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by Graham Adams / 18 May, 2018
Not wanting to be a burden is a valid reason for accessing assisted dying, writes Graham Adams, who is a cancer patient.
It was 8pm on a cold Friday night in a packed hospital emergency department. The triage nurse glared at me through the glass panels that shielded her from the throng of patients in the waiting room. “There are NO beds available!” she said. Her face was stony.
I was taken aback. It wasn’t my idea of fun to be standing shivering with a fever in front of a seriously overworked woman at North Shore Hospital, but my oncologist had told me to go there if my temperature spiked.
The nurse noticed my bewildered expression and her voice softened. “This is not the place for a cancer patient,” she said, as people behind me coughed and wheezed. “I’ll get you a mask to wear while you wait, and I’ll find you a room away from people just as soon as I can.”
Feverish, neutropenic chemotherapy patients are not the most welcome visitors at a busy emergency department. We’re not accident victims and we may or may not be an emergency. But until someone takes a blood sample, no one knows for sure. The level of neutrophils, which protect against infection, shift around in cancer patients and you can be neutropenic (ie deficient) and extremely vulnerable to life-threatening sepsis one week but not the next. Consequently, if a cancer patient’s temperature goes above 38°C, indicating the possibility of infection, they are instructed to present themselves at an emergency department as soon as possible.
The nurse was as good as her word. She commandeered a consulting room where I could lie down, blood was taken and a line put into my arm in case I needed IV antibiotics. Lying there for hours on my own waiting for a doctor to appear, I listened to a man somewhere along the corridor, groaning in pain, and an elderly woman, possibly a dementia patient, shouting, “Help me, doctor! Help me!”
It made me think about medical resources, dying, and the whole damn thing.
I figured it was okay for me to be on an interminable cycle of emergency department visits every time my temperature spiked while there was still hope my treatment would work – but would I want to be doing this repeatedly if I had only months, or less, to live?
Cancer patients eat up a huge amount of time and money being treated in their final months and weeks. At that point, wouldn’t allowing someone like me access to assisted dying be a win-win for me, the hospital and the health system? I wouldn’t have to suffer whatever pain and distress may be my fate in my final days – which is my ardent wish – and the money and resources saved could go towards treating patients who might regain a healthy life, rather than trying to preserve mine when I was doomed.
Saving precious health funding is not one of my primary concerns in wanting assisted dying to be available, but I would consider it a valuable side effect. It would give me the satisfaction of knowing that in sacrificing the last little bit of my life, for my own reasons, I would also be easing the burden on the health system just a little.
Hours later, a doctor appeared and apologised for the delay in getting to me. “Four ambulances arrived just after you were admitted,” she said. “We’ve been run off our feet.”
The idea of not wanting to be a burden to others – whether it’s those you love or even the unseen taxpayer – is rarely mentioned by supporters of assisted dying but often by opponents, and always as a bad thing.
Dr Stephen Child, a former chair of the New Zealand Medical Association and an opponent of assisted dying, told the New Zealand Herald in January that 48% of people requesting euthanasia in Oregon, where assisted dying is legal, list “burden to others” as their primary reason for doing so. He asked, “Does that mean they’re making an independent decision for a rational suicide or is there a degree of coercion in their decision-making?”
Well, it’s possible to find out easily enough – by investigating their motives, just as we do for live organ donors. Although it’s not common, donors can develop complications from the surgery to remove a kidney or a lobe of their liver that could cost them their lives. It’s a serious business.
Doctors recognise some would-be donors may have motives other than altruism – such as feeling obliged to help a family member or hoping to improve a damaged friendship. Consequently, counselling is offered to check what their true motives are. Similar checks can be done to assess that someone’s wish for an assisted death is free from coercion. David Seymour’s End of Life Choice Bill, currently being debated in the Justice select committee, details comprehensive provisions to make sure it is a free choice.
Investigations by the Canadian Supreme Court, the Royal Society of Canada, and the Victorian Inquiry into End of Life Choices concluded that such screening is effective in avoiding abuse in jurisdictions where assisted dying is legal.
It’s quite reasonable to not want to burden others with your suffering – not because loved ones are putting pressure on you but simply because you want to spare them the trauma and distress of watching you suffer when things have become hopeless.
In my own case, not wanting to be a burden has absolutely nothing to do with direct or indirect coercion, or even a fear of it. It’s simply motivated by concern for the psychological wellbeing of those who love and care for me. I know very well from my own sister’s death – tied to a hospital bed and screaming for hours as cancer overwhelmed her – just how traumatic a painful, distressing death can be, not only for the person in pain but everyone else involved.
It’s strange that opponents are often happy to accept that an essentially selfish motive – wanting to avoid pain – might be a valid reason for assisted dying, but are quick to dismiss an altruistic motive – not wanting to burden others – as unworthy.
Society recognises altruism as the most noble of human impulses, and the very essence of heroism, whether it’s a soldier or lifeguard or bystander putting their own life at risk to save someone. Nevertheless, it is unusual to hear anyone state publicly that not wanting to be a burden to others is a legitimate reason to access assisted dying.
