Document Sample
					Letter         from       Australia                                   Meanwhile, the far north has been attracting its share of
                                                                   medical headlines. The Northern Territory Government,

Adding insult to injury a                                          based in Darwin, passed the world's first euthanasia laws
                                                                   since the Nazi era, provoking predictable outrage,

new government makes                                               controversy, support and general hullabaloo. The medical
                                                                   establishment, as a rule, adopted a guarded attitude to
                                                                   these developments. Several spokesmen questioned the
medical waves                                                      need for such legislation at a time when palliative care was
                                                                   achieving increasing acceptance as a specialist discipline.
 Australian doctors, like practitioners everywhere, tend to be        Once the law was passed, the euthanasia lobby in Darwin
  a conservative lot. And for reasons of more than just self-      found their Semelweiss, a Dr Phillip Nietzke, who had
  interest, this extends to politics as well. Or Carmen            previously challenged the local establishment over supplying
  Lawrence, the last Labour Minister of Health, was regarded       methadone to heroin addicts. Several patients, in advanced
  with undisguised suspicion, if not open hostility, by the        states of illness and suffering intensely, declared themselves
  profession. Dr Lawrence, a psychologist by trade, had left-      available, if not desperate, to participate. The predictable
 wing credentials, was an outspoken feminist, and had the          media feeding frenzy commenced.
 support of the Prime Minister. Such a combination was not            Or Nietzke expressed his frustration about the diffiCUlty in
  likely to endear her to the medical establishment.               finding an independent psychiatrist to give the necessary
     When the government changed hands in March, the               approval to meet the requirements of the law. Eventually
 conservative Liberals were voted in and Dr Michael                Or John Ellard, probably the most well-known psychiatrist in
 Wooldridge was appointed Health Minister. Many doctors            the country, flew to Darwin and provided the certification.
 felt they were facing a more sympathetic politician. After all,   Mr Phillip Dent became the first patient in Australian history
 Dr Wooldridge was a former Gp. Few paid much attention            to die legally from euthanasia. Two more have followed since
 when he said that he was prepared to face any degree of           then.
 unpopularity in his efforts to bring the Health Department's         Opposition to the law did not die down; quite the
 budget under control.                                             opposite. A private member's bill to negate the law was
     Dr Wooldridge started by limiting the provider numbers        passed in Federal Parliament, leaving a lot of muttering in
 issued to doctors in the first 4 years after graduation           the States about intervention from Canberra. Or Nietzke is in
 (provider numbers are essential to charge fees to Medicare        despair, but the issue has legs and will go on and on.
 in private practice). Dr WooIdridge pointed out, not                 Meanwhile, the medical students are still fuming, the
 unreasonably, that he wanted GPs to finish the approved           ethnic lobby is outraged, and the medical establishment is
training scheme before going into practice and that some           wondering whether things really were so bad under a
specialties, like psychiatry and geriatrics, were short of         Labour government. Who would have thought things would
trainees. Furthermore, while rural doctors were in critically      come to such a pass? Why, less than two years ago the
short supply, there was clear evidence of an over-supply of        Minister was hailed as one of our own, a former GP who
doctors in the cities, resulting in over-servicing. Some newly     understood the needs of doctors. In some medical circles, a
graduated doctors go straight into the so-called 24-hour           dark and heretical thought is now being voiced - 'Come
clinics. These entrepreneurial c1incis have spread all over the    back, Or Lawrence, all is forgiven .. .'
cities, competing with established general practices by high-
volume turnover of patients.
                                                                   Robert Kaplan
     Final-year medical students, outraged at being deprived of
                                                                   Liaison Clinic
the possibility of earning $100 000 a year within a year or        310 Crown Street
two of graduating, staged noisy demonstrations, leaving the        Wollongong
Minister quite unmoved. After some equivocation, the
Australian Medical Association joined in. The Minister
promised negotiations, but made it clear that he intended to
get his way. As a concession to limit medical numbers
further, he suggested a 1a-year moratorium on issuing
provider numbers to foreign doctors - South African
doctors who are planning to emigrate take note! This
suggestion immediately provoked the ethnic lobby, who
have fought a long and difficult battle to get doctors from
their own language groups licensed to work in Australia.
     To add insult to injury, Dr Wooldridge then did what
Or Lawrence had only threatened, namely limiting Medicare
payments for patients in long-term psychotherapy, thereby
provoking the intense ire of psychiatrists who practised
psychoanalytic therapy. Whether the projected wrath of
therapists who spend their days listening silently to patients
free-associating is likely to deter the Minister is not known
as yet.

       Volume 88 No.3 March 1998   SAMJ

Shared By: