About us - Example letters

 

 

These are real letters that have been sent in the past and are representative of the type of content and respectful tone taken by this group.

 <A HREF=”http://www.gogentleaustralia.org.au/the_damage_done”>Damage Done</A>


 

   Doctors for Assisted Dying Choic

 

10 July 2017

 

The Hon. Trevor Khan MLC

Deputy President and Chair of Committees
Member, NSW Parliamentary Working Group on Assisted Dying

 

Dear Mr Khan

 Thank you for your letter of the 18th May 2017 inviting Doctors for Assisted Dying Choice to participate in public consultations on the Draft Voluntary Assisted Dying Bill 2017 (NSW).                   Our membership includes a wide spectrum of specialist and general medical practitioners and it is likely that many of our members would be fulfilling the role of primary medical practitioner or secondary medical practitioner, as a medical practitioner registered under the Health Practitioner Regulation National Law in a specialty in the medical profession that is relevant to the diagnosis or treatment of the terminal illness from which the patient is suffering, as specified in the Draft.

 

 We make the following comments and recommendations on medical matters in the Draft Bill:

 

 Clause 4 (a)

Raising the age limit at which a person may apply for assisted dying to 25, as proposed in the Draft Bill is not supported by medical science or current practice.   In NSW, as in other jurisdictions, patients are able to consent or refuse all treatments from the age or 18 and in many cases, younger. This consent includes permission for major operations, such as cardiac and renal transplant surgery. Persons aged 18 may also decline all medical care, if judged to be competent.

 

According to the NSW Minors (Property and Contracts) Act 1970 No 60

Part 2 Capacity at eighteen years

(9) 1  “… a person aged eighteen years or upwards on the commencement of this Act or who attains the age of eighteen years after the commencement of this Act:

(c)  is of full age and adult

This definition of adulthood and ability to give consent is the definition adopted by doctors when providing medical treatment.  Prescribing an authorised substance as described in the Bill, is a medical treatment.  In certain cases in NSW, there are provisions for a review of the clinical situation by a panel of experts and the family as well as the patient.

 While 9 (1)(b)  “except so far as the context otherwise requires, for the purposes of:

(i)  any Act, whether passed before or after the commencement of this Act”

allows the modification of this decision, there is no compelling medical reason why this should apply in this Act.

 Recommendation 4 (a): The age limit at which a request for assistance to voluntarily end life can be made to the primary medical  practitioner should be 18 years but there be a provision for a Board of Review for younger cases, if applied for.

 

Clause 4 (b)

For the purposes of the Act there may be justification in stating that the person has a terminal medical condition.  There is no compelling medical reason to add a time frame to the expected time of death to define a terminal illness.  A terminal illness is one which will result in death.  A practical point is that accurate prediction of the time of death is not always possible.

 Recommendation 4 (b): The 12 month time limit be removed and more emphasis be given to existential suffering as a trigger for the Application.

 Clause 4 (d)

Patient suffering is at the core of the issue. The current wording could be interpreted as the patient needing to be experiencing both pain and suffering or experiencing physical incapacity. For clarity of interpretation by the medical practitioners involved this sub-clause “...experiencing severe pain, suffering or physical incapacity to an extent unacceptable to the patient” should be modified.

 Recommendation 4(d): Clause 4(d) Should be modified to “...experiencing severe pain or suffering or physical incapacity to an extent unacceptable to the patient”.

 Clause 6

This is an essential clause.  Medical Practitioners have the right to choose not to provide or directly participate in treatments to which they have a conscientious objection, as set out in the Medical Board of Australia’s Good Medical Practice: A Code of Conduct for Doctors in Australia (section 2.4.6).  However, section 2.4.7 of the same publication makes it clear that doctors must not allow their “moral or religious views to deny patients access to medical care ... ”

 Recommendation 6: The Bill should include a reference to this Code, making it clear that a primary medical practitioner may refuse to provide or to participate in assistance in dying, but must not deny or impede a patient’s access to such assistance.

 Clause 9

 Recommendation 9: This is an essential clause consistent with general medical provision of treatment.

 

 Clause 10

Recommendation 10: An essential clause ensuring that only tested substances will be prescribed which are known to achieve the desired outcome.

We note that no specific medication has been mentioned in the Act. Worldwide, Nembutal (pentobarbitone) is considered best practice for this purpose.  We suggest that consideration be given to naming this medication and detailing the procurement process for the purpose of this Act.

 

 Clause 11 and Clause 12

Recommendations 11 & 12: These clauses are necessary to ensure that medical opinion is not clouded by potential gain by the providers of medical treatment.

 

 Clause 14

While the intent of this clause is obvious it engenders unintended outcomes.

Securing an appointment with a Specialist, even in the city, may take weeks, particularly as there may be a limited number of Specialists who choose to be involved in assisted dying. The imposition of a further prolongation of the time during which the patient must endure “severe pain, suffering or physical incapacity to an extent unacceptable to the patient” is cruel. 

In rural Australia, access to Specialists in situ is markedly restricted.  Access may be restricted as indicated above but an additional imposition could be that a lengthy journey by a seriously ill patient to the city may be necessary; again a cruel and an unnecessary imposition.

 Recommendations 14Clause 14 (3) (a) be amended to where it is possible the secondary medical practitioner is registered under the Health Practitioner Regulation National Law in a specialty in the medical profession that is relevant to the diagnosis or treatment of the terminal illness from which the patient is suffering.

After being examined by the Primary Medical Practitioner, the implementation of the condition relating to specialist qualifications should not cause delay in the determination of a patient’s ability to be assessed for the purpose of determining the person’s eligibility for assistance in dying.

