The Royal Australasian College of Physicians (RACP) says it will not take a single formal position on a topic that has divided its membership: voluntary assisted dying.
The position statement, released in November after two years of consultation, acknowledges the significant community support for legalised assisted dying schemes, which has led to the creation of one in Victoria which commences in June 2019.
But divergent views among clinicians have “constrained” the RACP from developing a single unified position, write the statement’s team of authors, led by New Zealand medical oncologist Dr George Laking.
“On the specific issue of a competent adult in the last stages of incurable illness requesting voluntary assistance to die, the RACP supports a clinical approach of critical neutrality to encourage reflective dialogue,” they write.
The RACP makes a series of recommendations, stating that if legalised, schemes must:
- Be underpinned by adequate physician-patient relationships to protect against ‘doctor shopping’ and ‘tick box’ approaches
- Protect vulnerable individuals and groups
- Protect participating doctors who want to remain anonymous
- Protect doctors who don’t want to take part
Importantly, any scheme should not replace palliative care and “must not be seen as part of palliative care”, the statement says.
“Patients seeking voluntary assisted dying must be made aware of the benefits that palliative care can offer at the end of life and referral to specialist palliative care should be strongly recommended,” the statement affirms, but notes that such referrals cannot be made mandatory.
Physicians should not be forced to take part in assisting a patient to die, nor have to refer to a physician who is willing to assist.
At the same time, “neither should they hinder patients from accessing such services” the statement says.
The College also stresses that its statement “should not be taken as support for legislative change” .
It says protections should be available for both participating and objecting practitioners who do not wish to be identified for reasons of harassment and stigma.
“Provision could be made for practitioners who are willing to participate in restricted ways, e.g. in a limited range of cases, or in only providing a second opinion.”
The College cautions against singling out specialties to be able to participate, finding this could “create barriers to access or lead to an inexperienced medical practitioner confirming a request.