Among the things that Australia would rather you didn't know about -

The Victorian bill has a ridiculous number of safeguards built in. By all accounts, it's by far the most stringent in the world for this type of legislation.

Albedo said:

If only we were all Bob Katter. A perfect world.

(FWIW my opinion's pretty much along the lines of the AMA statement - the legality or otherwise of assisting suicide is a matter for the parliament and the people to decide, but whatever the law the medical fraternity should have nothing to do with it, for pretty straightforward ethical reasons.)

Click to expand...

Not to hijack the thread but as a medical provider I have to object to this assertion. There are plenty of providers who see the alleviation of suffering as a valid medical action. And I'd challenge any physician involved in that politically correct and extremely cowardly AMA position to state with certainty they would report colleagues that ordered morphine as needed when a ventilator was discontinued. Anyone who has worked in a US ICU knows full well staff administer lethal doses of morphine rather than let people struggle to breathe when that ventilator is turned off on a patient to let them die.

Edited to add, people draw lines in different places.

Sorry, back to the less controversial topic of saving the crocs.

MaeZe said:

Not to hijack the thread but as a medical provider I have to object to this assertion. There are plenty of providers who see the alleviation of suffering as a valid medical action. And I'd challenge any physician involved in that politically correct and extremely cowardly AMA position to state with certainty they would report colleagues that ordered morphine as needed when a ventilator was discontinued. Anyone who has worked in a US ICU knows full well staff administer lethal doses of morphine rather than let people struggle to breathe when that ventilator is turned off on a patient to let them die.

Edited to add, people draw lines in different places.

Sorry, back to the less controversial topic of saving the crocs.

Click to expand...

I'm talking about the Australian AMA statement, which doesn't say anything about reporting anyone. I haven't checked what the US version says.

I've also worked in palliative care, I've prescribed morphine for terminal respiratory distress, and I've watched people die. Giving adequate opioids to alleviate distress in the terminal phase of dying is very different, in my mind, to hastening death up to six months before they reach that phase. I wouldn't participate in the latter. I don't think it's consistent with 'doing no harm'. But I wouldn't sanction anyone who feels differently.

Albedo said:

I'm talking about the Australian AMA statement, which doesn't say anything about reporting anyone. I haven't checked what the US version says.

I've also worked in palliative care, I've prescribed morphine for terminal respiratory distress, and I've watched people die. Giving adequate opioids to alleviate distress in the terminal phase of dying is very different, in my mind, to hastening death up to six months before they reach that phase. I wouldn't participate in the latter. I don't think it's consistent with 'doing no harm'. But I wouldn't sanction anyone who feels differently.

Click to expand...

Whoops, how American-centric of me to assume American Medical Association. My bad.

It appears the Australian version is similar to the American version: Amercian AMA position statement:

5.7 Physician-Assisted Suicide
Physician-assisted suicide occurs when a physician facilitates a patient’s death by providing the necessary
means and/or information to enable the patient to perform the life-ending act (e.g., the physician provides
sleeping pills and information about the lethal dose, while aware that the patient may commit suicide).
It is understandable, though tragic, that some patients in extreme duress—such as those suffering from a
terminal, painful, debilitating illness—may come to decide that death is preferable to life. However,
permitting physicians to engage in assisted suicide would ultimately cause more harm than good.
Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be
difficult or impossible to control, and would pose serious societal risks.
Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at
the end of life. Physicians:
(a) Should not abandon a patient once it is determined that cure is impossible.
(b) Must respect patient autonomy.
(c) Must provide good communication and emotional support.
(d) Must provide appropriate comfort care and adequate pain control.

Click to expand...

My point is unchanged: Unsupported assertion and hypocrisy, a twofer.

I'm guessing you know damn well that "adequate pain control" is an ideal we can't always achieve. So then what?

