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Preference: Law

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World Medical Association calls for more nations to sign treaty against nuclear weapons

The World Medical Association has issued a plea to all nuclear armed and nuclear dependent States to sign the Treaty on the Prohibition of Nuclear Weapons.

The treaty, which prohibits the development, testing, production, possession, stockpiling, use, or threatened use of nuclear weapons was signed in July by 122 non-nuclear weapon States.

The WMA is now urging all those States that have nuclear weapons, or rely on the nuclear weapons possessed by others, to also sign the treaty.

It opened for further signatures at United Nations in New York on September 20.

Other organisations joining the WMA in the call include the International Physicians for the Prevention of Nuclear War, the International Council of Nurses, and the World Federation of Public Health Associations.

All of the groups signed a joint statement welcoming the landmark treaty as “a significant forward step towards eliminating the most destructive weapons ever created, and the existential threat nuclear war poses to humanity and to the survival of all life on Earth”.

WMA President Dr Ketan Desai said: “Even a limited nuclear war would inflict a substantial death toll as well as causing cancers, chronic diseases, birth defects, and genetic damage.

“In addition, it would bring about catastrophic effects on the earth’s ecosystem. This could subsequently decrease the world’s food supply and would put a significant portion of the world’s population at risk of famine.

“We share the treaty’s conclusion that the elimination of nuclear weapons is the only way to guarantee that nuclear weapons are never used again under any circumstances.

“The States that currently possess nuclear weapons or rely on the nuclear weapons possessed by others can and must completely and irreversibly dismantle the warheads, nuclear weapons programs and facilities, and cease all nuclear weapons related activities which threaten the security of everyone, including their own citizens.”

Two days before the treaty opened for further signatures the WMA marked its 70th anniversary and World Medical Ethics Day.

The WMA was founded on September 18, 1947, just one month after the
war crimes trial of German doctors in Nuremberg.

After the experiences of World War II, representatives of the medical profession decided it was necessary to establish a new international medical organisation to develop medical ethics and to cooperate globally.

The WMA was founded with 27 countries and held its first annual General Assembly in Paris in 1947. Today the Association has a membership of more than 100 national medical associations as constituent members from around the world. It has become the global platform to develop medical ethics, the rules of the profession.

Since 1947 it has developed ethical standards that are reflected in many national laws, international regulations and treaties.

In 2003 the Association decided to mark its anniversary by holding an
annual World Medical Ethics Day on September 18 to promote the presence of
ethics in medicine. Since then, national medical associations have
celebrated the day with various activities.

Dr Desai said the achievements of the WMA over the past 70 years had been enormous in promoting the highest standards of medical ethics in the profession.

Membership has grown significantly and the WMA’s many statements have become a central part of health policy around the world.

CHRIS JOHNSON

[Editorial] For universal health coverage, tomorrow is today

In a Comment published alongside the Lancet Series America: Equity and Inequality in Health in April, 2017, Senator Bernie Sanders (I-VT) wrote: “Today, we must do everything we can to prevent the repeal of the [Affordable Care Act (ACA)] and oppose attempts by the Trump administration to undermine it by failing to enforce the law or promulgating regulations that would sabotage it. Tomorrow, we must work to join the rest of the industrialised world and guarantee health care to all citizens through a Medicare-for-all single-payer system.”

[Editorial] Last days of the Rohingya of Rakhine

While the UN Security Council issued a statement last week calling to end the violence against the Rohingya Muslim population of Northern Rakhine State, Myanmar, military forces were burning more villages. In 3 weeks, over 400 000 people (more than half of them children and 400 newborn babies) have made the perilous boat voyage to Bangladesh, fleeing a violent campaign of scorched homes, killings, rapes, and landmine injuries. Although Nobel Laureate Aung San Suu Kyi finally broke her silence this week condemning all human rights violations in Rakhine, she fell short of criticising the notorious Tatmadaw national army, which has a gruesome record of human rights abuses and of acting in flagrant disregard for international law.

Tobacco smoking – enough of the puff

BY ROB THOMAS, PRESIDENT, AUSTRALIAN MEDICAL STUDENTS’ ASSOCIATION

It is no surprise that the smoking of tobacco has decreased significantly from a generation ago, amid targeted and widespread programs to deter its use. Indeed, in Australia we seem to view our stringent tobacco legislation and divestment movements as huge wins for public health. However, what may come as a surprise is that our smoking rates are still roughly one in seven people, and it continues to cause more deaths than alcohol and illicit drugs combined.

