Dr. Cameron McLaren:

I present on this topic a lot to medical students and the question about the Hippocratic Oath comes up quite often. I talk to them about which Hippocratic Oath we would really like to follow or talk about because if we talk about the original Hippocratic Oath, we are talking about a document that states:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant.

There are many outdated things in this document. It was updated most famously by Professor Lois N. Magner. The updated modern version of the Hippocratic Oath actually does not have an inclusion about not administering lethal medication. The oath itself was written in a time when medical providers or physicians were often called upon to act as government or political assassins as well and, therefore, part of the oath was to try to reduce or to self-regulate that practice.Many aspects of that oath are not applicable to current society and therefore to medical practice. I do not believe its relevance should be taken as gospel.

I hear also the point about the pain and the untreatable nature of some painful conditions. My perspective on that is if you talk to our patients who are going through assisted dying, that is not one of the most common reasons for applying for assisted dying. We did a pooled analysis of the reasons for applying for assisted dying of 344 applicants in the first 12 to 18 months of voluntary assisted dying. The most common was loss of dignity, the second was being less able to engage in activities that make life enjoyable and the third was losing autonomy. Importantly, only one patient out of the 344 reported uncontrollable pain, inadequate pain control or concern about it as the sole reason. Most of these people were reporting multifactorial reasons for applying. That goes back into the fact that what it really provides patients is that control. Often, these are people who have lost control since their diagnosis over the course of weeks, months or years. This is something they can do to bring that control back to themselves. Even if, as Dr. Allcroft said, they use medication, I believe approximately 30% of people who receive medication end up not taking it, it provides significant comfort to them to know that they have a trump card.

If their fears as to how their end-of-life care process is going actually materialise, they know they have a trump card. It provides them that comfort of being able to avoid their worst nightmare.

I agree with the point about the naming of conditions because there is a difficulty about making this too prescriptive. We have also seen that with people with certain conditions. I will take the Deputy's lead and not name the conditions. We have encountered conditions that are often very difficult to prognosticate even moreso than cancer, motor neurone disease or neurological diseases that were found ineligible because we are unable to prognosticate. That does not mean that people are not suffering. It does not mean they are ineligible under every other aspect of our eligibility criteria. However, we cannot progress their cases due to their not having a condition with a prognosis of less than six months. A line in the sand needs to be drawn at some point. A consideration for any jurisdiction considering this legislation is where that line is going to be. That is certainly a consideration for the committee.