More needs to be done for end of life care – AMA president


Nationally consistent palliative care services and standards are urgently needed to improve quality end of life care, says the Australian Medical Association.

The call came with the AMA’s release of its updated position statement on Euthanasia and Physician Assisted Suicide 2016, which maintains its position that doctors should not be involved in interventions with a primary aim of ending of a person’s life.

While assisted death remains illegal in Australia, there is increasing pressure on governments to consider legislation that could be framed to allow for people to access these services.

South Australia has made a number of unsuccessful attempts to have it passed through parliament and Victorian politicians are due to debate proposed legislation any day now.

The Victorian Parliament’s Legislative Council Legal and Social Issues Committee tabled a report in June that recommended passing laws making it legal for a terminally ill patient at the end of their life to ask a doctor to help them die.

AMA president Dr Michael Gannon applauded the quality of the report, and conceded that a ‘significant proportion of our members’ were keen to see it happen in Australia.

However they also want legislation that offers clear protection for patients and doctors.

“We must also maintain the ability of doctors, nurses and health professionals to conscientiously object to participation,” he told the limbic.

The updated position statement is the result of a comprehensive year-long policy review by the AMA, including a survey of AMA members, and was updated against the backdrop of increased community and political debate on euthanasia and physician assisted suicide.

“I think the statement is very positive,” Dr Gannon said. “There’s something in the policy statement that has something for everyone.”

He said there would no doubt be critics, and he appreciated there was a wide range of opinions on euthanasia and assisted suicide, but the statement was a reflection of the survey results.

He said it was important that the AMA had its collective views heard, especially in a climate where some state parliaments were currently considering euthanasia legislation.

“The key outcome from our policy review – and the core message from our updated Position Statement – is that there needs to be much greater investment in quality end of life care, especially nationally consistent palliative care services,” he said.

The AMA Position Statement on Euthanasia and Physician Assisted Suicide 2016 replaces the Position Statement on the Role of the Medical Practitioner in End of Life Care 2007 (Amended 2014).

Dr Gannon said that the AMA maintained its position that doctors should not be involved in interventions that have as their primary intention the ending of a person’s life.

“This does not include the discontinuation of treatments that are of no medical benefit to a dying patient. This is not euthanasia,” he said.

He said greater investment in improved end of life care must be accompanied by a comprehensive education and information campaign to raise community awareness of the care, compassion, and medical and nursing assistance and expertise that is available to assist patients in the final stages of their lives.

“The compassionate care of dying patients is the priority of every doctor,” he said.

“Doctors have an ethical duty to care for dying patients so that they can die in comfort and with dignity. We are always there to provide compassionate care for each of our dying patients so they can end the last chapter of their lives without suffering.”

Dr Gannon said there was a strong community misconception that doctors already engaged in the practice of administering high doses of drugs like morphine at a patient’s final stages of terminal illness in order to expedite their death.

This highlighted the need for clearer understanding of palliative care services at a community level, and national standards would also help with this.

He said doctors providing best practice end of life care and relieving pain should not be construed as a silent nod to euthanasia.

“They are fundamentally different and that should be a well-understood ethical doctrine,” he said.

“There is already a lot that doctors can ethically and legally do to care for dying patients experiencing pain or other causes of suffering This includes giving treatment with the intention of stopping pain and suffering, but which may have the secondary effect of hastening death. This is known as the principle of double effect.”

Dr Gannon said euthanasia legislation was a societal issue, but he hoped doctors would have input into the development of any guidelines.

“If new legislation does come into effect, doctors must be involved in the development of the legislation, regulations, and guidelines to protect doctors acting within the law, vulnerable patients, those who do not want to participate, and the wider health system,” he said.

Doctors were also keen to ensure the legislation be strong enough to avoid it becoming a slippery slope that extended the right to euthanasia to anyone. Dr Gannon highlighted the recent move in the Netherlands to allow an alcoholic to end his life.

“That’s a bridge too far for the vast majority of doctors,” he told the limbic.

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