{"id":3207,"date":"2017-09-22T06:17:46","date_gmt":"2017-09-22T05:17:46","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=3207"},"modified":"2017-10-30T14:00:11","modified_gmt":"2017-10-30T13:00:11","slug":"does-the-doctrine-of-double-effect-apply-to-the-prescription-of-barbiturates-syme-vs-the-medical-board-of-australia","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2017\/09\/22\/does-the-doctrine-of-double-effect-apply-to-the-prescription-of-barbiturates-syme-vs-the-medical-board-of-australia\/","title":{"rendered":"Does the Doctrine of Double Effect Apply to the Prescription of Barbiturates? Syme vs the Medical Board of Australia"},"content":{"rendered":"<p style=\"text-align: left;\"><em><strong>Guest Post: Xavier Symons<\/strong><\/em><em><strong><br \/>\nPaper:\u00a0<a class=\"highwire-cite-linked-title\" href=\"http:\/\/jme.bmj.com\/content\/early\/2017\/09\/12\/medethics-2017-104230\"><span class=\"highwire-cite-title\">Does the doctrine of double effect apply to the prescription of barbiturates?\u00a0Syme vs the Medical Board of Australia<\/span><\/a><\/strong><\/em><\/p>\n<p>&nbsp;<\/p>\n<p>My recently published article analyses the controversial Victorian Civil and Administrative Tribunal (VCAT) hearing <a href=\"https:\/\/www.vcat.vic.gov.au\/sites\/default\/files\/resources\/Syme%20v%20Medical%20Board%20of%20Australia%20%28Review%20and%20Regulation%29%20%5B2016%5D%20VCAT%202150.docx\"><em>Syme vs The Medical Board of Australia<\/em><\/a>. In that hearing, Dr Rodney Syme, an Australian urologist and euthanasia advocate, was defending his practice of prescribing Nembutal to terminally ill patients. The Medical Board of Australia (MBA) had found that Syme\u2019s behavior posed \u201ca serious risk to persons\u201d and placed a condition on Syme\u2019s license that prevented him from engaging in medical care \u201cthat has the primary purpose of ending a person\u2019s life\u201d. Syme appealed the MBA decision, testifying to VCAT that he prescribed the drug with the intention of relieving their existential suffering and not to assist in suicide. Essentially, he argued that the Doctrine of Double Effect (DDE) could be applied to justify his actions.<\/p>\n<p>The aim of my article is to debunk Syme\u2019s claim. I argue that a close scrutiny of his actions reveals that, at the very least, he intended to give patients the option of suicide. Insofar as this is the case, DDE cannot be invoked as a justification.<\/p>\n<p><!--more--><\/p>\n<p>DDE can be roughly summarised as follows:<\/p>\n<p><em>The doctrine of double effect states that, where certain criteria are met, a person acts ethically when acting to bring about a good or morally neutral effect, even if her action also has certain foreseen, though not intended or desired, bad effects.<\/em><\/p>\n<p>Traditional definitions of DDE include the following four criteria:<\/p>\n<ol>\n<li><em> The act itself must be good or at least morally neutral.<\/em><\/li>\n<li><em> The agent must not intend the bad effect.<\/em><\/li>\n<li><em> The bad effect must not be used as a means to achieve the good effect.<\/em><\/li>\n<li><em> The \u2018goodness\u2019 of the good effect must outweigh the \u2018badness\u2019 of the bad effect, and there must be no other reasonable way to attain the good effect.<\/em><\/li>\n<\/ol>\n<p>I argue that Syme\u2019s actions fail to meet criteria 2 and 3. I argue that Syme\u2019s proximate intent when prescribing Nembutal was to to give patients the option of suicide. He was, in this sense, intending a bad effect. He furthermore used what on a traditional definition of DDE would be considered a \u2019bad\u2019 means\u2014the prescription of Nembutal\u2014to achieve a \u2019good\u2019 end\u2014the relief of suffering. If I\u2019m correct, Syme\u2019s DDE justification is untenable; his actions are sufficiently similar to other cases of assistance in dying so as to warrant prohibition. <em>(Note that euthanasia and assisted suicide (E-AS) are currently illegal in all Australian States or Territories, though several jurisdictions are considering E-AS legislation).<\/em><\/p>\n<p>There are, to my mind, two main reasons why the ruling is significant. The first is that it challenges the Australian medical community\u2019s understanding of what constitutes \u201cethically acceptable practice\u201d in end-of-life care. VCAT has given conditional approval the prescription of Nembutal in cases where a terminally ill patient is suffering existentially. This will presumably influence future decisions made by the MBA and the Australian Health Practitioner Regulation Agency (AHPRA), and it could conceivably influence guidelines provided by organisations such as a Palliative Care Australia and Palliative Care Victoria. The second reason is this: the logic behind the ruling could be applied in circumstances other than end-of-life care. It is conceivable that, using VCAT\u2019s logic, a practitioner could justify the prescription of Nembutal to <em>any<\/em> patient suffering existentially, regardless of the case of that suffering. All that matters is the intention of the doctor; provided the stated intention is to \u201cprovide control\u201d, then the prescription of Nembutal is permissible. If I\u2019m right, we could see the doctrine of double effect invoked in increasingly unusual circumstances to justify the prescription of Nembutal. That is, unless the ethicists, clinicians and the judiciary recognise the flaws in VCAT\u2019s <em>Syme <\/em>ruling.<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Guest Post: Xavier Symons Paper:\u00a0Does the doctrine of double effect apply to the prescription of barbiturates?\u00a0Syme vs the Medical Board of Australia &nbsp; My recently published article analyses the controversial Victorian Civil and Administrative Tribunal (VCAT) hearing Syme vs The Medical Board of Australia. In that hearing, Dr Rodney Syme, an Australian urologist and euthanasia [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2017\/09\/22\/does-the-doctrine-of-double-effect-apply-to-the-prescription-of-barbiturates-syme-vs-the-medical-board-of-australia\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2153,2146,511,443,591],"tags":[],"class_list":["post-3207","post","type-post","status-publish","format-standard","hentry","category-guest-post","category-in-the-courts","category-in-the-news","category-jme","category-life-and-death"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Does the Doctrine of Double Effect Apply to the Prescription of Barbiturates? Syme vs the Medical Board of Australia - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2017\/09\/22\/does-the-doctrine-of-double-effect-apply-to-the-prescription-of-barbiturates-syme-vs-the-medical-board-of-australia\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Does the Doctrine of Double Effect Apply to the Prescription of Barbiturates? 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