You are asserting that hastening death at the very end somehow differs from hastening it a week out? Two weeks out? What makes an hour out any different? Surely the end-stage terminal cancer patient is just as likely to die as the patient being extubated to die.

The idea that relieving suffering is against the Hippocratic Oath is not just short-sighted, I'd wager that position was originally influenced by religious dogma, not rational medical practice alone.

An ideological objection to assisted end of life care which involves drawing an arbitrary line at how many minutes/days/weeks before death is it OK to assist the patient is not evidence based on its face.

The AMA (American) POV on Euthanasia is the same:

5.8 Euthanasia
Euthanasia is the administration of a lethal agent by another person to a patient for the purpose of
relieving the patient’s intolerable and incurable suffering.
It is understandable, though tragic, that some patients in extreme duress—such as those suffering from a terminal, painful, debilitating illness—may come to decide that death is preferable to life.
However, permitting physicians to engage in euthanasia would ultimately cause more harm than good.
Euthanasia is fundamentally incompatible with the physician’s role as healer, would be difficult or
impossible to control, and would pose serious societal risks. Euthanasia could readily be extended to
incompetent patients and other vulnerable populations.
The involvement of physicians in euthanasia heightens the significance of its ethical prohibition. The
physician who performs euthanasia assumes unique responsibility for the act of ending the patient’s life.

Click to expand...

If it is tragic, how is that compatible with 'healer'? And I don't buy the slippery slope argument.

I don't agree our mission is only 'healer' and not 'suffering reliever'. Seems rather out of date to limit medical care to healing when healing is not always an option. Should physicians and other providers abandon patients we cannot heal? Of course not.

A week before my father died of liver cancer he asked me, "is this what it's like"? I don't recall my exact answer but it was something to the effect that he had time left. I didn't realize what he meant until to my shock, he let out a frustrated groan. He was done, he wanted it over. He'd done everything he wanted/needed to, to be ready to go. What was the point of making him suffer another week? So his doctors didn't risk a slippery slope?

All that education and experience and we can't be trusted not to slip down the slippery slope? But it's fine to relieve suffering at the end of life of the person struggling to breathe by providing a lethal dose of morphine?

mccardey said:

It's pretty stringent.

Victorian residents over the age of 18, of decision making capacity, who have six months to live and are in intolerable suffering can be granted access to lethal medication to end their life.

Click to expand...

There's 68 safeguards in place, including:

The proposed laws require a terminally ill person to make three clear requests to end their life and approval from two doctors — one specialising in the illness the person is suffering.

They would also limit the option to people of sound mind, ruling out those suffering dementia.

Those approved would be given a “permit” to self-administer lethal drugs, with doctors only able to dish out the dose when a person is physically unable.

Doctors, family or friends face life in prison if they administer the substances in circumstances where the terminally ill patient has a permit to manage it themselves.

Those who “improperly induce” a person to seek to die face hefty fines and up the five years in prison.

Click to expand...

The full details of the bill.

mccardey said:

It's pretty stringent.

Victorian residents over the age of 18, of decision making capacity, who have six months to live and are in intolerable suffering can be granted access to lethal medication to end their life.

Click to expand...

It's more stringent than the Northern Territory legislation. (Which was rapidly overturned in 1997 by the Commonwealth under John Howard.)

First, sorry about your Dad, MaeZe. I can't imagine what it's like to lose a parent that way. All my loved ones so far have died quickly from strokes or heart attacks. But one of my living grandparents has dementia, and the other has end stage COPD, and I know what it's like to watch someone you love, with already scant quality of life, face an unstoppably worsening future.

MaeZe said:

Whoops, how American-centric of me to assume American Medical Association. My bad.

It appears the Australian version is similar to the American version: Amercian AMA position statement:My point is unchanged: Unsupported assertion and hypocrisy, a twofer.

I'm guessing you know damn well that "adequate pain control" is an ideal we can't always achieve. So then what?

