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11 May 2018

Transcript:   AMA President, Dr Michael Gannon, ABC Radio Brisbane, Breakfast with George Roberts and Rebecca Levingston, Friday 11 May 2018

Subject:  Euthanasia and physician-assisted suicide

GEORGE ROBERTS:   The Australian Medical Association is very concerned about the impact David Goodall's story will have on suicide prevention efforts. It says that suicide and medical care are two very different things. Dr Michael Gannon is the National President of the Australian Medical Association.

Good morning, Dr Gannon.

MICHAEL GANNON:   Good morning to you both.

GEORGE ROBERTS:   So, the AMA strongly opposes assisted dying, and why is that?

MICHAEL GANNON:   Well, I think that we're talking about a number of different things here. The AMA has a position opposing euthanasia, but what you're very specifically talking about here is physician-assisted suicide. Dr Nitschke hasn't changed his lines over a long period of time. It's intellectually dishonest to say that doctors should stay out of this conversation, the AMA should stay out of this conversation, and then be talking about a process that involves the doctors administering lethal substances.

So, our Position Statement acknowledges the wide divergence of opinions on the topic of euthanasia, especially as most people understand it in regard to ease of suffering, in the end of life context. But Dr Nitschke and his extremely well-funded political organisation talk frequently about the issue of rational suicide. We worry about the mixed messages this sends when we are very interested, as a medical profession, in suicide prevention.

GEORGE ROBERTS:   When you say that - the rational suicide - isn't that though different from the kind of mental health issues that we all want to prevent and we all want to try to ease? When we're talking about Dr Goodall, he had to go through a process where his mental health was checked, assessed, and he was found to be sound of mind before he went through this process.

MICHAEL GANNON:   Well, you're talking about two different things there. What you are talking about is the fact that Dr Goodall was deemed to be competent in making a decision. Now, if a 34-year-old who is in the middle of a messy divorce, who's lost their job, has a chronic pain syndrome, commits suicide, that might be rational. Dr Nitschke would say that that is a reasonable decision. I would say that is tragedy.

I would ask you, at what age do we as a community celebrate the rational suicide of an individual? Because I have great concerns if someone says that you're allowed to do this at 104, what is the cut-off? Is it 94, is it 84, is it 74? What we know from the Dutch experience is that if you legislate, if you legalise euthanasia, physician-assisted suicide, you normalise, it becomes normal, and then we start to have more and more complicated conversations about which lives are valuable and which lives aren't.

REBECCA LEVINGSTON:   Well, Dr Gannon, what has the Dutch experience been since assisted suicide is legal? Have there been more deaths of younger people?

MICHAEL GANNON:   There has, and in fact the suicide rate in the Netherlands continues to rise much higher than in comparable countries nearby that don't have euthanasia physician-assisted suicide. So, if we look over the last decade, suicide rates - we're talking about different issues here, but it is important - the suicide rate in the Netherlands is going up at the same time that in neighbouring Germany and France the rate is going down. Now, this is important, and the AMA's statement - in addition to recognising the wide range of views in the community - also clearly states that we mustn’t forget the impact on the remainder of the health system.

REBECCA LEVINGSTON:   I just want to interrogate those figures a little more though, Dr Gannon. You say the suicide rate is going up, is that for older citizens who are choosing - who are not terminally ill, who are choosing this end of life option? Or is or is it people who are unhappy, mentally unwell?

MICHAEL GANNON:   So, this is a very important point. The euthanasia rate is going up. The physician-assisted suicide rate is going up. Four-and-a-half per cent of Dutch people die under their euthanasia physician-assisted suicide regulations. In addition to that, the suicide rate is increasing. If you normalise suicide, then you normalise those choices in people. I would say that I was in the budget lock up on Tuesday night, and one of the things I was excited about was the $70 million worth of money that's going to organisations like Lifeline, like SANE, like beyondblue, in suicide prevention. You legislate physician-assisted suicide, you send a message to the community. That needs to be thought about when we talk about the laws in Victoria, potential laws in Western Australia, and elsewhere.

REBECCA LEVINGSTON:   Well, there's a couple of things in that, though, and I wonder whether the increasing suicide rate also speaks to the changing nature of society more broadly and people being more willing to have a conversation about this and seeking those options. There's also changing rates of religion.