Dr Lance O’Sullivan is one exception. RNZ reported in October last year that while “many people who chose euthanasia in overseas jurisdictions included in their motives that they felt they were a burden on their family, the hospital or even the taxpayer”, O’Sullivan “was not concerned” about this. RNZ reported him saying, “I don't think it should be dismissed as an inappropriate component to a decision.”
Dr Jack Havill, a former intensive care specialist and former president of the End-of-life Choice Society, agrees. He told North & South, “Feelings of being a burden to others are legitimate and common among many people who are dying” – and these feelings are “simply a part of their unbearable suffering”.
In short, if we accept that unbearable suffering is a good reason for assisted dying, we have to admit that fearing being a burden on others is an integral part of that suffering.
“Of course,” Havill adds, “just because a person feels they are a burden to others does not make them eligible for assisted dying under the End of Life Choice Bill. The patient has to be terminal or have irreversible, untreatable suffering and be in an advanced state of decline. But no one can say that the feeling of being a burden to others is not part of their suffering.”
Auckland Anglican Bishop Jim White also supports the notion that not wanting to be a burden is a valid reason. In his 2016 submission to the Health select committee, he wrote, “It is also noteworthy in the assisted dying debate that people may choose to die for the good of others (as adjudged by themselves). While we want to be certain that there has been no coercion in this decision, it can be a legitimate reason…”
It is entirely pertinent that a bishop should make that point; Christianity centres on the sacrifice of one man dying on a cross in order to save the rest of humanity from the burden of sin. Self-sacrifice lies at the very heart of our Christian heritage. As St John wrote in his gospel: “Greater love hath no man than this, that a man lay down his life for his friends.”
This was published in the May 2018 issue of North & South.
by Graham Adams
Published: April 26, 2018 1:33PM
Source: Gisborne Herald
On April 18, The Gisborne Herald reported that East Coast MP Anne Tolley was seeking feedback from the public on assisted dying because, she said, she has always represented her voters’ opinions in conscience votes, even if it meant going against her own beliefs.
This seems a laudable and democratic approach, although the fact that she reckons the electorate remains evenly split over the End of Life Choice Bill is disturbing.
It has raised eyebrows because polls over 20 years have shown a clear majority in favour of assisted dying. Why, you might wonder, would the East Coast electorate be so markedly different from poll results produced over decades?
Among the more recent, a Newshub poll in February showed 71 percent supported the End of Life Choice Bill, with 19.5 percent against and 9.5 percent unsure.
A Horizon poll conducted last June put support for assisted dying for those suffering from end-stage terminal illness at 75 percent, with only 11 percent opposed.
Support was also very strong for medical assistance to die for people with irreversible conditions, such as motor neurone disease, which may not cause death in the immediate future, with 66 percent in favour and 15 percent opposed or strongly opposed.
It would seem very odd if East Coast voters’ preferences differed substantially from consistent, long-term polling.
It certainly can’t be ascribed to the fact her electorate is represented by a National Party MP elected with a healthy majority. The Horizon poll showed that National voters, at 83 percent in favour, were a higher proportion than any other party.
It seems most likely that Tolley’s assessment of an even split is based on the feedback she is receiving. Unfortunately, this is often highly inaccurate, not least because those opposed tend to be noisier than supporters (for various reasons, including religious motivation).
Certainly that is what former North Shore MP Wayne Mapp found when he tried to gauge his electorate’s opinion before the 2003 vote on Peter Brown’s Death with Dignity Bill, which was narrowly defeated at its first reading.
In comments on a Kiwiblog post in June 2017, after the End of Life Choice Bill had been drawn from the ballot, Mapp recounted: “When this issue last came up (in 2003), I voted in accordance with the views of the electorate as expressed by the hundreds of letters and emails with a North Shore source that came into the office. They were 70 percent opposed.
“A few months later (after the parliamentary vote), I did a proper scientific opinion poll of the electorate. The result was the reverse, with 70 percent in favour.”
Mapp said he conducted the survey because he twigged that the initial wave of letters and emails represented a campaign by a minority of opponents (including from religious organisations) and suspected they didn’t represent the majority’s wishes, as he discovered was the case.
He never had the chance to vote for another bill to reform the assisted dying law because none was presented before he left Parliament in 2011.
Hopefully, Anne Tolley will become aware of the folly of basing her vote on the number of emails and letters she receives and take notice of the fact that polls show those opposed are reliably less than 20 percent.
If she wants to know what her electorate thinks on assisted dying, she really needs to conduct a scientific poll of her own, or to uncover the reasons her electorate is not split along the same lines as the rest of the country.
Attached is a Horizon Research report similar in form to the previous one done in June 2017.
This was commissioned by EOLC and includes 4 questions which have relevance to the debate on EOLC at the moment. It shows continued strong support for EOLC with very small numbers in opposition. A great piece of information to show to MPs or doubters as to the cause.Parts of it could also be used when you are giving an oral submission.
Paul Courvette and his wife Liana. "He was thrilled he could chose the time and place of his death," Liana said. Photo / supplied
Paul Couvrette awoke, like any other day. Except it wasn’t any other day – it was the day Couvrette had chosen to die.
