A CHALLENGE TO THE AUSTRALIAN MEDICAL
ASSOCIATION
The Australian Medical Association, in common with most medical
associations, has been vehement and ruthless in its opposition to any form
of legalised voluntary euthanasia no matter what the circumstances. This
has created enormous difficulties in providing the best possible health
care of candidates for legal voluntary euthanasia in the Northern Territory.
It has also given undeserved support for the Andrews Bill which, if passed
in the Australian Senate, will overturn the Northern Territory Rights of
the Terminally Ill Act.
In the following letter, an Adelaide medical practitioner and member
of the Australian Medical Association challenges the credibility of the
Association's position.
Dr. Keith Woollard
President
Australian Medical Association
January 8th, 1997
VOLUNTARY EUTHANASIA
Dear Keith,
I have been following with great interest and growing alarm the debate
on voluntary euthanasia. This is with special reference to the Senate enquiry
prior to the vote on the Andrews Bill in the Upper House.
Again I question the apparent unanimity of medical opinion as presented
in statements from the Federal A.M.A. supporting the Andrews Bill and it's
intention to oppose the regulation of the suspected widespread covert practice
of Voluntary Euthanasia. I reflect on the origins and democratic basis
of this stance taken up by the A.M.A. Executive. I anticipate that this
originates from the Annual Conference. I would still question how accurately
this reflects the quiet opinions of the membership not to mention the views
of the wider medical community who unwisely have decided against membership
of the A.M.A.
I would remind you that in that Conference a motion supporting the status
quo was proposed by the Chairman of the Northern Territory Coalition Against
Euthanasia. This was introduced in the closing stages of the Conference
and without prior circulation to the delegates, thereby inhibiting their
opportunity to canvas the opinions of their membership on the subject.
I would further remind you of the constitution of the membership of
the sub-committee of the Ethics Committee of the Federal A.M.A. set up
in 1996 to review the A.M.A. policy on Voluntary Euthanasia. This committee
was entirely composed of doctors who were clearly opposed to any change
in the legislation. This seems to me to have been a biased selection, politically
unsound and even undemocratic.
Delegates to that Conference would I suppose come from those practitioners
who may be identified as the "medical establishment". I wonder how many
of you have realistically and confidentially sought the opinions of the
craft group membership that you represent. I suspect that this research
has been inadequate and incomplete. In addition I would suspect that even
in private conversation, the supporters of voluntary euthanasia may be
reluctant to emphasise their views, however regrettable that may be. I
would maintain that in a matter as serious as this that the Federal Executive
has no right to present such a polarised viewpoint without the assistance
of a referendum.
I wonder how many of you have been able to consider this matter in a
logical and dispassionate way remote from the other and non medical influences
to which we are all subject. Surely, it must be the epitomy of excellent
care that a lost cause must be abandoned in the most caring manner possible.
And don't talk to me of palliative care since it has been agreed that there
is a small percentage of patients who cannot be comfortably managed in
this way; and this is not to mention the painless but terminally incapacitated
individuals.
Why then do the "doctors" oppose this practice? Firstly, at least in
this country, we don't live with death comfortably. We don't have a daily
experience of it in sufficient numbers to allow an adequate familiarity
as may be the case in other parts of the world. Then, I suspect that Australians
suffer a degree of 'National Agoraphobia' and the loss of any of us (whether
by death or departure) deepens that neurosis.
It's worth reiterating that we are a proud lot who suffer failure poorly.
One can see this for example in our attitudes to medical litigation, which
seems to excite irrational and uncharacteristic responses from many of
us. In these situations rationality and logic seem to desert us.
Then there is the question of power. When I was a Branch Councillor
here in South Australia, I attempted to resuscitate this subject for debate
by the Branch Council. To my surprise my motion was seconded by a most
senior doctor who might be described as being "right-wing" and unlikely
to normally support the practice of voluntary euthanasia. When I subsequently
spoke to him to thank him for his support, I received the unexpected response.