 Clause 15

Provides clear guidelines for the provision of information by the Primary Medical Practitioner and is to be supported

Recommendation 15:  Clause 15 should be accepted.

 Clause 16

16 (1) The essential attainment of a consultation with a psychiatrist or psychologist implies that all persons making a request for assisted dying are mentally unstable, are not of sound mind and their decision-making capacity is adversely affected.  There is no medical evidence supporting these assumptions.

 One of our experts, a Professor of Clinical Liaison Psychiatry, makes several points with regard to this:

16 (2)

 (a) “Sound mind” is an archaic term, although we do understand that it is still used in legal terminology.  “Competence” is a more appropriate medical term.

 (b) There is no reason to think that psychologists are skilled in making determinations about decision making capacity (DMC). Psychiatrists are medically trained and understand the effects of medical illness on mental capacity.  Australian psychiatrists complete 6 months training in consultation-liaison psychiatry where they learn about the interface of psychiatry and medicine and about capacity testing.

 The psychiatrist should not be asked to determine if DMC has been “adversely affected”, but whether or not the person has DMC, specifically with respect to the decision to ask for assistance to end his or her life.

 (c) There is no reason to believe that psychologists or psychiatrists have any expertise in determining whether the "assistance has been made freely” or “voluntarily” or in fact “after due consideration”, though the last will form some part of the capacity assessment.

 Recommendations 16: That the primary and the second medical practitioner be allowed to follow current practice and call for competence assessment only if there is a clinical suspicion.

Psychologists not be engaged for this purpose.

“Soundness of mind” should be replaced by “competence”; the correct medical term.  Competence be in relation to this decision alone.

Social Workers be engaged on the team if required.

 Clause 17

 Recommendation 17: 17 (a) (ii) Should be slightly reworded to “the illness is causing the patient severe pain OR suffering or physical incapacity to an extent unacceptable to the patient.

Sub-clause 17 (a) (v).  While this sub-clause may be desirable, the decision is the decision of the patient who is suffering, not the spouse, partner or family of the patient.

Recommendation17: 17 (a) (v) The primary medical practitioner should ask the patient if he has considered the possible implications of the patient’s assisted death for the spouse or de facto partner or family, but this should not be a requirement.

 

 Clause 18 (2)

There is no medical necessity to delay the signing of the Certificate for a minimum period of 7 days.  No other agreement between a patient and a medical practitioner for the provision of medical treatment requires a minimum delay period between a verbal request for treatment and a signed request for treatment.

 Recommendation 18 (2): Remove the 7 day requirement.

 Clause 19

 The provision of an interpreter is an important factor.  In relation to the credentialing of the interpreter, the Bill should specify that this person is not only officially certified by the State in the relevant language or Auslan but that they hold no relation or interest to the patient.

 Recommendation 19:  That the Bill include further tightening of the requirement of an interpreter to be independent of the patient and family.

 Clause 21

There is no medical justification for a close relative to be able to make an Application to the Supreme Court to question the decision of an adult person to give permission for a medical treatment for that person.    The Certificate is signed after application by the patient and approval by three registered medical practitioners.  It is an infringement of the patient’s right to determine his or her own medical treatment and an insult to the integrity of the medical practitioners.

 Recommendation 21: Delete Clause 21.

 Clause 24 (1)

Is essential not to infringe the beliefs or integrity of a medical practitioner

Recommendation 24   (1): Accept as consistent with desirable medical practice.

 Clause 24 (2)

Is consistent with current medical procedure when care of a patient is transferred to another practitioner.

Recommendation 24 (2): Accept as consistent with desirable medical practice.

 

 Clause 25

Is essential for the protection of a protected person, who is acting in good faith, under the conditions of the Act.

Recommendation 25: Accept Clause 2.

 Clause 27

Is sound and would add weight to ensure the provisions of Clause 25 prevail if contested.

Recommendation 27: Accept Clause 27.

 Clause 29

This Clause provides legal guidelines for the provision of a Death Certificate by the Primary Medical Practitioner, under the conditions of the Act.

Recommendation 29: Accept Clause 29.

 

Oversight

 We note that the Draft Bill does not contain any reference to mechanisms of oversight or review of the functioning of the assisted dying legislation.  We believe that this a deficiency.

 The Victorian Legislative Council Legal and Social Issues Committee Inquiry into end of life choices recommended the establishment of an Assisted Dying Review Board, (Para8.9.1). 

The recommendations are summarised in the paragraph headed Oversight, page 21, Ministerial Advisory Panel, Voluntary Assisted Dying Bill Discussion Paper.

 The composition of the Board is suggested.  The function of the Board will be to ensure that doctors are complying with requirements of the assisted dying act, by retrospectively reviewing the actions of medical practitioners in each instance of voluntary assisted dying.  The Board will not be involved in the approval or rejection of requests from patients to access assisted dying: that will remain the role of the primary doctor and independent secondary doctor in each case. 

For the purposes of transparency and accountability, the Board should produce reports to Parliament, which are available to members of the community.

 

We believe these recommendations could provide a framework for similar proposals to be developed in the NSW Assisted Dying Bill.  We endorse these recommendations from a general and medical perspective.

 Recommendations:

That

  • an Assisted Dying Review Board be established within the framework of the NSW Voluntary Assisted Dying Bill.
  • the Board reports to Parliament on the functioning of the Bill
  • the Board produces an annual summary of activities under the conditions of the Bill
  • the summary is available to members of the community.

 

In conclusion:

 We hope that our comments on medical aspects of the Draft Voluntary Assisted Dying Bill 2017 (NSW) are useful in assisting in determining the content of the Bill.  It is obvious from the name of our organization that the members are doctors who support the concept of choice in assisted dying.  In most cases this support results from member’s experiences in their practice in dealing with dying patients in unrelievable distress.

