The Australian Medical Association (AMA) executive (policy group) recently concluded a major review of its official policy on assisted dying. The last major review was in 2007. Through a deeply flawed process the AMA executive continues to expressly disrespect the diversity of views amongst Australian doctors - a diversity confirmed by its own review - and hasn't altered its opposition to assisted dying in any meaningful way.
Unrepresentative of Australian doctors
The AMA promotes itself as "leading Australia's doctors," yet more than two thirds of Australian doctors (70.5%) are not members. Its executive might like to think it's leading, but most Australian doctors aren't following. Claimed representation is particularly important when it comes to professional medical practice policies, because the AMA behaves as though its policies apply to all Australian doctors.
So who did the AMA consult in conducting its major review of policy on assisted dying? Only its own members. In other words, the AMA claims to represent all Australian doctors, but in reality consulted less than a third of them in the setting of assisted dying policy. As AMA member Dr Rosemary Jones pointed out, some doctors eschew the AMA becauseof its opposed stance towards assisted dying. That creates a key sampling bias in the AMA's study… against assisted dying.
Further, the response rate to its survey of members was around 13%, meaning that only the most engaged AMA members (thus around 4% of all Australian doctors) offered a voice.
There are numerous flaws in the AMA's survey. Here's just one. In the preamble to the questionnaire, the AMA expressly told responding doctors (who, remember, are AMA members and probably don't want to tick off their association) what its official policy on certain end-of-life decisions were. Then, in the first questions, it asked the doctor whether they agreed with the policies: strategies certain to result in substantial confirmation and acquiescence biases.
This just isn't on. As a professional social and market researcher, I sent a detailed critique of the many problems with the survey to AMA President Dr Michael Gannon. I received a courteous but dismissive response from administration. A highly-respected Fellow of the Australian Market & Social Research Society sent a similar critique, also receiving a non-committal reply.
While the AMA hasn't published the survey results in detail yet, key headline statistics have been reported. What did the AMA discover on the basis of a methodology swayed against assisted dying?
- Around four out of ten doctors believe that doctors should be involved in assisted dying cases, while around five out of ten thought they shouldn't. One out of ten had no view either way.
- If assisted dying were legalised, a majority said that doctors should be the ones to do this work.
That's a clear message that a substantial proportion of doctors think assisted dying can not only be legitimate practice, but is the business of the medical profession - at least for those who wish to participate.
And what did the AMA executive make of these important insights after deliberating on them for months? Here are the AMA's previous and 'revised' core policy statements:
Previous (2007) statement
'Revised' (2016) statement
"The AMA believes that medical practitioners should not be involved in interventions that have as their primary intention the ending of a person's life. This does not include the discontinuation of futile treatment."
"The AMA believes that doctors should not be involved in interventions that have as their primary intention the ending of a person's life. This does not include the discontinuation of treatments that are of no medical benefit to a dying patient."
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