Issue 45 / 23 November 2015

IT is a problem for democracy that strident minorities are able to achieve undue notice in some controversial matters.
In relation to end-of-life issues and political judgement, this was highlighted by Stephen Sedley, a former UK Lord Justice of Appeal, who in an essay titled “The right to die” wrote: “Why are MPs so out of kilter with public opinion? Part of the answer, familiar to US politicians, may be fear for their seats. Any votes to be won by support for assisted dying are eclipsed by the damage that can be done by hate campaigns”.
Professional advocacy can suffer a similar fate. Earlier this year, an invitation to Dr Rodney Syme to speak at the Royal Australasian College of Physicians (RACP) annual congress in a session on end-of-life issues was withdrawn. Dr Syme is a well known advocate for legislation to allow medically assisted suicide.
In a statement made to the conference, the College said it had “received feedback from Members shocked that Dr Syme was on the program in the first place and similarly we received feedback from some Members of the College, concerned that he had been uninvited”.
When I was informed that Dr Syme’s invitation had been withdrawn, I wrote to the RACP asking that it respect differences of opinion and maintain an open approach when engaging speakers on matters of controversy and concern. We need to recognise divided judgements and ensure that none are arbitrarily silenced.
The incoming RACP president Dr Catherine Yelland, in an email reply to me, noted the action had followed “a substantial number of College members” expressing “significant and repeated disquiet over several months”. Because of this, she suggested that the College had “acted appropriately in the interest of our collective membership”.
The same letter affirmed that “end-of-life care is a topic of great importance, and one that the College feels warrants a national conversation”.
Yet the plan for such a conversation was stifled by what appears to have been a determined collective effort by opponents of medically assisted suicide, which, at the time, was not matched by contrary opinion.
The issue was on the national agenda again earlier this month when the ABC’s Q&A program “Facing death” reignited the conversation in the community. Well-moderated, there was passionate and civilised debate from panel and audience members with diverse views. An underlying theme was the value of dialogue between advocates of palliative care and assisted dying.
One important component of opposition to assisted suicide stems from concepts of life as God-given and holy. Death is less often regarded so, yet it could be seen as equally God-given and holy. 
In the words of St. Francis: “And thou most kind and gentle death, waiting to hush our latest breath, O praise him, Alleluia”.
I think I have support for my request to the RACP from another Francis from the same camp — the current Pope.
In his address to Congress recently, Pope Francis affirmed the need for dialogue, saying, in part: “We know that no religion is immune from forms of individual delusion or ideological extremism. This means that we must be especially attentive to every type of fundamentalism, whether religious or of any other kind.”
He also said: “The complexity, the gravity and the urgency of these challenges demand that we pool our resources and talents, and resolve to support one another, with respect for our differences and our convictions of conscience”.
There must be room for different opinions to be aired within our professional bodies, with the aim that common ground will be sought and respect for difference affirmed.
It would be appropriate for the RACP, and other medical associations, to state an intention and to frame policies that support relevant expressions of “differences and convictions of conscience”.
Emeritus Professor Ian Maddocks is an eminent palliative care specialist, recognised internationally for his work in palliative care, tropical and preventive medicine. He was Senior Australian of the Year in 2013.

15 thoughts on “Ian Maddocks: Divided opinion

  1. Jennifer Brown says:

    <p>I too was dismayed by the late cancellation of Dr Syme&#39;s presentation at the RACP annual meeting. Accordingly I phoned Dr Yelland to indicate my disappointment in &nbsp;what I felt was the stifling of debate on what is a very important issue. I had a fair hearing from Dr Yelland and then an invitation to participate in the panel on end of life issues at that meeting. I had an opportunity to put my view that it is time for Australia to pass legislation that allows physician assisted dying in line with the Oregan legislation with its appropriate controls and safe guards. However this opportunity was brief and I believe the College should take up the challenge to look at different models and to debate the issue vigorously.</p><p>I developed MS myself when I was 30 and it gave me pause to be grateful that as a physician I had both knowledge and access to medications to end my life if my situation became intolerable. In the 30 years since, I have been fortunate to be well and set up palliative care services for which I have enormous respect. However I believe that all of us should have the right to make decisions about our dying. Not only do I believe that, many polls consistently show that more than 70% of the population believe that. As a profession ,<span style="line-height: 1.5;">&nbsp;I do not believe we have the right to ignore them. In fact I believe that the profession and our College have a responsibility to engage, debate and consult with those we serve.&nbsp;</span></p>

  2. randal williams says:

    my last comment on euthamasia, I promise!

