AMD Newsletter 16 November 2018
Voluntary assisted dying is one of the most difficult and divisive issues faced by our profession. The reason for this is not hard to understand: the concept of a doctor actively participating in the death of a patient raises fundamental questions about the nature of medicine and the ethical purposes we serve.
Historically, physicians and medical professional associations have opposed medical assistance in dying in any form. Nonetheless, in spite of this established tradition, there has been a prolonged debate about the appropriateness of legislation to permit assisted dying in certain limited circumstances. What is more, the affirmative case has gained substantial support within both the medical profession and the wider Australian community.
The debate itself, however, has not been without problems. Because views on both sides are often fervently held, positions have sometimes become entrenched, making respectful dialogue difficult to establish. The intensity of the debate and the polarisation of perspectives have often caused anxiety within professional organisations struggling to define approaches that adequately serve their members. In seeking to develop a position on these vexed and difficult issues the RACP has encountered this exact problem.
It has been my personal view (which I have expressed in various places) that the existing law in Australia and New Zealand provides sufficient scope for doctors to respond to the needs of dying patients. As a result, I have argued that, while clarification of the law – specifically, that relating to the “principle of double effect” – would be helpful, voluntary assisted dying legislation may not be necessary. However, there is an urgent need for the development of more refined and rigorous approaches to the multiple ethical issues presented at the end of life, distinguishing – for example – the questions raised in connection with fully competent patients suffering from terminal illnesses, with neonates, with people with debilitating, non-terminal illnesses, and with patients who lack capacity for psychiatric or other reasons.
Notwithstanding the personal views of myself and others, the public debates in Australia and New Zealand have continued vigorously, with multiple proposals to change legislation. In response this pressure, in 2016 an RACP Working Party was established, under the chairmanship of Dr George Laking, to develop a statement to help members navigate their way around the issues. The committee (of which I was a member) conducted extensive consultations and vigorously debated the best way to carry out its task. In the course of this process, the Victorian Parliament passed the Voluntary Assisted Dying Act 2017, which provides for a form of assisted suicide for competent patients in the final stages of terminal illnesses experienced as causing “intolerable suffering”.
The outcomes of the Working Party’s deliberations were published on 9 November and are available here. We accept that our attempts to provide a useful and balanced presentation of the issues will not be universally regarded as satisfactory. Nonetheless, we do hope that they will contribute to deeper understanding and a fruitful continuation of the dialogue.
The Working Party recognised that the medical communities in Australia and New Zealand are divided on many of the issues relating to assisted dying and that physicians in good faith hold widely differing, often vigorously opposed, views. We took for granted that within our College cultural and ethical diversity are highly valued and deeply respected. For this reason, a decision was made not to propose a position statement that purported to represent the views of all fellows and trainees, but rather we sought to identify common ground and provide guidance to help members decide for themselves about the matters at hand. We characterised our approach as “critical” of all perspectives and “neutral”, in the sense of avoiding prior commitments to established entrenched perspectives.
Despite the intensity – and occasional acrimony – of the debates, we discovered that there is indeed much common ground. Everyone agrees that all patients should receive timely, equitable, good quality end-of-life care, with access to specialist palliative care where appropriate. Everyone agrees that physicians should not be forced to act contrary to their values and beliefs. There is consensus that physicians should not abandon patients who hold values and beliefs different from their own but should continue to ensure that they have access to the highest quality ongoing care.
It is universally recognised that special issues can arise in relation to individuals who are very vulnerable and that these may need particular attention. It is accepted that physicians must affirm the value of their patients’ lives, take care with communication in relation to the delicate issues that arise in serious and terminal illness, and remain alert to the risks of coercion and conflict. However individual legal jurisdictions may decide to proceed in relation to assisted dying, rigorous documentation and data collection are needed to assess the quality of practice and changes that are introduced, including their impact on patients, their families and health professionals.
Whatever our personal views, we must accept that the issues and problems are difficult, and can be painful and sometimes intractable. The concept of “suffering” itself is complex, and goes far beyond the experience of physical pain. For many people, suffering can generate positive values, which can encompass cultural, spiritual and religious meanings. Palliative and supportive care can alleviate much pain and related symptoms, but obviously do not, and cannot, aspire to relieve all suffering for all people in all circumstances.
