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Handbook of the South Australian Voluntary Euthanasia Society (SAVES)
THE RIGHT TO CHOOSE: THE CASE FOR LEGALISING VOLUNTARY EUTHANASIA
8. THE ROLE OF THE MEDICAL PROFESSION
Voluntary euthanasia should only be carried out by medical practitioners.
It is from their patients that the request will come; it is they who have
the skills to assess the condition and advise the patient, the means to
comply with the request, and the professional integrity and organisation
to implement and monitor the practice.
Voluntary euthanasia is a measure of last resort, a final treatment
option available to doctors dealing with unrelievable suffering. There
must be an informed request from the patient and the right of the doctor
to refuse must be absolute. There must be safeguards prescribed by law
as well as guidelines for sound practice developed within the profession.
The procedure, always intensely personal, must never be undertaken lightly.
It should be carried out by the attending doctor, as extra assurance of
a carefully considered decision. This assurance would be missing if, (as
has been suggested), the patient could be passed on for euthanasia to be
administered by someone else.
It is sometimes argued that doctors as preservers of life should not
be involved with voluntary euthanasia. But doctors are involved
because it may be the most compassionate response to the situations they
face. As Quill and others have said:
"One of medicine's most important purposes is to allow hopelessly
ill persons to die with as much comfort, control, and dignity as possible.
The philosophy and techniques of comfort care provide a humane alternative
to more traditional, curative medical approaches in helping patients achieve
this end. Yet there remain instances in which incurably ill patients suffer
intolerably before death despite comprehensive efforts to provide comfort.
Some of these patients would rather die than continue to live under the
conditions imposed by their illness, and a few request assistance from
their physicians." [14(e)].
The degree of medical involvement is already considerable. Journals
of medicine and medical ethics carry numerous articles that consider how
such requests should be responded to, or how they have in fact been responded
to, including by euthanasia [40],[41]. Surveys of doctors' attitudes and
practices have indicated their participation in and support for voluntary
euthanasia, but also, disturbingly, the extent of non-voluntary euthanasia.
It seems likely that the latter would be reduced if there were provision
for an advance request.
As noted in the previous section, voluntary euthanasia is currently
practised outside the law without the benefit of professional guidelines,
training or consultation. Both patient and doctor are compromised; many
patients die in unwanted and avoidable distress; even those who are helped
to die do not necessarily obtain as good a death as their circumstances
might warrant. Doctors may make the decision without knowing the patient's
wishes. It is better that voluntary euthanasia should be practised openly
and under rules that respect both the status of the doctor and the rights
of the patient.
In condemning voluntary euthanasia and opposing legislation, medical
associations are contributing nothing to the resolution of this unsatisfactory
situation. They are also failing to represent perhaps half their members,
just as they would be if they gave support.
As mentioned in Section 5, the same quandary is presented by abortion,
recognised by the World Medical Association in a statement, (adopted by
the SA Branch of the AMA), to the effect that the Association cannot take
a stand on abortion because of the division of opinion among doctors, but
supports the individual conscience of the doctor. Although the two measures
are different in practice and from an ethical viewpoint, it would be consistent
to adopt the same position on voluntary euthanasia.
The regulation of medical conduct rests primarily with the profession
in such areas as training; ethical standards; corporate support; and the
sharing of professional wisdom and experience. The medical profession enjoys
a high reputation in these regards and should be capable of making adaptations
appropriate to the introduction of voluntary euthanasia.
The ultimate sanction in medical conduct in South Australia is provided
by the Medical Practitioners Act, 1983, establishing the Medical
Board and the Medical Practitioners Professional Conduct Tribunal and setting
up procedures for "maintaining high standards of competence and conduct
by medical practitioners". It can be assumed that these bodies would operate
to regulate the practice of voluntary euthanasia and that sound practice
guidelines (see Appendix A) would be formulated by the Medical Board.
It is clear that voluntary euthanasia is needed. Inevitably it will
one day be lawful. It is important that health care professions, doctors,
nurses and pharmacists, as well as social workers and counsellors, should
by then be adequately prepared. Rather than blindly oppose the concept,
or seek arguments for rejecting it, doctors individually and the profession
corporately should be critically examining the practice, considering the
implications of a change in the law and suggesting how this might be done.
The change can come about with, or without, their collaboration and input;
the choice is theirs.
The outline proposals in Appendix A are an invitation to turn from academic
or speculative debate to consider what could become a practical reality.
Ultimately the testing ground is legislation that establishes our right
to choose the manner of our dying and facilitates the participation of
medical practitioners. If it is thought the proposals will fail to do this
well, the response should be to suggest how they might be improved. The
alternative is to muddle along under the present law that:
"condemns a significant number of dying patients to intolerable pain
and distress (and) imposes on a number of caring medical practitioners
the threat of prosecution and professional ruin for doing what they believe
their professional duty requires." [30].
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