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ACT Right to Life AssociationN E W S L E T T E R |
Michael Moore’s proposed amendments
Independent MLA Michael Moore has proposed an amendment to the Medical Treatment Act 1994 which, The Canberra Times (16 July 1996) reported, would change a key section of the Act which allows pain relief ‘to the maximum extent that is reasonable under the circumstances’ to read ‘to the [maximum?] extent that the individual deems necessary’. Mr Moore has not yet released the text of the proposed amendment.
President of the ACT Right to Life Association, Jeremy Stuparich, said that the ACT should be cautious about Michael Moore MLA’s suggestion that the Medical Treatment Act be amended to allow patients, rather than a ‘health professional’ as defined in the Act, the final say as to how much pain relief they require.
"The Medical Treatment Act is written to allow patients to have a full input into their treatment - but it recognises that pain relief is a complex issue and requires the expertise of a trained health professional. Any doctor who ignored their patients’ advice about pain would risk a malpractice suit. Michael Moore’s amendment may in fact lead to a poorer level of pain relief for patients.
"For example, it is well recognised by palliative care workers that patients can reach a point where injecting them with more morphine does not lead to more pain relief. It takes a skilled health professional to recognise that this point has been reached, to counsel the patient accordingly and reduce the morphine dose to an appropriate but lower level.
"There is also the danger that changing this legislation will conflict with the Crimes Act prohibition of counselling, aiding or abetting suicide. This would, for example, expose patients suffering from depression to the danger of assisted suicide."
Ms Joanne Ramadge, president of the South Eastern Region Branch of the Association of Palliative Care Nurses said that "there has not been one request by Mr Moore, to either of the major institutions specialising in palliative care in the ACT, to observe or discuss that [palliative] care." (The Canberra Times, 3 Aug 96).
Ms Ramadge also pointed out that "another distressing issue raised by Mr Moore is the use of morphine to kill patients ... An aftermath of this argument and resultant publicity is the probability of instilling fear in some people who may need morphine to relieve their pain."
Mr Moore has stated that the amendment will not introduce ‘active euthanasia’ and that he intends to introduce a full euthanasia bill next year. Until the amendment is released it is difficult to determine the full implications of his proposal.
However, it appears likely that Mr Moore wishes to reinstate the same words or similar words to those proposed by the Select Committee on Euthanasia in 1994 in their Medical Treatment Bill. It also appears he may have the numbers to pass the amendment.
The current Assembly numbers with respect to euthanasia appear to be 9 against and 8 in favour.
Although Chief Minister Kate Carnell opposed Michael Moore’s euthanasia bill, Mrs Carnell may be willing to support Mr Moore’s proposed amendment.
Last year Mrs Carnell stated (ACT Legislative Assembly Hansard, 22 November 1995) "... I would like to see the words that were originally put forward by the [Select] Committee [on Euthanasia] reinstated, or similar words inserted, to ensure, once and for all, that the patient has a right to adequate pain relief. I know that an amendment to that part of the Bill watered it down substantially ... I hope that an amendment along the lines I have spoken about is brought forward soon to achieve the end that I’m sure we all want."
Concerns were raised at that time by a number of community groups, including ACT Right to Life, about the implications of the Medical Treatment Bill.
ACT Right to Life wrote to Members of the Legislative Assembly in August 1994 after obtaining legal advice on the Medical Treatment Bill.
Of particular concern in the Medical Treatment Bill, as first proposed, were the provisions that a patient had a right to "... maximum relief from pain and suffering" (clauses 4(a) and 22).
In the submission to MLAs, ACT Right to Life noted that the text of the Bill as then drafted would mean that a health professional who had deliberately procured the death of a patient would be virtually ensured immunity from conviction for the offence.
If a health professional were charged with the homicide of a patient, the prosecution would have to lead evidence to exclude the possibility that death may have resulted from things done by the health professional to satisfy the patient's right "to maximum relief from pain and suffering".
In practice with those clauses it would have been virtually impossible to obtain such evidence and euthanasia by health professionals would have been possible.
The then ACT Attorney General Terry Connolly MLA stated in debate (ACT Legislative Assembly Hansard, 21 September 1994) that the Government did not share the concern of a number of people in the community with regard to the Bill. However, Mr Connolly said that "... given the sensitive nature of the subject and the concerns in the community, the Government did feel that it was appropriate to make it even clearer and, with an abundance of caution, to provide a clear provision to ensure that the requirement for pain relief is qualified."
President of ACT Right to Life, Jeremy Stuparich, has written to Members of the Legislative Assembly to urge them to oppose any moves to undo the safeguards against euthanasia contained in the Medical Treatment Act.
Legalised euthanasia in the NT
Greg Smith LLB, Barrister at Law and spokesman for the Australian Federation of Right to Life Associations, spoke at the international conference "The Threat of Euthanasia", held in Hilversum, The Netherlands, 16-19 June, 1996. Extracts from Mr Smith’s speech appear below.