The complexity of the ethical issues is such that we need to move on from formulations restricted to crude binary terms. Rather, our focus must be on refining our own understanding and awareness of the vast array of distinctions and possibilities, while extending our abilities to communicate with patients and their families who hold views that differ from our own. Although in some respects we may find ourselves leaving tradition far behind, the ancient values of openness, trust and respect for difference endure, and remain as fundamental as they have ever been.
I urge all fellows and trainees to read the RACP Statement on Voluntary Assisted Dying and to contribute to the continuing debate.
As always, I am keen to receive comments, thoughts, and suggestions about the ideas contained in this article.
Professor Paul Komesaroff FRACP AM
President Adult Medicine Division
Telephone: +61 (0)417 55 26 59
AChAM President’s Report
The AChAM continues to have a strong presence at both a national and state level. On 31 October I represented the Chapter at a forum on developing a National Treatment Framework for Alcohol and other Drugs, hosted by the University of New South Wales’s Drug Policy Modelling Program. Professor Adrian Dunlop attended the second Therapeutic Goods Administration (TGA) Advisory Meeting on Opioids on 29 October, with discussions at the meeting focused on TGA responses to issues with Schedule 8 opioids.
Over the next few months we will be focusing on finalising the Chapter’s Evolve statement and working with the Faculty of Public Health Medicine on a College position statement on the approach to illicit drugs in Australia.
We are excited to announce further additions to the program for next year’s International Medicine in Addiction (IMiA) Conference:
- Dr Jen Delima on Addiction in Indigenous populations
- Dr David Jacka on Refugee mental health and addiction
- Dr James Foulds with working on Co-morbidity
- Dr Joseph Doyle with a Hepatitis C treatment update
We will also welcome three international keynote speakers to IMiA 2019:
- Professor Jon E. Grant on Gambling and behavioural addictions
- Professor Rajita Sinha on Stress and resilience
- Dr Iván Montoya on New horizons/approaches in the USA
IMiA will take place from 1 to 3 March 2019, with early bird registrations closing in two weeks on 30 November 2018. Register early to secure your discounted registration.
The Chapter Committee will hold its next face to face meeting at the RACP office in Sydney on Friday, 7 December. If you have any feedback, questions or comments for us, you can get in touch with the Committee via our secretariat at AddictionMed@racp.edu.au.
Dr Martyn Lloyd-Jones
Australasian Chapter of Addiction Medicine
AChPM President’s Report
The Chapter Committee met on Friday, 19 October at the RACP office in Sydney for a productive final meeting of 2018. You can read the Committee’s Communique from the meeting online.
The Committee commenced work to review its Evolve list of low value clinical practices. The original list was written a number of years ago with an intended audience of non-palliative medicine specialists in mind, and since that time the focus for Evolve has shifted to be specialty-specific. The Committee will complete its review over the coming months and circulate the draft list for consultation.
The Committee would like to raise awareness of the Post-Fellowship specialty recognition policy, which enables Fellows of the RACP with extensive experience in a specialty different to the one they completed their training in to be recognised by the RACP as a physician in the second specialty. It was thought that perhaps many Fellows are not aware of this policy. For more information please see the Post-Fellowship specialty recognition policy section at the bottom of this webpage or contact the Education Officer for Palliative Medicine at PalliativeMedTraining@racp.edu.au.
From 2021 completion of all three Supervisor Professional Development Program (SPDP) workshops will be compulsory for all RACP supervisors. Palliative Medicine supervisors are encouraged to prepare for this change by getting in early and signing up for a face-to-face or online workshop. The AChPM Committee also strongly encourages experienced supervisors to complete facilitator training so they can conduct SPDP workshops in their local area or at conferences/other events. If you have any questions about the upcoming changes, workshop availability, or anything else regarding supervision, you can contact the Supervisor Learning Support team at firstname.lastname@example.org.
The AChPM will next meet via teleconference in early 2019. In the meantime, if you have any feedback or comments for the Committee please do not hesitate to contact us through our secretariat at PallMed@racp.edu.au.
With kind regards,
Professor Greg Crawford
Australasian Chapter of Palliative Medicine
AChSHM President Report
The AChSHM formally recognises the outstanding contributions made by Fellows of the Chapter through biennial awards announced at the AChSHM Annual Scientific Meeting. For 2018 the Chapter will grant an award for Outstanding Contribution to Education and Training in Sexual Health Medicine, and one for Outstanding Contribution to Research in Sexual Health Medicine. Nominations for the awards close next Wednesday, 21 November 2018. If you know a Fellow deserving of recognition for their contribution to Sexual Health Medicine I encourage you to nominate them.
