Not a member? Join now »
Welcome to our news page. Please note: you must be a member and logged in to leave comments.
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on its website, is full of misleading statements – some ignorant, some dishonest and some merely reflecting an outdated ethical stance.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.
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.
Let’s now respond to the NZMA’s raft of so-called problems with the Act’s eligibility criteria:
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.
There is nothing new about the concept of a doctor helping somebody who is already dying hasten the end to spare further pain and suffering.
It is not some fanciful New Age idea, as some seem to think in the lead-up to this month’s referendum on the End of Life Choice Act.
Euthanasia (the word translates as “good death” in Greek) was practised in Ancient Greece and Rome, where writers and philosophers reported that good emperors prayed for a dignified and pain-free farewell.
After becoming in 1893 the first country to allow women to vote, New Zealand developed a trailblazing reputation for social reform, but has fallen behind in legalising medical assistance to die, which is seen by advocates as the last human right denied citizens – the right to die when and how one chooses.
Switzerland has allowed assisted dying (barring any selfish motive) since 1942. In 1997, the US state of Oregon introduced laws that have been copied elsewhere and the Netherlands followed suit in 2001 and Belgium followed a year later.
More than 200 million people in the Americas, Europe and Australia now live in jurisdictions that allow the terminally ill to get a doctor’s help to end their lives peacefully and painlessly, with strong safeguards to protect the vulnerable.
Doctors are understandably divided on the issue and it is known that many in New Zealand support assistance to die but will not say so publicly while it remains a crime subject to 14 years’ imprisonment. Despite this, two studies have shown that more than four per cent of doctors deliberately hasten death for some terminal situations.
Medical associations around the world are fundamentally conservative and remain formally opposed, even though, like in New Zealand, they have never surveyed their members - who are a minority of practising doctors anyway.
Although the Hippocratic oath is rarely cited today as students graduate from medical schools, opponents of assisted dying insist that it prevents a medic’s involvement. A Dutch historian who has studied the practice in Ancient Greece and Rome, Anton J L Van Hoof, refutes this.
He said in a paper published in Social Science and Medicine magazine in 2004 that in those days a doctor “shunned death as a failure of his art”. He added: “Sometimes a doctor was called in to assist in voluntary death, a role that was not forbidden by the Hippocratic Oath. An appeal to this oath by opponents of euthanasia in the modern sense of the word therefore is mistaken.
“Even if the Hippocratic Oath had some meaning as a professional ethical code, it should not be understood as dealing with assisted suicide, but with surreptitious murder by a doctor.”
Van Hoof insists: “There is ample positive proof that ancient doctors were ready to assist in suicide…the ancient physician had a position that radically differed from that of his modern colleague. In our medicalised world, the doctor is increasingly placed in the moral position that priests used to have.
“The ancient paradigm invites us to redefine the doctor’s role. Why should he be the arbiter of life and death, instead of limiting his role to that of an instrument of euthanasia like his ancient colleague?”
Van Hoof gives the example of the peaceful death of the Emperor Augustus, as reported by the Roman Empire historian Suetonius - “For almost always on hearing that anyone had died swiftly and painlessly, he prayed that he and his might have a like euthanasia, for that was the term he was wont to use.”
The Dutch historian comments: “Augustus preserves his bodily decorum. He is not left alone in his final moments, but friends and family surround him. He does not lose the grasp of his mind, apart from a minor slip. Augustus’ end is without much suffering, the euthanasia he had longed for.”
The result campaigners are fighting for in the October 17 referendum.
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.
In the run-up to the euthanasia referendum, conservative Christians are leading a campaign to sow doubt about passing an assisted dying law. Graham Adams finds it odd that they never mention religion.
With only weeks to go before advance voting begins for the election, a very expensive campaign is running across mainstream and social media — and on billboards along roadsides — to persuade voters to say no in the assisted dying referendum.
The group behind this last-gasp attempt to sway voters is the Safer Future Charitable Trust, which is registered as a third party promoter with the Electoral Commission for the referendum. Its “public information” arm, Votesafe.nz, has devised an online quiz that has been shared more than 100,000 times, it has put up 250 billboards nationwide, and it has paid for ads to appear alongside news articles in major publications.