As a young person, I’m astounded when I see friends and other young people lighting up. On the one hand, it’s probably good that myself and others have such a cultural distaste for this deadly habit, but on the other it’s tragic to see people beginning something that they will inevitably struggle with for years.

Like many medical students, I’ve spent time in respiratory medicine and seen patients dying of cancer, infection and chronic obstructive pulmonary disease, where people describe their existence as “slowly drowning”. There is simply no safe level of tobacco consumption. It shocks me that this harsh reality, not just the threat of cancer, causes more than 15,000 Australian deaths per year and yet young people continue to pretend they’re invincible.

Interestingly, in the US and UK, smoking rates are now dropping to comparable or even lower levels than in Australia, where our plain packaging and advertising laws are very strong. On a pure price disincentive, we still have some of the most expensive cigs in the world, yet perhaps we are starting to see diminishing returns on smoking rates. Clearly, more needs to be done.

Earlier in the year, AMA President Dr Michael Gannon gave out the “Dirty Ashtray Award” to the State most behind on their smoking crackdown. The Northern Territory, 11-time recipient of that award, has a rate of smoking of more than one in five, with comparatively lax laws regarding smoking in pubs, clubs and even schools. We cannot sit by while children and young people are indoctrinated into a culture where smoking is tacitly accepted.

Some advocates for smoking reduction have looked at the possibility of e-cigarettes as a tool for cessation or alternative. We must be wary of these products, none of which have yet proved to be useful as cessation tools, and may in their use and marketing make smoking more socially acceptable.

Many universities have some form of a tobacco-free policy available on their websites. However, many of these are not enforced or incomplete, meaning that smoking and particularly passive smoking continue. As medical students, we call for more stringent tobacco-free policies to reduce prevalence and change attitudes.

While universities are a great target, we need also to ensure that smoking-related disease does not become a disease of the poor. There is a significant gap in smoking rates between the highest and lowest economic quintiles (8.0 per cent and 21.4 per cent respectively). Although this gap is slowly closing, we need to pursue methods of education and intervention that promote equity and work for the people most at risk.

At the patient level, it’s important for doctors to remain vigilant, to work with smokers to quit. We acknowledge this is not easy, it is often a long and relapsing process, but ultimately it cannot just be ignored. Thankfully in medical school we are taught some of the tools of motivational interviewing, but we can’t afford complacency.

Complacency cannot be afforded at the Government level, too. The Council of Australian Governments several years ago made the target of 10 per cent daily smokers by 2018, a rate we may just fall short of. Continued efforts, including banning in public places, availability of support to quit programs and widespread public education need to continue. This is not a fight we can say we’ve won just yet.

Twitter: robmtom
Email: rob.thomas@amsa.org.au

Press Club address covers wide range of topics

AMA President Dr Michael Gannon’s Address to the National Press Club of Australia was both well delivered and well received – covering a wide range of topics of importance to health practitioners and their patients.

It was the second time Dr Gannon had addressed the Press Club, a Canberra-based national institution and forum for policy debate, and will likely be the last as President of the AMA.

During the nationally televised event on August 23, Dr Gannon laid out the AMA’s priorities for the future and highlighted its recent achievements in influencing policy outcomes.

He also fielded a range of questions from the Canberra Press Gallery.

Titled Beyond the Freeze – Time for Heavy Lifting in Heath, Dr Gannon noted there had been numerous changes in the realm of health policy since he last spoke at the Press Club 12 months ago.

“There is no more talk of co-payments,” he said.

“The cuts to pathology and diagnostic imaging bulk billing incentives have been reversed.

“The general practice pathology rents issue has, for the most part, been resolved.

“The Medicare freeze has a ‘use by date’. It can’t come soon enough.”

Dr Gannon said while the AMA wanted an immediate end to the freeze right across the Medicare Benefits Schedule, it didn’t quite get it.

The hour-long address, which involved both a speech and a question and answer session, was moderated by National Press Club President Chris Uhlmann.