The AChSHM 2019 Annual Scientific Meeting (ASM) website has been launched, with next year’s theme being New Frontiers. The 2019 ASM will present a range of scientific sessions including transgender health, syphilis and sexual health in youth. We’ll also look at what we currently do well and how we can share these models of care. Each session will focus on how technology intersects with sexual health medicine, and how care varies from urban settings to those in rural and remote practices with a focus on Indigenous health. The ASM will be held at the Novotel in Brisbane on Saturday, 16 March, and followed by a Trainees’ Day at the RACP Office in Brisbane on Sunday, 17 March 2019.
Applications have opened for the Penelope Lowe Trainee Prize, which will be held at the 2019 ASM. The prize is named in memory of Dr Penelope Lowe, Fellow of the AChSHM and former Chapter Trainee Representative, who passed away in 2010. The $500 prize will be awarded to the best oral abstract presented by a trainee at the ASM. Applications close Thursday, 31 January 2019.
The Sexual Health in Aboriginal and Torres Strait Islander Communities Expert Reference Group has recently developed a consensus statement on the clinical implications of a positive syphilis serology test in the context of a previous negative syphilis point of care test. The consensus statement was developed to assist the implementation of the Action Plan Enhanced response to addressing sexually transmissible infections (and blood borne viruses) in Indigenous populations, which is led by the Australian Health Protection Principal Committee. The consensus statement will be used to guide the interpretation of syphilis point of care testing results, specifically in areas of northern Australia affected by the syphilis epidemic.
I will be presenting an update on the syphilis epidemic in northern and central Australia in Aboriginal and Torres Strait Islander People at the upcoming RACP South Australian Annual Scientific Meeting, SA Horizons – Scanning the next 10 years, to be held at the Adelaide Convention Centre on Saturday, 1 December.
The AChSHM Committee will hold its next face to face meeting on Friday, 30 November at the Sydney College office. If there are any issues you would like to raise with the Committee, or if you have any feedback for us, please don’t hesitate to contact us through our secretariat at email@example.com.
Associate Professor Catherine O’Connor
Australasian Chapter of Sexual Health Medicine
Upcoming Webinar – Australasian Sleep Association, Professor Stuart Mackay
Upper Airway Surgery for Obstructive Sleep Apnea (OSA)
This webinar will include a discussion of contemporary assessment for and implementation of sleep surgery in adults, and discuss other paradigms of care, including traditional and "pop up clinic" approaches to assessment of OSA and possible future directions for surgery. The Webinar will involve Professor Stuart MacKay and his Fellow in sleep surgery, Dr Leon Kitipornchai.
When: Monday, 19 November 2018 at 4:00 PM (Canberra, Melbourne, Sydney)
Register in advance for this webinar: here
After registering, you will receive a confirmation email containing information about joining the webinar.
This webinar is part of the Specialty Society Webinar Service that is being undertaken by the Royal Australasian College of Physicians in partnership with its affiliated specialty societies.
Adolescent and Young Adult Medicine (AYAM) Committee
The Adult Medicine Division (AMD) is currently seeking a Fellow and an advanced trainee to represent AMD on the Adolescent and Young Adult Medicine (AYAM) Committee. Adolescent and Young Adult Medicine (AYAM) is a branch of medicine focused on the health and medical care of adolescents and young people aged 10 – 24 years.
The AYAM Committee was established to explore ways in which support for young people's health could be furthered within the College – with relevance for both the Adult Medicine Division and the Paediatrics and Child Health Division.
AYAM focuses on the unique health needs of adolescents, including:
- Transition difficulties for adolescents.
- Evolving social pressures on young people.
- Engaging with young people in the healthcare system.
- Developing youth friendly health services and spaces in care facilities.
- Improving the safety and quality of healthcare.
The AYAM Committee are dedicated to promoting excellence in skills, expertise and ethical standards through future training and education at the RACP. The AYAM Committee aim to connect and represent trainees and Fellows across Australia and New Zealand by providing a place for information, resources, policy statements and media releases relating to Adolescent and Young Adult Medicine.
If you are interested in joining the AYAM Committee as an AMD or Advanced Trainee representative please fill out an expression of interest form and provide a copy of your curriculum vitae to firstname.lastname@example.org.