All are designed to create doubt about whether the End of Life Choice Act is “safe” — and thereby persuade voters that it should be rejected at the referendum.
The amount of money needed to mount this blitzkrieg against the Act is impressive. Andrew Denton, the prominent broadcaster who founded the national organisation Go Gentle Australia to champion assisted dying laws, says the New Zealand campaign involves “serious resources”, and “far in excess of anything we’ve seen in Australia”.
But if the money being spent by opponents such as Votesafe surprises Denton, their tactics don’t.
“Go Gentle has remained in touch with our friends in New Zealand and have watched as the referendum draws closer,” he says. “From long experience with the deceptive tactics of our opponents, we have identified similar ruses being played out in New Zealand — which the New Zealand media has been slow, or unable, or unwilling, to expose.
“We have found that opposition to assisted dying laws can almost always be sheeted back to organisations with conservative Christian values who make deliberate efforts to conceal their true motivations.
“Their aim is to thwart the wishes of the overwhelming majority — upwards of 80 per cent in Australia and closer to 70 per cent in New Zealand — who want to see more compassionate end-of-life choices.”
It’s certainly true that Votesafe never offers religious reasons for its opposition. In fact, when I asked why it didn’t, a spokesperson replied: “We find it strange that you bring religion into a legal and medical argument.”
But what supporters of a law change find really strange, however, is that so many of those who lead the groups hostile to reform have conservative religious backgrounds but rarely declare that fact or mention religion at all.
Votesafe’s chair and campaign manager, Henoch Kloosterboer, for instance, has a Diploma in Biblical Studies, Theology, from New Zealand’s Laidlaw College, which says its students are “united by evangelical faith and a common commitment to working out the Gospel in twenty-first century Aotearoa”. Courses on offer include “God and Creation”
Votesafe’s trustees are Kloosterboer, Gael Goulter and Richard Martin. Last year, Goulter was one of three co-authors who submitted on behalf of the Maxim Institute to the parliamentary select committee considering the Abortion Legislation Bill 2019.
Maxim’s submission opposed abortion reform — just as it had opposed assisted dying in earlier submissions and same-sex marriage before that.
All this is hardly surprising, of course, given that the Maxim Institute belongs to the New Zealand Christian Network, which itself belongs to the World Evangelical Alliance (WEA). The WEA subscribes to “an orthodox biblical” position that includes a commitment to “sanctity of life”.
From 2018 – 2019 Kloosterboer worked as the creative director of DefendNZ, which is a campaign run by Voice for Life to prevent the End of Life Choice Act coming into force. On its website, Voice for Life bills itself as “New Zealand’s oldest and largest pro-life organisation” and boasts of a lineage that goes back 50 years to the formation of the Society for the Protection of the Unborn Child (SPUC) in 1970.
SPUC was, of course, closely allied to the Catholic Church in its campaign against abortion throughout the 1970s. As Te Ara Encyclopedia puts it: “The Catholic Church was SPUC’s most important source of members and money.”
Like the Catholic Church and many Pentecostal groups, Voice for Life is “dedicated to building a culture where human life is valued and respected from conception to natural death” and wants a New Zealand “where acts of abortion and euthanasia are unthinkable and unnecessary”.
In keeping with Voice for Life’s ultra-conservative stance, DefendNZ launched an extensive video campaign in March 2019 in opposition to the End of Life Choice Bill.
The Catholic Church has also endorsed Votesafe as a reliable source of information — including its online quiz, which has been widely criticised as slanted.
In a letter sent on August 10, Christchurch bishops firmly instructed congregations to vote “no” — and recommended Votesafe as well as four other organisations opposing the End of Life Choice Act: Family First, Risky Law, the Care Alliance and the Maxim Institute.
As with Votesafe, each of these groups opposing the End of Life Choice Act have strong links to conservative religion — but they are links that are rarely, if ever, mentioned in the media.
In fact, once you connect the links between the leaders of the organisations involved in the campaign to defeat the End of Life Choice Act, you end up with a wiring diagram that spans the religious right.
