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Vulnerable at risk from NSW "End-of-Life Guidelines"

Sydney auxiliary Bishop Anthony Fisher has expressed concern that the new NSW Health Department Guidelines for Decision Making at the End of Life "lack the sort of clear safeguards necessary to protect vulnerable patients".

Bishop Fisher described the Guidelines, which are designed to assist health care professionals involved in end of life decisions and care, as "strong on procedure, weak on principle".

"Without a principled ethical approach to end-of-life-care, vulnerable people are at risk," he said.

Bishop Fisher is spokesman on health ethics for the Catholic Church in Sydney and Episcopal Vicar for Life and Health in the Archdiocese.

He conceded that the Guidelines, which were tabled in State Parliament on Thursday, 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". But "they do not tell us how to make a good decision in this area".

He stressed that 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and other incompetent patients are the most vulnerable and without clear guidelines about when treatments should be withdrawn they may fall prey to "false compassion and inappropriate judgments that some people are not worth caring for," he said.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."

Vulnerable people at risk from new NSW "End-of-life Guidelines (Archdiocese of Sydney 4/3/05)

Archdiocese of Sydney | Bishop Anthony Fisher
End of LIfe Guidelines (NSW Department of Health - Google cache)
Life Office, Archdiocese of Sydney

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7 Mar 2005