Medical Journal of Australia最新文献

To the Editor: The Australian National Agreement on Closing the Gap is an undeniably important piece of political infrastructure.¹ The new approach, outlined in the 2020 National Agreement, vows to achieve First Nations equity by recognising the strength of, and empowering, First Nations people, communities and organisations.

By its nature, “closing the gap” inadvertently places non-Indigenous Australians above First Nations people and sets outcomes of non-Indigenous Australians as the gold standard. Although it is important to understand the relative and disproportionate disadvantage that First Nations people experience in Australia, the closing the gap narrative continues to perpetuate deficit discourse and encourages the benchmarking of First Nations outcomes against non-Indigenous Australians.

This deficit-driven process of benchmarking has become increasingly prevalent in First Nations-focused research, where the research problem is often described by the relative gap between First Nations people and non-Indigenous Australians. In many cases, highlighting the gap provides little value to the research, and only persists to promote deficit discourse — by continually defining the gap, we continually emphasise the deficit.

Progress towards equity for First Nations people has been slow, stunted and non-existent in many of the Closing the Gap target and priority reform areas.² In light of this, the importance of moving away from the deficit narrative surrounding First Nations outcomes is being increasingly recognised.³ Driving high quality research in genuine partnership with First Nations people is key to driving real change. As such, it is critical that researchers, reviewers and journals play their part in shifting the deficit narrative.

Defining the research problem is integral to effective dissemination of research findings and attraction of funding. For health research, this often means defining rates of disease morbidity and mortality. These statistics are seldom positive but provide important context to research studies. Shifting the deficit narrative in First Nations health research should not mean that important, but negative, statistics are omitted from the story; rather, researchers should remain cognisant of the deficit narrative that comparison of First Nations outcomes to non-Indigenous Australians perpetuates, and should seek to only compare outcomes where it is absolutely pertinent to the context of the study.

No relevant disclosures.

To the Editor: Recently, I had the privilege of providing end-of-life care for a remarkable man who had contributed a great richness to the cultural life of Australia. A New Zealander by birth, he came to Australia as a young man and over the subsequent four decades, built a life in Victoria. He had witnessed both good and bad deaths; a brother had died uncomfortably following an aspiration, whereas his mother had “a beautiful dying”, her suffering eased with a morphine infusion. We shared a wonderful conversation as this articulate and thoughtful man reflected on these deaths and how they guided his thoughts as he considered his own. He valued both his dignity and the impact that the manner of his death would have on those he would leave behind, and had sought out assisted dying so that he could die on his own terms.

Voluntary assisted dying (VAD) involves medical assistance to end life when the suffering from a terminal disease becomes intolerable. In Victoria,¹ South Australia² and Western Australia,³ eligibility for VAD is restricted to Australian citizens and permanent residents.⁴ The intended purpose of this restriction is to prevent patients travelling to access VAD.⁵ However, the consequence of this legislative language is to deny access to New Zealanders who have substantive connection to Australia, and who otherwise enjoy many of the rights and obligations of Australian citizens. New Zealand citizens are entitled to live, work and freely access most government benefits (including Medicare) in Australia, and so may choose to not apply for citizenship. As of 2023, there were 598 000 New Zealanders residing in Australia,⁶ many of whom are not eligible for VAD by circumstances of their Australian residency alone. If they remained in New Zealand, they would be entitled to access VAD there.⁷

This was the case for my patient, who discovered his ineligibility too late in his disease process. Although palliative care gave him a relatively quick and comfortable death, it did not give him a death on his own terms. Although I recognise the value of preventing medical tourism for the purpose of VAD, the current requirement is unnecessarily restrictive and the law, as it stands in Victoria, is unjust. The more nuanced approach taken in other states, which requires three years of residency, would remedy this inequity.

The family of the patient reviewed this letter and provided written consent for publication.

No relevant disclosures.