SAVES is not affiliated with Exit International / Dr Philip Nitschke and opposes the public availability of a 'peaceful pill'.

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.

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.

* Report to Parliament on the Care of People who are Dying in South Australia. South Australian Health Commission. 1997.