Support for voluntarily assisted suicide coming from the AMSA

As reported in Sky News, and validated by myself from the Australian Medical Students’ Association (AMSA), that the AMSA members have voted to endorse a policy which supports Voluntarily Assisted Suicide (VAS) should it become legal in Australia.

The press release (which can be accessed here) details that the association recognizes that VAS is not yet legal in Australia, and can only be implemented once legalized. Additionally, VAS should not be a replacement for a quality palliative care program; nor should it be implemented unless all other treatment options have been exhausted.

The press release by the AMSA is a measured and logical approach to the idea of physician assisted euthanasia. There has been discussion recently in the media regarding this issue, with quite far-flung statements being made both ways. Here is my opinion on the matter which has come from work as a palliative care social worker, aged care manager, aged care nurse and emergency department nurse:

  1. Reasonable and sound-minded individuals do not want to end their life.
  2. Certain illnesses and chronic conditions can cause such pain and suffering that NO palliative treatment can mitigate the debilitating symptoms and lead to a good quality existence.
  3. All treatment options, assisted suicide amongst them, need to be measured against that quality of life test.
  4. In this country, as in many others, when the family pet has become too sick to lead such a quality existence their owners are given the choice to end the animal’s life with dignity and without suffering. However, because we are human and not a domesticated animal some are meant to suffer a painful and meaningless existence while their body deteriorates to the point of failure. If our beloved pets are given such an option why not our human family members?
  5. Voluntarily assisted suicide (or physician assisted suicide) does not mean the doctor or health professional is condoning people ending their life. Neither is it (as I heard on the radio yesterday) a violation of the Hippocratic Oath. It is a trained health professional allowing a person-centered care plan which details how they wish to proceed with their medical care. This, to me, is similar to how we now implement not-for-resuscitation orders.

The Australian Medical Association’s code of ethics expands on the Hippocratic Oath, and point 1.4 section c I think says it succinctly

Respect the right of a severely and terminally ill patient to receive treatment for pain and suffering, even when such therapy may shorten a patient’s life.

For those in the medical community I can hear you already saying “but Ray, that’s not what this statement is intended for.” I know that. But what it does is highlight the need for ALL health professionals to recognize that there comes a point where we must pull back and allow patients to shorten their life; if that shortening comes with dignity, control and comfort.

I have been, and always will be a supporter of a balanced and reasonable assisted dying policy. Let us make sure there are safeguards in place to prevent misuse. Let us make sure there are processes in place to ensure death is peaceful and quick. But most of all let us allow an individual with no hope of recovery and only staring at a prolonged existence of suffering and decay to choose when they decide to end their life.

I would very much like to hear your opinions.

Until next time,


Sky News- Doctors in training support assisted dying

Australian Medical Student Association- press release

Australian Medical Association- code of ethics


Are we taking care of our new nurses?

As I sit at my computer I ponder what to write. Then I think to the new graduate nurses who I work with every day. In a previous life I was a university lecturer, and the same statements I hear each day from my new graduate nurses I heard from those students: “I can’t find a new graduate position”. So I wonder, what is the current state of new graduate registered nursing uptake in 2017?

This question should be an easy one to answer. The Australian Health Practitioner Association (AHPRA) agency is requiring all student nurses to be registered with them in order to fulfill clinical placements. So finding out the number of students enrolled in accredited nursing programs in Australia should be easy, right? Not so fast. I search of the AHPRA website revealed NO data on the number of student nursing registrations. Despite this AHPRA quite easily detailed a report about the number of nurses registered in Australia all the way back to 2012, along with pertinent demographic data which I used in an earlier post. So why has AHPRA not bothered to reveal student nursing numbers?

So why does this matter?

Because nursing is a profession which cannot be automated and is increasing in demand! You cannot simply create a machine to do what a nurse does, despite some attempts otherwise. In our most vulnerable state nurses provide the personal care we need. And nurses need the complexity of thought needed to provide intricate assessment of a patient’s needs and identify problems before they cause serious life-and-death situations such as those of Vanessa Anderson.

And let’s face it, the Australian public is becoming older and needing more healthcare. Modern healthcare is allowing for longer life expectancy, and with that older adults will utilize more healthcare. Additionally, the baby boomer generation will expect greater results in terms of customer care which will require adequate numbers of appropriately trained and attentive nurses. So where will these registered nurses come from?

