were made legal at the state and territory level, doctors should be involved in helping terminally ill people die rather than dig in on principle and boycott the process.

Reflecting this, the AMA has altered its position to say: “If governments decide that laws should be changed to allow for the practice of euthanasia and/or physician-assisted suicide, the medical profession must be involved in the development of relevant legislation, regulations and guidelines.”

This would protect doctors who acted within the law, as well as ­patients at risk of coercion and “undue influence”, or those who might ask to die for fear of being a burden to family and carers.

“The fact that a majority of doctors don’t support a change in our statement or the law did not surprise me,” Dr Gannon told The Australian. “What did surprise me is that our members have made it very clear that if society moves, they want doctors involved in ­euthanasia. A conservative view might be that this is not medicine, that ending patients’ lives is not what doctors do and that role should go to another group in ­society, maybe a new professional group.”

The AMA last reviewed its position on euthanasia in 2007 and amended the platform two years ago. The replacement policy states that a failure by doctors to initiate or continue life-prolonging measures for a dying patient does not constitute euthanasia.

Addressing what doctors should do if a patient asked for help to die, the updated statement says the request should be “fully explored” but not acted on. “Such a request may be associated with conditions such as depression or other mental disorders, dementia, reduced decision-making capacity and/or poorly controlled clinical symptoms,” it says.

“Understanding and addressing the reasons for such a request will allow the doctor to adjust the patient’s clinical management … or seek specialist assistance.”

Dr Gannon said there was confusion among some doctors where to draw the line between euthanasia and the doctrine of “double effect” in medicine — palliative measures that could hasten a dying patient’s death.

“What is so important is the distinction of primary intention,” he said. “One of the things that is ­asserted frequently is that euthanasia is happening in hospitals around Australia every day. That is simply not the case.”

Citing drugs and compounds that have been linked to doctor-­assisted suicide, Dr Gannon said: “If it was the case that doctors were prescribing insulin or potassium or Nembutal every day, then that would be entirely inappropriate. But to prescribe high doses of ­opioids like morphine to a dying patient, that does not constitute euthanasia.

“The doses of morphine that people are given at the final stages of a terminal illness are not enough to end your life or my life. The fact is that people are dying, and part of that process is the failure of different organ systems.

“We want to emphasise the ­really important role of doctors in caring for human beings … all the way through to the end of life. Doctors are trying to provide the best possible care, being compassionate, being fair and trying to make people feel dignified and comfortable as they inevitably move on.”

Ben White, of the Australian Centre for Health Law Research at Queensland University of Technology, agreed it was legal for doctors to provide pain relief that hastened death as long as the ­intent was to alleviate patients’ suffering, not kill them, and the treatment accorded with good medical practice.

In his first direct comments on the South Australian euthanasia legislation that was voted down last week on the casting vote of the Speaker, Dr Gannon described the failed bill as dangerous. As reported by this newspaper, an initial draft of the proposed “death with dignity” law in SA failed to specify that it would apply only to terminally ill people.

A parliamentary inquiry in Victoria in June recommended that voluntary euthanasia be made available to people dying in untreatable pain. The state government is due to respond soon.