 

Yours sincerely

 Dr David Leaf B Med FRACGP FACRRM (davecharlie@ozemail.com.au),

Professor Rufus Clarke MA MD PhD MPH FRACS FAFPHM (rufusclarke1@bigpond.com)

for NSW State Convenor Group

 and

 Names of agreeing members here

 

 


 

 

 

 Letter to members Tasmanian Assembly 

 

 

 

Doctors for Assisted Dying Choice

 

 

17th May 2017

 

 

Title MP name MP

Member for Electorate

 Address

 

Dear Salutation Surname

 Doctors for Assisted Dying Choice is a group of medical practitioners from all States and Territories in Australia. We believe that rational adults who are suffering from a medical condition, with no realistic chance of cure or relief from intolerable symptoms, should have the legal option of seeking medical assistance to end their lives, under carefully prescribed conditions, at a time of their choosing.

 We consider that the Tasmanian Voluntary Assisted Dying Bill 2016, to be debated on May 24th, encompasses much wisdom and experience, distilled from previous legislative processes overseas and fine-tuned with more recent Australian legislative endeavours.  As such it incorporates more clarity of intent, more safeguards and more compassionate understanding than all previous Bills in Australia.

Our submission focuses on the role, involvement and responsibilities of doctors, in ensuring that assisted dying is available only to those who satisfy the rigid criteria of the Act, while protecting the infirm and vulnerable from abuse.  We have identified these tasks in the applicable Sections below.

 

 S 4 Clearly indicates that there is no extension of the circumstances in which a person’s life may be ended by a doctor or any other person, except as permitted by the conditions of the Act.

 S 8 Defines the restrictive condition and only situation in which a doctor can assist in the death of a person – the person must be an Eligible Person, as defined by the criteria of the Act.

 S 9 Details the exact conditions that have to be satisfied before the person’s primary medical practitioner can define the person as an Eligible Person and prevents slippery slope scenarios developing due to the specificity of the criteria to be an Eligible Person.

 S 10 Further prevents any slippery slope by requiring the person’s primary medical practitioner to determine that the person is competent and making the request voluntarily.

 S 11 Eligible Medical Condition.  Does not refer to the vague and open-ended term terminal illness, but precisely outlines the medical circumstances in which the Act may be applied.  These circumstances are quite clear and restrictive.  The doctor and the person, in joint consultation, decide if there is an Eligible Medical Condition.

 he doctor must determine that:

 

  •  the person has the advanced stages of a serious, incurable, irreversible medical condition, and
  • there is no reasonably available medical treatment or palliative care that would relieve the person’s suffering in a manner that is acceptable to the person.

 

The person must decide that:

  • the medical condition is causing persistent, intolerable suffering and
  • there is no treatment that would relieve the suffering that is acceptable.

 This Section emphasises the seriousness of the medical condition and that no reasonably available medical or palliative care options are available; voluntary assisted dying is complementary to these options, not competitive.

 It is anticipated few persons will avail themselves of the assisted dying opportunity

 S 14 This section further clarifies the role of the primary medical practitioner, with extensive checks and balances involved (discussions with eligible person, medical record reviews, second opinion with counsellor, feedback to the eligible person etc).

 S 18 and S 19 Further emphasise the collaborative and interactive roles of the primary and secondary medical practitioners, both of whom must be convinced that the request is an Eligible Request and the medical condition is an Eligible Medical Condition. These sections emphasise the objectivity of the medical opinions by ensuring the independence of the primary medical practitioner and the secondary medical practitioner.

 The actions to be implemented if the opinions of the primary and secondary medical practitioner differ are also detailed.

 S 22 Defines the partnership functions between the Eligible Person and the primary medical Practitioner and details again the stringent criteria that must be satisfied before the final declaration that the person is an Eligible Person. 

These include determining that the patient’s request is an Eligible Request, as define by the Act, discussing with the person whether there are any relevant treatment options available that may adequately improve the person’s medical condition or relieve the person’s suffering.

 The primary medical practitioner must also offer the Eligible Person an opportunity to rescind any assisted dying request.

 S 23 Lists more conditions and safeguards that must be present before the primary medical practitioner may issue an assisted dying prescription.  To ensure thsafety of the prescribed medication, the primary medical practitioner must personally deliver the prescription to the pharmacy, must collect the medication and must retain possession of the prescribed medication until the prescribed medication is to be administered.

 S 24 Indicates that the medication may be self-administered or administered by the primary medical practitioner, only.  If self administration is chosen, the medical practitioner must remain in the near vicinity of the person, while the medication is being ingested.

 S 25 Prescribes the duties of the medical practitioner to ensure safe collection of any unused medication.

 

 We have closely reviewed and analysed the Tasmanian Voluntary Assisted Dying Bill 2016.  We believe it offers the Tasmanian community a further, considered direction when planning end of life choices.  As such, we see it complementing the existing medical and palliative care models. We urge you to enable a legislative pathway for this Bill to be enacted.

 

Yours sincerely

 

 Dr Scott Bell, Member Tasmanian Convenor Group, Doctors for Assisted Dying Choice

Bell Scott Dr (scottbell1950@gmail.com)  0419 527 354

 and

 Members’ names and qualifications go here in 2 columns.