He ate breakfast, like any other day. He walked his dogs on the beach, like any other day. Then, after a final dinner with family and a last glass of Scotch, the 72-year-old announced: “I’m ready now”.
He lay down on his bed with his wife, he thanked the doctor and the nurse who were about to administer his lethal injections, he told his wife once more how much he loved her. Then he died quietly and comfortably at home.
With aggressive cancer having spread from his lungs to his brain, and with no chance at recovery, Couvrette chose to die on his own terms – how and where he wanted.
In Canada, where Couvrette lived, he had that choice. In New Zealand, politicians are now preparing to vote on the same right for Kiwis.
“He was thrilled that he could choose the time and place of his death. He had no fear,” his wife of 11 years, Liana Brittain, told NOTED.co.nz. “He was totally at peace with his decision. He was very upbeat.”
In May last year, Couvrette became the first medically-assisted death on Prince Edward Island, Canada’s smallest province, near Nova Scotia on the Atlantic coast.
As New Zealand now tussles with the moral and legal arguments inherent in assisted dying, it’s worth examining how the practice has worked in other countries.
Around 2000 people died with medical assistance in Canada in the first 12 months following the June 2016 legalisation, according to a Canadian Government report released in October last year. In the first six months, from June-December 2016, Canada recorded 803 assisted deaths nationally. During the subsequent six months, however, the number jumped 47 per cent, with 1179 people choosing medical assistance for death. Even with the increase, the number of assisted deaths in Canada still represents less than 1 per cent of all deaths.
The most common medical condition that led people in Canada to opt for medically-assisted death was cancer, which accounted for about 63 per cent of cases.
The Canadian assisted death legislation is based on the “Oregon model”, named after the US state first to introduce legislation, which permits assisted death for mentally competent people with terminal illnesses who have a defined life expectancy. Seven US states (California, Colorado, Hawaii, Montana, Oregon, Vermont, and Washington), plus Washington DC, all follow the Oregon model, as does Victoria in Australia. New Zealand legislation, if passed, would likely also follow this model.
In other countries – such as the Netherlands, Belgium, and Switzerland – the law allows for medically assisted death for sufferers of depression, advanced requests for dementia patients, and for minors with terminal illnesses.
In Canada, advocacy and lobby group Dying With Dignity continues to fight for more relaxed assisted dying controls – including rights for people with mental illnesses, dementia, and for people under-18. Meanwhile, on the other side of the fence, Dying With Dignity chief executive Shanaaz Gokool said, opposition groups continue to fight in court for restrictions. It’s an ongoing battle.
“The opponents have not been quiet. Like us, they’re participating or trying to participate, in the legal cases challenging aspects of the federal assisted dying law. There are a number of anti-assisted dying petitions that are circulating, including in churches, schools and at universities. There are groups that are trying to keep patients from being allowed to access assisted dying in publicly funded facilities such as hospitals and long-term care facilities,” she said.
“As it happens, these groups are much, much better funded than we are, even though they represent the point of view of only a small fraction of the Canadian population.”
The procedure is obviously not to everyone’s religious or moral tastes. Many conservative opponents in Canada still – as in New Zealand – can’t stand the idea. But supporters believe strongly that it should be an option for an individual in pain.
“There are many, many ways you can choose consciously to celebrate the end of your life,” Brittain said. “You can also choose to have palliative care, palliative sedation, you can choose to die naturally, you can choose to voluntarily stop eating and drinking. [Assisted dying] is not for everyone … it’s a choice.”
Her husband chose “quality of life over quantity”, she said. He didn’t want to waste away, and he didn’t want to endure treatments that would restrict or ruin his final weeks or months, Brittain said.
His death – with or without medical assistance – was imminent and inevitable. So, instead of suffering for an extended period, he was able to go out how he wanted.
“A lot of thought went into it. But I can assure you – once Paul made that decision, it was like the weight of the world had been lifted off his shoulders.”
“We had this amazing celebratory 10 days prior to his procedure. [Paul’s death] was a blessing. It was so empowering for him to have that opportunity to not only die with dignity but to dictate all the terms of his passing,” Brittain said.
For Rob Rollins, the chance to opt out of his suffering and dictate the terms of his impending death, “brought him so much peace”.
Rollins, 56, of Ontario, had fought throat cancer for 18 months – but after 40 radiation treatments, chemotherapy, and throat surgery had left him unable to eat or drink, he decided he was ready. Like Couvrette, he chose to die at home, on a date and time that suited him.
“We talked about it and for him, it was something that was very important – he wanted to be able to die on his terms, no hospitals, no comas, none of that type of stuff,” said his husband John MacTavish.
And, like Couvrette, Rollins’s spirits lifted once he decided to set the date and time of his death. He set a date three days ahead: January 6, 2017.
“Once that decision was made, and things put into place, those three days were the best days that Rob had had in years,” MacTavish said. “He had total control, he was able to not need as many pain meds … We just had three of the most incredible days that just brought everything together, all of our 28 years together, and it brought him so much peace.”
