South Australian Voluntary Euthanasia Society
The following is from the SAVES Newsletter, The VE Bulletin, Vol 16 No 2, July 99
Care of the Dying (5th Report)
The Care of People who are Dying is the subject of an
annual report to the South Australian Parliament by the
Department of Human Resources (formerly the Health
Commission). The fourth report was reviewed in the
SAVES Bulletin of November 1998 (see below). The fifth Report,
which is the subject of this note, covers the period 1
September 1997 to 31 August 1998.
The report examines the year's activities and achievements
in relation to the 37 recommendations made by the Select
Committee on the Law and Practice Relating to Death and
Dying. Once again it presents a proud record of palliative
care services, impressive in their quality and scope. An
appendix containing extracts from the Strategic Plan for
Palliative Care Services 1998-2006 outlines proposals for
future development. We can consider ourselves well
served in this developing area of health care with its high
degree of accountability.
A principle outcome of the work of the Select Committee
was the passage of The Consent to Medical Treatment and
Palliative Care Act 1995. This provided schedules for the
appointment of a medical agent and/or the completion of
an advance directive, and established a registry of
directives and nominated agents. It replaced and
improved upon the 1983 Natural Death Act, which found-
ered largely because it was little known among the general
public, or even among doctors and other health carers.
The 1998 report refers to efforts made to promote public
awareness of the new Act, but fails to comment on the
success or otherwise of these, or on what use has been
made of the schedules and the registry. Among the
findings of community-based research with which I was
associated was that there was widespread ignorance of the
Act, and/or misunderstanding of its provisions, and an
unmet need for advice on how to make effective use of
them. Unfortunately this research, although funded by the
Health Commission, is not acknowledged and its main
findings have been disregarded.
It is a matter of concern that a major piece of
legislation affecting the medical care of people at the
end of their lives may be underutilised because it is not
known, or not understood. The active involvement of
general practitioners could make a big difference, but
the research program designed to explore this aspect
failed to secure adequate funding.
A recent pamphlet issued by the Australian Medical
Association headed "General Practice. The Modern
Patient-Doctor Relationship is a Partnership" speaks of
the GP as "an important source of advice on health
and lifestyle". Surely the patient's role in end-of-life
decision-making should have a significant place in the
partnership.
Eric Gargett
The following article is from the SAVES newsletter, The VE Bulletin, Vol 15 No 3, Nov 98
Care of the Dying (4th Report)
The Select Committee on the Law and Practice
Relating to Death and Dying is remembered mainly
for bringing about the Consent to Medical Treatment
and Palliative Care Act 1995 which is the basis of
our current Living Will guidelines. But the
Committee made other recommendations which were
adopted, one of which required the Minister to report
annually to Parliament on the Care of People who
are Dying in South Australia.
The fourth report, issued in December 1997 with a
brief supplement in January this year, is a substantial
document of 31 pages and three appendices.(*) The
principle sections deal with Funding; National and
State Projects; Optimal Service Delivery and Service
Provision (i.e., the "desirable" and the "actual"); the
Consent Act (why not call it the Palliative Care Act?)
and education on the Act; Community and
Professional Awareness; Service Provider Education;
and Ethical Considerations.
One is immediately struck by the scope and quality
of the programs which feature in what we so lightly
refer to as "palliative care". It is not surprising that
claims have been made that South Australia leads the
country in this field of medical practice. Meticulous
annual monitoring exposes both achievements and
unmet needs. Existing services are operating at full
capacity and the case for expanding resources is
obvious.
This is particularly true in light of the growing
likelihood that voluntary euthanasia will eventually
receive legal recognition. Voluntary euthanasia
should only be implemented if patients can be offered
the free choice of optimal palliative care. When
voluntary euthanasia was legalised in the Northern
Territory, and medically assisted suicide in Oregon,
there was a flurry of concern over the inadequacy of
palliative care resources and they were substantially
increased.
In the section of the report dealing with ethical
considerations there is a paragraph headed
CURRENT DEBATES ON EUTHANASIA AND
ASSISTED DEATH. Anne Levy's Bill had been
referred to a Select Committee at that stage, leading
to the following comment:
"The proposed Bill is
unique in that it proposes to incorporate an advance
directive that would cover active voluntary
euthanasia. If the Bill passes into legislation it will
clarify concerns about medical decisions at the end of
life."
And so say all of us. So why not do it? Maybe
MPs don't read the report.
Eric Gargett
* Report to Parliament on the Care of People who
are Dying in South Australia. South Australian
Health Commission. 1997.
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