 

 

 


 


 

 

Voluntary Assisted Dying discussion paper

Voluntary Assisted Dying Bill 2016

Victorian Parliament

 

 

 Doctors for Assisted Dying Choice

drs4assisteddyingchoice.org

30th March 2017

 

Professor Brian Owler

Chairman

Ministerial Advisory Panel

Victorian Assisted Dying Bill Discussion Paper

 

Dear Professor Owler

Re: Submission to Advisory Panel

Doctors for Voluntary Assisted Dying Choice 

Please find below the Submission to the Ministerial Advisory Panel from Doctors for Assisted Dying Choice in response to the Key Issues posed by the Panel.

 

The Person

  •  The Medical Treatment Planning and Decisions Act 2016 is sufficient. There is no need for further legislation concerning decision making capacity, in this context. The patient’s General Practitioner is generally the ideal professional to assess decision making capacity as they will know the patient over time and usually prior to the diagnosis of the illness.
  • A psychiatric assessment will only be required where one or both of the assessing doctors have concerns or doubts regarding the patient’s decision making capacity or if the request seems inappropriate, given the nature and stage of their illness. To avoid prolonged delays to patients who are badly suffering it will be necessary to ensure there is a mechanism to obtain a prompt psychiatric assessment.   

It would be rare for any other Specialist assessment to be necessary or appropriate.

 

Access and Eligibility

  • Greater specificity is not required to define end of life.  The time to end of life varies greatly and depends on the condition of the person, the illness and its variable rate of progress.
  • The definition of a serious and incurable medical condition should be determined by the patient and the doctor.  The patient can assess whether the condition is serious to that patient and the doctor can assess whether it is incurable, using current understanding of the disease.

The Parliamentary Committee further recommended that an eligible person must be

“...suffering from a serious and incurable condition which is causing enduring and unbearable suffering that cannot be relieved in a manner the patient deems tolerable”.

The obligation to satisfy these two requirements is unreasonably restrictive and discriminatory and not consistent with the statement that

“...the Committee believes that the needs of the patient must be squarely at the centre of an effective framework. Ensuring that the rights of patients are respected depends on the expertise and judgment of those working within the framework, particularly doctors.”

It is generally accepted by doctors, on whom the Committee charges the responsibility for “Ensuring that the rights of patients are respected that predictions of time till death are inaccurate. 

Even if this were not so, both suffering from a “serious and incurable condition” or experiencing “an enduring and unbearable suffering“ can and do occur without the patient being at the end of life.

Patients with Parkinson’s Disease, multiple sclerosis, amyotrophic lateral sclerosis and some congenital diseases are suffering from a “serious and incurable condition” but may not be “at the end of life”.  Forcing them to wait till they are near death before relief can be obtained, under the law, is cruelly condemning them to suffering that many would choose not to prolong unnecessarily, when a gentle death, at the time of their choosing and consistent with the Committee’s belief that “...the needs of the patient must be squarely at the centre of an effective framework” would be preferable.

Conversely patients may be suffering from “enduring and unbearable suffering that cannot be relieved in a manner the patient deems tolerable” without being at the end of life.  Examples are patients with respiratory failure requiring continuous oxygen dependence, chronic renal failure necessitating frequent dialysis, Locked in Syndrome or incapacitating stroke requiring  total dependency care.  Forcing ongoing continuation of life of a patient experiencing enduring and unbearable suffering that cannot be relieved in a manner the patient deems tolerable, is not consistent with the recommendation that “...the needs of the patient must be squarely at the centre of an effective framework”.

A qualifying term, such as “in the foreseeable future” would be preferable and consistent with the Committee’s belief that “...the needs of the patient must be squarely at the centre of an effective framework”.  Certainly there is no justification for choosing an arbitrary time, such as the last 6 months of life, as in American legislation.  This time limit is based on insurance requirements for eligibility for hospice and palliative care. No such requirements exist in Australian health care. 

  • Mental illness alone should not qualify under this legislation.

 

Making a request

  • Adequate safeguards would be achieved if two independent doctors with no conflict of interest make independent and thorough assessments after being provided with adequate background information about the patient’s condition.  Both doctors must be satisfied that the request is voluntary, appropriate and without coercion. 

The patient should be assessed without family or carers present so the possibility of influence or coercion can be explored.

  • Specification of a defined time period that must pass between the first and final request may prolong the time during which the patient is suffering. The requirements are
    •  to make an appointment with the first doctor
    •  be examined by that doctor; the doctor who then has to make a comprehensive report
    • the report has to be sent to the second doctor
    • the patient must make an appointment with the second doctor
    • the second doctor must make a report and refer the report to the first doctor
    • the patient must make another appointment with the first doctor who must then ensure that all requirements have been satisfied and must review all aspects of the patient’s request.

The distress caused by this prolonged period of required bureaucracy must be endured by a patient with enduring and unbearable suffering. Prolonging the suffering even more, by a prescribed period, is not justifiable.

  • There is no reason for any new offences to be legislated.

 

Properly informed

  • The legislation should include prescribed information that the medical practitioner must provide to a person requesting voluntary assisted dying. The list provided by the Parliamentary Committee is sufficient. In the case of Voluntary Assisted Dying it is better to err on the side of being prescriptive with the information provided in a language and format that the patient is comfortable with.

            The patient must understand the diagnosis, what treatment (both therapeutic and palliative) are     still available, the likely course of the illness, the manner of death if Voluntary Assisted Dying is     not employed and the likely manner of death if Voluntary Assisted Dying is undertaken (including       what will occur in the very unlikely event that the lethal drug does not work).

            Part of the information about Voluntary Assisted Dying will be conditions that the patient must    agree to includes:

  • that as few people as possible should be aware that the medication is stored  in their home
  • no mention of having the medication should be made via emails or to non-essential people
  • that the medication will be returned promptly to the pharmacist if they decide not to use it.
  • Online resources to support the assessing doctors should be easily available.

