The AMA Federal Council gathered at Canberra in mid-March for its first meeting of 2019.
The two-day session included intense policy discussion and the finalisation of a number of Position Statements. Directors, Councillors, and Committee Chairs reported to the Federal Council, as did AMA President Dr Tony Bartone.
The upcoming Federal Budget and the looming federal election shaped the debate.
“The past few months have been extremely busy trying to set the agenda, trying set the conversation and trying to set the platform for what is obviously going to be a very important election when it comes to health,” Dr Bartone said in his President’s report.
“It couldn’t have been any busier than it was in the first week of the sitting of Parliament when we visited eight Ministers and Opposition spokespeople and other Members in the House in their offices.
“And we also essentially set up office in Aussies café (in Parliament House) and we were sought out by many people in terms of what were we doing, who were we seeing and what do we have on our agenda.
“We were the sought-after group in terms of health advocates…
“I do want to assure that we don’t play favourites. We have really, really strong, trusting relationships on both sides of the House.”
The AMA’s Budget submission was highlighted, as was the election document the AMA will release once the election is called.
It was described in the meeting as a “living document” and Federal Councillors discussed updates and revisions to what will be a powerful tool by which to gauge the strength of health policy announcements from political parties during the election campaign.
A review was also given of the AMA’s role in the successful passage through Parliament of the so-called Medivac Bill, which gives doctors more say in the fate of sick asylum seekers on Nauru and Manus.
A full communiqué from Federal Council Chair, Dr Beverley Rowbotham will be published in Australian Medicine soon.
Some of the positions the Council took, however, are included here.
Pill testing at music festivals
The AMA reaffirmed its support for sanctioned, appropriately supervised, and monitored high-quality pill testing trials to minimise the risk to young people, and build an evidence base to determine the effectiveness of pill testing in Australia.
Federal Council formally and unanimously reinforced the AMA’s support for the trials.
“The AMA strongly backs pill testing trials, but they must be medically supervised, involve suitably sensitive testing equipment, and be supported by the State and Territory Governments,” Dr Bartone said.
“The trials must not be in isolation. They must be part of an overarching harm minimisation strategy.”
The AMA’s support for authorised trials of pill-testing is longstanding, and part of the AMA’s position on harm minimisation.
Dr Bartone said that it is important that there are appropriate controls, funding, and evaluation of any pill testing trials.
“We also want to see rigorous evaluation of these trials being considered by the COAG Health Council as part of a suite of measures to promote harm minimisation,” he said.
“The AMA believes that there should be less focus on policing and prosecution, and increased investment in interventions that avoid or reduce harm to young people.
“Pill testing will not completely solve the problems associated with illicit drug consumption by young people at music festivals, but it does provide an avenue for opportunistic engagement with health professionals, drug and alcohol counsellors, and highly-trained peer educators.
“Authorised and medically-supervised pill testing provides an avenue to establish rapport, and to provide important harm minimisation messages to young people attending music festivals and other events.”
The AMA remains concerned about pill testing kits sold online and at pharmacies, which are being used as alternatives to properly conducted, medically-supervised trials.
The age of criminality
The AMA is calling for the age of criminal responsibility to be raised to 14 years of age. The new policy was passed at the Federal Council meeting.
The age of criminal responsibility is the age at which a child is considered capable of being dealt with by the criminal justice system. Currently, children aged 10 can be charged, prosecuted, and imprisoned.
Dr Bartone said raising the age of criminal responsibility will prevent the unnecessary criminalisation of vulnerable children.
“Australia has one of the lowest ages of criminal responsibility in the world,” he said.
“The criminalisation of children in Australia is a nationwide problem that disproportionately impacts Aboriginal and Torres Strait Islander children.
“Most children in prison come from backgrounds that are disadvantaged. These children often experience violence, abuse, disability, homelessness, and drug or alcohol misuse.
“Criminalising the behaviour of young and vulnerable children creates a vicious cycle of disadvantage. and forces children to become entrenched in the criminal justice system.
“Children who are forced into contact with the criminal justice system at a young age are also less likely to complete their education or find employment, and are more likely to die an early death.”
The AMA wants the Commonwealth and State and Territory Governments to support developmentally and culturally appropriate health, education, and rehabilitative-based alternatives to the criminal justice system.
The AMA has released its updated Position Statement on Conscientious Objection 2019 (replacing the Position Statement on Conscientious Objection 2013), following its approval at Federal Council. The policy was reviewed as part of the AMA’s routine, five-year policy review cycle.
A conscientious objection occurs when a doctor, as a result of a conflict with his or her own personal beliefs or values, acknowledges that they cannot provide, or participate in, a legal, legitimate treatment or procedure that would be deemed medically appropriate in the circumstances under professional standards.
A conscientious objection is based on sincerely-held beliefs and moral concerns, not self-interest or discrimination.
Doctors are entitled to have their own personal beliefs and values, as are all members of the community.
“However, doctors have an ethical obligation to minimise disruption to patient care and must never use a conscientious objection to intentionally impede patients’ access to care,” Dr Bartone said.
The AMA advises that a doctor with a conscientious objection should:
- inform the patient of their objection, preferably in advance or as soon as practicable;
- inform the patient that they have the right to see another doctor and ensure the patient has sufficient information to enable them to exercise that right;
- take whatever steps are necessary to ensure the patient’s access to care is not impeded;
- continue to treat the patient with dignity and respect, even if the doctor objects to the treatment or procedure the patient is seeking;
- continue to provide other care to the patient, if they wish;
- refrain from expressing their own personal beliefs to the patient in a way that may cause them distress;
- inform their employer, or prospective employer, of their conscientious objection, and discuss with their employer how they can practise in accordance with their beliefs without compromising patient care or placing a burden on their colleagues; and
- always provide medically appropriate treatment in an emergency situation, even if that treatment conflicts with their personal beliefs and values.
The tone and emphasis of the Position Statement has been amended. Rather than taking a prescriptive line, the Position Statement now takes a reflective approach where a doctor is asked to focus on what really should matter the most – the impact of their decisions on the patient in front of them.