Mr Uhlmann at the time was also the ABC News Political Editor, but has since resigned to join the Nine Network as Laurie Oakes’s replacement as Political Editor.

Not one to be passive while in the moderator’s chair, Mr Uhlmann joined in with his Press Gallery colleagues to grill Dr Gannon on a few policy areas.

One insightful exchange was over the emotive issue of euthanasia and the role doctors have in end-of-life care.

“Could you speak just a little bit more on the principle of double effect?” Mr Uhlmann asked.

“I don’t think that most people actually understand that it’s available and actually exists in Catholic canon law, that if someone dies as effect of their pain management being turned up to a point where that’s the secondary effect, that’s something you can even request in a Catholic hospital.”

Dr Gannon’s response was both revealing and informative.

“One of the things you have to be very careful doing when you’re talking on ethical matters is to invoke Catholic canon law, because there are some people who would have great concerns about that,” he said.

“But, Chris, who I know is a scholar in this area, will be able to tell you that this all goes back to St Thomas Aquinas. This is well established in Catholic ethics. And it’s a well-established ethical principle which is very much secular as well.

“But in very simple terms it means that if your primary intention is to relieve suffering, and by secondary effect it has the effect of hastening someone’s life, that is ethically, completely distinct from the intention of ending someone’s life.

“So, if we look at proposed assisted dying laws, the intention is to end the patient’s life. If you look at palliative care, the intention is to relieve pain and suffering. The intention is important.

“I can promise you that palliative care physicians, the nurses who work with them, the teams they work in, they’re a great example of multidisciplinary care for all of us, but they work very carefully and compassionately to provide a level of care which is seven levels above the morphine drip that you’ve all heard of.”

CHRIS JOHNSON

 

COAG move on mandatory reporting welcomed

The Council of Australian Governments (COAG) Health Council has resolved to develop a nationally consistent approach to mandatory reporting provisions for health practitioners.

The move has been warmly welcomed by the AMA.

Federal and State and Territory Health Ministers have agreed to consult with practitioner and consumer groups, and develop a nationally consistent proposal for consideration at the next COAG Health Council meeting in November 2017.

The agreement follows months of lobbying and advocacy from the Federal and State AMAs, highlighted by discussions in face-to-face meetings between Health Minister Greg Hunt and AMA President Dr Michael Gannon in recent weeks.

Dr Gannon said that the AMA had always advocated for treating practitioners to be exempted from mandatory reporting requirements.

“Mandatory reporting laws deter health practitioners from seeking early treatment for health conditions that could impair their performance,” Dr Gannon said. 

“We have advocated long and hard at both the federal and State level for changes the mandatory reporting provisions.

“It is an issue that the AMA and the whole medical profession feel passionately about. It affects every doctor, their families, their loved ones, and their colleagues.”

Delegates to the AMA National Conference in May were unanimous in seeking amendments to the mandatory reporting requirements under the National Law, so as to not dissuade medical practitioners from seeking necessary medical treatment or assistance. 

The intention of the legislation was to ensure the protection of the public by requiring doctors and other health practitioners to report colleagues whose health was impaired.

But this created a barrier for health professionals to access health care, particularly in relation to mental illness. The lived experience of doctors’ health advisory services across the country confirms these fears.

“Mandatory reporting undermines the health and wellbeing of doctors,” Dr Gannon said.

“It is a tragic reality that doctors are at greater risk of suicidal ideation and death by suicide. This year we have lost several colleagues to suicide.

“While there are many factors involved in suicide, we know that early intervention is critical to avoiding these tragic losses. 

“The AMA has identified that mandatory reporting is a major barrier to doctors accessing the care they need.

“The real work begins now. We need action from all our governments.

“The medical profession and the public need a sensible system that supports health practitioners who seek treatment for health conditions, while at the same time protecting patients. 

“We urge all Health Ministers to work cooperatively to come up with an achievable agreed proposal at their next meeting.”

CHRIS JOHNSON

Communiqué from Federal Council meeting 17-18 August 2017

BY DR BEVERLEY ROWBOTHAM, CHAIR OF FEDERAL COUNCIL

Welcome to the inaugural communiqué from Federal Council highlighting the debates had, and decisions taken, at its meeting in Canberra in the depths of winter on 17-18 August.