 

Confirming a request

  • The opinion of a doctor who is a Specialist in the illness from which the patient is suffering is not necessary and, in many country areas of Australia would be impossible to obtain. However, the assessing doctors must be experienced (minimum of 5 years’ experience, RACGP or equivalent) and participating in a CME program.      

            Ideally, Additional training will be required before providing VAD support.                                  

            The training would cover the

  • essential steps of assessment and counselling of a patient requesting VAD support
  • essential steps of assessment and counselling of a patient requesting VAD support
  • reporting and documentation requirements
  •  resources for information to be discussed with the patient.
  • Referring to a Palliative Care Specialist should be optional, not prescribed by legislation.

 

Conscientious objection

  • Conscientious objection is a moral decision of the Health Practitioner.  It operates in the community now, in everyday practice.  In general it is well handled.  No change is required.        In particular no legislation should be introduced to deny the Practitioner’s ethical freedom.
  • Health Practitioners should not be required to make a specific referral to another doctor to provide Voluntary Assisted Dying but it would be expected that they will provide appropriate medical background information on request.
  • Health Practitioners who have conscientious objections should be required to declare their objection if assisted dying is requested.

 

Administering the lethal dose of medication

  • The patient has undergone rigorous assessment before reaching the time of administration of the drug and has decided that that is what is wanted.  The patient has been made aware that the request may be withdrawn at any time; this includes prior to administration by the doctor who has played a major role in the assessment process.

Before the doctor administers the drug, both assessing doctors have agreed that the patient cannot self-administer the medication and that the patient will need assistance. In this case, as indicated by the Parliamentary Committee, “...a doctor should be able to assist the person to die by administering the drug”.

No additional safeguards are necessary.

  • The administration should occur at a time and place that respects the patient’s wishes but is also acceptable to the doctor.

 

Attendance

  • Any Health Practitioner whom the patient chooses should be allowed to be present at the time of self-administration but the Health Practitioner should not be obliged to attend.

 

Lethal dose of medication not effective

  • If the patient does not die after the ingestion of the drug, counselling should be repeated, after recovery, to assess the patient’s intent.  Should the patient request further VAD, it should be administered, in a higher dose, with the doctor present.

The obligation of a Health Practitioner is to respect the patient’s decision for assisted dying.  No treatment should be instigated nor an ambulance called.

  • A document should be provided by the prescribing doctor with instructions to complete immediately before ingesting the medication.  This document will state that
    • I am taking this medication voluntarily and without any other person encouraging or influencing me.
    • I understand this medication will bring about my death quickly and peacefully
    • No ambulance is to be called and no resuscitation efforts are to be made

 After a person has died

  • The doctor writing the death certificate must ascertain whether the medication was used and, if not, arrange its prompt return to the pharmacy.
  • The cause of death must be certified as the primary illness.
  • The death should be a reportable death only if the doctor has concerns about the death.

 

Oversight

  • A stand-alone independent Assisted Dying Review Board should be established with oversight and reporting powers but no investigatory powers.
  • The Assisted Dying Review Board should be provided with de-identified data as soon as a written request for voluntary assisted dying is obtained, showing
    • The diagnosis and age of the patient.
    • The details of the Primary and Secondary doctors, including confirmation that they have completed the Voluntary Assisted Dying training.
    • Confirmation that the prescribed list of information has been discussed and provided to the patient.
    • When the medication is prescribed and dispensed.
    • If and when the medication is used and the outcome.
    • Confirmation that the medication is returned to the pharmacy if it was not used.
  • The reporting should be real time via a website portal or phone.
  • The website should also contain documents and information to be provided to the patient and links to resources for information about the patient’s illness and palliative treatments.
  • Another agency should be involved only when a breach of procedure or safeguards has occurred.
  • The oversight body should not have investigatory powers. If investigation is needed, this should be done by the appropriate investigative agency.
  • Either of the assessing doctors should be able to consult with a member of the board at any stage during the process if they have any questions or concerns about the assessment or process of voluntary assisted dying.

 

Additional safeguards

  • The parliamentary committee's framework provides sufficient protection to vulnerable people.
  • No additional safeguards are necessary.

 

Liability and Insurance

  • Health practitioners who act in accordance with the new legislation in good faith and without negligence should be immune from any legal liability.
  • Insurance companies should act with the cause of death as recorded on the death certificate – not as suicide. They should not have access to information from the Assisted Dying Review Board.

 

Conclusion

  • We are not aware of any further issues related to the Parliamentary Committee's recommended framework that require the Ministerial Advisory Panel's consideration?

 

Yours sincerely

 

Dr Doug Gaze and Victorian Convenors Group

And

 Names of members here

 

 


 

 

Doctors for Assisted Dying Choice

 

 

 24A Renown Av

 Tranmere SA 5073

 

  08 8431 9134

 

 24 July 2015  

  

 Lilian Topic

 Secretary

 Legal & Social Issues Committee Parliament House

 Spring Street, Melbourne VIC  3002

 

 Dear Ms Topic

Re: Submission – Inquiry into End of Life Choices

In Australia the ability of a person to exercise a preference in end of life choices is constrained by factors not freely or easily controlled by that person, such as location of the person’s domicile, type of illness, medical practitioner attitude, legal inconsistencies  and religious pressure.

 

Location

Location plays a major role in limiting access to specialist palliative care for the optimal management of end of life care.  Palliative care services and practitioners are concentrated in major cities and less well represented in distant townships and country areas.  The provision of on-line consultation allows some alleviation of this divide but is not a completely satisfactory alternative to that provided by face-to-face, experienced carers.  Choice of institutional care options is likely to be similarly reduced.

