By Anthony Barich
The Australian Medical Association is against euthanasia and its President believes doctors should not be expected to decide whether a person requesting euthanasia is under duress.
Dr Andrew Pesce, AMA national president, responded to The Record’s enquiry regarding the Voluntary Euthanasia Bill 2009 to be debated in WA Parliament from 21 September which stipulates that two doctors unrelated to the patient must assess the eligibility of the applicant for the administration of euthanasia.
This includes judging whether the patient is under duress or undue influence, which Liberal MLC Nick Goiran, a lawyer, told The Record are contract law concepts that doctors are ill-equipped and likely unwilling to make judgments on.
Dr Pesce, an obstetrician and gynecologist, told The Record last week that doctors are “not in a position to assess a person’s social circumstances”.
The doctor’s position is especially difficult if the doctor is the family GP, knows them well and is likely to be the one administering the euthanasia, he said.
“If they’re the GP for the family members that makes it a more complex decision on behalf of the doctor,” Dr Pesce said.
“Doctors are placed to make medical assessments of the nature of the illness; maybe whether it’s an illness which would be one whether you’d consider euthanasia an option, and make medical assessments.
“But they’re not in a position to make such a significant assessment of the patient’s social circumstances. Perhaps as the family doctor they have insights and can provide, but if that will be used as a yardstick (as to the patient’s eligibility for euthanasia), it should be made by someone apart from the medical dynamics of the patient.”
He said England’s current proposal to appoint a tribunal to judge whether a patient is under duress is preferable to treating physician.
However, he said the AMA is flatly against euthanasia.
“We believe that doctors should not have to do anything where the only intention is to end life. Our obligation is to relieve suffering, and while doctors must do things which sometimes end up hastening death in pain relief, sedation etc, euthanasia is a treatment whose express purposes is to end life,” he said.
Mr Goiran said that if the Voluntary Euthanasia Bill 2009 were to become law, people will make these decisions under duress or undue influence, and they can’t be protected, because “if you want to remedy it after the event you can’t go to court”.
“It’s a legal impossibility to protect people from involuntary euthanasia once you allow voluntary euthanasia,” Mr Goiran said.
He said that Greens MLC Robin Chapple, who introduced the Bill, attempted to address these issues in the Bill by saying the doctor who has to make the decision must take into consideration whether the person is under duress, “but that’s just a cheap one liner, because what if the doctor doesn’t address that; how do you remedy that situation after the event?” Mr Goiran added.
“Is that doctor qualified to determine if the person is under duress? It’s a legal concept; and I don’t know that doctors want to be making those kinds of decisions.”
Mr Goiran said the very fact that Mr Chapple includes these clauses in the Bill shows he accepts it’s a concern and a problem that people enter into the situation under duress.
“By trying to draft laws like that into the bill, he confirms the point that it’s impossible to protect such people,” Mr Goiran said.
“The person is the only other witness apart from the doctor when the decision is being made, and what if after the event the family is upset and believes the grandmother was under duress?”
In a letter sent to Mr Goiran on 11 September, 2009 advising him of the Bill he intended to introduce into Parliament, the Greens MLC said the Bill will provide immunity from criminal and civil liability to a medical practitioner who administers euthanasia to a terminally ill person in accordance with that person’s wishes, provided that euthanasia is administered strictly in accordance with the requirements of the Bill.
One of the six “safeguards” Mr Chapple says the Bill has in place is that two medical practitioners must, independently of each other, assess the eligibility of the applicant for the administration of euthanasia
If the two medical practitioners determine that the applicant is eligible for euthanasia, the applicant may sign a second notice of consent indicating that euthanasia should be administered.