EUTHANASIA To be or not to be

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EUTHANASIA
To be or not to be
A/Prof. David O. WATSON
Consultant Physician
UNDA Fremantle, 12 August 2010
EUTHANASIA: To be or not to be
MY TASK
• Introduction
• The moral dilemma
• Effects on clinical care
• Conclusions
EUTHANASIA: To be or not to be
INTRODUCTION
• Who am I?
• My professional background and practice
• My associations with the Sisters of St. John of
God, the care of the dying and UNDA
EUTHANASIA: To be or not to be
THE MORAL DILEMMA-1
• “ ‘Euthanasia has come from the Greek, and has
evolved from the concept of ‘easy death’ to that
of ‘mercy killing’ in modern usage” (1)
• From the physician’s standpoint euthanasia will
be restrained by the physician’s desire, where
possible to find alternatives but it is not
impossible that the number of requests for
euthanasia…..will increase” (2)
EUTHANASIA: To be or not to be
THE MORAL DILEMMA-2
• “There remains a question which has to be faced
by all doctors, including those who support
euthanasia. ‘Why would it be thought that
doctors should provide euthanasia?’” (3)
• “A generation of doctors has arisen in the
Netherlands which has not known a time when
there was significant opposition to euthanasia in
their country, and who have learned that doctors
may treat particular patients or kill them” (3)
EUTHANASIA: To be or not to be
THE MORAL DILEMMA-3
• Who are these patients?
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The frail aged
Those with dementia
Survivors of severe head injury
Those with serious terminal physical illness
Those with incurable mental illness
Severely impaired children and adults
EUTHANASIA: To be or not to be
EFFECTS ON CLINICAL CARE-1
• In 2010 and beyond good medical care demands
teamwork
• “Only 50% of patients report adequate control
[of pain] in repeated surveys conducted
internationally” (4)
• “Conducting research in palliative and end of
life care is notoriously difficult…..”. (4)
EUTHANASIA: To be or not to be
EFFECTS ON CLINICAL CARE-2
• Medical records are poor
• “…..management of end-of-life in acute
hospitals is often inappropriate and cruel” (5)
• Acute care is not always the most appropriate
• “Doctors have a professional and moral
mandate to use every reasonable means available
to free patients from the pain and other
symptoms that cause them to suffer”. (6)
EUTHANASIA: To be or not to be
EFFECTS ON CLINICAL CARE-3
• “In 2007, 1.9% of all deaths in Flanders were
the result of euthanasia (ending of life at the
patient’s explicit request), a rate that was higher
than that in 1998 (1.1%) and 2001 (0.3%)”. (7)
• “In 1.8% of all deaths, lethal drugs were used
without the patient’s explicit request, a rate that
was lower than that in 1998 (3.2%), but similar
to that in 2001 (1.5%)”. (7)
EUTHANASIA: To be or not to be
EFFECTS ON CLINICAL CARE-3
• The imperatives of clinical care
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Attend to all the needs of each individual patient
Provide the best possible care that resources allow
Practice in a peer review environment
Practice contemporaneous medicine
Undertake audit and review of practice
Work in teams that include the patient and those
who support the patient
EUTHANASIA: To be or not to be
EFFECTS ON CLINICAL CARE-4
• Euthanasia fundamentally upsets the balance
between doctor and patient
• We must consider the advisability of allowing
doctors to act in a way contrary to the rest of
society
• There are serious concerns in removing
constraints on the way doctors can conduct
themselves
EUTHANASIA: To be or not to be
EFFECTS ON CLINICAL CARE-5
• Legislating in favour of euthanasia is no
substitute for
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Improved record-keeping
Better research
Improved pain and symptom management
Better teamwork
EUTHANASIA: To be or not to be
CONCLUSIONS
• Overseas experience suggests legislative support
for euthanasia erodes standards of end-of-life
care
• Euthanasia becomes available to a wider group
than those with terminal cancer
• Support for euthanasia fundamentally upsets the
doctor-patient relationship
• It is no substitute for better care
EUTHANASIA: To be or not to be
REFERENCES-1
• 1. “Euthanasia: evolution in Holland 19691992”. WATSON D.O. Paper at the Australian
Management College. 14 December 1992.
• 2. “Euthanasia and other medical decisions
concerning the end of life”. Van deer MAAS
P.J. et al. LANCET 1991;338:669-674.
• 3. “Medical aspects of euthanasia”. POLLARD
B.J. MED J AUST 1991;154:613-616.
EUTHANASIA: To be or not to be
REFERENCES-2
• 4. “What physicians need to know about palliative
care”. SPRYUT O. RACP NEWS; April 2010:14-15.
• 5. “Diagnosis of dying”. HILLMAN K. THE
HEALTH ADVOCATE; April 2010:17-20.
• 6. “Regarding euthanasia”. ROY D.J. et al. EURO J
PALL CARE 1994;1:57-59.
• 7. “Medical End-of-Life Practices under the
Euthanasia Law in Belgium”. BILSEN J. et al. N ENG
J MED 2009;361:1119-1121.
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