"The Legislative Assembly of the Northern Territory became the first legislature in the world to pass legislation allowing medical practitioners to perform voluntary euthanasia or assist in suicide of terminally ill patients, when on 25 May 1995 by a majority of 1 vote they passed the Rights of the Terminally Ill Bill (ROTI).
"The Bill, now the Act, which has since been amended, is set to come into operation on 1 July 1996. A Bill to repeal the ROTI Act, called the Respect for Human Life Bill, was introduced into the Legislative Assembly on 15 May 1996 but will not be debated for several months. The President of the Northern Territory Branch of the Australian Medical Association and other prominent Territorians will apply this month to the High Court of Australia for an injunction to stop the ROTI Act coming into operation.
"In any event, lack of co-operation by the Australian Medical Association, nurses and aboriginal groups make it doubtful that the Act will come into operation on 1 July."
"The objects of the Act immediately create controversy. It is stated to be `an Act to confirm the right of a terminally ill person to request assistance from a medically qualified person to voluntarily terminate his or her life in a humane manner, to allow for such assistance to be given in certain circumstances without legal impediment to the person rendering the assistance, to provide procedural protection against the possibility of abuse of the rights recognised by this Act; and for related purposes.'
"The initial statement `to confirm the right of a terminally ill person to request assistance from a medically qualified person to voluntarily terminate his or her life in a humane manner' is false in its terms. There is no such right under the laws of the Northern Territory, which punishes murder by doctors and everyone else with a penalty of up to life imprisonment. Also under the NT Criminal Code it is an offence punishable by up to life imprisonment to aid, counsel or procure anyone to commit suicide."
"The operative section of the ROTI Act is section 4 which states:
`4. Request for assistance to voluntarily terminate life. A patient who, in the course of a terminal illness, is experiencing pain, suffering and/or distress to an extent unacceptable to the patient, may request the patient's medical practitioner to assist the patient to terminate the patient's life.'
"What does the expression `terminal illness' mean under the ROTI Act? `Terminal illness ... means an illness which, in reasonable medical judgement will, in the normal course, without the application of extraordinary measures or of treatment unacceptable to the patient, result in the death of the patient.'
"Note that the expression `extraordinary measures' is undefined, leaving it up to a medical practitioner to decide:
(a) whether reasonable medical judgement would predict the illness would kill the patient;
(b) what are extraordinary measures."
"But the most uncontrollable words in the definition are `or of treatment unacceptable to the patient'. This opens up the ROTI Act and permits doctors to commit euthanasia on a far greater group of patients than those we would normally consider to be terminally ill, namely persons dying of incurable cancer. Where patient autonomy is paramount as here, the definition could catch asthmatics, persons with chronic heart ailments or kidney disease, or diabetes, who are dependent on regular treatment which in normal circumstances may keep them alive for many years.
"What of sufferers of multiple sclerosis and diseases of a similar nature who want to die? What of quadriplegics and paraplegics ... ?"
"Unlike the Netherlands, there is no provision for the coroner or the police to investigate any particular death authorised by the ROTI Act. Doctors and those assisting them are immunised from criminal prosecution, civil action or disciplinary action.
"The doctor is required to send a copy of the death certificate and such details of the patient's medical record as relates to the terminal illness and death of the patient. The Coroner at the end of each financial year is to advise the Attorney-General of the number of patients killed under the ROTI Act the previous year and the Attorney-General is to report the numbers to the Legislative Assembly.
"The upshot of these provisions is that the Coroner has no role to investigate euthanasia performed by doctors under the ROTI Act, unless a complaint was made that the conditions of the Act have not been complied with. Such a complaint would be very difficult to investigate, as the victim would be dead and the witnesses to the death likely to exercise their right of silence, lest they incriminate themselves."
Euthanasia developments in the ACT
On Sunday, 26 May 1996, ACT Labor Party Leader Andrew Whitecross MLA addressed a small group of Voluntary Euthanasia Society members at their Annual General Meeting.
President of the ACT Right to Life Association, Jeremy Stuparich, attended the meeting and issued a media release to warn the ACT Labor Party that they stood little chance of being returned to government in the ACT if they supported radical social policies like voluntary euthanasia.
Mr Stuparich expressed concern that Mr Whitecross had speculated about broadening the scope of euthanasia legislation to people who were not terminally ill. "Andrew Whitecross dismissed the validity of the ‘slippery slope’ argument while a moment before he had raised the possibility of euthanasia for people who are not in a ‘terminal phase of a terminal illness’ [as Michael Moore MLA’s legislation defines it] and people who are not terminally ill at all", said Mr Stuparich.
"The ACT Labor Party lost government in 1995 partly because they had alienated significant groups in the ACT community with their support for things like euthanasia", Mr Stuparich said. "The ALP needs to regroup with moderate policies which don’t discourage people from voting for them."
Capital Ten TV News reported (Monday, 27 May 1996) that "Andrew Whitecross insists there’s no change in ALP policy. He says the aim of yesterday’s address was to show some compassion in the euthanasia debate.
"‘I acknowledged to members of the Euthanasia Society that Michael Moore’s bill didn’t address all the circumstances in which people in the Voluntary Euthanasia Society would like to see euthanasia available as an option.’
