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The New Zealand Medical Association devalues members

Ann David's column in the Gisborne Herald: 10 March 2018

The New Zealand Medical Association (NZMA) has made its submission to the Justice Select Committee in a coruscating rant against assisted dying. Its arguments are remarkably similar to those of the Catholic church: potential coercion and doubts about mental competence to decide.

To assist it in coming to its 12-page conclusion, it “commissioned” Grant Gillett, Professor of Medical Ethics at Otago University, who has been implacably and vocally opposed to assisted dying since 1995, to advise it. The NZMA got what it chose to get: comfort to maintain its status quo.

The NZMA has its own internal code of ethics. In its Preliminary Statement it assures us: “This document does not purport to set out rigid, immutable rules . . . . The Code will be reviewed at regular intervals and, to this end, comment and feedback is invited.”

Feedback from whom? From Professor Gillett and its own Ethics Committee who devised the current Code of Ethics? Where is the progressiveness in that? Where is the reflection of society’s changing needs and values? Of doctors’ changing professional experiences and the corresponding changes in their own understandings and values? Where is the viewpoint of the NZMA’s customers as spoken for by its doctors who listen daily to requests for assisted dying, and to whom the doctor has no better response than some vague promise to “keep you comfortable”, knowing that this promise cannot always be kept?

Where is the balanced advice taken also from the many ethicists who have no moral objection whatsoever to assisted dying? What have professional ethics come to — captivated as they are by a minority club pushing a political barrow?

Are we really to believe that doctors, who currently make judgements about whether coercion and mental competency are present when patients request life support to be switched off or decide to discontinue life-prolonging treatment, are unable to make the same judgements about requests for assisted dying?

Are we to understand that doctors, who currently offer terminal sedation to patients they consider eligible for this life-ending process, are somehow unable to make an assessment of eligibility for assisted dying?

Terminal sedation is palliative care’s option of last resort. It involves discontinuation of all treatment, discontinuation of nutrition and hydration and administration only of sedatives that put the patient in a coma-like state, plus the administration of pain and symptom control medication. Most of us believe that the discontinuation of nutrition and especially hydration will result in a speedy death. Not so. It can take two or more weeks, and there’s nothing surer that starving and dehydrating a patient will cause death, unless the underlying disease or condition gets to them first — which it doesn’t always do, from my own personal experience.

The NZMA boasts 5000 members but about one third of these are probably medical students, so let’s say about 3300 practicing doctors are members. That means they represent 20 percent of the registered, practicing doctor population of 15,500. Does the NZMA feel obliged to do the thinking for their student members as “duty of care”, perhaps?

Their stance does nothing but widen the gap between some thinking doctors and their patients, about 75 percent of whom want assisted dying as an option.

The 15,500 registered, practicing doctors derive their licence from the NZ Medical Council. Without registration, a doctor cannot lawfully practice in New Zealand. This body is neutral on the subject of assisted dying. The NZMA has chosen to get political with it.

So having driven the wedge between doctors and their patients, it is now up to the NZMA to weave a pathway to reconciliation

The New Zealand Medical Association devalues members

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