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End of Life stance disqualifies the NZMA – doesn’t it? – when Govt seeks medical advice on regulations under new law

12 Oct 2020 1:06 PM | Philip Patston (Administrator)

This post was written by Dr Jack Havill, a retired intensive care medical specialist, and David Barber, Media Adviser to the End-of-Life Choice Society.


The New Zealand Medical Association’s position paper “End of Life Choice Act Referendum – what New Zealanders need to think about”, published on its website, is full of misleading statements – some ignorant, some dishonest and some merely reflecting an outdated ethical stance. It also demonstrates considerable confusion about the Act.

Furthermore, the association cannot claim to speak for the medical profession – its members represent less than 20% of doctors in New Zealand.   The NZMA also has no right to claim that its opposition to the End of Life Choice Act “represents the views of a strong majority of our membership”.  It has never surveyed its reputed 5000 members (who include medical students granted free membership) – it has merely called for anecdotal responses to its stance.

The NZMA’s stance is unfortunate, because when the Act is passed, it will have disqualified itself from giving leadership and advice to the government departments charged with drawing up regulations for operation of the new law during the statutory 12-month establishment period. There can be  no other option when the NZMA persists in claiming that assisted dying is unethical and insists it will not participate.

This contradicts the wishes of more than 60% of voters, according to the latest opinion poll.

Terminology

We question the terminology in the NZMA’s document. It uses the terms “euthanasia” and “doctor assisted suicide” when neither of these are written in the Act.  This is a common ploy of opponents of assisted dying (AD).

Euthanasia may be voluntary or involuntary. At the very least, therefore, the NZMA could use the term “voluntary euthanasia”.

The use of the word “suicide” is simply fear-mongering. Assisted dying is not the same as suicide. People who are terminally ill do not want to die – they are already coming to the end of their life.  They simply want to have a say on the issue of how and when they die. AD occurs after extensive consultation with medical practitioners and is more akin to a medical procedure to relieve suffering.

Internationally, in jurisdictions where more than 200 million people can choose assisted dying, nowhere has the incidence of suicide increased.  It is more likely that terminally ill patients commit suicide in the absence of legalised AD.

Eligibility criteria

Let’s now respond to the NZMA’s raft of so-called problems with the Act’s eligibility criteria:

  • “Difficulty in predicting time of death” – When a patient is approaching death with unbearable suffering and in an advanced state of decline, any doctor can easily make the judgement required under the Act. Most times, AD takes place only a few weeks before death is obviously going to occur.
  • “The problem of doctors who have had no previous contact with the patient” – The  doctor always has to access opinions of previous carers, doctors and specialists involved in diagnosis and treatment.
  • “Measurement of unbearable suffering” – Only the patient can decide whether they have unbearable suffering, although carers will have a very good idea when that is present. Suffering may be physical, psychological, or existential but physical signs will usually be present and none are relevant unless the patient is terminally and approaching death.
  • “If a patient declines treatment – does that alter the situation?” – This is a regular occurrence in medicine and there’s no reason why it should have any bearing on eligibility for AD. The patient can also decline palliative care.
  • “The interpretation of likely to die” – Simple criteria over six months. As the patient approaches death and is in an “advanced state of decline” this becomes clear to the patient and relatives, let alone professionals.
  • “Does a steady state such as a quadriplegic make one eligible?” – If patients are not terminal, they are clearly not eligible.
  • “It is unclear whether unbearable suffering could include depression” – It would be unusual for someone suffering unbearably not to have some depression but if they are not terminally ill they will not be eligible, and they have to be able to reason properly.

The NZMA’s comment that the “criteria may change down the track” is facile. Of course the law may change down the track – either to be more restrictive or to allow more access to AD. This is part of our parliamentary democracy and the Act requires regular reviews of the law’s operation.

The coercion canard

The NZMA paper talks of vulnerability and coercion. Overseas experience shows that those who access AD are less vulnerable than others in society. They tend to be younger, wealthier, more educated, married and not in residential care. While elder abuse is common in general society, no study shows significant coercion among those asking for AD.

The NZMA regrets the lack of a stand-down period in the law.  In most cases, there will be a lengthy period – perhaps months – while the patient discusses the issues with their doctor and relatives before they sign a request. Then, a second doctor is brought in, followed by at least another 48 hours while the registrar assesses the documents and a time is set for the actual AD process. Even at this stage, the patient can defer it for another six month before restarting the processes.

Finally, two surveys, previously reported in the New Zealand Medical Journal, have shown far more support from doctors for AD than the NZMA suggests.

A survey of Waikato General Practitioners in 2015 showed doctors almost equally divided on the issue – 47.1% would fully support or probably support AD while 47.3% opposed.

In 2018, a Horizon Research survey commissioned by NZ Doctor found 37% supported AD, 11% were uncommitted and 52% were opposed. It is common knowledge in the profession that doctors are reluctant to make their views known while assisted dying remains a crime but the numbers indicate that there will be no difficulty in getting enough to cooperate when the Act comes into force.

We note that the NZMA descended from the British Medical Association, which also opposes AD. But on October 8, the BMA reported the results of its biggest-ever survey of members’ opinions on the issue, showing a majority want it to drop its opposition.

It also showed 50% of doctor members’ support a law change to allow AD, with 39% against and 11% undecided.

© End-Of-Life Choice • PO Box 321, Gisborne 4040 • Email: office@eolc.org.nz




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