By Harriet Grayson in Health Services Daily

From: https://www.healthservicesdaily.com.au/doctor-supported-death-squads-make-an-appearance/21901

It was just another day at the NSW Special Commission of Inquiry into Healthcare Spending, where today’s death squad is tomorrow’s complex care committee.

Establishing hospital or LHD-based committees to make decisions about further interventions for complex patients would be beneficial in reducing low-value care but carry a reputation of being “doctor-supported death squads”, an inquiry has heard.

A senior clinician with Mid North Coast LHD told the NSW Special Commission of Inquiry into Healthcare Spending that having an official body within LHDs to oversee complex cases would be beneficial in reducing low-value care and would take the pressure off clinicians.

“If NSW Health instructed each board to have a complex care committee, and a clinician took a patient to that committee, and the committee made a decision that was supported by the NSW government, it becomes the complex care committee’s responsibility for the decision that was made,” said Dr Steve Begbie, executive clinical director for the Hastings Macleay Network in the Mid North Coast LHD.

“That would take a lot of pressure off clinicians so that they’re not making a decision as an individual clinician that the 95-year-old mother that’s been loved and cherished by the family is not suitable for surgery in this situation.

“They’re not the subject of criticism when what [they’re] trying to do is [frame this] as low-value care – not that the individual was of low value, but that the care was of low value.

“[When] you’re trying to explain to the family that what the [patient] needs is comfort at this point, not high-tech medicine or surgery, [a complex care committee] would be a potential solution.”

However, according to Port Macquarie Base Hospital’s director of surgery Dr Bruce Hodges, efforts to set up such a committee and bring along senior clinicians had been met with fierce resistance, including claims the committee would be nothing more than a “doctor-supported death squad”.

“We tried to introduce it at our hospital, and senior clinicians said: ‘You’re taking away my authority as an individual to make a decision’, and ‘you are just going to be the death squad’,” Dr Hodges said.

Dr Begbie replied that it was important to recognise the sensitive nature of terminology used to describe the committees in addition to their terms of operation, but ultimately the utility of the committees to reduce the weight shouldered by clinicians in navigating these discussions superseded concerns over their reputation as “death squads”.

“That’s why I [recommend] changing from a low-value care committee to a complex care committee, because there’s probably less in the term,” he said.

“We’re going to have to make hard decisions one way or another out of this commission, and any big decisions [are] going to be disliked in certain circumstances, so it doesn’t really matter what someone whose interests stood in the way was calling it.

“Discussing it in negative terms shouldn’t be a reason not to do it if it’s the right thing to do.”