Australian & New Zealand Society of Blood Transfusion Annual Research Fund 2019
Applications for the Australian & New Zealand Society of Blood Transfusion (ANZSBT) Research Fund Award for 2019 are now open.
In 2019, the society will award a total sum of $50,000 comprising either a single grant of $50,000 or smaller grants totaling $50,000. The ANZSBT Council has nominated the following research priorities for 2018: transfusion in rural and remote settings; transfusion in the fetal, neonatal and paediatric settings; transfusion in Indigenous populations or minority groups of Australia or New Zealand; or transfusion in the elderly.
For further information, including the application form visit the ANZSBT website.
Please note that an applicant does not need to be an ANZSBT member.
Applications will close on Friday, 1 February 2019.
Urogynaecological Mesh Senate Inquiry
The Australian Government has tabled its response to the Senate Community Affairs Reference Committee Urogynaecological Mesh Inquiry. A copy of the Government’s response is available on the Department of Health’s website
. In addition, the Therapeutic Goods Administration (TGA) has launched a web hub
to help consumers and health professionals find information about urogynaecological surgical mesh.
New approach for 2019 Divisional Clinical Examination scoring
A new approach to scoring candidates’ performance in the Divisional Clinical Examinations was approved by the College Education Committee on 2 November 2018. The way that candidates need to prepare for the examination has not changed: candidates still need to demonstrate the same skills and competencies as they have in past years. The Divisional Clinical Examinations will continue to consist of two long cases and four short cases involving real-patient situations.
The changes in 2019 will include:
- A clarified examination purpose, and definitions of the long case and the short case.
- Improved scoring guides for examiners that link the purpose of the exam to the candidate scores and guide the application of a new six-point scoring scale.
- A score combination grid to combine each candidate’s scores for the long cases and short cases, determining their overall pass/fail outcome.
Details of the changes for the 2019 Divisional Clinical Examination, scoring guides, videos explaining the new approach, and examples of how the score combination approach works, along with other information, is available on the RACP website’s exam information page.
Congratulations to RACP Fellow Professor Georgina Long and Professor Richard Scolyer
Congratulations to RACP Fellow Professor Georgina Long and her colleague Professor Richard Scolyer – winners of the Research Australia GSK Award for Excellence. They have been recognised as world leaders in melanoma research for their groundbreaking work that has changed the diagnosis and treatment landscape of melanoma and tripled life-expectancy of advanced melanoma patients.
Learn more here.
Physician Training Surveys
The Physician Training Surveys are open until Sunday, 2 December 2018. We invite you to complete your survey and encourage your colleagues to complete theirs – a high response rate means areas of excellence can be recognised and training can be improved. To thank you for your participation, you can enter a prize draw to win one of four 256GB iPads.
All eligible participants* have been emailed their survey link. If you can’t find it – please check your junk folder. If you believe you are eligible but have not received a link, please contact Celeste Gilbert from the RACP survey team at email@example.com.
The information you provide is strictly confidential and will be used for research purposes only. Your responses will have all identifying details removed and will then be aggregated.
If you would like to verify the study, or have any questions about how the data will be used, please consult the RACP survey website or contact Member Services.
*As the survey is reviewing specific clinical aspects of training, trainees and educators in the below Divisions, Faculties or Chapters are not eligible:
- Clinical Diploma of Palliative Medicine
- Nuclear Medicine (RANZCR trainees)
- Nuclear Medicine Positron Emission Tomography
- Occupational and Environmental Medicine (AFOEM)
- Palliative Medicine - Chapter
- Public Health Medicine (AFPHM)
- Time-limited Intensive Care pathway to FRACP (Adult Internal Medicine or Paediatrics and Child Health)
Time to Recharge with up to 60 per cent off at selected hotels
RACP members have access to the buying power of the world’s largest online travel agency, offering over 100,000 promotional deals and competitive rates on hotel accommodation in more than 71,000 locations worldwide.
No matter your destination or whether it’s for business or leisure, browse through an extensive range of properties, from resorts, villas to executive apartments and five-star luxury suites.
To access this benefit, visit your RACP Member Advantage website or call 1300 853 352.
Terms and Conditions apply. Savings dependent on availability and location. Information correct as at 7/11/2018.
Conferences and Events
The Royal Australasian College of Physicians publishes notices of events and courses as a service to members. Such publication does not constitute endorsement or mandating of any such events or courses.
Please visit the medical positions vacant webpage for career opportunities.