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In a couple of weeks from now New Zealanders will vote in a referendum on the End of Life Choice Act. Both sides in this debate are motivated by compassion. Those in favour are motivated by compassion for those who are dying and are experiencing unreleivable and intense suffering. Those opposed are motivated by compassion for those who might be vulnerable to being coerced or misguided into agreeing to end their life prematurely.
Both sides also express fears. Those in favour fear unbearable suffering. They fear too that they might find themselves caught up on a relentless medical treatment treadmill. Those against fear that the legislation’s safeguards might prove ineffective, and vulnerable people will be murdered. They fear too that government and doctors will have a license to kill.
Of all these fears, the only one for which there is solid evidence is the first. While hospices and palliative care do invaluable work they have their limits. A report by Palliative Care Australia in 2018 stated that despite excellent care, a small but significant group of patients suffer unbearably as they die – somewhere between 2-5%. This is also borne out in other studies. As Drs Munglani and Bhaskar eminent UK consultants in pain medicine have said “some pain is unresponsive to the most powerful analgesics.”
Increasingly the medical profession and ethicists recognise that individuals are best placed to make decisions about their own care and treatment. There is also a strong religious ethical stream that would want to honour individuals’ consistent desire to remain in charge of their lives and dignity for as long as possible, and to take responsibility for their life.
Imago Dei asserts that human reasoning, autonomy, and responsibility are reflective of God. Theologies that somehow portray the sacredness of life as removed from the dignity and autonomy of every individual are flawed. The sanctity of life is not the sanctity of suffering, or disregarding steps to avoid it. As Rabbi Romain said, “it is a cruel God who uses human agony as a divine blackboard for relatives looking on.”
There will though always be concerns that a minority of individuals might not be mentally competent, or that they are being unduly pressured by family or other factors. This is the primary motivations of the majority of churches here and overseas who oppose assisted dying legislation, namely to protect those who are disabled, feeling coerced, suffering from depression, the chronically ill, or the confused.
And this is why rigorous, independent safeguards need to be in place. Please look at https://www.referendums.govt.nz/endoflife.../summary.htmlfor the criteria of who is eligible for assisted dying, and then at the safeguards proposed.
The experience of other countries is valuable for studying the consequences and unintended effects of assisted dying laws, now available in four European countries, Canada, Columbia, Victoria (Aus) from 2017, Oregon for the last 20 years, and other US states, making it available now to one in six Americans.
Despite stories to the contrary, consistent overseas data shows that voluntary assisted dying laws are safe and not a ‘slippery slope’ - the vulnerable are not targeted, suicide does not increase, and trust in doctors is not eroded. There are no studies which reveal coercion to be a problem.
The Hospice Association in Oregon opposed that state’s assisted dying legislation . In the years since it was enacted hospice though changed its mind. Its dire predictions had not been realised. Instead they had experienced a massive expansion of palliative care.
The Oregon legislation allows the patient, after meeting the set criteria, to be prescribed a pill. The patient must self-administer the pill. Their experience is that only 1 in 25 who made the formal request actually used the prescription. The presence of a pill in itself gave relief.
Although this self-administering would exclude some who would meet the criteria in the End of Life Choice Act, it does have the advantage of removing the doctor or nurse practitioner from the role of administering the lethal dose. One of my hesitations about our Act is the effect, conscious or subconscious, on the medical personnel involved.
My hope is that no one will ever need to call upon the provisions of this Act. Like most of us I hope, when my time comes, to die quickly and peacefully, preferably at home, preferably beside those who love me. But I’ve been a minister long enough to know that this ideal is not the reality for many. And there are a few in their terminal stages who experience prolonged and unrelievable pain. It is for them, despite the hesitations I still might feel, that I will vote in favour of this legislation.
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