Will there be a nursing ‘shortage’?

Last year Monash business school did a study on on the climate of the nursing and midwifery workforce. The Monash report determined that an occupation which is demanding, such as nursing, should likely see between three to six percent of its workforce intending to leave. However, this study showed that 32% were considering leaving the profession, with 25% determined to do so. Even the Department of Health in a report filed in 2013 stated their figures indicated Australia had adequate numbers of nursing staff only up to 2016. Another poll found that 100% of nurses surveyed stated that the government undervalued their role.

Ah, but overseas nurses can fill the void? It is true that a significant number of nurses are overseas-trained? The Australian Bureau of Statistics reported in 2013 that one-third of nurses (33%) were overseas-trained, up from 25% in 2001. This fact has been highlighted as a reason why Australian new graduate nurses cannot find post-registration employment. But with 33% of the 342,221 nurses registered in Australia overseas-trained in 2016 is the overseas nurse a threat to our domestic nursing cohort? Some may think so. The Australian Nursing and Midwifery Federation feels that the 457 visa program for overseas nurses is “… being taken as a shortcut and that employers see it as a quick fix.”

Troubles post-study for nurses

Publicity around newly registered nurse employment seemed to peak in 2014-2015. ABC news reported that ” thousands of nursing graduates are unable to find work in Australian hospitals.” Even in 2016 the rumbling of underemployment of nursing graduates continued. In West Australia a WA Today article reported that only 500 of about 1500 (33%) newly graduated nursing students secured a nursing role. The Health Times reported that of the new graduate nurses in 2007 97.4% were able to secure full-time employment; however, in 2014 that figure dropped to 80.5%.

So where do we go from here?

Firstly, we need to have clear evidence as to the extent of the problem. I would call on AHPRA as the registration body to release statistical figures about the number of student registrations, just as they have done for registered and enrolled nurses. With that information we can clearly see how many students we have in nursing programs in Australia. Additionally, I would call on AHPRA to include a statistical figure on the number of overseas-trained nurses registered in Australia. As they are the governing body and provide the certification that overseas nurses are able to work in this country they would be able to provide figures as-such.

Secondly I would suggest the Department of Health re-visit their strategy paper on nursing retention and recruitment. This report is from 2013 and stated the nursing workforce was only adequate until 2016. If the government does care about the potential nursing workforce into the future reviewing their strategies and making a future policy framework would be necessary. It would also be helpful for the Council of Australian Governments to convene on this issue as they are the primary employer of a large number of nurses through the public health hospital system.

Without adequate statistical data there can be no informative discussion regarding the debate over new graduate nurses in Australia. One thing is certain, without adequate places for these energetic and qualified nurses to go the profession will continue to struggle in providing adequate healthcare to the increasing ageing population of Australia. Policy makers and statisticians need to act now in preventing a healthcare crisis in the future.


AHPRA: Student registration-

Advantech: Industry 4.0: It’s happening – Nurses are replaced by Robots-

The Australian: Coroner blames hospital for death-

Sydney Morning Herald: Healthcare is a booming industry and Australia is in the box seat-

Sydney Morning Herald: With an ageing population is healthcare sustainable?-

Monash University: What Nurses & Midwives Want: Findings from the National

Survey on Workplace Climate and Well-being-

Department of Health: 7.2 Nursing and midwifery retention-

Australian Bureau of Statistics: 4102.0 – Australian Social Trends, April 2013-

Sydney Morning Herald: Nurse graduates ‘locked out’ of workforce as migrants get jobs-

Health Times: Generation Next – Helping Graduate Nurses and Midwives Find Jobs-

ABC News: Thousands of nursing graduates unable to find work in Australian hospitals: union-

NSW Nursing and Midwifery Association: Nurse graduates unemployed or underemployed-

Health Times: Nursing shortage expected to worsen-

WA Today: All trained up with nowhere to go: WA’s hundreds of unemployed graduate nurses-

Should the government regulate family size?

A report in the Medical Journal of Australia has toyed with the idea of poor families being encouraged to limit the size of their families through discouraging more than a set number of kids.

Professor Jones cited the increase of children within the system over the last two decades. Professor Jones stated “We need to ask politically charged questions, such as should we be developing policies that encourage disadvantaged families to have fewer children”.

