Vulnerable people at risk from new NSW “End-of-life Guidelines”

By Most Rev. Anthony Fisher OP
Auxiliary Bishop of Sydney
4 March 2005

“Without a principled ethical approach to end-of-life-care, vulnerable people are at risk,” said Bishop Anthony Fisher OP, and spokesman on health ethics for the Catholic Church in Sydney. Bishop Fisher, who is Episcopal Vicar for Life and Health in the Catholic Archdiocese of Sydney, was commenting on the Guidelines for end-of-life care and decision-making which were tabled in Parliament yesterday afternoon by the New South Wales Government.

Bishop Fisher said the Catholic Church is concerned that the new guidelines are “strong on procedure, weak on principle” and that “they lack the sort of clear safeguards necessary to protect vulnerable patients”.

The guidelines are obviously the product of a great deal of hard thinking and do offer some good advice on processes for reaching decisions about patient care towards the end of life, the Bishop suggested. “However, they do not tell us how to make a good decision in this area.”

Health care professionals need guidance on what are ethical reasons for limiting treatments, not just who should be involved in decision making, or how to reach consensus in difficult circumstances.   “Weasel words like ‘appropriate’ and ‘inappropriate’ care don’t help here,” Bishop Fisher said.

“Although the guidelines rightly oppose euthanasia, assisted suicide and other illegal practices, without sound ethical principles that promote respect for human dignity, people could still make decisions that caring for the unconscious, the severely handicapped, the demented and the less articulate is ‘inappropriate’. The new guidelines could end up encouraging euthanasist thinking,” Bishop Fisher argued.

Patients at the end-of-life and other incompetent patients are the most vulnerable and without clear guidelines about when treatments should be withdrawn they may fall prey to “false compassion and inappropriate judgments that some people are not worth caring for,” he said.  “Value free decision making processes do not protect vulnerable patients.”

Traditional healthcare ethics hold that it ethical to ‘limit’ treatment where it is overly burdensome or no longer working. But it is never ethical to do so because a particular patient’s life is judged to be ‘burdensome’ or ‘futile.’ “Medical care which fails to distinguish between ‘burdensome treatments’ and ‘burdensome people’ represents a radical departure from the Hippocratic tradition and community expectations about medical care.”

There comes a time where the focus of healthcare legitimately shifts from cure to comfort and preparation for death.  But patients, families and health professionals need clear ethical guidance at this difficult time. “Sadly these new guidelines represent a lost opportunity in this respect,” Bishop Fisher said.

“Vulnerable patients should neither be over-treated nor under-treated. These guidelines could have helped ensure that. But with all their talk of ‘appropriate’ and ‘inappropriate’ care they fail to ensure this.”