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The following article is from the SAVES newsletter, The
VE Bulletin, Vol 14 No 3, Nov 97
The Law and Medical End-of-Life
Decisions in Australia
The results of the survey by Helga Kuhse, Peter Singer, Peter Baume
et al. of Australian doctors designed to enable comparisons to be made
with practice in the Netherlands were published early this year in the
Medical Journal of Australia. The survey showed that the way medical end-of-life
decisions are made in Australia is less satisfactory than in the Netherlands.
A Fact Sheet and article [go to article]
on the survey were published in the July 97 issue of the VE Bulletin.
The Australian Medical Association requested two additional questions
be appended to the survey and it was agreed that the responses to these
questions would be reported separately. This has now been done in an article
published in the 1 September 1997 issue of the Medical Journal of Australia.
(Nespolon HM, Kuhse H, Clark M, Woollard KV. Medical end-of-life decisions
and legislation. Med J Aust 1997; 167: 282-3.)
The questions were intended to show whether Australian doctors felt
constrained by the current law in their end-of-life decision making. The
questions were:
Q24: Did your perception of the law, as it applies in your
State or Territory, inhibit or interfere with your preferred management
of the patient and end-of-life decision?
Q25: [To be answered by those who answered YES to Q24]
Would enactment of laws providing defined circumstances in which a drug
may be administered with a terminal illness, with the explicit intention
of hastening the end of life, have enabled your patient to receive better
of more appropriate care?
A large majority (91%) of doctors responded NO to Q24, with 8%
responding YES. Of those responding YES to Q24, 69% thought
that new laws permitting euthanasia would have enabled the patient to receive
better or more appropriate care and 30% thought not.
Dr Michael Ashby, Director of Palliative Care in the Department of Medicine
at Monash University, in a comment published with the article suggested
that the responses to these questions showed the limitations of an empirical
"market research" approach to ethical and legal issues in medicine. It
is difficult not to agree because we are left wondering how to interpret
the figures.
Is this an example of the medical arrogance that goes with "we are outside
the law because doctor knows best"? Does it mean that most doctors are
out of touch with their patients when it comes to end-of-life decision
making? Or do most members of the general public change their opinion regarding
voluntary euthanasia when they actually face death? Or does it mean that
although euthanasia is an option that should be available to all, it is
ultimately requested and needed by relatively few? (The survey suggested
the current figure for those receiving a requested medically hastened death
was 1.8% of all deaths.)
As quoted in the Canberra Times of 4 September 1997, Helga Kuhse said
that the results of the two questions did not undermine the case for legislating
for euthanasia.
"The fact that 8 per cent of responding doctors thought that existing
laws precluded them from providing care is of great moral significance.
It suggests that many Australians die in suffering and pain and provides
a prima facie argument for law reform," she said.
The results of the second question strengthened that argument.
"The fact remains that a very considerable number of doctors who chose
to answer the question thought that the decriminalisation of euthanasia
and/or assisted suicide would have allowed their respective patient to
receive better care."
The survey found more doctors (46%) wished to have the option than not
(36%).
The Australian Medical Association will continue to lack credibility
in representing their members' views on the voluntary euthanasia issue
while they refuse to carry out an authentic survey of their membership's
views.
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