Rollins scheduled his death for 11.30am. MacTavish bundled his husband up in their wedding quilt and hugged him as the doctor administered the series of fatal injections.
“Four minutes later, it was over. I have witnessed [many] deaths – friends, people I worked with, loved ones – and this was the most beautiful experience of my life, in a way, to see how it is and how it should be,” MacTavish said.
“I think [assisted dying] is the most humane thing we can do as human beings for each other. I think everybody deserves the right. In any country … it’s the right thing to do for individuals who suffer and who just say ‘enough’.”
Source: Kapiti News
By: David Haxton
"It's not an easy read," David Barber warns.
"There are heart-breaking stories in this book which are written by friends and relatives who have watched their loved ones die horrible deaths."
Mr Barber, from Waikanae, along with retired intensive care specialist Dr Jack Havill, has compiled Dying Badly — New Zealand Stories.
The real-life stories are from a small number of the thousands of submissions to parliament's inquiry into the issue of assisted dying for the terminally ill.
He said the 93 page book, published by the End-of-Life Choice Society of New Zealand, illustrated the need for a compassionate change in the criminal law to allow medical assistance to die for those who choose to end their suffering safely and peacefully in a loving environment without risking a jail term for relatives and friends with them at the time.
"We want the law to change to allow people to die with dignity."
The stories were from a cross-section of society.
"They're heart-rending stories but they're stories that need to be told."
Mr Barber has a personal interest in voluntary euthanasia as he saw his wife Frances rapidly decline from Alzheimer’s disease.
"I knew Frances well and I know that she did not want to live in the condition and would have welcomed the ability to choose an end to her suffering had she retained her mental faculties," he earlier said before a health select committee inquiry into assisted dying.
He said the law change to allow voluntary euthanasia had to happen noting "every poll shows around 70 to 75 per cent of voters want a law change".
"It will happen — it's just a matter of when."
Moreover, as Dr Havill and Mr Barber said at the start of the book, "We are confident that in our time our compassionate society will demand that justice prevail and New Zealanders will acquire the ultimate human right of the 21st century — the right to die with dignity."
Copies of Dying Badly — New Zealand Stories are available from PaperPlus Coastlands, in Kapiti, or by going to either www.eolc.org.nz or yestodignity.org.nz
by Graham Adams / Noted /19 March, 2018
Questions linger over the motivation for setting up a sham traffic stop to identify Exit members and exactly how often similar breaches of the law occur.
The IPCA report into a bogus alcohol checkpointthat police used to identify attendees at a pro-euthanasia meeting was finally delivered last Thursday, well overdue and seriously underweight.
Although a brief eight pages, it took nearly 18 months before it was ready for public release after complaints had been laid in 2016, and eight months after the IPCA said the report’s release was imminent.
It offers startling insights into police practice, none of them heartening. Of course, its major finding — that the October 2016 vehicle checkpoint in Lower Hutt was illegal — could not have come as a surprise to anyone acquainted with the law. It was such a flagrant abuse of police powers granted under the Land Transport Act — which restricts checkpoints to matters of land transport enforcement such as testing alcohol levels and checking car registration — that the police took the unusual step of handing themselves into the Independent Police Conduct Authority for what was widely expected to be a public flogging.
As it turned out, the report is quite gentle with the police — as, indeed, is often the way with the IPCA. Nevertheless, despite the indulgent, softly, softly approach, it is thoroughly alarming.
First, neither the Detective Senior Sergeant nor Detective Inspector who ordered the checkpoint to identify the elderly attendees at the Exit meeting stopped to consider whether it was legal. They rang their superiors, the Acting District Commander and the Area Commander, to get approval for the checkpoint shortly before it was implemented. But both failed to warn it would be illegal under the Land Transport Act (and would also not be covered by general powers to prevent suicide as permitted by section 41 of the Crimes Act). No legal opinion was sought and they allowed it to proceed.
As the report notes: “The Acting District Commander and the Area Commander should have recognised that the proposed actions were unlawful and should have advised the officers.”
Just as worrying was the admission by the Detective Senior Sergeant that “police have used similar checkpoints in the past for intelligence purposes”. And the five officers who conducted the bogus alcohol traffic stop also said they assumed it was fine because checkpoints had been used for gathering intelligence before.
It seems extraordinary that all the police involved — including very senior officers — either didn’t understand that the checkpoint was illegal, or didn’t bother to consider its legality, or accepted that it was de facto police policy to use checkpoints primarily for intelligence-gathering.
The authority skirts around this last possibility by noting it “is not aware of any other instances where checkpoints have been established for purposes other than land transport enforcement and have not gathered any evidence which supports this assertion. In addition, there is no police policy which supports the [Detective Senior Sergeant’s] view [that they are used for intelligence].”
This is a long way from saying it hasn’t happened before or even that it is uncommon. As Otago University law professor Andrew Geddis told Noted: “Absence of evidence is not evidence of absence.”
Assistant Commissioner Bill Searle, on behalf of the police, accepted the IPCA’s findings, admitting in a statement that “establishing a vehicle checkpoint to identify meeting attendees was unlawful”. But he excused the officers’ behaviour because “our staff acted in order to protect life and did not intentionally break the law”.