In giving his report, AMA President Dr Michael Gannon made mention of the many recent advocacy wins of the AMA. He reported that the working relationship with the Federal Government has evolved following the compact agreed at the time of the Federal Budget in March, enabling frank and effective engagement with Health Minister Greg Hunt.

Dr Gannon reported that benefits of this engagement can be seen in recent successes with the Minister moving to scrap the draft national maternity services framework which was opposed by the AMA for lack of obstetrician and GP involvement; and support by Minister Hunt to work with State and Territory colleagues to remove mandatory reporting from the National Law. Advocacy on this latter issue has been strongly supported by Federal, State and Territory AMAs, which uniformly endorse the WA approach to mandatory reporting.

The Secretary General’s report provided a comprehensive overview of the AMA’s medico-political advocacy. The Secretary General Anne Trimmer noted that the Governance Institute’s 2016 Ethics Index, with research undertaken by IPSOS, ranked the AMA as the most ethical of the national membership and industry associations.

She reported that the secretariat is working with the Minister’s advisers and the Department of Health to shape appropriately targeted after hours GP services, arising from the draft MBS Review report into these services. The secretariat is working with the NBN to finalise criteria for improved access to broadband in rural areas with a proposal to grant Public Interest Premises status to medical practices under the satellite footprint.

Two of Federal Council’s committees are working with the secretariat to develop a new advocacy strategy for aged care with funding and technology identified as priority areas. Federal Council also agreed to campaign for additional funding for the incoming Practice Incentive Program Quality Incentive and strongly opposed recently flagged proposals to increase the return of service periods for future bonded medical places program participants.

The Federal Council noted updates on the two major government reviews currently underway, the MBS Review and the Private Health Ministerial Advisory Committee review of private health insurance arrangements. An informal grouping of approximately 30 members is working with the AMA to inform its response to the draft reports. Work on the PHMAC review has slowed over the winter period although a new working group on risk equalisation has been established. The AMA will be advocating for changes to the risk equalisation pool to facilitate coverage OF pregnancy under all levels of PHI cover.

Federal Council discussed the Government’s review of the medical indemnity schemes. The AMA has worked closely with the Department of Health to shape the terms of reference and remains strongly committed to the schemes as an effective mechanism to moderate the cost impact on practices and patients. The AMA has been communicating to the profession the need for active engagement in the review by Colleges, Associations and Societies.

The AMA is represented on a small working group to review the Health Professional Online Services (HPOS) system, which emerged as vulnerable to fraud. The Minister for Human Services, Alan Tudge, kept the President informed of the steps taken to ensure integrity of the system prior to the establishment of the review of health provider access to Medicare numbers.

With a Senate inquiry underway into the value of private health insurance and medical out of pocket costs, the Federal Council set aside a policy session to consider the issues in depth. The AMA lodged its submission at the end of July (the submission can be read at submission/submissions-out-pocket-costs-australian-he…).

The submission included data on billing practices collected from a poll of members.

Federal Council, noting the growing public commentary calling on limits on out of pocket medical expenses, agreed that the priority was to correct misleading statements about the role of doctors’ fees in the debate about affordability of health care. An animated debate ensued with Councillors contributing a range of views based on their personal experience.

The issue has been largely driven by private health insurance and the growth in gaps in coverage and exclusions. Federal Council noted that there had been limited complaints to the Private Health Insurance Ombudsman about out of pocket expenses. Federal Council also noted that many medical services had always had an element of out of pocket contribution, not to be confused with the charging of an excessive fee which the AMA strongly opposes. Federal Council agreed that there needs to be greater clarity on what constitutes an excessive fee and that this needs to be clearly communicated to the public.

The President acknowledged the comments of Federal Council and noted that he had an opportunity to address these issues in his upcoming address to the National Press Club (the transcript of the President’s address can be read at media/dr-gannon-national-press-club-address-0).

The AMA’s work on public health initiatives continues, ranging from road safety to obesity and physical activity. Federal Council heard progress reports from working groups led by Councillors and debated draft position statements on road safety, obesity and physical inactivity. Other working groups are considering nutrition, mental health and the social determinants of health. A revised position statement on mental health is in development in conjunction with the AMA psychiatrists’ group.