He told me that he supported my motion because "he wouldn't want the nurses
to usurp our role in undertaking euthanasia". Elsewhere I have heard comments
to the effect that "we don't want a third party interfering in our end
of life decisions" and further that "we wish to continue to manage these
situations in our traditional way". I am afraid this was never a tenable
position and is even less so now. The euthanasia cat is well and truly
out of the bag. How comfortably does the A.M.A. Executive view the potential
if not inevitable prosecution for murder of one of our members in a "mercy
killing"?
I read with dismay the Hansard transcript of the speech by Ms. Trish
Worth. I regret her use of unacceptably emotive words such as "execution".
I am saddened that she stoops to quote Dr. Pollnitz in his comment that...
"some of my colleagues cannot be trusted to kill. There are doctors
whose own peculiar emotional needs are met by the blend of power and intimacy
in a death-dealing relationship...It can be argued that those doctors who
are most interested in performing euthanasia are those whose own emotional
needs in the matter should disqualify them"
This is an appalling criticism that Dr. Pollnitz makes of his colleagues.
Where was the rebuttal from the A.M.A. of this shocking assertion? Let
us assume for the moment that there may be some validity in this unlikely
claim. If indeed there are amongst our number "death dealing doctors",
then if anything it strengthens the argument for restricting the practice
by supervising legislation, and to protect the public from the depredations
of these mad medicos!
My anger at the biased viewpoint of A.M.A. statements on this matter
has prompted me to consider again my membership. Mature reflection has
convinced me however that it's better to stay and fight. As a lifetime
Liberal voter, Ms. Worth has lost my vote on this one as has Dr. Brendan
Nelson whom I recall stating in our annual A.M.A. Dinner that "the politicians
know better than their electorate and that he would be supporting the Andrews
Bill".
In the intransigent opposition exhibited by the A.M.A. against voluntary
euthanasia, I am reminded of the "Three Blind Mice" and remember what happened
to them at the hands of the Farmer's Wife!
With best wishes,
ROBERT A. JONES
Medical Practitioner, Adelaide.
Dr Woollard has kindly given permission for his reply to Dr Jones to be
presented here:
Dear Robert,
Thanks for your recent note on euthanasia.
The AMA, as you know, has long agreed with the statements from the World
Medical Association opposing euthanasia. Before the Northern Territory
legislation was first introduced, I took steps to have the policy reviewed
extensively. The Ethics Committee contains members with a wide range of
views. The sub-committee which you commented on at one stage was merely
a small number of experts asked to advise the AMA on technical matters
relating to palliative care.
The final decision to continue to oppose euthanasia was made, with almost
no dissent, by the Federal Council of the AMA following an invitation for
submissions to all of the branches of the AMA. None of those submissions
suggested that we change our position.
Nonetheless I personally have remained concerned to try and get some
grass roots views on this troublesome issue.
As you are probably aware, a recent MJA publication found that some
90% of doctors declined to assist a hypothetical patient requesting euthanasia.
Last year, an opportuntity arose to obtain further information. Drs
Kuhse, Baume and Singer received a NH & MRC grant to repeat the Netherlands
survey on doctors' attitudes to care of dying patients. At my request,
the investigators kindly added two questions to that survey to obtain doctors
views of the Northern Territory legislation. Those results are not yet
available but when they are, they should enable me to know whether the
view that I am putting forward is truly representative of the medical profession
and members of the AMA.
I have done everything I possibly can to ensure that we tap into the
feelings of as many members of the AMA as possible on this issue and will
continue to do so. For that reason I am very grateful when doctors such
as yourself, who hold opposing views, take the trouble to write to me and
I do read all of the letters. When the results of the Kuhse survey are
available for presentation I will ensure that they get wide publicity.
Kind regards,
KEITH WOOLLARD, President
20 January 1997
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