This indicates the police hierarchy accepts that all the officers involved did not understand they were breaking the law, because if, in fact, they did know the checkpoint was illegal they must have been intentionally breaking it.
For the rest of us, not knowing the law is no excuse, but apparently, it serves as one for the police, even though they swear an oath to uphold it.
And in what way could they be acting to protect life when they admitted they had no concerns that any of the attendees at the Exit meeting were in imminent danger of committing suicide? Turning up announced at the homes of some 15 of them, and asking whether they had a secret stash of Nembutal and about their association with Exit is hardly going to be reassuring if any one of them had, in fact, been suicidal. There seems to have been no consideration given to just how frightened and threatened many of these mostly elderly people might — and did — feel at police appearing on their doorstep.
The report’s account of the police officers’ alarm about the attendees’ well-being thoroughly stretches credulity. The Detective Inspector described covertly monitoring the Exit meeting: “It wasn’t until we heard [them] conveying all these possibilities to commit suicide… that we were of the view that the risk level had raised considerably… There was a real possibility that [someone could commit suicide] within five to seven days once they had that information.” (The report notes: “No explanation was given for how these timings had been arrived at.”)
Yet, the officers clearly knew beforehand that they were monitoring a meeting of an organisation whose sole purpose is to provide information on how to end one’s life peacefully. In fact, the Detective Senior Sergeant and Detective Inspector told the Authority that they asked for a surveillance warrant for the Exit meeting because they “suspected that some of the conversations at the meeting would be about supplying and using pentobarbitone”.
How could they be surprised and alarmed when Exit members discussed exactly that?
The checkpoint was triggered by the investigation into the death of Annemarie Treadwell, a 77-year-old Wellington woman who died in June 2016 after taking pentobarbitone, aka Nembutal.
It led to Wellington Exit co-ordinator Susan Austen being charged with three counts of importing pentobarbitone as well as a charge of aiding Treadwell’s suicide.
Austen pleaded not guilty to all the charges, which were a result of a police operation that collected her emails and bugged her phone and her house — including recording the Exit meeting immediately before the checkpoint was set up to identify attendees.
The police claim the reason the checkpoint was set up and names taken was concern for the welfare and safety of the Exit members who attended that meeting and had nothing to do with the investigation into Treadwell’s death.
The authority noted it would be concerned if the subsequent welfare visits to the homes of the meeting attendees “had been utilised as a tactic to progress the police investigation into the activities of Ms Z [the woman they believed had counselled Treadwell before her death]”.
Yet, a Lower Hutt Exit member, who wasn’t named, commented to Stuff about the police visit to her home after she had been stopped at the checkpoint: “[The police] said they were investigating the activities of the leader of the [Exit] group. They did not explain further what they meant by this.”
Also, another of those visited, “Mr W”, told the IPCA he found the welfare visit “odd”, and stated: “I think they were there for other reasons than just about my state.”
In February, Austen was found guilty on two of the charges of importing pentobarbitone but acquitted on the much more serious charge of aiding a suicide, which carries a maximum sentence of 14 years’ imprisonment.
The jury apparently accepted the defence’s contention that simply possessing a lethal drug, whether it is intended to be used or not, could have a “profound palliative effect to reduce suffering” that may even extend life by reducing anxiety from anticipating an unpleasant death.
Furthermore, Treadwell was not only a member of Exit but also an activist for the euthanasia cause and had submitted an impassioned plea for a law change to the Health select committee looking into assisted dying. She also had written a note found after her death asserting that no one had coerced her or influenced her in any way to take her own life.
Exit International’s head, Dr Philip Nitschke, described Austen’s trial as a “show trial with one objective — to ‘send a message’ and frighten any elderly New Zealander tempted to put in place a personal, practical end-of-life plan”.
For the police to visit Exit members who attended a lunch devoted to discussing a perfectly legal act such as suicide smacks of overreach, if not a campaign of harassment or intimidation, especially as it was conducted during a time of heightened political sensitivity over euthanasia. At the time the checkpoint was conducted in 2016, the parliamentary select committee inquiry into New Zealanders’ attitudes to assisted dying was still under way.
Nitschke viewed it as a direct attempt to intimidate Exit members. And many people will not be convinced that concern for the Exit members’ welfare was the real reason for the checkpoint or the home visits. At Susan Austen’s trial, when the police said they had obtained the names of the Exit members to make sure they were okay, her supporters laughed.
Maryan Street, the president of the End-of-Life-Choice Society, which is agitating for a law change but is not associated with Exit, said last week of the IPCA report: “The finding confirmed that those stopped at the bogus checkpoint were targeted for their beliefs and lawful activism, not because of any threat to law and order or public safety.”
She asked the police to provide “assurances that [the] campaign for a law change will not be targeted with unwarranted surveillance and intervention”.
Inevitably, questions were raised about why the checkpoint was authorised in the first place. Wellington human rights lawyer Michael Bott said, after the checkpoint hit the news in 2016: “It appears to be some kind of moral crusade driven from someone on top to stop people going to a public meeting to learn about Exit and their goals.”