Federal Council received reports from each of its practice group councils, and from its committees. The State and Territory AMAs and Australian Medical Students’ Association provided reports on current areas of advocacy.

 

Questions asked and answered during Press Club appearance

 In addition to delivering a wide-ranging 30-minute speech at the National Press Club, AMA President Dr Michael Gannon spent another half hour at the podium fielding questions from the Canberra Press Gallery.

The issues raised by the inquiring reporters ranged from doctors’ fees, to refugee health, to codeine prescriptions, to marriage equality – and a whole lot in between.

On the subject of cost-shifting by the States to patients covered by private insurance who are attending public hospitals, Dr Gannon said he had made the point directly to Health Minister Greg Hunt, that flexibility must be maintained.

“We don’t want a situation where insured patients are prohibited from care in public hospitals,” Dr Gannon said.

“They might live in a rural area where there’s no alternative; no fancy, shiny, private hospital there in the region. It might be the case that a doctor with sub-specialist expertise only works in a public hospital. It may be that they need the intensive care unit that only exists in a public hospital. It may simply be the patient’s choice. So, wherever we land, we must end up with flexibility.

“One of the things that’s led to this problem is the fact that the States and the Territories and the Commonwealth have underinvested in public hospitals. So, the public hospitals are looking for new revenue streams, and sometimes they’re a bit too tricky and clever trying to get hold of insured patients when they’re not actually providing any greater level of care.

“But I also think this is an area where the private health insurers need to step up to their part of the responsibility.”

In his speech, Dr Gannon described the push by insurers for doctors to publish their fees and customer referrals as “dangerous territory”.

In response to questioning about that, he said informed financial consent was very important.

“But I don’t trust a website owned by the insurers to produce un-vetted information about the quality of the magazines in the waiting room, whether or not the receptionist was rude, and I have great concerns about people not being able to obviously interpret quality data,” he said.

“It’s a lot more complicated than a cheesy website might appear.”

Drug testing welfare recipients

The AMA President was highly critical, when he was asked about it, of the Government’s plan to drug test welfare recipients.

“If I had to put a nasty star on the Government’s last Budget, it was this mean and non-evidence-based measure. It simply won’t work,” Dr Gannon said.

“This is not an evidence-based measure (and) will not help. We don’t expect people in most industries to have drug testing before they turn up to work.

“It’s simply unfair and it already picks on an impaired and marginalised group. It’s not evidence-based. It’s not fair. And we stand against it.”

NDIS

On the question of the NDIS eligibility of people with mental health conditions, Dr Gannon said the scheme needed certainty of funding to ensure proper access and eligibility.

“This is going to be a very difficult and vexed issue for Governments now going forward,” he said.

“Talk to the experts. Talk to the GPs, the psychiatrists, the psychologists, the carers who are there providing that care every day. Look at the evidence. Look at what works, and fund it according to what might be expected to work from international evidence, or from talking to home-grown experts here in Australia.”

Same-sex Marriage

On marriage equality, the President said he wouldn’t lecture parliamentarians on legislative approaches, but a risk existed that the wider discussion on the issue will have mental health impacts on people directly affected.

“Equally, we live in a democracy where people are entitled to have their say. I faced criticism of our Position Statement from within the membership, and I have made it very clear that we, as an organisation, are a broad enough church that we can accommodate different views on this topic,” he said.

“And I am not uncomfortable with the Australian people being given their say. We believe that this is an area of discrimination and therefore does have health impacts. We would like to see it resolved. We would like to see the Government, the Parliament, getting on in other crucial areas of public policy, but we are silent on the exact details about how we get there.”

Codeine prescriptions

On codeine, and the AMA’s agreement with the decision to make it available only by prescription, Dr Gannon said the AMA’s position was not a unilateral statement.

“This is very much the AMA supporting the Therapeutic Goods Administration, the TGA, in their independent science-based analysis of the issues,” he said.

“Now, many people might not know that there’s already 25 countries where codeine requires a prescription. Many people might not know that the science tells us that we all metabolise codeine very differently. So for a significant minority of us, we metabolise it in a way that is extremely potent, every bit as powerful as morphine, and is a common cause of death from opioid overdose.

“Not only have we told the Minister we support the TGA’s decision, we are also telling the State and Territory Health Ministers that we do not want to see exemptions from this. That’s wading into very, very dangerous territory, when the independent regulator looking at scientific evidence is overrun by an industry that has a different view.”

