Suffering, euthanasia and professional expertise

Xavier Symons1

1 Research Associate, Institute for Ethics and Society, University of Notre Dame Australia. L1, 104 Broadway (PO Box 944), Broadway NSW 2007. Email: xavier.symons@nd.edu.au

Many bioethicists have considered the question, ‘is appropriate for a doctor to be involved in actively ending a patient’s life’? Discussion of this issue has typically focused on the compatibility of euthanasia with the doctor’s role as a ‘healer’. In this paper I approach the question from a different angle; I consider whether doctors are qualified to make the value judgement involved in assessing the appropriateness of euthanasia for a patient.

I begin my paper by discussing the nature of suffering, and specifically the nature of the suffering experienced by patients who request euthanasia. I argue that the kind of suffering experienced by patients requesting euthanasia is far more complex than mere physiological pain and distress. In the second section of the paper I argue that the sort of suffering experienced by patients desiring euthanasia falls outside the area of expertise of clinicians; I suggest that clinicians are acting beyond their professional capacity when they make a judgment about the appropriateness of euthanasia for such individuals. I conclude by presenting a number of options for policy makers to address this problem of professional expertise.


Biography

Xavier is a Research Associate with the Institute for Ethics and Society at the University of Notre Dame. He is also a PhD candidate with the Centre for Moral Philosophy and Applied Ethics at the Australian Catholic University. In 2016 he is a visiting scholar at Georgetown University’s Pellegrino Center for Clinical Bioethics. Xavier is deputy editor of the onlin bioethics news service BioEdge.

Policy and law for Australia to prevent complicity in foreign transplant abuse

David Matas1

1 Faculty of Law, University of Manitoba, 602-225 Vaughan Street, Winnipeg, Manitoba, Canada, R3C 1T7, dmatas@mts.net

Because of a shortage of organs, patients in need of transplants wait long periods and become desperate, spurring transplant tourism. What are the professional ethics and legal standards which Australia needs to develop to prevent complicity in foreign transplant abuse? The paper would attempt to answer that question.

For foreign transplant abuse, China would be used as a case study. China has been sourcing organs from prisoners in large numbers, in violation of international ethical principles. Researchers have concluded that a significant number of these sources are prisoners of conscience  Christians, Buddhists and, primarily, practitioners of Falun Gong. The Government of China claims that prisoner organ sourcing has stopped, but the claim is unverifiable and there is substantial contrary evidence. Australian patients, by obtaining transplants in China, and Australian medical professionals, legislators and governments, by not doing what can be done to prevent that from happening, become complicit in Chinese abuses.

The paper would consider what the Australian medical profession, legislators and governments have already been doing to avoid complicity in foreign transplant abuse. Second the paper would update the research on transplant abuse in China.

To assess the situation in Australia, the paper would consider already developed international and local ethical and legal standards. While the focus would be Australia, what other jurisdiction have done on this subject would be presented.

The conclusions would be, first, that despite Chinese official assurances to the contrary, organ sourcing from prisoners continues. Second, there are many steps which could and should be taken in Australia by medical professionals, legislators and governments to avoid complicity in foreign transplant abuse, but which have not yet been taken.


Biography

David Matas is an international human rights lawyer based in Winnipeg, Manitoba, Canada.  He is co-author with David Kilgour of the book “Bloody Harvest: The Killing of Falun Gong for their Organs” published in 2009 and co-editor with Torsten Trey of the book “State Organs: Transplant Abuse in China”, published in 2012.  He is a member of the Order of Canada.

Can opt-in cardiopulmonary resuscitation be legally and ethically justified?

Dr Susan Hertzberg1

1Prince Of Wales Hospital

The era of modern of cardiopulmonary resuscitation (CPR) began in the late 1950s and despite evolving recommendations to improve outcomes, the rate of successful resuscitation remains disappointingly low. CPR was originally developed to save the lives of people who arrested unexpectedly- “ hearts too young to die”- but it is now the default treatment for any patient in any hospital or aged care facility (ACF) in Australia unless the patient has a “not for resuscitation” (NFR) order. There are many problems with the opt-out option of CPR. They include; assuming rather than obtaining patient consent, patient’s and family’s unrealistic expectation of the likelihood of success, low uptake of the NFR form meaning many patients who will not benefit from CPR still get it, lack of consensus around futility at the end of life, legal uncertainty around NFR orders, reluctance on the part of the medical team to have an emotionally charged conversation and failure to offer patients and their families better alternatives for end of life care. It is time to re-evaluate the way in which CPR is delivered to patients whose “hearts are too old or too frail to live” and it is time to adopt an opt-in CPR model for residents of aged care facilities and hospices. This talk will review the process of CPR and its associated mortality and morbidity. It will address the symbolic function of CPR where it is clearly futile; the concept of the dishonest and ethically questionable ‘slow code.’  The current procedure for opting out of CPR using the NFR order form and the legal uncertainties associated with this form will be reviewed.  I will outline the logistics of opt-in CPR and conclude that it is time to demonstrate clinical leadership in situations where inappropriate use of CPR is prolonging death, not life.


Biography

Dr Susan Hertzberg is an Emergency Physician working as senior staff specialist in the Ermergency Department at the Prince of Wales Hospital (POWH) where she is the Co -Director of Emergency Medicine Training. She holds Masters Degrees in both Health Law and Bioethics from the University of Sydney. She is on the Ethics Committee and the Fellowship Examination Committee of the Australasian College for Emergency Medicine. She is a tutor in ethics in the Faculty of Medicine at the University of New South Wales and a conjoint senior lecturer in the POW medical school.

About the Association

The Australasian Association of Bioethics and Health Law (AABHL) was formed in 2009.

It encourages open discussion and debate on a range of bioethical issues, providing a place where people can ask difficult questions about ideas and practices associated with health and illness, biomedical research and human values.

The AABHL seeks to foster a distinctive Australasian voice in bioethics, and provide opportunities for international engagement through its membership, journal and conferences.

Members come from all the contributing humanities, social science and science disciplines that make up contemporary bioethics.

Many members have cross-disciplinary interests and all seek to broaden the dialogues in which all members of the wider community ultimately have an interest.

The AABHL is a supportive, creative and challenging community that provides a rich source of continuing academic refreshment and renewal.

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