WA’s take on assisted dying has many similarities with the Victorian law – and some important differences

The  Conversation

Ben White, Katrine  Del Villar, Lindy  Wilmott, Rebecca Meehan

Western Australia may soon become the second Australian state to permit voluntary assisted dying, with the release on Tuesday of its Voluntary Assisted Dying Bill 2019.

As in Victoria, whose law is now just under two months old, the bill was the product of reviews by a parliamentary committee and ministerial expert panel. It’s expected to be debated in the Western Australian parliament in three weeks.

So how does what’s being proposed compare to the law in Victoria? . . . [Full text]

Euthanasia bill falls short on freedom of conscience

Objecting students unprotected, refusal may incur civil, criminal liability

Sean Murphy*

Western Australia’s Voluntary Assisted Dying Bill 2019 includes provisions intended to protect all registered health practitioners who refuse to participate for reasons of conscience. By virtue of the Health Practitioner Regulation National Law (Western Australia) this includes nurses, midwives, pharmacists, radiologists, psychologists and other professions.

However, the bill explicitly excludes students, probably to ensure that only non-student practitioners are permitted to accept and process requests, assess patients and provide euthanasia or assisted suicide (EAS).  Unfortunately, the effect of this exclusion is that nothing in the bill prevents students from being required to participate in all aspects of EAS delivery under the direction of a fully qualified registered health practitioner, or making such practical training a requirement for professional qualification.  This would be inconsistent with one of the guiding principles in the bill (Section 4(1)j), so it may be an oversight that will be corrected during the legislative process.

Fully qualified registered health practitioners may refuse to participate in the request and assessment process, prescription, supply or administration of lethal drugs, and to be present when the drugs are administered (Section 9(1)).  The bill further states that, by identifying these actions, it does not intend “to limit the circumstances in which a registered health practitioner may refuse” to do them (Section 9(2)).  This would seem to extend protection to include refusal to do do things not specified in the section, but obviously related to providing euthanasia or assisted suicide, like setting an intravenous line for administration of lethal drugs.  That interpretation is consistent with the definition of voluntary assisted dying, whichincludes “steps reasonably related to such administration.”  Clearly, this would include any of the actions explicitly required by the law, such as assessments, notifications, acting as a witness, dispensing lethal drugs, filing reports, etc., as well as setting intravenous lines and other technical preparations for providing EAS.

Sections 112 and 113 provide protection from civil and criminal liability and disciplinary proceedings for those involved in processing and fulfilling EAS requests if they act in accordance with the law. Section 113(4) extends this protection to omissions in accordance with the bill, but not to the refusals it permits.  Since “omission” does not mean “refusal”, this may reflect either an oversight in drafting or a deliberate decision to expose objecting practitioners to liability.

What could prove to be most contentious is the requirement in Section 19(5)b that an objecting physician give a patient “information approved by the CEO” of a public service department, perhaps a health department.  Whether this will be acceptable to objecting practitioners will depend entirely on the substance of the “approved” information.  It is unlikely to be problematic if it consists of general information about how to contact other physicians or health authorities.  On the other hand, resistance is likely if the “approved” information portrays euthanasia and assisted suicide as morally acceptable services or directs patients to EAS providers.  Objecting practitioners may refuse to comply if the law effectively compels them to express support for moral views they reject, or forces them to facilitate what they consider to be immoral or unethical acts by directing patients to EAS providers.

Vancouver doctor cleared of wrongdoing in probe into assisted death at Orthodox Jewish nursing home

The Globe and Mail

Kelly Grant

British Columbia’s physician regulator has cleared a doctor of any wrongdoing for sneaking into an Orthodox Jewish nursing home that forbids assisted death and ending the life of a resident who wanted to die in his own bed.

In a letter dated July 5, 2019, the College of Physicians and Surgeons of British Columbia (CPSBC) dismissed an official complaint against Ellen Wiebe, saying the Vancouver doctor did not break any of the regulator’s rules when she helped Barry Hyman, 83, die inside the Louis Brier Home and Hospital. . . [Full text]

Survival of Patients With Liver Transplants Donated After Euthanasia, Circulatory Death, or Brain Death at a Single Center in Belgium

Nicholas Gilbo, Ina Jochmans, Daniel Jacobs-Tulleneers-Thevissen, Albert Wolthuis, Mauricio Sainz-Barriga, Jacques Pirenne, Diethard Monbaliu

Abstract

Journal of the American Medical AssociationTransplantation of organs donated after euthanasia may help alleviate the critical organ shortage.1 However, aside from preliminary data on lung transplantation,2 data on graft and patient survival following transplantation of organs donated after euthanasia are unavailable. Because donation after euthanasia entails a period of detrimental warm ischemia that hampers graft survival, similar to donation after circulatory death,3 results after transplantation of this type of graft need to be carefully evaluated.


