Positive and negative medical developments
BY PROFESSOR MICHAEL KENNEDY
There have been enormous advances in medicine since I commenced practice. The life span of patients with cardiovascular diseases has increased by decades, asthmatics experience spectacular symptomatic and long-term improvement, peptic ulceration is essentially cured, hypertension has been controlled using medications that are well tolerated, some malignancies are cured, and so the list goes on and on.
With these advances it is amazing that the promotion of euthanasia has returned to prominence after having been considered unethical and actively opposed by medical associations in the past. No matter how expressed, it is about doctors being directly involved in the act of killing a fellow human being. Intentional killing is anathema in civilised societies.
Professional bodies need to support doctors acting within the law so it is not surprising they have taken a more neutral stand on the topic as it moves closer to home. More remote bodies such as the World Medical Association are able to maintain an independent profile and completely oppose euthanising patients, however it is expressed.
The acceptance of euthanasia into medical practice has much greater implications than it would superficially appear. Medical students will be entering a profession where intentional patient killing is acceptable practice. Therapeutic guidelines will need to include a specific protocol. Killing protocols still in use in some United State prisons and those used in other countries for euthanasia sometimes fail.
Frequently, patients suffering from neuromuscular degenerative diseases appear in the media supporting euthanasia. The eminent neurologists John Walton and Roger Bannister were among the strongest public and at committee level opponents of euthanasia legislation. There are many drugs now in the clinical trial stage that may considerably improve the outlook of these patients. When penicillin was first used in a patient with terminal sepsis it was described by the administering doctors as a ‘miracle’.
Conscience votes in legislative chambers will often reflect the effect it will have on holding one’s seat, or even government, in times of close elections. One member of the NSW legislature stated they would vote in favour as that was the ‘majority’ opinion coming in from the electorate. So much for detailed consideration of the issues.
There is no question that the bar drops once laws are passed. This usually begins in drafting the legislation by altering the time expected for death. Overseas it now extends to children, the demented and the depressed. Public debates on euthanasia are usually well scripted, highly emotional, and sometimes feature high profile public personalities but they never use the word killing.
The English House of Lords select committee undertook an extensive review of the matter before the expansion of palliative or terminal care as a subspeciality. A similar authoritative body should commence a similar review before unacceptable and unnecessary practices undermine the fabric of medicine. Medical Colleges, Associations and Societies should decide to move in this direction and avoid taking the neutral pathway. The profession as a whole should also work towards the banning of medicalised killing in a similar manner to which it opposes capital punishment.
Professor Michael Kennedy is a Consultant Physician in private practice and Conjoint Associate Professor UNSW.
Views expressed in the above article are those of the author and do not necessarily reflect official policy of the AMA.
Published: 14 Mar 2018