AMA: Voluntary Euthanasia Bill - Ending Life with Dignity 2013 (second letter)

First Floor, 80 Brougham Place, 
North Adelaide SA 5006

Dear Members of Parliament

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

We write to you again 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 which have been introduced by the Hon Dr Bob Such MP.

The AMA(SA) would like to repeat, in the strongest possible terms, its opposition to both Bills, considering them to be fundamentally and irretrievably flawed. 

Even for individuals who may support euthanasia, the AMA(SA) regards these Bills to be in the realms of dangerous folly which have the potential to damage the basic tenets of clinical practice in ethical and compassionate end-of-life care.  We recognise that there are divergent views on euthanasia and that the voluntary euthanasia bill proposed may go to a conscience vote. However, these Bills would simply create bad, and damaging, legislation.

Members are probably aware that the AMA does not support euthanasia: it believes that medical practitioners should not be involved in interventions that have as their primary intention the ending of a person's life.  This is different to the discontinuation of futile treatment, which falls within the currently accepted definition of palliative care, and is adequately addressed by current legislation.

Setting this aside, however, as detailed in our previous letter to you, these Bills 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 therefore have the potential to confuse and compromise the provision of good end-of-life care, with resulting distress to patients and their families. 

Our concerns about the many flaws of these Bills have been echoed in submissions by the Palliative Care Council SA and the Law Society of SA. 

We also 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.

This lack of consultation and engagement is in complete contrast to the recently passed Advance Care Directives Act 2013 to which AMA(SA) gave its strong support as being world leading in its potential to improve end-of-life care.  The Advance Care Directives Act 2013 addresses the critical issues brought up by proponents of euthanasia.  It does this by greatly advancing patient self-determination and autonomy, removing legislative flaws which have forced doctors to provide futile care to patients in the past, and reiterating the ability of doctors to provide adequate treatment to relieve the pain and distress suffered by their dying patients, even if it may have the secondary effect of hastening death.  The AMA(SA) commends the Parliament for its foresight in this area.

The assistance that good palliative care can provide is not well understood, and we have a crucial need for good, well-resourced palliative care.  Euthanasia must not be the end point of poor resourcing of end-of-life care.

We urge Members of Parliament to turn your valuable attention, time and advocacy in the House to the critical need for a health system that strongly supports good end-of-life care. 

Introducing fundamentally flawed voluntary euthanasia legislation is not the way to do this and in fact will produce the opposite effect, with resulting distress and harm.

The AMA(SA) therefore 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 dangerously flawed.

Having commended the Parliament for its foresight in passing the Advance Care Directives Act, we implore you to reject these two Bills. We would welcome dialogue with Members of Parliament on what can be done to better support palliative care and the needs of people who are suffering from a terminal illness.

Yours sincerely

Dr Patricia Montanaro
AMA(SA) President

  AMA: Voluntary Euthanasia Bill - Ending Life with Dignity 2013 (second letter)