But on the issue of mental health and end of life choices, I want to - and let me just make a comparison with another controversial area relating to medicine. Are you suggesting that people don't understand the difference between assisted suicide and mental health issues in the same way that you might argue that people can't understand that a conversation about medicinal cannabis is different to a conversation about illicit drug use?

MICHAEL GANNON:   Well I think the interesting comparison you make there is that advocates for change in society sometimes deliberately muddy the waters. If you want to talk about cannabis, the reality is that there is probably a limited scope of use in an evidence-based fashion for medicinal cannabis. I mean, its use in the palliative care setting, the use in the paediatric epilepsy setting, I think is well established. And we don't want any barriers in the use of medicinal cannabis, but people who favour a permissive attitude to recreational cannabis deliberately muddy the waters and deliberately overstate the benefits of medicinal cannabis with a broader political aim.

What I'm saying is that we've got to be very, very careful in the way we talk about suicide. And I think that there are different people in this space with different views. There's a whole range of views. There are a lot of Australians - and we know this from poll after poll after poll - who believe that there might be a place for euthanasia in the end of life setting.

When you start to ask doctors to get involved in that, when you start to say if you've made a rational decision, if you've contemplated it - and again, it doesn't need to be the right decision - for someone to go ahead and use one of the death machines in Switzerland or in other jurisdictions, they just need to be competent. They need to be found to be able to make a decision. These are very, very complex areas, and this is nothing to do with the end of life debates that we would like to focus on.

GEORGE ROBERTS:   You're listening to Dr Michael Gannon, the National President of the Australian Medical Association. Dr Gannon, can I just read out a text from one of our listeners, who says: “My grandfather is 94 and in a home, paralysed with dementia and Parkinson's. He has zero quality of life and has done so for the past three years. The industry of aged care is keeping him alive. The poor guy has no choice anymore but to slowly rot in a bed. How can this be humane?”

And when doctors are asked to sign the Hippocratic Oath and look after the best interests of human life, at what point do you get to where it's not the role of the doctor to allow someone to end their life if they wish?

MICHAEL GANNON:   Well, in terms of the law as it stands, and in terms of medical ethics as they exist, there is nothing even remotely ethically dubious about withdrawal of care or non-continuation of futile care. So, for example, if you've got someone with a chronic disease who catches pneumonia or something like that, there is nothing ethically dubious about deciding not to race them into hospital and give them broad spectrum antibiotics, intravenous fluids, et cetera. If we look at the Victorian laws due to come into effect in about 18 months' time, there is an exclusion for people with dementia. Of course, what has happened in many jurisdictions over the years is that people promoting euthanasia, physician-assisted suicide, have managed to get in a minimalist law. They often call it a very safe law, and then over time those laws are expanded.

We've seen that for example in the Netherlands, so that over time it has been used to include people with mental illness like depression or anxiety, it has been extended to include people with dementia. It's been extended to include children. Now, this is not for doctors to say what should and shouldn't happen. This is a matter for society and its Parliaments. But if you're going to ask doctors to be involved, I have an opinion, and doctors know more about end of life decision making than probably any other professional group in society. It's also our job to speak up for vulnerable populations that, unlike Dr Goodall, don't have a say, don't have the wisdom, the intellect, and the access to the media to tell their story.

GEORGE ROBERTS:   Dr Gannon, that's sort of one of the points that Philip Nitschke made about the Victorian laws. He said that they're too restrictive and almost impossible. Are you concerned that the Victorian laws will eventually lead to more liberal laws?

MICHAEL GANNON:   Well, the Victorian laws will not be enough for Dr Nitschke, and they will not be enough for the advocates within Exit International. This is the international experience. There are people who will seek a more and more permissive approach to the issue. Again, I'd give great emphasis to this. This is not - doctors don't get to decide the laws of the country. But if you're going to ask doctors to be involved in something which is contrary to 2,500 years of medical ethics - well, you might expect them to have an opinion. You're trained from day one of medical school to respect human life, to try and preserve human life. There's nothing ethically dubious about withdrawing from treatment when it's time to do so, but asking doctors to kill patients - that is very, very difficult, and it's at odds with what we've been taught since day one.

REBECCA LEVINGSTON:   Dr Gannon, very much appreciate your time this morning. Thanks so much.

MICHAEL GANNON:   It's a pleasure.

REBECCA LEVINGSTON:   Dr Michael Gannon, the National President of the Australian Medical Association.

11 May 2018

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Published: 11 May 2018