Dr Kerryn Phelps, AMA President, with Richard Glover, Radio 2BL

The debate before the AMA saw contributions from Philip Nitschke, who we talked to on Drive on Friday. But how was he affected by news that Nancy Crick may not have had cancer, as revealed by the Coroner?

Doctor Kerryn Phelps is the Federal AMA President and joins us right now on the Drive Show. Good afternoon.

PHELPS: Hi, Richard.

GLOVER: It was in some ways a debate you had planned for a long time, it just happened to coincide with these quite dramatic events in Queensland.

PHELPS: Yes, and just the decision to have that debate in open national conference was an issue in itself and I think very much the right decision was made in retrospect because we were able to hear very passionate proponents for both pro-euthanasia and anti-euthanasia side of the debate, and I think we got a very good airing from also the specialists we had present from palliative care.

GLOVER: Can you summarise the mood of the meeting for me and what was said?

PHELPS: It was a very high level of debate and very passionate at times. I think the mood of the debate was very much one of as a profession lets get together and combine our experience and combine our compassion and lets see what we can do about coming up with a solution, a guideline, to review our ethics around this very difficult situation.

At the end of the day it was an affirmation of existing AMA policy, but it was a strengthening of the call for better funding and resourcing of palliative care facilities so that people who do have terminal illness, who are in pain, who are suffering with different symptoms, not just pain, are able to receive the high quality of palliative care that they deserve.

GLOVER: I must say this was one of the most extraordinary things about the debate for me was the fact that Nancy Crick was encouraged and offered palliative care only because she became the subject of this huge debate and she obviously gratefully accepted it. You thought a normal community would be offering this to everybody who even had any urge towards- -

PHELPS: Without doubt, and when you talk to people who are involved in palliative care they're scratching around on limited resources. The last Federal Budget did recognise palliative care but, of course, it's something that I think has not had nearly enough attention over the years and I think that people would hardly even give any notice to this euthanasia debate if we had really adequate community services and palliative care and disability services.

GLOVER: You feel that some of the people who are urging it, a change of the law, would change their mind if there was sufficient palliative care available?

PHELPS: Certainly, and I think if they had a lot more information about what was going on in other parts of the world as well. One of the points that really struck me yesterday was when Ethicists Professor Margaret Summerville, who came over from Canada for the debate, made the point that in Holland where they have legal euthanasia they have recently released a study which shows that 1200 people have received lethal injections without knowing that they were going to receive them.

GLOVER: How could that have come about?

PHELPS: The decision was made by the relatives in some cases. In some of those cases the people didn't understand, were not competent to understand or give permission, so the decision was made by others on their behalf.

So I think when we're using the word "voluntary" we need to be very careful how we use it, and when we're using the word "euthanasia" we also need to be equally careful about our definition because I think that there has been a hijacking of the high moral ground by the pro-euthanasia lobby in many respects, saying if you have compassion then you will agree with euthanasia. But it doesn't necessarily follow because the people who are very much for providing adequate community support services and palliative care have no shortage of compassion, I can assure you.

GLOVER: That's right. Talking about definitions, euthanasia is normally defined as somebody with a terminal illness taking their own life and yet it seems from the early medical reports that Nancy Crick may well not have had this cancer at this stage.

PHELPS: That's quite correct, and I think that we also have a number of people who would rather die than die alone. I think in the case of Nancy Crick the fear that she expressed was dying alone and the fact that she died with 21 supporters around her, at her own hand, how much better might it have been if she'd had her symptoms controlled and had at some time in the future, when nature took its course, died with her loved ones around her supporting her.

I think that we mustn't look to physician assisted suicide or euthanasia as a cure for loneliness or as a cure for the fear of dying alone. That's where I think we need as a community to really have the talk of death being far more out in the open. I think we've lost a lot of the rituals around dying in our society and part of that's been the loss of extended family and extended community support.

GLOVER: It has been headlined that you've made some sort of policy change at this conference that would see doctors clear to hasten death, as one headline put it. Has there been a change?

PHELPS: No, there hasn't. There's been a clarification of the policy which really brings the ethical parameters in line with the legal situation, and that is that doctors who have the primary intention of relieving pain and suffering in patients are ethically in fact obliged to provide that relief even though a foreseen secondary consequence of that action might be to hasten the patient's death.

GLOVER: Okay, but it can't be their primary intention.

PHELPS: It can't be their primary intention.

GLOVER: Rather it's a subsequent result.

PHELPS: Yes, and a foreseen secondary consequence.

GLOVER: Okay. Just on a separate matter the Federal Health Minister, Kay Patterson, has said this afternoon that some doctors are over prescribing antibiotics and she's worried that this is reducing resistance and so forth, what do you say to that?

PHELPS: I think it's very handy political rhetoric when a government is about to slash a billion dollars from the PBS. I think it's using doctors as scapegoats and I think to say that doctors are over prescribing - we haven't yet seen a definition of the correct rate of prescribing except that the government says they're paying too much, and that's not necessarily clinically appropriate.

GLOVER: You would agree, though, that generally this country is over prescribing antibiotics in ways that they're not necessarily useful for, for things like the cold, and that has got bad consequences.

PHELPS: No, I don't. I think it's been very handy political rhetoric and people who are wanting to find someone to blame for the blowout in the PBS say doctors must be over prescribing because I know somebody who had a cold once and they got antibiotics.

Well, the truth is that if you are working in general practice or a general medical practice and you have a child that has a screaming earache and you look at their ear and you think maybe it's viral, maybe it's bacterial - I mean you don't want to take the risk of it getting worse and getting complications of a middle ear infection that hasn't been treated.

I think partly there's a bit of defensive medicine that goes on with this as well - you know, tied in with the litigation problem that we're seeing at the moment. But, by and large, people come to the doctor when they think that the problem is not going away at its own accord. Then you make a judgement call. Most of the time you'll be right, some of the time you won't be. But I don't call that over prescribing.

GLOVER: But isn't it true - and let's not blame doctors for this entirely - but the patients can come in and for a thing like a cold they want to go out with a piece of paper, that feels reassuring, and the old doctor thing of take seven stones and put it under your pillow and take one out every day, doesn't seem to work with a modern audience? (laughter)

PHELPS: (laughter) Works with a cold.

GLOVER: That's what I mean, it works. But they think: Oh, God, that sounds like - you know, I'd rather a drug.

PHELPS: I think there's a lot of misunderstanding about what goes on in the general practice surgery and if we're just talking about respiratory infections for example - I mean people don't want to just know do I need an antibiotic or do I not, they want to know whether there is something that you can give them to relieve the chest pain or relieve the earache that they have, or the runny nose. And you go through a whole range of discussions about all of the different symptoms that they have and it might come down to hot lemon juice and honey and some Panadol.

But I think people do appreciate having an opinion from their doctor about whether or not they need particular types of treatments, whether it has become bacterial, and usually have a two way conversation about these things with patients.

GLOVER: But if the problem is not over prescription why are we seeing the development of this high level of resistance everywhere, which has got its own problems of course?

PHELPS: Well, because there is use of antibiotics. When we didn't have antibiotics and people were dying of common bacterial infections there was the greatest rejoicing when penicillin was developed. The fact is that we do have a lot of bacterial infections in the community and because there are a lot of bacterial infections we also have a lot of antibiotics used, and quite justifiably so.

If there are areas where prescribing can be demonstrated to be inappropriate then doctors will always respond to the evidence and change their prescribing patterns accordingly. We've got ample evidence of that.

GLOVER: Okay. Kerryn, thank you.

PHELPS: Thanks, Richard.

Ends