"He says he specifically referred to people who suffer from diseases whose quality of life has deteriorated to the point where they want to die."
Despite Mr Whitecross’s protestations, this TV news report merely seems to confirm the concerns Mr Stuparich expressed.
On 23 June 1996 president of the ACT Right to Life Association, Jeremy Stuparich, welcomed the news that the ACT Labor Party had decided to allow a conscience vote on voluntary euthanasia. Mr Stuparich also encouraged the ALP to drop euthanasia from its agenda when it conducted the foreshadowed review of policies for the next election.
"The Labor Party should be congratulated for allowing its parliamentary members a conscience vote on this issue, but it also should recognise that ALP support for radical social policies such as euthanasia was one of the factors which led to its defeat in 1995", said Mr Stuparich.
"I am concerned however", Mr Stuparich said, "over whether a real conscience vote is possible in a party where the two Labor MLA’s who opposed euthanasia in the Legislative Assembly last year were called ‘rats and scabs’ (Canberra Times, 23 June 1996), despite the fact that those two MLAs had been given a de-facto conscience vote by the ALP.
"In order for the conscience vote to have any real meaning, the ALP should foster a full and open debate on the issue within the Party. The decision to adopt voluntary euthanasia as a party policy was made in 1991, without general party debate, after it had been looked at by the ALP’s Legal and Administrative Reform Policy Committee."
Abortion drugs now publicly accountable
On 26 May this year the Australian Parliament passed an amendment proposed by Senator Brian Harradine (Independent, Tasmania) to the Therapeutic Goods Administration Bill which will make approval of abortion drugs a public process.
Senator Harradine's amendment has created an administrative roadblock to the importation, trialing, licensing and marketing of abortion drugs. Now the Minister for Health and Family Services, Dr Michael Wooldridge, is directly responsible for the importation of RU486 and other anti-progesterone abortifacient drugs.
The Minister is required to report to Parliament each decision to allow importation of these drugs.
In 1994 there was great controversy over the importation of RU486 into Australia for trials by the Family Planning Associations in Victoria and New South Wales. The importation of RU486 was approved by a Departmental delegate, a public servant from the Therapeutic Goods Administration who was delegated decision-making power by the Minister under the Customs (Prohibited Imports) Regulations.
As a result of Senator Harradine's questions at Estimates Committee hearings as far back as 1988, undertakings were given and policy adopted that no such exemption would be given or clinical trials approved unless the Minister for Health was involved in the decision.
However, in 1994 neither the then Health Minister, Senator Graham Richardson, nor then Family Services Minister Senator Rosemary Crowley were consulted by the Departmental delegate prior to the exemption being granted.
Health Minister Graham Richardson acknowledged that the official assurances were "breached" and said that the Government would see whether it could rectify the situation (Senate Hansard, 17 March, 1994). He soon resigned and nothing was done.
In addition to this blunder, the trials were criticised for not having detailed consent forms to point out to women considering taking part in the trials the potential hazards of RU486 to their health.
RU486 (also known as Mifepristone and sold in France as Mifegyne) is a progesterone antagonist. It is a synthetic steroid which blocks the positive effects of the hormone progesterone, which is necessary to sustain the rich, nutrient lining of the womb during pregnancy.
When the function of progesterone is inhibited by RU486, the womb's lining is broken down and the foetus is destroyed in the process. This is RU486's most common function. If administered after fertilisation but prior to implantation, RU486 is intended to make the womb unreceptive to the embryo because the lining is inadequate for the embryo to attach.
However RU486 has a significant "failure" rate when used alone. To make it more effective, the three RU486 tablets taken by the pregnant women are followed several days later by a prostaglandin injection or suppository. This causes powerful uterine contractions to expel the foetus.
Despite the combination of both drugs, overseas experience is that there is an estimated five percent of cases where a surgical abortion has to be performed.
A major factor behind the research and promotion of RU486 is the use that can be made of the drug for population control. It is for this reason that RU486 attracts the financial support of the Human Reproduction Program (HRP).
The World Bank, United Nations Population Fund, United Nations Development Program and World Health Organisation are sponsors of the HRP program.
HRP priorities are recommended by an advisory committee of which Professor Etienne-Emile Baulieu, the scientist most closely associated with RU486, has been a member. Authorisation for use in developed countries precedes widespread distribution in developing countries because distribution at a cost-plus price in that market is mandated by company contracts with HRP.
Ausaid allocates funds to the HRP program from aid money.
The HRP is committed to research directed at perfecting existing abortion technology and developing new abortion drugs. The new abortion drugs are seen by the HRP as heralding an exciting new era in birth control/population control technology.
The push to approve RU486 in developing countries could have horrendous ramifications on women's health, where there are inadequate health services to deal with RU486 induced complications.
The RU486 controversy in Australia has highlighted the inadequate system that exists for evaluating the ethical and legal ramifications of trials of hazardous drugs on women. The passage of Senator Harradine's amendment will mean greater accountability and will give an opportunity for public scrutiny in this important public health issue.
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