 

Restrictions on provision of terminal medical care 

It is acknowledged that even with optimal palliative care availability, 5-10 % of patients continue to experience inadequate relief of their suffering.  Current medical practice fails these people.  This is the group who will receive relief of their suffering only by death; but it is this group whose achievement of the desired relief is somewhat of a lottery and dependent on the medical practice of their care givers.

 The Palliative Care Council makes the statement that voluntary euthanasia and assisted death are not part of palliative care.  This claim is rational; if voluntary euthanasia or assisted death were practiced openly as part of palliative care, palliative care givers would be acting illegally.

 The appropriate use of drugs for symptom control is an established and effective part of palliative care.  When large doses of sedatives are used in the presence of refractory symptoms, the practice becomes terminal sedation: the end point is death of the patient.  The essential difference between the administration of drugs to achieve euthanasia or to undertake terminal sedation is the intent of the doctor responsible for the procedure.  Even when requested by the patient, intending to end a life by terminal sedation is illegal: administering drugs sufficient to control symptoms, which may result in the death of the patient, is not illegal.  The end point of each procedure is the same: the legality or not is based on the intent of the medical practitioner which can be known only to each practitioner at the time.

It is recognized that a few medical practitioners do agree with a patient’s rational request to end suffering by administering drugs in sufficient concentration to control symptoms by the ending of the patient’s life.  This practice requires both subterfuge and personal courage on behalf of the practitioner: it persists in the face of its illegality because it has ethical impetus, a feature to which current laws are blind. 

 Type of illness

A person’s ability to achieve assistance in obtaining relief of intolerable suffering may depend on his or her type of illness.  The consensual withdrawal or removal of life sustaining treatment from a patient is legal, even if this action results in the patient’s death. The consensual administration of drugs to a patient not dependent on life support, is illegal.  The inconsistency of the legal illogicality is obvious and discriminatory.

 Continued Religious Influence

Within the community there exists a small, vocal and strong opposition to assisted death and voluntary euthanasia on the basis that human life is sacred and divinely given.  In general these groups are well supported by various religious bodies, which allow them to exert political influence disproportionate to their numbers and to maintain the limitations on assisted death as a choice at the end of life: a choice which is favoured by more than 75% of the Australian community in general. A similar number of people professing a religion see voluntary euthanasia as consistent with their faith.   Australia has become a secular society, but a society in which the freedom to practice personal and religious beliefs is retained and respected.  The maintenance of law based on the beliefs of a selected, but disproportionally influential few, significantly reduces choice in end of life care for the majority and is implicitly undemocratic.

 

Increase in end of life choices

Currently many Australians die in unsatisfactory circumstances and with unrelieved suffering.  We have outlined areas which limit the provision of optimal choice of care at the end of life.  Some are location dependent and difficult to solve but the salient restriction which can be addressed and which is desired by most of the Australian community, is the removal of the undemocratic legislation prohibiting voluntary euthanasia and assisted death as a choice in end of life care.  The essential element in any liberalisation of the law is that of personal choice.

  Yours sincerely

 

Associate Professor Arnold Gillespie

and 97 members

 

 


 

 

3 May 2014

 

The Editor 

Sydney Morning Herald

 

 Frustrated at the failure of parliamentarians of all States to enact legislation to allow voluntary euthanasia in defined circumstances, Dr Rodney Syme has courageously elected to make public his role in the death of Steve Guest, in 2005 (SMH 28 April 2014).  Dr Syme has taken this brave course to force police action, which is likely to result in judicial activity, in the hope that a Court decision might facilitate parliamentary action.  The undersigned members of Doctors for Assisted Dying Choice applaud the action of Dr Syme and strongly advocate the modification of the law in all States to permit voluntary euthanasia and physician assisted dying in legally defined circumstances.

 

 We also challenge the ill-informed view that all doctors are opposed to voluntary euthanasia. Currently it is illegal for a doctor to even sit with a terminally ill person with intolerable symptoms who has decided to terminate his or her life.  We believe that assisting people with intolerable symptoms, who have made an informed decision to die, is the ultimate compassionate, palliative care action. 

 

Sincerely

Doctors for Assisted Dying Choice

 

 

 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------

 

2 May 2014

 

The Editor, The Age

Dear Sir/Madam,

 

The undersigned doctors write in support of Dr Rodney Syme who has admitted his part in the death of Steve Guest in 2005.  Steve Guest died by his own hand, using a drug supplied by Dr Syme.  The Police decided that no action was required but now are likely to investigate, given further information supplied by Dr Syme.  Given the failure of legislatures to enact permissive legislation, Dr Syme has concluded that a favourable judicial conclusion may influence the Parliament to take action.

 We write also to contradict the ill-informed belief that doctors are opposed to liberalisation of the law.   We strongly support the modification of the law to permit voluntary euthanasia and physician assisted dying in legally defined circumstances.  We favour a legal framework in which decisions to end life are entirely patient-centred and not reliant on the views of a doctor.  We are appalled that currently it is illegal for doctors to even sit with a terminally-ill person with intolerable symptoms, who has decided to take his or her own life.  End-of-life assistance in whatever form should be a final, compassionate act of palliative care and should be legal. 

Yours sincerely

 Doctors for Assisted Dying Choice

 

 


 

 

Letters to South Australian parliamentarians

 

 Doctors for Assisted Dying Choice

 

 

25 October 2013

 

Hon «FirstName» «LastName» MLC

Parliament House

Adelaide SA 5000

 

  

Dear «Title» «LastName»

 

As a national medical group we aim to provide our elected representatives with updates of worldwide developments in end-of-life thinking. Accordingly, from time to time we will send you quotations from respected medical journals, with the references, so that the full articles may be obtained.

