AMA: Voluntary Euthanasia Bill - Ending Life with Dignity 2013

AUSTRALIAN MEDICAL ASSOCIATION (SA) INC
First Floor, 80 Brougham Place, North Adelaide SA 5006

Dear Members of Parliament 

Re: Voluntary Euthanasia Bill - Ending Life with Dignity 2013 & Consent to Medical Treatment and Palliative Care (Withdrawal of Nutrition and Hydration) Amendment Bill 2013 

We write in regard to the Voluntary Euthanasia Bill Ending Life with Dignity 2013 and Consent to Medical Treatment and Palliative Care (Withdrawal of Nutrition and Hydration) Amendment Bill 2013. Recent copies of both proposed Bills have been provided to the AMA(SA) by the Hon Dr Bob Such MP. 

The AMA(SA) strongly opposes both Bills, considering them to be fundamentally and irretrievably flawed. 

While the medical community has a range of opinions on euthanasia, the AMA position statement remains clear: "The AMA believes that medical practitioners should not be involved in interventions that have as their primary intention the ending of a person's life".  Treatment where there is a specific intent to end life constitutes euthanasia. 

The AMA strongly supports the appropriate provision of good quality palliative care to patients in the terminal phase of a terminal illness.  In providing this care, doctors should be able to provide adequate treatment to relieve the pain and distress suffered by their patients, even if it may have the secondary effect of hastening death.  This protection for South Australian doctors is already clearly provided for under the present Consent to Medical Treatment and Palliative Care Act 1995 (Consent Act). 

It is of significant concern that these Bills appear to have major elements that are ill-conceived, indicate a fundamental lack of understanding of current concepts in end-of-life care, and show a confusion in understanding of the critical difference between palliative care and euthanasia. 

They have the potential to confuse and compromise the provision of good end-of-life care, with resulting distress to patients and their families.  We do not believe that these Bills have been the products of an acceptable level or period of informed community and stakeholder consultation and engagement and consider that they would bring divisiveness and confusion. 

Section 28(2)(b)(iii) of the Ending Life with Dignity Bill indicates that a medical practitioner may carry out a voluntary euthanasia request by "withholding or withdrawing medical treatment in circumstances that will result in an end to life".  The withholding or withdrawal of treatment that is determined to be futile in a patient in the terminal phase of a terminal illness does not constitute euthanasia, falls within the widely accepted definition of current palliative care practice, and is already clearly provided for under the present Consent Act.  This key component of the proposed Bill indicates a fundamental failure to understand the critical difference between euthanasia and palliative care. 

The proposed amendment to section 17(2a) of Consent to Medical Treatment and Palliative Care (Withdrawal of Nutrition and Hydration) Amendment Bill 2013 states that "a medical practitioner must not withdraw or withhold life sustaining measures consisting of the artificial nutrition or hydration of a patient" with the implication that a patient "suffers discomfort" from this.  It is widely accepted that the clinical states of dehydration and loss of appetite are part of the normal process of dying and do not, in and of themselves, cause distress or suffering, particularly in an unconscious, dying patient.  These states must be differentiated from the symptoms of thirst and hunger, which may sometimes be distressing, but can be alleviated. 

Ironically, the proposed amendment would have the likely effect of forcing medical practitioners to provide artificial nutrition and hydration for an unconscious and dying patient who is unlikely to be suffering from distress from dehydration or loss of appetite, through the provision of potentially distressing measures such as invasive tubes via the throat or surgically via the stomach, or via needles into the veins.  This proposition goes against the best interests of the patient if the aim is to alleviate suffering, and is inconsistent with accepted principles of good medical care. 

The above are merely two examples in Bills that we consider to be flawed overall and which we do not believe should advance in any form. 

The lack of consultation and engagement in these Bills is in contrast to the Advance Care Directives Bill 2012. The AMA(SA) has given its support to the Advance Care Directives Bill (contingent on amendments advised to us in January 2013) as it has the view that it advances patient autonomy, simplifies the system for patients to express their wishes, reaffirms the ability of medical practitioners to provide adequate treatment to relieve the pain and distress of a dying patient, and clarifies that doctors do not have to provide treatment which they believe is futile.  The AMA(SA) does not believe that the provisions of the Advance Care Directive Bill 2012 constitute or advance euthanasia. 

The AMA(SA) opposes the Ending Life with Dignity Bill and the Consent to Medical Treatment and Palliative Care (Withdrawal of Nutrition and Hydration) Amendment Bill on the basis that they are fundamentally flawed, are not the products of acceptable levels of consultation and engagement, and are likely to cause more confusion and harm than good.  It is also surprising that these Bills are being progressed at the same time the Parliament is being asked to consider the Advance Care Directives Bill

We acknowledge Dr Such's stated intention to assist people who are terminally ill and in pain; however, we would urge Members of Parliament to direct your support towards the provision of good palliative care services, which are presently under-supported.  We would welcome dialogue with Members of Parliament on how better care and support can be provided to people who are suffering from a terminal illness. 

Yours sincerely 

Joe Hooper 
LLB(Hons), BSc(Nursing), Dip Applied Science 
Chief Executive Officer

  Voluntary Euthanasia Bill - Ending Life with Dignity 2013