I have spoken before about professional healthcare bodies weighing in on political matters. However, a case (however thin) could be made that this is a health issue. There is a a far more concerning component to this topic.

History has shown that regulating reproduction has caused anger and disdain from society. A prime example is abortion, either by surgery or via the ‘morning after’ pill. Any attempt to limit a woman’s ability to choose how many children she has would most likely cause similar back-lash. What would be the penalty for violating the birth maximum, withdrawal of funding? Then the burden of care will still rest on the government via social services, hospitals or other agencies.

And what is called ‘low income’? Centrelink funding? Inability to buy a house? Lack of steady income? There are many Australians teetering on low income. Where would society be willing to draw the line? And what would happen if a family who had over the set maximum of children found themselves in that low-income category?

I think you understand my position on this. While it may be true that the number of children burdening the government’s budget has grown Australians have steadfastly held the belief of a ‘fair go’ and to remain non-judgemental.

Your thoughts?


Sydney Morning Herald: Should poor people have fewer children? Medical Journal of Australia

Medical Marijuana, treatment or just an excuse to light up?

A trend amongst the medical community over the last few years is the use of medical marijuana. According to National Institute on Drug Abuse medical marijuana ” refers to using the whole, unprocessed marijuana plant or its basic extracts to treat symptoms of illness and other conditions.” Australia has joined 25 other countries in investigating and adopting the use of medical marijuana for treatment in certain patients.

While there is no doubt that recreational use of marijuana is illegal and harmful there have been some benefits shown around pain control and neurological disorders such as Parkinson disease. There are other well known and respected medications which have similar roots in illicit narcotics, opiates such as Morphine is a prime example.

In recent months the TGA has reported to have introduced a scheme to allow for importation of marijuana to allow patients to undertake treatment. The Age has also reported that Australia is following America’s lead in introducing university programs to teach cultivation, legislation and production of marijuana crops.

Is allowing medical marijuana leading our society down a slippery-slope and making it easier for individuals who want a high to obtain their product, thereby the government indirectly condoning it’s use? I think not. Symptom control is a difficult process in those with chronic or severe pain. If we can minimize the use of opiates and help better control pain and other symptoms through the use of marijuana than do we not as a society owe it to ourselves to take this opportunity?

I applaud the Australian government and the healthcare and academic community for continuing its progression to add this treatment to the arsenal available. While I do not believe that there are those who are naive to the fact that there will be nasty side-effects the benefits can outweigh the costs. At least allowing for the trials will give the medical community the information it needs to decide on its future use.

References used:

Drug Facts: Marijuana as Medicine

The Age: Australia’s first medicinal cannabis course to teach students ‘whole continuum’ of plant Medical marijuana legal in Australia: What it means for you

Medical Daily: Medical Cannabis 2016: New Benefits Of Medicinal Marijuana

Should Healthcare Groups support social causes?

In looking through my Twitter account, @NSalutis, I found an article re-tweeted

by AMA from 9 news discussing the AMA’s support for same-sex marriage and it got me thinking. Should a professional body such as the AMA throw their considerable reputation and support behind a social cause?

At the outset I would like to state I support same-sex marriage, and homosexuality in general. The cause supported is irrelevant. What is important is the support being given. Is there a healthcare-component to same-sex marriage? Does same-sex marriage promote physical health? I am not so sure.

In a position paper released by the AMA president Dr. Michael Gannon he states that not allowing same-sex marriage could lead to poor outcomes. As part of his statement Dr. Gannon talks about high-risk behaviours as a result of stress relating to discrimination, but this does not directly link to same-sex marriage.

Another point made in the statement was the lack of official recognition of marriage by same-sex partners could lead to poorer health outcomes due to a lack of decision-making powers by said partners. But is this not also true of the numerous heterosexual ‘partners’ living together in this country? Some even having children together? In my own experience within the public health system allows for any adult to nominate their next-of-kin, which would allow a homosexual patient nominate their partner.

Therefore, I do not think this issue is one of public health, and therefore not in the perview of a healthcare body. It is political. And by making a statement it is assumed every member of the AMA backs this stance. I am not sure I would want the same from my professional body.

I am interested in what others think?

Dr. Gannon’ statement on the AMA website Article

Nine news article Article