You are asserting that hastening death at the very end somehow differs from hastening it a week out? Two weeks out? What makes an hour out any different? Surely the end-stage terminal cancer patient is just as likely to die as the patient being extubated to die.

Click to expand...

There's the doctrine of double effect in play: taking an action to benefit a patient (alleviating suffering) that you know will cause harm (respiratory depression/death) can be ethically acceptable as long as the harmful effect wasn't intended. But if you act to cause death, it seems hard to reconcile that with primum non nocere unless you want to radically redefine harm in medical ethics.

Why does it matter whether it's a month or a week or minutes? I don't think there's an easy catch all answer to this. Intellectually I know the terminal phase rarely lasts months or weeks, and that people who are stable or even deteriorating can be comfortable, because I've seen how good palliative care works. But it's as much my feeling. It wouldn't be compatible with my own sense of ethics to prescribe something with the intention of killing somone. It wouldn't be medical. Let assisted dying be de-medicalised. Develop a new and adequate set of ethics around it. Come up with a new profession to practice it.

I don't agree our mission is only 'healer' and not 'suffering reliever'. Seems rather out of date to limit medical care to healing when healing is not always an option. Should physicians and other providers abandon patients we cannot heal? Of course not.

Click to expand...

If you're a doctor, under the new Victorian legislation you could choose to become a 'coordinating practitioner' for a patient if they requested assistance with dying. I could choose not to participate. This seems kind of fair. The legislation, at my limited reading, doesn't specify whether I'd be obligated to refer the patient to another practitioner or not.

The bill also doesn't seem to specify whether a practitioner who agrees initially to be the coordinating practitioner can pull out, or not. The patient can, of course, but the bill makes it clear that the practitioner has to be the one to administer the drugs if the patient becomes incapacitated. What if someone was willing to prescribe, but not to push? It's going to be interesting to see how the law is tested.

Damn, stuff got pretty real in poor Macca's lighthearted crocodile thread. Sorry!

Is the government downplaying wildlife risks in Australia different from our government downplaying the risks of gun violence here? As I understand it, foreign tourists are very apprehensive about becoming crime (or murder) victims on a trip to the US.

One guess about which animal kills more humans each year than all the others put together (well, except for mosquitoes, possibly. They spread Malaria and other diseases) worldwide.

Still want to visit Australia someday.

Roxxsmom said:

...our government downplaying the risks of gun violence here?

Click to expand...

Your "here" must not be the US. The so-called minority liberals and Dems who occupy places in every single branch of the US government and judicial system where I live constantly harp on skewed statistics of gun violence while downplaying the beneficial aspects of privately-owned firearms.

Roxxsmom said:

One guess about which animal kills more humans each year than all the others put together

Click to expand...

That's easy: Drunk and distracted drivers.

Roxxsmom said:

Is the government downplaying wildlife risks in Australia different from our government downplaying the risks of gun violence here? As I understand it, foreign tourists are very apprehensive about becoming crime (or murder) victims on a trip to the US.

One guess about which animal kills more humans each year than all the others put together (well, except for mosquitoes, possibly. They spread Malaria and other diseases) worldwide.

Still want to visit Australia someday.

Click to expand...

It's not so much the government playing down the risk of crocodile attack as Katter and his very small cohort playing up the risk. Since 1985, there have only been 11 fatal attacks in Queensland. This year was a bad year -- so far two people have been killed by saltwater crocs in the state. Both attacks occurred in populated areas*. There was a third fatality in the Northern Territory.

Katter wants to cull crocodiles, where cull = reduce numbers so far that there's no chance of contact between crocodiles and humans. He seems to think that not informing tourists of the dangers is a sensible approach, because if they know, they won't visit. Much of what Katter says is not well thought out.

