Blood cancers

Oncologists split over medically assisted dying


The peak body for medical oncologists won’t adopt a formal position on medically-assisted dying after its survey revealed members are deeply divided over the issue.

The Medical Oncology Group of Australia’s anonymous survey of  attitudes to legalised voluntary assisted dying (VAD) programs was completed by just over half (55%, 362 oncologists) of the membership. The responses showed that 47% disagreed with the concept on ethical grounds, while 36% agreed and 17% were “neutral”.

MOGA had sought to establish a majority position on the contentious issue, which will become a reality for doctors in Victoria next year.  Australia’s first legalised assisted dying program will require patients be aged 18 or over, expected to live less than 12 months due to a medical condition and have decision-making capacity.

But in a position statement based on the survey, MOGA chair Professor Chris Karapetis and his co-authors note “a clear majority was not established” on medically assisted dying and they “cannot be sure of the views of the remaining 45% of members”.

The 8-point statement notes that “MOGA neither opposes nor supports VAD as a legally acceptable practice in specifically defined situations”.

The statement also advises that:

  • MOGA supports the right for physicians to be conscientious objectors, something which 94% of survey participants agreed with.
  • Palliative care specialists and psychiatrists should be involved in the VAD process – including psychiatry involvement to determine patient competence for patient consent –both ideas were backed by most survey participants.
  • A medical specialist with a detailed knowledge of the disease in question and all the treatment options should be required to be involved in the evaluation of a patient who has requested VAD.

The MOGA survey found while 36% of medical oncologists agreed with legalised voluntary assisted dying, only 14% believed physicians should have to administer a lethal medication.

Most oncologists (80%) said they would not be prepared to write a script for lethal medication, but 20% said they would and a further 36% would refer the patient on to someone who would. A majority (62%) of oncologists said physicians should not be required to be involved in dispensing a lethal medication.

Meanwhile, more than a third of oncologists (37%) said physicians involved in VAD should be required to monitor a patient until they died.

Any legalised program needs to have in-built protections against the risk of patient coercion and allow patients to change their mind, writes Professor Karapetis, from the Department of Medical Oncology at Flinders Medical Centre, Adelaide.

The position statement also highlights how VAD programs have the potential to cause negative impacts on healthcare professionals, leading to an emotional burden, professional stigma and even possible legal repercussions if the process is disputed, and could pose a risk to the therapeutic relationship.

“Bringing medical assisted dying into the ethos and practice of physicians and oncologists irrevocably changes and may undermine the relationship between patient and the healthcare professional”.

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