    I reiterate that once our prime intent is to kill our patient rather than relieve suffering ( with earlier death as an likely consequence)   then we will have lost our way as a profession which has always had as its basic and fundamental principle the enhancement and preservation of human life. I believe legalised euthanasia will be the classic ethical ‘slippery slope’ open to abuse in our imperfect  world. Doctors and nurses have always known how to relieve suffering in terminal patients, also knowing it will hasten their inevitable death. The INTENT is the key.  

  3. Ian Akastair Bonnin says:

    Thanks to Professor Maddocks for his reasoned and principled plea for open discussion. The debate on euthanasia and assisted suicide will not go away because some RACP members suffered “disquiet” at the prospect of hearing a view contrary to their own, and managed to silence Dr Syme. I disagree with Dr. Yelland’s assertion that the college “acted appropriately”. On the contrary, it is in the interests of the membership that the college fosters open and rigorous discussion of all issues in ethics and medicine. If members disagree with Dr Syme they should debate him, not gag him.

    I also thank Professor Maddocks for acknowledging the hidden influence of religion. We require authors to declare financial affiliations that might influence them, but this is not the case with religious affiliations. A doctor with a faith-based belief in the sanctity of God-given life cannot be other than opposed to euthansaia and assisted suicide. This does not invalidate his or her opinion per se, but when presenting views as an expert professional, such fundamental influences should be openly acknowledged.

    Censorship of diverse views is not confined to the RACP. The Australian & New Zealand Society of Palliative Medicine recently polled members on a proposal to amend its Position Statement to declare euthanasia and assisted suicide unethical, and to expunge an acknowledgement of the diversity of views held by members and the public. The proposal was carried by an unspecified majority, and thus my specialty society rendered diversity invisible.

    I am an atheist and Palliative Medicine specialist.. I respect the religious faiths of my colleagues and friends,

  4. Ian Maddocks says:

    Dear semi-retired one,

    i do not fear an erosion of trust if assisting dying under clearly defined circumstances is de-criminalised; rather it might increase patient trust.  I think of two instances where single aged female patients with terminal cancer died suddenly and unexpectedly at home. I felt sure that they had taken accumulated analgesia/sedatives. My regret was that they had not been able to share the decision to do that with me, and I was not able to be there to ensure that no disaster of half-death occurred. When I can sit with patient and family through the last hours it is a moving and very comfortable experience for all. These women had to deny that opportunity for themselves, their loved ones and me.

  5. randal williams says:

    Another comment;  

    There is little discussion in the euthanasia debate about who administers or provides the means to end life. If you provide the the patient with the means to end their life then, as their doctor, it is ethically no different to administering it yourself, although it may protect you legally. Once we start this process we are going to lose a fundamental trust from the community in the medical profession that will be almost impossible to regain.

  6. David Henderson says:

    I agree that the decision to revoke Dr Syme’s invitation to speak was a poor one.  I have only heard him talk once, but In contrast to some advocates of euthanasia, Dr Syme appeared to present a reasoned argument, based no doubt on his experience with a lethal disease that often ends painfully.  I do not agree with his views and do not wish to be involved in euthanasia, but like death itself, euthanasia is a binary proposition and argument has become increasingly polarised, so that the grey edges, such as exceptional circumstances, are lost.

    I suspect that the reported widespread public support for euthanasia is at least partly due to the passionate presentation of individual cases, that outweigh discussion of the risks, such as coercion by family and supporters and the gratification that comes from administering “strong” treatment.

    I agree with other commentators, that the College has strayed into areas of political activism that are outside its principal purpose an expertise, which risks diluting its reputation for sound professional advice, political retribution, and alienation of the fellowship.  However a rational debate on euthanasia and palliative care would be a topic that should be within its ambit.  