 

Quote No. 6:

  

“There is evidence of advancement of palliative care in countries with legalised euthanasia, also after the legalisation of euthanasia and/or assisted suicide. The idea that legalisation of euthanasia and/or assisted suicide might obstruct or halt palliative care development thus seems unwarranted and is only expressed in commentaries rather than demonstrated by empirical evidence.”

 

Legalisation of assisted dying does not harm palliative care, study concludes.

 

Dyer C. British Medical Journal 2011; 343: d6779  

Commenting on: Palliative Care Development in Countries with a Euthanasia Law. Report for the European Association for Palliative Care; October 4, 2011. 

 http://www.commissiononassisteddying.co.uk/wp-content/uploads/2011/10/EAPC-Briefing-Paper-Palliative-Care-in-Countries-with-a-Euthanasia-Law.pdf

 

We, the South Australian members of Doctors for Assisted Dying Choice, continue to urge you to respect the views of the majority of your electorate in support of the Ending Life with Dignity Bill 2013.

 

Yours sincerely,

(Signed by South Australian Members)

 

 

Doctors for Assisted Dying Choice 

 

 

17 October2013

 

 

Hon «FirstName» «LastName» MLC

Parliament House

Adelaide SA 5000

 

 

 

Dear «Title» «LastName»

As a national medical group we aim to provide our elected representatives with updates of worldwide developments in end-of-life thinking. Accordingly, from time to time we will send you quotations, with the references, so that the full articles may be obtained.

 

Quote No. 5:

 

“Making someone die in a way that others approve, but he believes a horrifying contradiction of his life, is a devastating, odious form of tyranny.”

 

 

Ronald Dworkin, QC

 

Emeritus Professor, University College London

Previously – Chair of Jurisprudence, Oxford University. Fellow of University College Oxford.

Professor of Jurisprudence, University College, London. Professor of Law, New York University.

 

 

Dworkin died of leukaemia in London on February 14, 2013 at age 81.

 

Faculty of Law News (Oxford) http://www.law.ox.ac.uk/newsitem=537

 

Orbituary The Guardian 14 February 2013. http://www.theguardian.com/law/2013/feb/14/ronald-dworkin

 

Obituary NY Times 15 February 2013. http://www.nytimes.com/2013/02/15/us/ronald-dworkin-legal-philosopher-dies-at-81.html?_r=0

  

 

We, the South Australian members of Doctors for Assisted Dying Choice, continue to urge you to respect the views of the majority of your electorate in support of the Ending Life with Dignity Bill 2013.

 

 

Yours sincerely,

(Signed by South Australian Members)

 

 

Doctors for Assisted Dying Choice

 

1 October 2013

 

 Dear…appropriate addressee

 

 

As a national medical group we aim to provide our elected representatives with updates of worldwide developments in end-of-life thinking. Accordingly, from time to time we will send you quotations from respected medical journals, with the references, so that the full articles may be obtained.

 

Quote No. 4:

 

 

“Despite the huge progress made in palliative medicine in terms of symptom control, many are intractable (refractory symptoms), either because the treatment is ineffective or because the treatment itself is intolerable”

 

 

 

Palliative Sedation in End-of-Life Care and Survival: A Systematic Review

 

M Maltoni, E Scarpi, M Rosati, S Derni, L Fabbri, F Martini, D Amadori, and O Nanni.

 

Journal of Clinical Oncology, 2012; 30:1378-83.

 

 

We, the South Australian members of Doctors for Assisted Dying Choice, continue to urge you to respect the views of the majority of your electorate in support of the Ending Life with Dignity Bill 2013.

 

Yours sincerely,

 

(Signed by South Australian Members)

 

 

 

Doctors for Assisted Dying Choice

 

29 September 2013

 

Dear...appropriate addressee

 

As a national medical group we aim to provide our elected representatives with updates of worldwide developments in end-of-life thinking. Accordingly, from time to time we will send you quotations from respected medical journals, with the references, so that the full articles may be obtained.

 

Quote No. 3:

 

"... our Death with Dignity program has been well accepted by patients and clinicians….

…..[it] allows patients with cancer who wish to consider this option to do so within the context of their ongoing care and accommodates variation in clinicians' willingness to participate”

 

Implementing a Death with Dignity program at a comprehensive cancer center.

Loggers ET, Starks H, Shannon-Dudley M, Back AL, Appelbaum FR, Stewart FM.

N Engl J Med. 2013; 368(15):1417-24. doi: 10.1056/NEJMsa1213398.

 

We, the South Australian members of Doctors for Assisted Dying Choice, continue to urge you to respect the views of the majority of your electorate in support of the Ending Life with Dignity Bill 2013.

 

Yours sincerely,

(Signed by South Australian Members)

 

 

Doctors for Assisted Dying Choice

 

 

 

16 September 2013

 

  

Dear...appropriate addressee

 

As a national medical group we aim to provide our elected representatives with updates of worldwide developments in end-of-life thinking. Accordingly, from time to time we will send you quotations from respected medical journals, with the references, so that the full articles may be obtained.

 

Quote No. 2:

 

“That there is a moral right, grounded in autonomy, for competent and informed individuals who have decided after careful consideration of the relevant facts, that their continuing life is not worth living, to non-interference with requests for assistance with suicide or voluntary euthanasia.”

 

Quotation from: Section 8, Conclusions. End-of-Life Decision-Making in Canada: The Report by the Royal Society of Canada Expert Panel on End-of-Life Decision-Making 

Bioethics. 2011 November; 25(Suppl 1): 1–4.doi: 10.1111/j.1467-8519.2011.01939.x

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3265521/

 

We, the South Australian members of Doctors for Assisted Dying Choice, continue to urge you to respect the views of the majority of your electorate in support of the Ending Life with Dignity Bill 2013.

