Professor Ilora Finlay, Baroness Finlay of Llandaff, was a keynote speaker at the AMA (WA) End-of-life Choices and Palliative Care Symposium held in Perth. At this symposium, Professor Finlay presented an examination of the issues and risks – both clinical and societal – of legalising assisted suicide in Western Australia.
Professor Ilora Finlay,
Baroness Finlay of Llandaff
Baroness Finlay has much insight into the euthanasia debate in the UK and why it has not been legalised, insights she pointed out that Australians may benefit from knowing about.
Baroness Finlay is a Professor of Palliative Medicine at the University of Cardiff and an Independent Crossbench member of the House of Lords. With an impressive list of positions held, both past and current, Professor Finlay is highly regarded for her clinical policy and service development leadership in palliative care and health services in the UK.
She also served on the Select Committee on the Assisted Dying for the Terminally Ill Bill and is Co-Chairman of Living and Dying Well, an organisation that examines the evidence around euthanasia and assisted suicide.
Professor Finlay mentioned that in-depth studies along with parliamentary committees asking questions of experts resulted in the rejection of assisted dying in the UK.
Professor Finlay shed light on significant loopholes that exist in legislation in countries around the world and warned Australia not to follow suit.
Her advice was as follows: “The advice I would give doctors, during this time when the topic of assisted dying legislation is debated and potentially brought to Parliament is to: Give legislators the advice you are qualified to give – namely, that seriously ill people are often vulnerable and that the main drivers of pressure for ‘assisted dying’ are personal or social [autonomy, fear of being a burden] rather than medical.”
She particularly highlighted that doctors partaking in assisted suicide are acting “beyond their professional competence” and that providing lethal drugs “is incompatible with clinical care”. A study in the UK conducted in 2015 found that only one out of seven GPs would consider a request for assisted dying if it were legalised.
Professor Finlay also explained that “dying has become increasingly medicalised, with every crisis met with a rush to hospital-based emergency care”. A result of this is that “families all too often lose touch with the experience of caring for dying relatives and observing the pattern of natural death”.
Professor Finlay also pointed out when “we are unfamiliar with something, we fear it; and what we fear we seek to control”. By being out of touch with the pattern of natural death, society seeks to want to control the timing of death, evident by the word “control” appearing over and over again in the “assisted dying” campaign.
Professor Finlay also spoke about the importance of safeguards should assisted dying be legalised. She mentioned that “safeguards should be real-world proofed, reflecting the pressures of clinical practice, the impact of serious illness on patients and the complexities of personal, social and family dynamics.
Finally, she warned that jurisdictions that have normalised assisted dying have ever increasing numbers and widening scope. She pointed out that assessments take time, which detracts from creative thinking regarding how to improve a patient’s life, and “doctors cannot in most cases know what coercive or emotional pressures exist in a patient’s home life”.
When posed the question of what changes to end-of-life care should we be advocating for, Professor Finlay responded that specialist palliative care input early in an illness results in better quality of life, lower symptom scores, less depression and, surprisingly, better time until death.
Another benefit, she said, is that palliative care is cost-effective through fewer unplanned admissions. This means that we should be campaigning for training posts, research posts and more seven-day service teams in palliative care on a national minimum template.
Importantly, GPs in rural areas need support around the clock as they carry responsibility for all first-line care. With more specialist teams and pooling rotas, such an advisory service has enormous teaching potential too.
Professor Finlay added: “Doctors are often asked if a patient has ‘mental capacity’ but capacity assessment is decision and time specific – it is not straightforward and needs training.”
Recently we had the story of golfer Jarrod Lyle who, after a long battle with cancer, opted for palliative care, highlighting the importance of spending quality time with his loved ones. Contrast this story to that of Dr Alida Lancee, who admitted to giving a lethal injection to a terminally ill patient.
Those who have had positive experiences in palliative care should be encouraged to speak up, write submissions and let their stories be heard.
In Tasmania a bill introduced to legalise euthanasia was lost 13 votes to 12. In South Australia in 2016 a bill was also lost when votes were tied and the casting vote of the Speaker was cast. Last year in NSW a bill was defeated 20 votes to 19. A bill to legalise euthanasia may soon come before the Parliament of Western Australia, as a result of the joint parliamentary committee report being tabled this month.