The final report by the WA Ministerial Expert Panel on End of Life Choices, chaired by Malcolm McCusker, has recommended a WA assisted suicide bill that has less protections than Victoria.
Unlike in Victoria, their WA model permits doctors to raise the subject of euthanasia with their patients. FamilyVoice WA Director Darryl Budge has highlighted the high risk of patients being steered into assisted suicide, in a recent media release.
A patient whose death is “reasonably foreseeable” within 12 months can apply, whereas it is six months in Victoria. The panel has thus rejected the advice from AMA (WA) about prognosis: “Death must be imminent within 6 months, as the outcome of the medical condition. Further, all measures must have been exhausted to remediate the person’s suffering.”
A doctor and a senior clinical nurse may assess a patient for approval, to determine if they have “decision-making capacity”. In Victoria, it is two doctors. More concerningly, the Panel recommended that “neither doctor [nor the senior nurse] is required to be a specialist regarding the person’s disease or illness.” Rather than recommending more palliative care in regional areas, the panel justified these decisions by referring to “the scarcity of medical practitioners in many country districts and towns of Western Australia.”
The panel recommended that mental illness (assuming “decision-making capacity) is not a barrier, but did not set any requirements for expert psychological or psychiatric care in these situations.
Regarding the Victorian assisted suicide law, the former AMA vice-president Stephen Parnis said the fact that 68 “so-called safeguards” were a central pillar of Victoria’s assisted suicide legislation affirms the clear risk of wrongful deaths.
“In order to satisfy the needs or demands of a number of people to be able to take their own life when they choose, we are putting many more frail, vulnerable, dying people at risk. The word ‘dignity’ is bandied about here, as if dignity at the end of life hasn’t existed until this day,” he said. “I’ve assisted thousands of people at the end of their life over 27 years of medical practice. Dignity does not require a lethal potion.”
Legislation is expected to be introduced into the WA Parliament after it resumes from its winter recess on 6th August 2019.
The following is the full May 2019 open letter from the West Australian Medical Specialist Group, consisting of 27 actively practising Palliative Care consultants:
The McGowan Government has invited public comment on its discussion paper Ministerial Expert Panel on Voluntary Assisted Dying.
We write as WA palliative care specialists whose vocation is caring for those who are dying. Between us, we have been privileged to care for tens of thousands of patients and their families. We would like to explain our position regarding the Government's proposal to legalise euthanasia. In our conversations with our patients, their families, politicians, and even our medical colleagues, we are concerned about the confusion and misunderstanding regarding euthanasia and palliative care.
The confusion starts with the language. The discussion paper uses the term "voluntary assisted dying". This term is ambiguous. It could be used to describe palliative care: we provide assistance to people who are dying. It would be less confusing if the discussion paper were entitled Ministerial Expert Panel on Euthanasia and Assisted Suicide. The older term "mercy killing" has fallen out of use, but is actually a more accurate description than "voluntary assisted dying".
The proposal to legalise euthanasia and assisted suicide involves a massive change in the ethics of our society. "Do not kill" is a foundational ethical principle which has been observed by every civilisation for thousands of years.
Euthanasia and assisted suicide are not medical treatments, and most emphatically not part of palliative care.
We agree with the World Health Organisation statement on palliative care:
- Affirms life and regards dying as a normal process;
- Neither hastens nor postpones death;
- Provides relief from pain and other distressing symptoms;
- Integrates the psychological and spiritual aspects of patient care;
- Offers a support system to help patients live as actively as possible until death; and
- Offers a support system to help the family cope during the patient's illness and bereavement.
We support the patient's right to:
- Refuse treatment (such as surgery and chemotherapy);
- Cease treatment deemed unnecessary (such as kidney dialysis, ventilators and admission to ICU);
- Control symptoms (including pain, breathlessness and agitation); and
- Choose where they will die.
Most people want to die at home. In Perth we are blessed with an excellent range of palliative care services, whether the patient is in a hospital, a Palliative Care Unit or at home. Sadly, many Western Australians do not have access to these services.
Unlike euthanasia, palliative care aims to provide total care (body, mind and spirit) for patients and support for their families.
With modern medications and procedures, we can almost always control symptoms. In extreme cases, at the request of a dying patient and his or her family, we have occasionally used deep sedation to control symptoms that did not respond to the usual treatment.
Rarely, a patient will say to us, "doctor, I just want to end it all". Contrary to popular opinion, the reason for such requests is not pain, but despair and loneliness also called "existential suffering". Euthanasia is not a treatment for despair and existential suffering. Provision of holistic care by a skilled interdisciplinary team of health professionals enables patients and families to acknowledge and attend to distress within themselves and their relationships. The time before death offers unique opportunities for psychospiritual growth and allows for healing even without a cure.
We agree with the discussion paper that, "too many Western Australians are experiencing profound suffering as they die. This is, in part, due to inequitable access to palliative care".
According to the parliamentary records of 3rd April this year, Western Australia has the lowest proportion of specialist palliative care doctors of any state in Australia. We have 15 full-time equivalents for the state, less than one third the number required to meet national benchmarks.
According to the Honourable Jim Chown, whose motion was supported unanimously, WA needs at least another $100 million per year spent on palliative care for staffing and education, in addition to funding for infrastructure such as palliative care wards and beds.
We do not believe euthanasia or assisted suicide are solutions to suffering. We reaffirm our commitment to our patients: we will continue to care for you to the best of our ability, guided by your choices, but we will not kill you. Although we work in a variety of institutions, these opinions are our own and not necessarily those of our employers.
Prof Douglas Bridge. BMedSc (Hons). MBBS. FRACP, FRCP (UK). FAChPM. DTM&H; Dr Anil Tandon, MBBS, FRACP; Dr Derek Eng, MBBS. FRACGP. FAChPM; Dr Ashwini Davray. MBBS, MD, FRACP. FAChPM; Dr Mary McNulty, MBBS. FAChPM; Nurse Practitioner Giuliana Duffy, MN; Dr Paula Moffat MBBS, FRACP, FAChPM; Dr Alice Phua, MBBS, FAChPM; Nurse Practitioner Lou Angus. MN: Dr Andrew Hart, MBBS. FRACP, FAChPM: Dr Shannyn George, MBBS, FRACP, FAChPM: Dr Sampath Kondasinghe. MBBS, FRACP; Dr Kevin Yuen.MBBS, FAChPM; Nurse Practitioner Natalie Panizza, MN: Penelope Tuffin, Adv Prac Pharm; Dr Ellen Knight. MBBS, FAChPM; A/Prof Alison Parr. MBBS. MSc, FRCP (UK), FRACP, FAChPM; Dr Lisa Cuddeford. MBBS, CCT, MRCPCH, FRACP: Dr Ranbir Dhillon, MBBS, FAChPM; Dr Carolyn Masarei. MBBS, MRCP (UK). PGDipMed(PC), FAChPM; Dr Scott Lee, MBBS, FRACP. FAChPM; Nurse Practitioner Claire Doyle. MN