 

 

 

Yours sincerely,

(Signed by South Australian Members)

 

 

 

Doctors for Assisted Dying Choice

 

 

 

9 September 2013

 

Dear...appropriate addressee

 

As a national medical group we aim to provide our elected representatives with updates of worldwide developments in end-of-life thinking. Accordingly, from time to time we will send you quotations from respected medical journals, with the references, so that the full articles may be obtained.

 

Quote No. 1:

 

“The consistency of international views indicates a mandate for legislative and medical systems worldwide to listen and understand this.”

 

Quotation from: Why do we want the right to die? A systematic review of the international literature on the views of patients, carers and the public on assisted dying.  

Hendry M, Pasterfield D, Lewis R, Carter B, Hodgson D, Wilkinson C. Palliat Med. 2013;27:13-26. doi: 10.1177/0269216312463623

 

We, the South Australian members of Doctors for Assisted Dying Choice, continue to urge you to respect the views of the majority of your electorate in support of the Ending Life with Dignity Bill 2013.

 

 

Yours sincerely,

(Signed by South Australian Members)

 


 

11th August 2010

Dear [Politician Name],

Re: Recent findings in Voluntary Euthanasia

This letter addresses a frequent concern that legislators express in regard to VE, known as the "slippery slope". This is the idea that an act to legalise VE which in itself may not be ethically repugnant or illegal on a small scale, will lead to an unacceptable increase in the use of VE and even the ending of a person's life against their wish.

We draw your attention to information we have taken from the website of the Department of Human Services, Government of Oregon reporting the experience of legalised VE in Oregon, USA.

Last year there were 19.3 physician-assisted deaths per 10,000 total deaths (0.19%). This is the rate after 12 years of legalized physician-assisted suicide, and represents a total of 59 deaths out of 30,000 deaths in 2009. As in previous years, more individuals were legally prescribed lethal drugs than actually took them (see figure in appendix).

Thus, the incidence of VE remains very low, the overall increase is slight, consistent with gradual acceptance by a society that physician-assisted dying legislation is compassionate, and the un-used prescriptions point to patients not being pressured, or forced, to take that option.

This is an excellent example of evidence refuting the idea of a 'slippery slope' of run-away euthanasia. We are happy to respond to any questions you may have.

Yours sincerely

John Willoughby—for the group

 

Appendix: The Oregon voluntary euthanasia experience from 1998 to 2009.

 

The Oregon voluntary euthanasia experience from 1998 to 2009

 


Letter to Editor of the Adelaide Advertiser

10th September 2011

With the introduction of the legislation proposed by Hon Ms Steph Key and The Hon Dr Duncan McFetridge we are at a critical point in our society's approach to end-of-life matters. The effect of the proposed legislation will be that un-relievably distressed adults may request medical assistance that would shorten their lives. At present, a doctor acting on such a request could be charged with murder: this proposed Bill seeks to provide medical carers with a defence against such a criminal charge.

The two of us are members of a national group of 127 doctors and specialists. We write on their behalf to both support and to criticize the Bill. We support it for the diminished threat of compassionate medical carers being charged when they respond to a request for assistance at the end of life. We criticize the Bill because patients who make a decision to have assistance to end their life, deserve to have their decision supported by law and we still seek to achieve this. We cannot conceive a rational basis for opposing such assistance and we are perplexed by minority groups who do oppose it.

In the meantime, the Key/McFetridge Bill has our support. Medical carers regularly deal with difficult life and death decisions in which the patient's opinion is pre-eminent. The Key/McFetridge Bill will, for the first time in SA, enable effective open communication at what is a very sad time for all involved and provide one more option for suffering individuals.

With best wishes

Dr Rosemary A Jones         Emeritus Professor John Willoughby

Writers for members of Doctors for Assisted Dying Choice

 

Letter to SA Parliamentarian, Dr Bob Such

Dr Bob Such

Member for Fisher

Parliament House

Adelaide SA 5000

Dear Dr Such

We are doctors from all Australian states who have recently joined forces in the cause to legalise voluntary euthanasia.  Our website can be found at drs4assisteddyingchoice.org

We strongly support your stance on this cause, which we all recognise is supported by the most powerful of ethical arguments.  We do feel, however, that aspects of your Bill will preclude several groups of patients whose medical indications for requesting an assisted death are equally as strong ethically as patients who are the focus of your Bill. 

While those with advanced cancer, who are in pain and in the terminal phase of terminal illness, would benefit from the passage of your Bill, individuals who are suffering unbearably from permanent deprivation of their vital functions deserve the right to request a peaceful end-of-life; these functions would include the capacities of secure breathing, eating, drinking, and self-care.   You, yourself, have indicated in the SA Parliament that the provisions of your Bill will be utilised no more than rarely. We have the view that the exclusion of unbearably distressed individuals who have fixed, non-fatal or slowly destructive illnesses, will be seen to be arbitrary compared to the compassionate options your Bill will provide for those with end-stage cancer.

We will, of-course, provide a supportive medical campaign for your currently proposed Bill, as exclusionary as it is.  However, we would make the strongest of public efforts to achieve reform that gives choice to patients on the basis of even-handedness in the face of equivalent medical need.

As representatives of Doctors for VE Choice, Drs Rosemary Jones, Arnold Gillespie and John Willoughby would appreciate the opportunity to meet with you to discuss these matters.  Would you kindly advise us if you are receptive to discussion, and if so, suggest a time for meeting?

Yours sincerely

[This was signed by over forty doctors from Doctors for Assisted Dying Choice]

 

 


 

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