Risky Law, for example, was authorised by Vote No to the End of Life Act, which is registered as a promoter for the End of Life Choice Act referendum. The lobby group has been endorsed not only by the Christchurch Catholic bishops mentioned above, but it is also being recommended by the church’s bishops to the board members of Catholic schools as a guide to how “dangerous” they think the Act is.
The chairman of the lobby group is Dr Peter Thirkell. Dr Thirkell chaired the Wellington Ecumenical Chaplaincy Trust Board from 2004-2017 and is a former secretary of the Care Alliance.
The Care Alliance was set up in 2012 by National MP Maggie Barry and John Kleinsman, director of the Catholic bishops’ mouthpiece, the Nathaniel Centre, to agitate against MP Maryan Street’s assisted dying bill.
Unfortunately, as Denton noted, the reluctance by opponents to admit to any religious motivation for their campaign against the End of Life Choice Act is paralleled by the media’s apparent unwillingness to force them on the issue.
When Caralise Trayes promoted her book The Final Choice on various news media, interviewers managed to overlook her background as a member of the Ignite Faith Centre, a Pentecostal church in Arkles Bay, Whangaparaoa.
Having cast herself as a naive, wide-eyed journalist determined to discover the “truth” about assisted dying, Trayes certainly wasn’t going to draw attention to her faith herself.
When RNZ’s Colin Peacock asked whether deeply held religious convictions would mean a believer could never be “persuaded by any of the arguments” for a law change, Trayes replied: “Possibly, but I can’t speak on behalf or represent them in that capacity.”
For Trayes to pretend she can’t speak for those with conservative religious views when her own church promotes them was an astonishing evasion.
Despite Trayes’ professed neutrality, of the 21 people whose views she examined in her book, 17 were opposed to a law change.
In June, Richard McLeod, who heads Lawyers for Vulnerable New Zealanders, was interviewed by John Campbell on TVNZ’s Breakfast, alongside former palliative care doctor and assisted dying advocate Dr Libby Smales. No doubt aware of McLeod’s religious convictions, Campbell asked if McLeod had a “moral opposition to euthanasia per se” but he didn’t delve deeper into where that “moral opposition” might come from. When Campbell asked if any assisted dying law would ever satisfy him, McLeod fobbed him off.
In fact, McLeod told North & South magazine in 2017 that he is a member of Opus Dei (Latin for “Work of God”), the ultra-conservative Catholic organisation for lay people made infamous in Dan Brown’s The Da Vinci Code — and notorious for its practice of penitence, or what St Paul called “the crucifixion of the flesh”. For enthusiastic followers that can include wearing a spiked garter around their upper thigh, and using a cord to flagellate their back or buttocks.
Conservative Catholic teaching — as well as that of some Pentecostal and evangelical churches — makes it clear that both abortion and assisted dying are akin to murder. As the Christchurch bishops’ letter put it: “The Church is very clear that she respects life from conception to natural death.”
It’s worth noting that the Catholic Church’s position with regard to the sick and dying is not fully expressed by a simple reference to “the sanctity of life”. According to the Charter for Health Care Workers, released by the Vatican in English in 1995: Sickness and suffering afford “close union with the sufferings of Jesus”, which gives illness “an extraordinary spiritual fruitfulness”.
In February this year, McLeod was a guest speaker at a day-long workshop at Auckland University for ProLife NZ — a group of students dedicated to opposing any liberalisation of abortion or assisted dying laws. Its website opens with a photo of young people marching against abortion and holding a banner that reads: “Life begins at conception — no exception”.
The stated aim of the workshop was to train “pro-life activists” to “help defeat the End of Life Choice Bill at the coming referendum”.
Another guest speaker was Renee Joubert, Executive Officer of Euthanasia-Free NZ.
When I asked Joubert why her campaign against the End of Life Choice Act never mentioned religion, she replied: “We are a secular organisation with supporters across the political and religious spectrum. Some have religious affiliations and some don’t. In most cases we don’t know whether people have such affiliations or where they are on the political spectrum. Frankly, we don’t care.”
If the rank-and-file includes a range of beliefs, most of its leaders and founding members appear to be conservative Christians. In 2015 when Euthanasia-Free NZ was incorporated, its chairman was Richard Harward. He is a former Supreme Knight of the Knights of the Southern Cross New Zealand — which describes itself as: “A society of Catholic men in New Zealand actively involved in supporting the Church and each other through practical works, fraternity and promotion of the Gospel.”