Others at the time queried whether it had been politically motivated by those opposed to a liberalisation of the law. Act MP David Seymour asked: “There is then the question of motive. Who was pushing for this surveillance, what was their motivation, and why were the Police Minister and Solicitor-General not aware of such a politically sensitive operation?”
A spokeswoman for Judith Collins, the then Police Minister, told media the case was an operational matter for police, and directed all questions to them.
When Noted asked Michael Bott last week whether he believed the checkpoint and intrusions into the lives of Exit members were politically motivated, he replied: “I do not think a particular party was involved. But that certain senior officers are prepared to condone the unlawful detention of New Zealanders who had attended an Exit meeting does show perhaps the strength of their collective personal view about the subject matter of the [Exit] meeting.”
Professor Andrew Geddis, while concerned by the police’s illegal behaviour, identifies a wider problem. He told Noted: “There is the bigger picture of the police intruding into the homes of elderly people — many of whom will never have come to police attention before — simply because they want to consider end-of-life options. Because our law treats all decisions to end your life for any reason as being a ‘suicide’, it authorises anybody (including the police) to intervene to try to stop this from occurring.
“I think this is wrong — the law ought to distinguish between ‘suicides’ and ‘assisted dying’, which is what David Seymour’s End of Life Choice Bill before Parliament does.”
It is richly — and sadly — ironic that the IPCA report should be made public at the same time a debate is raging over the police’s pursuit policy, sparked once again by eminently avoidable deaths. A few days before the report appeared, two young people died in a crash fleeing police south of Nelson, which also killed a 53-year-old woman in another car.
Police chases saw 10 deaths in 2017, and 22 people die since 2014, yet the police stoutly defend them as essential to maintaining law and order. “Protecting life” doesn’t seem to feature. Those who die are presumably collateral damage in an overriding goal of never letting even a minor offender evade the law.
Nevertheless, we are asked to believe that the police were so concerned about protecting the lives of elderly people who were educating themselves about how to end their lives peacefully at a time of their choosing that they had a squad of police officers urgently set up an illegal checkpoint to harvest their details and visit them at home to quiz them about their association with Exit.
The Privacy Commissioner, John Edwards, investigated the collection of personal information at the checkpoint, separately to the IPCA inquiry. His report, which was also made public last Thursday, noted: “Some complainants said the visits from police made them feel uncertain about their ability to speak freely and anxious that more visits would follow.”
He concluded: “Police approached them after unlawfully collecting their information, and questioned them about a socially and politically sensitive subject. It is fair to say that the actions by the police officers caused those complainants harm.”
The matter may not end here. After the IPCA report was published, Andrew Geddis tweetedabout what he would do if he had been subjected to an illegal checkpoint: “Well, if I were one of those stopped, I'd be getting my lawyer to ask the police how much they’re going to give me for breaching my [NZ Bill of Rights Act] rights ... and readying a class action if they aren't forthcoming.”
Thursday, 15 March 2018, 12:12 pm
Press Release: End of Life Choice Society
The End-of-Life Choice Society wants an apology from the police for an illegal roadside checkpoint and assurances that its campaign for a law change will not be targeted with unwarranted surveillance and intervention, its President Maryan Street said Thursday.
The Independent Police Conduct Authority found that police acted unlawfully when five officers mounted a roadside checkpoint in October 2016 stopping people who had attended a voluntary euthanasia meeting in a Lower Hutt house.
The finding confirmed that those stopped at the bogus checkpoint were targeted for their beliefs and lawful activism, not because of any threat to law and order or public safety, Maryan Street said.
Some members of EOLC - which is campaigning for a change in the law to allow medically assisted dying for the terminally ill and those suffering intolerably - attended the meeting and were asked to give personal details, including their addresses, when stopped.
They were later visited at their homes by police officers making so-called "welfare visits" who asked if they were considering suicide.
"None of the people visited were at imminent risk of suicide," Maryan Street said. "The police frightened and intimidated adults who were not committing any crime in the misguided belief that they were looking after their welfare."
The IPCA found that the checkpoints were unlawful but deemed the visits "appropriate" and consistent with the police's duty to protect life.
"That is illogical," said EOLC secretary Carole Sweney. "How can action carried out as a consequence of an unlawful act be appropriate?"
Maryan Street said the IPCA report added pressure to the need for a law change. "All those involved in the criminal justice system, including the police, are dealing with issues that are beyond the scope of current laws.
"Issues of end-of-life choice should be dealt with as part of the health system and in the frameworks of human rights and the Bill of Rights."
Note: The End-of-Life Choice Society is not associated with Exit International, which organised the Lower Hutt meeting, but some members belong to both organisations. EOLC complained to the IPCA on behalf of its members who were stopped at the road checkpoint and later visited by police at their homes.
by Ann David (Waikanae)
Gisborne Herald – Published: March 10, 2018 11:25AM
The New Zealand Medical Association (NZMA) has made its submission to the Justice Select Committee in a coruscating rant against assisted dying. Its arguments are remarkably similar to those of the Catholic church: potential coercion and doubts about mental competence to decide.