The basics are these: Saltwater crocodiles live in the tropics. They are mostly coastal and sub-coastal in distribution, but in some places are found well inland. The most sensible behaviour in croc country is to assume that every creek, river, billabong, lagoon and farm dam is home to a 5m crocodile, not only the waterbodies with warning signs. As far as I know, no crocodile has gone on a murderous rampage in a school, shopping mall or concert, either indoor or outdoor.

* One death was of a local who was spear-fishing off Palmer Point near Innisfail. The other -- a ghastly incident -- was of an elderly woman with dementia, who wandered away from her care home in Port Douglas and went for a walk along a creek.

*thinks of my own dumb arse wandering alone alongside an estuary near Port Douglas a few years back ... didn't occur to me until I was back in the cabin how I was basically croc bait*

Honestly, Aussies seem to take a perverse pride in playing up our deadly animals. For those of us who live in cities (which is the vast majority of the population), the most dangerous critters here are swooping magpies or pets dogs that threaten to take out your legs while they're playing in the local park.

We love talking up our "everything will kill you" reputation.

- - - Updated - - -

Also, just to be clear, Bob Katter is a nutcase who isn't representative of our government or our people!

Albedo said:

First, sorry about your Dad, MaeZe. I can't imagine what it's like to lose a parent that way.

Click to expand...

Thanks.

Albedo said:

There's the doctrine of double effect in play: taking an action to benefit a patient (alleviating suffering) that you know will cause harm (respiratory depression/death) can be ethically acceptable as long as the harmful effect wasn't intended. But if you act to cause death, it seems hard to reconcile that with primum non nocere unless you want to radically redefine harm in medical ethics.

Click to expand...

I do want to redefine medical ethics. I think it's time.

Take the morphine because it's a clear example: for the practitioner who rationalizes it's for comfort and not to cause death, I have to wonder if that is a provider who doesn't stick around after writing the scrip.

Perhaps this could be a stepping off place for the medical profession to have a discussion about ending suffering without crossing that vague line of "as long as causing death is not on purpose". Heaven knows we cause enough accidental death with our interventions.

Albedo said:

Why does it matter whether it's a month or a week or minutes? I don't think there's an easy catch all answer to this. Intellectually I know the terminal phase rarely lasts months or weeks, and that people who are stable or even deteriorating can be comfortable, because I've seen how good palliative care works.

Click to expand...

This is where I have a hard time. I'm sure my dad felt like shit and specific pain was not the only reason. His ascites was especially bothering him. His doctor offered him a Levine shunt. Thank goodness I'd seen patients with Levine shunts. They are unsuccessful interventions. He'd be adding surgical pain and it wasn't going to relieve the distention that was so uncomfortable for him. We talked and he made the decision not to have the shunt.

So here's a case where the doctor, (and I didn't blame him), wanted to offer my dad some relief, better something than nothing, (a tradition the medical profession should also have a discussion about). There are many things we do to help patients that make things worse and when only worse options are available, that old 'something is better than nothing' mindset is more likely to be problematic. Yet 'death is better than suffering' in these cases is not considered.

Is it possible one remembers the palliative care successes while the failures are less memorable? Or could it be one imagines the palliative care is successful (like offering the Levine shunt) without recognizing the patient politely said things were OK afterward when they weren't?

Albedo said:

But it's as much my feeling. It wouldn't be compatible with my own sense of ethics to prescribe something with the intention of killing somone. It wouldn't be medical. Let assisted dying be de-medicalised. Develop a new and adequate set of ethics around it. Come up with a new profession to practice it.

Click to expand...

I understand that POV and every individual provider has a right to their POV regarding this matter. And you make a good case for the potential problems in the rest of your post.

I just hate seeing the POV rationalized as "not medical". It puts up a barrier to having a discussion of those issues you mentioned. It lets providers rationalize that end of life morphine really isn't to hasten death while avoiding a discussion that it really is. If an hour from death it's OK to speed death up, why not a week from death? Why is it not up to the patient (with restrictions of course because there are many times it is not appropriate and one has to ascertain the patient's actual wishes)?

be frank said:

Honestly, Aussies seem to take a perverse pride in playing up our deadly animals. For those of us who live in cities (which is the vast majority of the population), the most dangerous critters here are swooping magpies or pets dogs that threaten to take out your legs while they're playing in the local park.