Why the media fails to take an interest in the religious right’s influence on the assisted dying debate remains a mystery. Possibly, it is because New Zealanders are too polite to ask about someone’s religion, or perhaps it is because so many people know so little about religion that they don’t understand that fundamentalist and conservative Christians believe “Life is a gift from God that only He can interrupt.”
Another possible reason is that we don’t have a group as well organised as Go Gentle to confront the religious right. As Denton puts it: “A great deal of our work in Go Gentle has focussed on the necessary task of ‘bullshit busting’ — identifying and exposing the many deceptions and techniques used by opponents of assisted dying laws to sway public opinion.”
The churches, of course, realised a long time ago that religious arguments would cut no ice with a majority of New Zealanders. So the religious right now puts forward only “secular” arguments via ostensibly non-religious proxies, zeroing in on any parts of the legislation they can portray as weaknesses. Their aim, as Denton describes it, is to create fear, uncertainty and doubt.
The fact that David Seymour’s original bill was heavily amended to take account of critics’ objections — including restricting eligibility to the terminally ill with six months or less to live and making it explicit that mental illness, disability or advanced age alone cannot qualify anyone for an assisted death — appears to have made little difference to them. Nor the fact that a clear majority of MPs, 69-51, decided last November that the Act was safe to be presented to the public for ratification in a referendum.
The strategy adopted in this current saturation campaign by groups such as Votesafe is one that has been used widely overseas. They imply they are not opposed to euthanasia per se — “We’re just opposed to THIS bill.”
However, when Votesafe was challenged on Facebook to ask the lawyers who had critically analysed the End of Life Choice Act to “provide a draft of legislation that you believe would be safe”, it prevaricated.
As Denton puts it: “For religious conservatives, ‘Not This Bill’ means ‘Not Any Bill’.”
No one, of course, is arguing that followers of any religion should not have an unfettered right to express whatever view they like on assisted dying or any other topic. That is what freedom of religion means.
However, if they don’t reveal their loyalties and agendas when discussing assisted dying, it is impossible to know whether they are arguing in good faith — and whether any evidence would change their minds.
Certainly, someone who believes that your life belongs to God and only He can shorten it — or that suffering is a way of sharing in Christ’s sacrifice on the Cross — is never going to agree to any law allowing assisted dying, no matter how many safeguards are set up or how often inquiries from other jurisdictions show the practice is safe or free from abuse — as they overwhelmingly do.
Graham Adams is a journalist, columnist and reviewer who has written for many of the country’s media outlets including Metro, North & South, Noted, The Spinoff and Newsroom
Source: Southland Times
Euthanasia referendum: New Zealanders will vote on the End of Life Choice Act during the general election.
OPINION: What is the value of suffering and to whom is it of value?
What can you do when you have just had enough?
Who else’s business is this anyway?
These are the questions to be pondered in the upcoming referendum on euthanasia.
I am now 78. I graduated from Otago University in 1965 and have spent my working life in family medicine. I have attended well over a thousand births and many deaths as a family doctor.
In addition, I have been a DHB elected member in Nelson-Marlborough for 12 years and worked with councils and community and sporting organisations.
I have had simple heart surgery and have prostate cancer. Not surprising at all at my age.
Dr John Moore.
Death to me is expected and well prepared for – I have done my best in this regard. Life remains busy, active and lots of fun.
In our lives there is only one certainty. Life will end.
This fact is often not acknowledged in family conversations; indeed, the reverse is often the case and a culture of denial is fostered.
Death becomes a failure of treatment or somehow avoidable.
This unspeakability extends to the person doing the dying and often those giving professional advice. As a result, death becomes greatly feared instead of normalised.
The fear makes avoidance of the subject even worse.
Sadly, because of this, it is far from uncommon to find that families argue over treatment options for a parent who is unable to express their own wishes. Enduring emotional conflicts between siblings can result.
I guess I am just saying that we often do death badly in this country.
There can be poor communication, needless suffering and often much futile and expensive treatment. Families must be open to listening to personal wishes and expectations.
