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A doctor's right to free speech is attacked - so why the silence?

13 September, 2019

Last month Dr Alida Lancee was cautioned by the Medical Board of Australia after it declared her campaign for assisted dying reform threatened the public’s confidence in the medical profession.

The Perth GP rejected the claims saying she never claimed to speak on behalf of the profession and warned the board’s actions was an attack on doctors’ free speech.

Dr Heather McNamee asks why the main doctors groups have said so little in her defence.

This article was first published in AusDoc.Plus on 29 August 2019.

All doctors should be outraged at the attempt by the Medical Board of Australia to “gag” Dr Alida Lancee after she spoke publicly about her support for voluntary assisted dying reform.

The board claimed her comments made in numerous interviews over the last two years about her role in administering an injection which hastened the death of one of her terminal patients could undermine public confidence in the medical profession.

You can judge for yourself. The comments which alarmed the board so much are published below.

But the board’s actions raise serious issues for all of us.

Do you want to be treated as a second-class citizen who is denied the democratic right to free speech?

Will you allow yourself to be intimidated and threatened by the medical board into keeping quiet on issues you feel passionate about?

Or is it the job of a doctor to be an obedient public servant – kowtowing to the opinions of the medical board, happy to stay mute on important socio-political debates, in case you slip up and make an 'inappropriate comment' or 'fail to show insight' into the alleged 'consequences' of your words?

The move against Dr Lancee followed a medical board review of her actions in her treatment of her patient – a woman called Mavis Rose who, with the support of her family, gave explicit consent to terminal sedation because of the intense suffering she was going through.

These events had occurred more than twenty years ago but It seems when AHPRA could not gather enough evidence to discipline or attempt deregistration of Dr Lancee, they decided to try a different attack route - haul her over the coals for discussing her own experiences in a desire to inform the debate about the rights and wrongs of voluntary assisted dying.

There is one big question for me.

Whether you agree with voluntary assisted dying, whether you support or oppose euthanasia, this was an attack on free speech. There was no patient risk, no threat to the public's perceptions of the medical profession. But what has been the reaction of the AMA to all this, the supposed voice of our profession? Where were they, speaking out to defend the basic rights of doctors?

Missing in action. We heard nothing from them. In fact they did worse than that. They added to the medical board’s fire by stating (falsely) that Dr Lancee’s comments contradicted the medical profession's "generally accepted views".

Even if her views aren’t the "generally accepted" views (in fact, I believe they are), so what? Is that meant to be a point at which a doctor can be hauled before the medical board and told to be quiet.

Personally, as a doctor practising in Australia, I am insulted by the recent statements made by the WA AMA president that legalising VAD will clearly lead to "unlawful deaths".

I don’t think that is a generally accepted view of the medical profession.

Even more fanciful (and insulting) is its claim that medications issued for the use of a patient approved to access VAD, who later changed their mind could be, “used on a patient who no longer had capacity to consent” or worse still be used to “commit murder for financial gain”.

And no, I don’t think that is a generally accepted view of the profession either. It's ludicrous.

But although I may be appalled by the AMA WA's comments, I fully support its right to make them and I would defend the WA AMA president if the medical board came knocking for expressing such opinions.

Are we all spat out of the same mould, brainwashed at medical school, to think the same way? Are we meant to be incapable of independent thought – or rather forbidden to express independent thought just because we are members of the medical profession?

If so – bring on the tear gas and the rubber bullets – put me in shackles. I for one will not be silenced.

Dr McNamee is a GP in Cairns, and a member of Doctors for Assisted Dying Choice

The comments by Dr Lancee that landed her before the medical board

“Two years ago, I openly declared that I had provided assistance-in-dying at the request of some of my patients when their suffering became intolerable to them.” — Weekend West, 28 July 2018

“I agreed to help her and stop her suffering. I provided her with an injection which hastened her death.” — Weekend West, 28 July 2018

“I hastened this lady’s death ... currently this is called murder.” — Weekend West, 28 July 2018

“I have full support of the family and when they’re ready — and only when they’re ready — will the identity of the patient that I helped be made public.” — Yahoo News, 28 July 2018

“Death and dying aren’t medical matters. They’re human matters and every human being should have their own choice in how that dying should look.” — Yahoo News, 28 July 2018

“I’ve written death certificates truthfully and if they can’t find [the proof], then that’s not my duty to help them charge me with murder, is it?” — PerthNow, 1 January 2017

“I’m very encouraged that the Government is taking the thorough inquiry’s recommendations on board and is looking at not just legalising an already commonly practised choice for people to stop their suffering, when they’ve suffered enough, but also to ensure advance directives become universally available and mandated and adhered to by medical staff, and to ensure palliative care is available, particularly in a community setting.” — West Australian, 13 November 2018

The board also watched the Channel 9 program 60 Minutes on assisted dying, which was broadcast in September 2018.

When the interviewer comments, “Alida’s decided to reveal the right patient, and admit that she helped an 80-year-old woman die”, Dr Lancee is shown responding: “This is what I did for this lady. If you think that this is against the law, and I am a murderer, deal with me as you see fit.” 

In relation to the treatment of Mavis Scott, Dr Lancee says that she had the following exchange with Ms Scott: "‘Look, I will provide you with rapid terminal sedation and it is likely to cause you to die much sooner than otherwise.’ ‘Please’, she said, ‘please.’ So it was decided at that stage that I will provide that treatment and that’s what I did'.”

The interviewer asks: "How many times have you hastened someone’s death to relieve their suffering?" and Dr Lancee replies: "I have probably needed to provide it for seven or eight."