Gilbo N, Jochmans I, Jacobs-Tulleneers-Thevissen D, Wolthuis A, Sainz-Barriga M, Pirenne  J, Monbaliu D.  Survival of Patients With Liver Transplants Donated After Euthanasia, Circulatory Death, or Brain Death at a Single Center in Belgium. JAMA. 2019;322(1):78-80. doi:10.1001/jama.2019.6553

Pressure in dealing with requests for euthanasia or assisted suicide. Experiences of general practitioners

Marike E de Boer, Marja F I A Depla, Marjolein den Breejen, Pauline Slottje, Bregje D Onwuteaka-Philipsen, Cees M P M Hertogh

Abstract

Journal of Medical EthicsThe majority of Dutch physicians feel pressure when dealing with a request for euthanasia or physician-assisted suicide (EAS). This study aimed to explore the content of this pressure as experienced by general practitioners (GP). We conducted semistructured in-depth interviews with 15 Dutch GPs, focusing on actual cases. The interviews were transcribed and analysed with use of the framework method. Six categories of pressure GPs experienced in dealing with EAS requests were revealed: (1) emotional blackmail, (2) control and direction by others, (3) doubts about fulfilling the criteria, (4) counterpressure by patient’s relatives, (5) time pressure around referred patients and (6) organisational pressure. We conclude that the pressure can be attributable to the patient–physician relationship and/or the relationship between the physician and the patient’s relative(s), the inherent complexity of the decision itself and the circumstances under which the decision has to be made. To prevent physicians to cross their personal boundaries in dealing with EAS request all these different sources of pressure will have to be taken into account.


de Boer ME, Depla MFIA, den Breejen M, Slottje P, Onwuteaka-Philipsen BD, Hertogh CMPM.  Pressure in dealing with requests for euthanasia or assisted suicide. Experiences of general practitioners. J Med Ethics. 2019 Jul;45(7):425-429. doi: 10.1136/medethics-2018-105120. Epub 2019 May 15.

Doctors sign letter against ‘assisted suicide’ Bill

Newsie

More than 1000 doctors have signed an open letter saying they want no part in what they call assisted suicide.

The Care Alliance, a charity which opposes physician-assisted euthanasia, has taken out a full-page ad in the New Zealand Herald.

The signatories endorse the views of the World Medical Association and New Zealand Medical Association, that euthanasia is unethical, even if made legal. . . [Full text]

American Medical Association: Call It ‘Physician-Assisted Suicide,’ Not ‘Aid-in-Dying’

CNS News

Patrick  Goodenough

CNSNews.com) – Advocates of assisted suicide are dismayed that the largest association of physicians in the U.S. has decided to continue using the term “physician-assisted suicide” rather than euphemisms such as “medical aid-in-dying.”

Meeting in Chicago on Monday, the American Medical Association, by a vote of 360-190, adopted a report by its Council on Ethical and Judicial Affairs (CEJA) recommending that the term “physician-assisted suicide” continue to be used.

Significantly, the AMA also voted to reaffirm its Code of Medical Ethics’ current policy on assisted suicide – the view that allowing doctors to help patients to die “is fundamentally incompatible with the physician’s role as healer.” That vote was 392-162. . . [Full text]

AMA Reaffirms Stance Against Physician-Aided Death

Medscape

Marcia Frellick

CHICAGO — Delegates voted overwhelmingly to affirm the current policy opposing physician-assisted dying here at the American Medical Association (AMA) 2019 Annual Meeting.

After impassioned testimony from both sides at last year’s meeting, the Council on Ethical and Judicial Affairs was asked to further examine the issue.

“The AMA House of Delegates concluded that established guidance in the Code of Medical Ethics supports shared decisions that respect the deeply held beliefs of physicians and their patients with respect to assisted suicide,” said AMA President Barbara McAneny, MD. . . [Full text]

American Academy of Family Physicians, American Academy of Hospice and Palliative Medicine, American Academy of Neurology

Canadian Blood Services releases first set of national guidelines for organ donation after medical assistance in dying

The Globe and Mail

Kelly Grant

In the last moments before Bob Blackwood died, the doctor paused and, in front of a hushed crowd of operating-room staff, thanked Mr. Blackwood for the gift he was about to give.

It was the summer of 2017 and Mr. Blackwood, a 63-year-old former lawyer with a rare and excruciating neurological disorder, was about to become the first patient in Quebec’s eastern townships to donate his organs after receiving a medically assisted death.

“[The doctor] said he hoped that this was something they’ll be able to do more in the future to help save lives,” said Heather Ross, Mr. Blackwood’s widow. “It was just lovely how he put it.” . . . [Full text]

Deceased organ and tissue donation after medical assistance in dying and other conscious and competent donors: guidance for policy

James Downar, Sam D. Shemie, Clay Gillrie, Marie-Chantal Fortin, Amber Appleby, Daniel Z. Buchman, Christen Shoesmith, Aviva Goldberg, Vanessa Gruben, Jehan Lalani, Dirk Ysebaert, Lindsay Wilson and Michael D. Sharpe

KEY POINTS

  • First-person consent for organ donation after medical assistance in dying (MAiD) or withdrawal of life-sustaining measures (WLSM) should be an option in jurisdictions that allow MAiD or WLSM and donation after circulatory determination of death.
  • The most important ethical concern — that the decision for MAiD or WLSM is being driven by a desire to donate organs — should be managed by ensuring that any discussion about organ donation takes place only after the decision for MAiD or WLSM is made.
  • If indications for MAiD change, this guidance for policies and the practice of organ donation after MAiD should be reviewed to ensure that the changes have not created new ethical or practical concerns. . .
  • [Full text]

Downar J, Shemie SD, Gillrie C, Fortin M-C, Amber Appleby A, Buchman DZ, Shoesmith C, Goldberg A, Gruben V, Lalani J, Ysebaert D, Wilson L, Sharpe MD.  Deceased organ and tissue donation after medical assistance in dying and other conscious and competent donors: guidance for policy. CMAJ. 2019 Jun 3;191(22):E604-E613. doi: 10.1503/cmaj.181648.