Euthanasia

On palliative care and support of doctors who may wish to assist patients to die, he was very clear.

“We have inadequate legislation in most parts of Australia to protect doctors acting ethically and lawfully with inadequate doctrine of double effect legislation,” Dr Gannon said.

“Ninety-nine per cent of end-of-life decisions do not involve requests to die. That is a very, very, very small part of the system.

“And surely the aspiration of all people, whether they favour voluntary euthanasia or not, is to improve palliative care services.

“The AMA Position Statement makes it extremely clear that we understand this is a decision for society: it’s Parliament’s, it’s legislators’. The AMA’s position is that doctors should not participate in these arrangements.”

Refugee health care

Regarding the level of health care provided to asylum seekers in offshore detention, Dr Gannon said the ethical principles were very clear.

People seeking the protection of the Australian Government are entitled to healthcare standards the same as Australian citizens.

“So, that’s a matter of ethics and that’s a matter of law. What we’ve developed over the past 12 months or so is a relationship with the Chief Medical Officer of the Department of Immigration and Border Protection, so that when we receive discussions on individual healthcare episodes we are able to talk about them,” he said.

“… a difficult and vexed issue where a form of medical care, namely termination of pregnancy – which could relatively easily be provided on Nauru – can’t legally be provided because it’s illegal on the island.

“That means that if that cannot be provided, that those patients must be transferred to the mainland. This is a hotly contested political issue. I am not an immigration expert. But I like to think I’m an expert in medical ethics, and I’ve stated our position very clearly as to the health standards that we would expect.”

Private health insurance

On private health insurance, Dr Gannon said agreement must be reached on basic level of cover, or at least better transparency, so people know what they’re covered for.

“The policies that are nothing more than to dodge the tax penalty, they’re junk,” he said.

“The policies that limit you to care in a public hospital, I need to be convinced why they’re any better than being a public patient in our excellent public hospitals.

“Now I don’t want to spend my entire life arguing with the insurers. They have a right to make a profit. In fact they’ve got a corporate responsibility to deliver a profit. But they cannot deliver that profit on the back of diminished services to private patients. And if they don’t get it and they don’t get it soon, they will drive their industry off the cliff.”

CHRIS JOHNSON

The full transcript of Dr Gannon’s Q&A session at the National Press Club can be found here:

media/dr-michael-gannon-national-press-club-q-and

 

 

Political message in National Press Club speech

AMA President Dr Michael Gannon has called on all sides of politics to take some of the politicking out of health, for the good of the nation.

Addressing the National Press Club of Australia, Dr Gannon said some health issues needed bipartisan support and all politicians should acknowledge that.

“Some of the structural pillars of our health system – public hospitals, private health, the balance between the two systems, primary care, the need to invest in health prevention – Let’s make these bipartisan,” he said.

“Let’s take the point scoring out of them. Both sides should publicly commit to supporting and funding these foundations. The public – our patients – expect no less.”

During the nationally televised address, broadcast live as he delivered it on August 23, Dr Gannon warned political leaders that the next election was anyone’s to win and so they should pay close attention to health policy.

“Last year we had a very close election, and health policy was a major factor in the closeness of the result,” he said.

“The Coalition very nearly ended up in Opposition because of its poor health policies. Labor ran a very effective Mediscare campaign.

“As I have noted, the Government appears to have learnt its lesson on health, and is now more engaged and consultative – with the AMA and other health groups.

“The next election is due in two years. There could possibly be one earlier. A lot earlier.

“As we head to the next election, I ask that we try to take some of the ideology and hard-nosed politicking out of health.”

In a wide-ranging speech, the AMA President outlined the organisation’s priorities, while also explaining the ground it has covered in helping to deliver good outcomes for both patients and doctors.

The AMA’s priorities extend to Indigenous health, medical training and workforce, the Pharmaceutical Benefits Scheme, and the many public health issues facing the Australian community – most notably tobacco, immunisation, obesity, and alcohol abuse.

“I have called for the establishment of a no-fault compensation scheme for the very small number of individuals injured by vaccines,” Dr Gannon said.