To assist it in coming to its 12-page conclusion, it “commissioned” Grant Gillett, Professor of Medical Ethics at Otago University, who has been implacably and vocally opposed to assisted dying since 1995, to advise it. The NZMA got what it chose to get: comfort to maintain its status quo.
The NZMA has its own internal code of ethics. In its Preliminary Statement it assures us: “This document does not purport to set out rigid, immutable rules . . . . The Code will be reviewed at regular intervals and, to this end, comment and feedback is invited.”
Feedback from whom? From Professor Gillett and its own Ethics Committee who devised the current Code of Ethics? Where is the progressiveness in that? Where is the reflection of society’s changing needs and values? Of doctors’ changing professional experiences and the corresponding changes in their own understandings and values? Where is the viewpoint of the NZMA’s customers as spoken for by its doctors who listen daily to requests for assisted dying, and to whom the doctor has no better response than some vague promise to “keep you comfortable”, knowing that this promise cannot always be kept?
Where is the balanced advice taken also from the many ethicists who have no moral objection whatsoever to assisted dying? What have professional ethics come to — captivated as they are by a minority club pushing a political barrow?
Are we really to believe that doctors, who currently make judgements about whether coercion and mental competency are present when patients request life support to be switched off or decide to discontinue life-prolonging treatment, are unable to make the same judgements about requests for assisted dying?
Are we to understand that doctors, who currently offer terminal sedation to patients they consider eligible for this life-ending process, are somehow unable to make an assessment of eligibility for assisted dying?
Terminal sedation is palliative care’s option of last resort. It involves discontinuation of all treatment, discontinuation of nutrition and hydration and administration only of sedatives that put the patient in a coma-like state, plus the administration of pain and symptom control medication. Most of us believe that the discontinuation of nutrition and especially hydration will result in a speedy death. Not so. It can take two or more weeks, and there’s nothing surer that starving and dehydrating a patient will cause death, unless the underlying disease or condition gets to them first — which it doesn’t always do, from my own personal experience.
The NZMA boasts 5000 members but about one third of these are probably medical students, so let’s say about 3300 practicing doctors are members. That means they represent 20 percent of the registered, practicing doctor population of 15,500. Does the NZMA feel obliged to do the thinking for their student members as “duty of care”, perhaps?
Their stance does nothing but widen the gap between some thinking doctors and their patients, about 75 percent of whom want assisted dying as an option.
The 15,500 registered, practicing doctors derive their licence from the NZ Medical Council. Without registration, a doctor cannot lawfully practice in New Zealand. This body is neutral on the subject of assisted dying. The NZMA has chosen to get political with it.
So having driven the wedge between doctors and their patients, it is now up to the NZMA to weave a pathway to reconciliation.
by Graham Adams / 09 March, 2018
Susan Austen speaks to media after being acquitted of charges she aided the suicide of Annemarie Treadwell. Photo / Katie Scotcher, RNZ
The country’s biggest medical college is neutral, Suzy Austen is cleared of assisting a suicide, and Bill English quits Parliament.
Submissions to the Justice select committee debating David Seymour’s End of Life Choice Bill closed on March 6 after it had passed its first reading in Parliament with a handsome majority. Seymour did a round of media interviews to spur people to submit, while admitting it was likely that most of the more than 14,000 submissions would be in opposition.
He also noted that is often the case with moral issues, whether it’s civil unions or legalising prostitution, but that politicians are looking for quality over quantity — well-argued submissions rather than rote statements of position.
The same day submissions closed, there was an announcement with great significance for the euthanasia debate but it failed to get attention. The Royal New Zealand College of General Practitioners — which has 4800 members, representing nearly 90 per cent of GPs — announced publicly in its submission that it had adopted a neutral position on assisted dying.
Unfortunately, you’d never guess from the headline on its press release — “College of GPs does not endorse euthanasia” — but when Noted asked the college it confirmed it was, indeed, neutral: “We are not taking a position either way. Our board decided it was a decision for members to make as individuals.”
The spokeswoman conceded that the headline could be misleading “if that’s all someone read. It could be [incorrectly] construed as us being against euthanasia.
The biggest medical college in New Zealand taking a neutral position in public is momentous. As Auckland health lawyer and end-of-life researcher Pam Oliver told Noted: “That’s a major move by the college and will have considerable influence. The research evidence is pretty clear that a neutral or supportive stance by the relevant medical association, or college, is pivotal in doctors feeling comfortable to engage in providing assisted dying services. Anecdotally, it also appears to have a strong influence on whether politicians will vote in favour of legal AD.”
The college offered a raft of recommendations to improve the End of Life Choice Bill (including raising the qualifying age to 25) but by adopting a neutral stance it lessens the likelihood that doctors will feel shunned or censured by their peers if they support the practice or engage in it once it is legal.
The New Zealand Medical Association also made a submission repeating its stand against assisted dying in any form, but its influence has been undermined by revelations that it represents only around 20 per cent of registered doctors. That means it covers possibly fewer than 3000 of the more than 14,000 in practice.