  7. Greg Hockings says:

    No wonder there has been dissent within the RACP membership if open debate and discussion are being prevented. I am in full agreement with Drs Geffen and Champion. The RACP should focus on the many core issues in Australia at present – workforce planning, numbers and selection of physician trainees, falling clinical standards, problems with government bureaucracy and private health funds, and especially the poorly conceived proposals for revalidation of medical practitioners. I do not pay a substantial annual subscription for part of it to be diverted to supporting trendy left-wing causes.

  8. Johnny Khoury says:

    The most overt teaching about this comes from Matthew 24:28

    “Wherever the corpse is, there the vultures will gather”

  9. Dr Gary Champion says:

     I agree with Dr Geffen. The RACP has become so politicised towards the left that any dissenting voice is either dismissed or quashed. Sveral years ago a cell of climate change advocates was dismissed by the college because, I presume  a large number of Fellows felt uncomfortable regarding the political nature of the topic. Now the college is a very strong if not zealous promoter of  consequences of climate change & the influence of man in this change -there is to be no dissenting voice & if there are they are heretics who should be burnt at the stake , so to speak. The college news recently published an article in support of Gillian Triggs -the Human Rights Commissioner -she who wished to reward a man who almost bashed his wife to death with a bicycle with a monetary payment of close to 400000$. This is not the role of my college. As for Professor Maddocks  opinion I agree we need debate & exchange of views whether we agree with them or not. It would appear that the RACP has adopted a policy of silencing the dissenters, not all that differen from oppressive political systems.

  10. Dr. Kevin B. Orr says:

    If it were not for my active brain, my breathlessness would entitle me to a quiet and early death, self-administered, of course. Those who suffeer thus, or with pain, etc, with no cure and little relief, should be allowed to go quietly and with dignity. Discussion of this should not be stiffled by those who disagree.

  11. randal williams says:

    I am a little tired of hearing the “dying with dignity” argument by proponents of assisied suicide or euthanasia. Patients dying in medically supervised situations do not have an undiginified death in my opinion. Undignified deaths occur in road and aeroplane accidents and on the battlefield

    Doctors, nurses and palliative care specialists make the process as comfortable a possible for patients and relatives. If the patient is in unbearable pain they are not receiving proper palliative care. 


  12. robert marr says:

    An excellent article that exposes the RACP as a professional body unwilling to stand up to a few bullies in its ranks to alow free speech.

    The RACP actions are the opposite of the actions of a scientific body and the RACP stands condemned until they alow Dr Syme to speak at a future conference 

    Regardless of anyone’s beliefs the issue of medically assisted dying is worthy of debate and fair consideration of all views.

  13. Saul Geffen says:

    No suprise the RACP being arbitary, politically correct and stifling dissent. Probably too busy putting out thirty nedia releases on climate change or refugee policy.

  14. Steve Flecknoe-Brown says:

    Prof Maddox is right; a reasoned, informed discussion is needed, and should not be suppressed by those afraid of controversy.

    But slogans such as “Right to Die” do not constitute reason.  We all have not just a right to die, but a biological imperative to do so.  And the word ‘euthanasia’ itself is a deliberate attempt to skew the debate.  In its literal sense, euthanasia means a right or proper death.  This is not the same as mercy killing.

    The information part of the package should include the work of experienced palliative care practitioners – physicians, GPs and nurses. They all have the same passion for a right or proper death as the advocates of mercy killing, but they are the ones with extensive direct experience with the last days and hours of life.  Most choose not to hasten the end, knowing what precious moments can happen in that time if the patient’s symptoms are properly managed.

    Many of the people advocating mercy killing have been traumatised by the death of a loved one which didn’t go as well as it could have. It would be a good outcome of this discussion if all or most of those people became passionate advocates for better access to palliative care, rather then just switching off the lights.

  15. Marcus Aylward says:

    An eminently sensible and considered piece.

    The counter argument is that providing oxygen to “toxic” viewpoints, or choosing to enter debate with opposing views accords them an underserved respectability and status: think climate change, alternative medicine, abortion, nuclear power, nuclear disarmament etc.

    I would be reassured to know that Professor Maddocks’ openness would apply equally in all of those areas.

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