“I have called on the other States and Territories to mirror the Western Australian law, which exempts treating doctors from mandatory reporting and stops them getting help.

“We also need to deal with ongoing problems in aged care, palliative care, mental health, euthanasia, and the scope of practice of other health professions.

“In the past 12 months, the AMA has released statements on infant nutrition, female genital mutilation, and addiction.

“In coming months, we will have more to say on cost of living, homelessness, elder abuse, and road safety, to name but a few.

“Then there are the prominent highly political and social issues that have a health dimension, and require an AMA position and AMA comment.

“All these things have health impacts. As the peak health and medical advocacy group in the country, the community expects us to have a view and to make public comment. And we do.

“Not everybody agrees with us. But our positions are based on evidence, in medical science, and our unique knowledge and experience of medicine and human health.

“Health policy is ever-evolving. Health reform never sleeps.”

The address covered, among other things, health economics: “Health should never be considered just an expensive line item in a budget – it is an investment in the welfare, wellbeing, and productivity of the Australian people.”

Public hospital funding: “The idea that a financial disincentive, applied against the hospital, will somehow ‘encourage’ doctors to take better care of patients than they already do is ludicrous.”

Private health: “If we do not get reforms to private health insurance right – and soon – we may see essential parts of health care disappear from the private sector.

The medical workforce: “We do not need more medical school places. The focus needs to be further downstream.

“Unfortunately, we are seeing universities continuing to ignore community need and lobbying for new medical schools or extra places.

“This is a totally arrogant and irresponsible approach, fuelled by a desire for the prestige of a medical school and their bottom line.

“Macquarie University is just the latest case in point.”

And general practice: “General practice is under pressure, yet it continues to deliver great outcomes for patients.

“GPs are delivering high quality care, and remain the most cost effective part of our health system. But they still work long and hard, often under enormous pressure.

“The decision to progressively lift the Medicare freeze on GP services is a step in the right direction.”

On even more controversial topics, Dr Gannon stressed that the AMA is completely independent of governments.

While sometimes it gets accused of being too conservative, he said, it was not surprising to see the reaction to the AMA’s position on some issues – like marriage equality.

“Our Position Statement outlines the health implications of excluding LGBTIQ individuals from the institution of marriage,” he said.

“Things like bullying, harassment, victimisation, depression, fear, exclusion, and discrimination, all impact on physical and mental health.

“I received correspondence from AMA members and the general public. The overwhelming majority applauded the AMA position.

“Those who opposed the AMA stance said that we were being too progressive, and wading into areas of social policy.

“The AMA will from time to time weigh in on social issues. We should call out discrimination and inequity in all forms, especially when their consequences affect people’s health and wellbeing.”

Last year, the AMA released an updated Position Statement on Euthanasia and Physician Assisted Suicide.

It came at a time when a number of States, most notably South Australia and Victoria, were considering voluntary euthanasia legislation.

There was an expectation in some quarters that the AMA would come out with a radical new direction. But it didn’t.

“The AMA maintains its position that doctors should not be involved in interventions that have as their primary intention the ending of a person’s life,” Dr Gannon said.

“This does not include the discontinuation of treatments that are of no medical benefit to a dying patient. This is not euthanasia.

“Doctors have an ethical duty to care for dying patients so that they can die in comfort and with dignity.”

The AMA also takes Indigenous health very seriously.

Dr Gannon travelled to Darwin last year to launch the AMA’s annual Indigenous Health Report Card, which focused on Rheumatic Heart Disease.

“In simple terms, RHD is a bacterial infection from the throat or the skin that damages heart valves and ultimately causes heart failure,” he said.

“It is a disease that has virtually been expunged from the non-Indigenous community. It is a disease of poverty.

“RHD is perhaps the classic example of a Social Determinant of Health. It proves why investment in clean water, adequate housing, and sanitation is just as important as echocardiography and open heart surgery.

“The significance of challenging social issues like Indigenous health, marriage equality, and euthanasia is that they highlight the unique position and strengths of the AMA.

“The AMA was recently ranked the most ethical organisation in the country in the Ethics Index produced by the Governance Institute of Australia.

“People want and expect us to have a view – an opinion. Sometimes a second opinion.” 

Chris Johnson 

 

A transcript of the full address can be found here:
media/dr-gannon-national-press-club-address-0