Another momentous development in the assisted dying campaign that flew mostly under the media radar was the significance of a not guilty verdict in the trial of Suzy Austen in the Wellington High Court. Austen faced a charge of aiding the suicide of Annemarie Treadwell — an elderly woman who had long expressed her wish to decide the time and manner of her death. The Crown alleged Austen imported pentobarbitone (aka Nembutal), then provided it to Mrs Treadwell, who used it to commit suicide.
The defence lawyer, Dr Donald Stevens, QC, argued that Austen did not give Treadwell pentobarbitone with the intention that she should take it, but rather: “[Her] intention was that Annemarie Treadwell should have the comfort of knowing that she had control over her end-of-life issues and would have that control because she had the means, if she chose to use them, of ending her life at some point in the future.”
Stevens called as his only witness Auckland University’s Professor Glynn Owens, an eminent psychologist who has conducted extensive research into dying.
Professor Owens’ statement, read out in court, said: “The option of having aid available in dying may… give a patient peace of mind and a sense of reassurance, which lessens anxiety and psychological suffering at the end of life. Reduction in anxiety also leads to a reduction in the pain experienced by the patient.”
“The prospect of a good death” seems to “confer psychological advantages”, including “more attention to spiritual considerations and focus on quality of life” — which, together with less anxiety, may have the effect of extending life.
“The reduction in stress may impact both directly and indirectly on the progress of the disease. The body’s physiological response to stress has, over the past decades, become remarkably well-understood. Fundamental to this is a disruption of the body’s normal ‘homeostatic’ processes, the ‘fine-tuning’ of the body which optimises our physical health. The benefits of stress reduction in cancer care are now widely recognised, to the extent that some specialist cancer hospitals now prescribe activities such as meditation as part of the treatment programme.”
Professor Owens’ statement also said that a patient who knew they had the ability to control the end of their lives could “choose not to die prematurely” and might choose not to use the medicine at all — with evidence from Oregon showing that only 64 per cent of patients supplied with life-ending drugs ended their lives by taking them.
In short, providing a lethal drug for an ill patient to hold as insurance against a bad death may be viewed as palliative therapy. And providing a drug for its palliative effects even if death may be reasonably foreseen as an unintended consequence sounds very much like the doctrine of double effect.
Under the doctrine, a doctor is ethically allowed to administer drugs needed for pain relief even if they understand they may hasten a patient’s death, provided the doctor’s intention is to relieve suffering. Intention, in such a scenario, is everything.
Matt Vickers has noted the similarity. His wife, Lecretia Seales, took a case to the High Court in 2015 to establish her right to die with the assistance of her GP, asking for a ruling that her GP would not be at risk of a criminal charge.
Vickers told Noted: “I watched the Susan Austen trial with interest. The key point for me was that a jury of Ms Austen’s peers found her not guilty of assisting suicide because her intent was to ease suffering. Interestingly, this is extremely similar to the argument doctors use under the doctrine of double-effect. Does the Austen trial mean a doctor could give life-ending medication to a patient under existing law if their intent is not for a patient to take it?"
Vickers added: “Ms Austen's trial has emphasised that there is an extremely grey area within the law around the Crimes Act and assistance. It’s the same grey area that inspired my wife to take the case that she did.
“The End of Life Choice Bill doesn’t clear up that grey area completely, but it does provide a regulated and monitored process that extremely ill New Zealanders can avail themselves of in a way that is safe for them, their doctor and their loved ones. I think that’s a vast improvement on the status quo, and will help us shine a light on end-of-life practices in New Zealand.”
Last but not least in the run of good news for those in favour of an assisted dying law, Bill English has left Parliament. A devout, practising Catholic, he has been a hugely influential opponent of legalising assisted dying for decades, determined not to allow a bill to progress, even to select committee. He voted against legalising assisted dying in 1995, 2003 and 2017 at the respective bills’ first reading.
In November 2016, the then prime minister, John Key, acknowledged that he was personally in favour of assisted dying — as was more than half his party — but some “very strongly religiously orientated” MPs were adamantly opposed. English determinedly led that group and his absence in Parliament will make the passage of legislation less contentious.
It’s true that the party’s new leader, Simon Bridges voted against the End of Life Choice Bill at its first reading and has cited “sanctity of life” as one reason for his opposition. But he has also said he initially considered voting for it to at least go to select committee to be debated. He also said he wouldn’t rule out changing his mind, even if that seemed unlikely. Bill English would never have publicly entertained that possibility.
With English gone, the door to change has opened wider.
And change is closer internationally. In November, Victoria became the first state in Australia to legalise assisted dying for the terminally ill while, on March 6, Hawai’i’s state House of Representatives voted 39 to 12 to allow assisted dying. The bill now goes to the Senate for consideration.
Significantly, the Hawaii Medical Association, which has historically fought against “death with dignity” laws, said last year it would adopt a neutral position and not oppose legislation. Its executive director, Dr Christopher Flanders, said: “Sometimes the writing’s on the wall, and we have to accept that.”
If the bill is passed into law, as expected, Hawai’i will become the eighth jurisdiction in the US to adopt such a law, alongside Oregon, Washington, Montana, Vermont, California, Colorado, and the District of Columbia.
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