RACGP releases position statement on voluntary assisted dying

Matt Woodley

25/06/2019 3:43:57 PM

The RACGP recognises that changes to the law are a matter for society and government, and health professionals must operate within boundaries of state and federal law.

Older male patient
The position statement provides frameworks and commentary designed to ensure both patients and GPs are supported.

The statement acknowledges that states across Australia are either considering or have passed voluntary assisted dying legislation, and goes on to assert that any legislation must protect both doctors and patients from coercion.
It aims to provide frameworks and commentary to ensure patients and GPs are supported when or if legislation for voluntary assisted dying comes into the clinical setting.
The RACGP believes any legislation must:

  • protect both patients and doctors from coercion
  • ensure doctors are not compelled in any way to participate
  • have clear eligibility criteria
  • support the optimisation of end of life and palliative care services.
‘The RACGP is acutely aware there are a range of views on voluntary assisted dying, both within the general practice profession and the broader community,’ the statement reads.
‘Both proponents and opponents of voluntary assisted dying wish to alleviate suffering of dying patients, and recognise that doctors as medical professionals have ethical responsibilities.
‘This position statement has been written to ensure that both patients and [GPs] are supported when legislation for voluntary assisted dying is being considered and implemented.’
While the RACGP neither supports nor opposes voluntary assisted dying, it recognises there are patients who will request access to assisted dying if it becomes a legal option, and that any such requests require a respectful and compassionate response.
It also states that a lack of palliative care services should not compel patients into voluntary assisted dying, and that regular audit of services and government responsibilities should occur to prevent this from occurring.
Aside from determining what should be contained in any potential legislation, the RACGP has also outlined the acts it considers do not constitute voluntary assisted dying. These include:
  • withholding or withdrawing medical treatment, either in accordance with that person’s previously expressed wishes, or in a situation where the person retains capacity to make decisions and has refused life-sustaining interventions
  • withholding or withdrawing futile treatment
  • administering palliative medication with the intention of relieving a person’s pain and suffering, with the understanding that this may have a secondary consequence of hastening death
  • terminal or palliative sedation to induce decreased or absent awareness in order to relieve otherwise intractable suffering at the end of life.
Overall, the statement highlights the important role general practice has in providing end-of-life care and emphasises that GPs should always be guided by the principles laid out in the Medical Board’s Good medical practice: a code of conduct for doctors in Australia.
‘Recognising and supporting the role of general practice is central to meeting society’s growing need for high quality end-of-life care,’ the statement reads.
‘The rapport GPs build with their patients over years creates an ideal setting for end-of-life planning and care. GPs often have contextual knowledge of the patient and their family. Trusting, long-term GP–patient relationships can help facilitate timely discussions about needs and preferences in the context of various end-of-life scenarios.
‘A GP’s involvement in voluntary assisted dying will be determined by personal, cultural and religious beliefs, and our profession’s guiding ethical principles.’

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Dr Evan Ackermann   26/06/2019 9:17:28 AM

I think this is a really good statement and I thank all RACGP committees who contributed to it.

Nora Dabbagh   26/06/2019 10:06:37 AM

It is a good statement but my quiery is "Even when assisted dying laws comes into affect, and if patient given good palliative care and he / she is in suffering situation not alleviated with appropriate support- Why this has to fall on GP s to enact, and not on the Geriatrician or the Palliative Consultant...... but always on the GP as it happened with pain management ..... palliative..... always delegating from Specialist arenas to the GP."

michael kennedy. retired   26/06/2019 11:09:08 AM

I was wondering why there wasn't a poll of the membership re this issue rather than a committee coming up with a statement which neither supports or detracts from the topic .
Is there a need for a new system for dying in the first place .
Isn't the greatest freedom we have : we all are on the same page with regard the way dying is managed at all levels in the community .
Rather than a position statement , a series of questions for the membership to consider would have been a better starter rather than the trap of a position statement in the first instance.
eg in other countries what percentage deaths occur in this way .What is the experience re a doctor standing aside for personal reasons .
In human terms , what pressures, or loss of freedoms really come to operate on the patient when euthanesia exists. This is a human issue not legalistic in total
Our training teaches us to ask the right question or questions before getting the significant answer, isn't that right

Paul Jenkinson   26/06/2019 11:39:16 AM

In 2019,how is it that we can only offer suicide to those vulnerable people who are suffering so much?
What an indictment of our medical and social system .
There will be so many depressed,poor,socially isolated,aged abused who will be victims of this State sanctioned suicide.
This legislation comes into effect as we are reeling from the horror stories of the Aged Care Enquiries.
How tragically ironic.