Euthanasia, Voluntary Assisted Suicide (VAS), and Physician Assisted Suicide (PAS)
There has been increased media coverage regarding the issue of Euthanasia over recent months. This coverage may intensify in the New Year given the possibility of a private members bill seeking to legalise Euthanasia being introduced to Parliament during 2020.
AMA Tasmania’s approach is to provide relevant factual information and to ensure the public and our parliamentarians understand the formal AMA and World Medical Association (WMA) position on Euthanasia. In particular, we seek to ensure that two very separate concepts are not conflated by the public, parliamentarians, media and medical practitioners; namely, that Euthanasia, Voluntary Assisted Suicide (VAS) and Voluntary Assisted Dying (VAD) are not synonymous with Physician-Assisted Suicide (PAS).
The concept of PAS is contrary to the Australian Medical Association (AMA) and the World Medical Association (WMA) stance on Euthanasia as well as the ethical tradition of Medicine overall. From a pragmatic perspective, a medical practitioner does not have to be directly involved in the delivery of Euthanasia /VAS/VAD, even if Euthanasia were to be legalised in Tasmania.
Any debate around legalisation of Euthanasia /VAS/ VAD must not be framed by an expectation that registered medical practitioners will be permitted to be involved in the act of promoting, prescribing or delivering a medication with lethal intent (i.e. PAS).
The community should continue to trust that Medical Practitioners will compassionately and ethically safeguard human health (including dignity, comfort and safety) and life. Debate around the legalisation of Euthanasia/VAS must always carefully, clearly and deliberately separate the concept of PAS. PAS does do not have the support of AMA and WMA.
There has been increasing media commentary over recent months regarding a potential legislative push to legalise Euthanasia in Tasmania. Public debate on this issue is often framed by the opinions of those with strong personal views either for or against, legalising Euthanasia. This is understandable; the intentional ending of human life is as fundamentally counter to our community’s ethical sensibilities as is the notion of allowing a person to experience intractable suffering.
These seemingly irreconcilable ethical sensibilities are brought into a stark competition when the legalisation of Euthanasia is discussed. Those who support legalised Euthanasia identify unremitting human suffering as the basis for providing a competent and fully informed person with the option of voluntary Euthanasia. Those against, state that given the efficacy of modern palliative medicine and appropriate medical care, people with terminal illness or facing degradation of personal identity associated with a progressive degenerative disease, can be effectively and compassionately cared for when our community both funds high-quality health care and avoids futile medical interventions.
This debate is a dialectic between two ends of a viewpoint spectrum. Without invoking fraught arguments such as the moral “slippery slope” if Euthanasia were to be legalised, or promoting misleading perspectives on whether contemporary clinical care and palliative medicine is, or is not, capable of adequately and compassionately addressing patient suffering, we can still as a Profession and a community discuss the ethics, morality, and consequences of legalising Euthanasia in a calm, ethical and evidence-based manner. However, we do not frequently see this outcome in other jurisdictions, and there is the potential given recent media, that any forthcoming Euthanasia debate in Tasmania could go in the same unhelpful direction.
As Medical Practitioners, we always make a concerted effort to avoid projecting our personal beliefs onto our patients and our community. We must similarly take care not to publicly project our own stance regarding Euthanasia and PAS as being that of the Profession as a whole. To do so produces confusion regarding the position held by authoritative Professional organisations.
As registered medical practitioners we have an opportunity and responsibility in Tasmania too, with humility, support the community and our parliamentarians in developing a holistic consideration of the evidence, medical ethics and spectrum of options that surround the issue of Euthanasia and end of life care. The community should expect from Doctors a respectful and enlightening contribution, never point-scoring, slogans or sweeping generalisations.
Where do the major National and International medical associations stand concerning Euthanasia?
The World Medical Association (WMA) was founded in 1947 and currently has the National Medical Associations of 114 constituent countries as members. Medical graduates on entering the Profession commit to the Declaration of Geneva by taking the Physicians Pledge, which is considered the “Modern Hippocratic Oath ”. In the relevant section of the Pledge, it states:
AS A MEMBER OF THE MEDICAL PROFESSION:
- I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;
- THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;
- I WILL RESPECT the autonomy and dignity of my patient;
- I WILL MAINTAIN the utmost respect for human life;
In October 2019 the WMA affirmed its position on Euthanasia “The WMA reiterates its strong commitment to the principles of medical ethics and that utmost respect has to be maintained for human life. Therefore, the WMA is firmly opposed to euthanasia and physician-assisted suicide.”
The Australian Medical Association’s Position Statement on Euthanasia is also clear - “doctors should not be involved in interventions that have as their primary intention the ending of a person's life”. Furthermore, the AMA “recognises that there are divergent views within the medical profession and the broader community in relation to Euthanasia and Physician-Assisted Suicide” and “acknowledges that laws in relation to Euthanasia and Physician-Assisted Suicide are ultimately a matter for society and government.”
Dissection of statements from WMA or AMA to find potential loopholes or phraseology to imply tacit support for Physician-Assisted Suicide would be unhelpful and misleading. As the WMA states, the Declaration of Geneva “remains one of the most consistent documents of the WMA. With only very few and careful revisions over many decades, it safeguards the ethical principles of the medical profession, relatively uninfluenced by zeitgeist and modernism” and it “should not be read alone, but in parallel with the more specific and detailed policies of the WMA”.
The “Euthanasia Debate” - a Doctors Dilemma?
How might the Medical Practitioner reconcile the potentially divergent positions arising from personal views, the public’s requirement for objective information and the ethical stance of our professional associations?
Firstly, we must acknowledge the ethical, moral, clinical and legal complexity faced by our community, our legislature and by individual Doctors. Anyone suggesting this is a straightforward issue, as either a proponent for or opponent of legalising Euthanasia is misleading themselves. The majority of Medical Practitioners have their personal views, and they may well have strongly held convictions on Euthanasia and Physician-Assisted Suicide. However, we must recognise that they are just that, our personal views held as members of our community and shaped by personal and professional experiences. We must be careful not to speak as if for the all Doctors, or misrepresent the intent of Policy Statements by our professional organisations.
Secondly, always be very clear about the topic of debate - Euthanasia, Voluntary Assisted Suicide (VAS)and Voluntary Assisted Dying (VAD) are not synonymous with Physician-Assisted Suicide (PAS).
A debate around legalisation of Euthanasia, VAS and VAD should not in any way be framed by the expectation that a registered medical practitioner should be, or is required to be, involved in the promoting, prescribing or delivering of medication with lethal intent (i.e. PAS).
There is no requirement for PAS to be legalised even if the community and its legislature were to decide to legalise Euthanasia / VAS / VAD. The concept of PAS is entirely contrary to the WMA and AMA position and the ethical tradition of Medicine overall. The community should be in a position to trust that Medical Practitioners will continue to compassionately and ethically safeguard human health and life. The distinction between PAS and Euthanasia /VAS /VAD should always be carefully, clearly and deliberately acknowledged.
Prof John Burgess
President, AMA Tasmania