We love talking up our "everything will kill you" reputation.

- - - Updated - - -

Also, just to be clear, Bob Katter is a nutcase who isn't representative of our government or our people!

Click to expand...

I arrived in Sydney many years ago to the headline, "35 year old woman dies from Sydney Funnel Web spider." It was under her sheets, she got in bed and it got her.

But I admit to not being too worried about those 4 different poisonous Tasmanian snakes when we camped in Taz. One even swam by us when we were swimming in a pond.

Lol. Fair enough. Though my general response to things like the funnel web story is ... the fact it made the news should give some indication as to just how unusual an occurrence it was!

be frank said:

Lol. Fair enough. Though my general response to things like the funnel web story is ... the fact it made the news should give some indication as to just how unusual an occurrence it was!

Click to expand...

Choir preaching. I loved my time in Australia. One of the best countries I've ever traveled to.

As for dangers, I learned an important lesson the first time I left the country in my early 20s. Everyone said the Dominican Republic was dangerous, in the middle of a revolution. Turned out it had happened a decade earlier. I had a great time there.

Then there was Guatemala, devastated by a recent earthquake. You could hardly tell. Nicaragua on the other hand, had been devastated by a different earthquake and the city center of Managua was still in ruins. There hadn't been much about it at all in the US news.

Then I almost got caught up in their civil war. Somoza was living in a bunker and the military were dangerous even to tourists. Later the turmoil spilled over into Guatemala. Places I'd been later became archeological digs to uncover mass murder by the government.

The lesson, don't believe most of what you hear about a place you haven't been to, chances are good the dangers are over or underestimated by people who've never been there.

Last year on the Peninsula, I ran a spotlight across the water of a mangrove-edged beach at night and wasn't surprised by the amount of red eyeshine quite close to the shore. Having said that, I've done a lot of work in mangrove swamps from Townsville to Cape Tribulation and it is scary, but you take precautions. The most frightening incident was when we miscalculated the tide and had to wade across a creek, which was muddy with incoming water, so we couldn't see what was in there. My goodness, we moved quickly and with as little splashing as possible. We didn't make that mistake again.

My main concerns in the field are (in order):
1) dogs
2) pigs
3) men with dogs hunting pigs

In rainforest, those concerns are:
1) stinging trees
2) more stinging trees
3) falling trees (stinging or otherwise)

Snakes and spiders barely register.

Reminds me of the first alligator in the wilderness I encountered, well, maybe a boardwalk on Jekyll Island, Georgia isn't exactly wilderness. But when you are walking down a boardwalk trail over the marsh by yourself and you are an uneducated 20ish gal, seeing an alligator rustling right next to you is worrisome! I had no idea there were alligators there or that they weren't necessarily going to come after me.

It's wasn't until a while later I learned the difference between croc danger and gator danger, it's a matter of degree.

It was a beautiful boardwalk.


I should add, later on that trip I found the rangers in the Okefenokee Swamp getting in the water and using push poles to push the gators away. Who knew?

This is how things happen:

https://mypolice.qld.gov.au/blog/2017/11/30/man-charged-interfering-crocodile-trap/

It will be alleged the man approached the EHP officers and started arguing with them about the crocodile while they were reversing the trap trailer down the boat ramp.

The man allegedly stood on the trailer and extended the winch.

While the officers were pulling the trap out of the water, the man allegedly entered the water to waist depth and pushed at the trap.

It is alleged that when the officers directed him to exit the water and stop interfering with the trap as it was dangerous, he became verbally abusive.

The man’s behaviour caused the crocodile to become agitated and strike the side of the trap near where he was standing.

Click to expand...