To live well and die well seems a reasonable aim for existence
In NZ now we have a facility called Advance Care Planning which is a tool for leading discussion and individual decisions around dying and very serious illness. We have excellent hospices and palliative care systems too.
What we lack is the ability to make our own choice about when we have just had enough and want to go.
We can be obstructed by others who believe that they know what is best for us.
(The law at present allows us to suicide alone and unassisted – anyone present is criminally liable – but not to die by choice with care, dignity and with those we love around us.)
I always come back to this point: who else should have the right to impose their beliefs on my decision?
The End of Life Choice Act gives you and me some choice in the matter. Though still quite constrained, it is a step towards personal choice.
Studies overseas consistently show that what most people want is the right to say enough. They want control.
Knowing that this right of control exists provides much comfort whether it is used or not.
Those who feel duty bound to endure and suffer to the very end already have that right.
My life is my story and I should be allowed to write it myself. The same goes for you.
Dr John Moore was the first GP in Te Anau, 1968-1976, a leading figure in the Save Manapouri campaign and one of the original Guardians of Lakes Manapouri, Monowai and Te Anau. He now lives in Nelson.
Rowan Stephens is a retired GP. She practiced in the UK and NZ for 26 years.
I am a retired GP, I will be voting a resounding YES in the EOLC Act Referendum.
Over a lifetime of practice, I have seen many patients die. I am haunted by the knowledge that I have abrogated my responsibility to a small number of my patients.
I was prevented by law from fully easing their requests to end their unbearable suffering,
‘Be there at the end and help me die.’
‘Please give me some dignity in death’.
‘Put me out of my misery, you wouldn’t let your pet suffer like this’
I failed in my duty of care because of the existing law. People who trusted me and looked to me for help, for skill and compassion at the end of their lives, looked in vain. I was prevented from giving them what they needed and begged for, compassion, choice, the certainty that their inevitable death could be peaceful and dignified.
‘Primum non nocere’ encourages us to consider the consequences, the possible harm, of what we do and what we do not do, every intervention or omission and how they may cause harm, especially in the complex circumstances that often surround dying. Failing to provide assisted dying to those who request it and who meet the strict legal and medical criteria of this Act, does significant harm.
I trust my fellow colleagues to implement this law to the best of their ability, the EOLC Act will be a safe move towards better deaths.
International and New Zealand evidence
The latest and largest international review concluded from 20 years of data that that assisted dying is safe.1 Data demonstrate that no ‘vulnerable’ groups are overrepresented in those who access assisted dying in Oregon and the Netherlands,2 or Belgium.3 Oregon’s Act, which the EOLC Act is based on (plus adopting several safeguards from the Victorian legislation), has remained a strict piece of law.
Australian data tells us that 2-5% people, suffer unbearably as they die, in spite of excellent Hospice/Palliative Care (H/PC).4 This translates to at least 225-250 Kiwis, every year. Additionally, the Coroner’s office attributes 52 deaths/year, about one death per week to terminally ill, mentally competent Kiwis, ending their lives to end their suffering.5, 6 They have no kinder alternative. They deserve legal autonomy, to have choice about how, when, where and with whom.
Out of compassion for this suffering, research shows that doctors are already carrying out assisted dying. Over 5% of NZ GPs who responded to an international standardised survey admit they are intentionally hastening death regardless of the legality, and not always with patients’ consent.7, 8 It is safer for us and our patients to bring the practice of hastening death out into the open so doctors who are willing to participate can be protected under strict regulations and patients can give informed consent.
Research shows 45% of GPs and 37% of doctors support choice for the terminally ill.9 This number will grow with legalisation as we feel more comfortable discussing what has felt like a taboo topic within medicine for too long.
The gift of comfort
Dr. David Grube, from Oregon, is a deeply compassionate GP and H/PC Physician with 22 years of experience of working with Physician Assisted Dying. Dr Grube recognises the comfort patients and families feel when they are able to discuss such choices, palliation in itself. He describes the “gift’ of a good death for patients and their loved ones and describes this process as an intrinsic part of end of life care. In Oregon almost 90% of patients who access their law, are already receiving H/PC and are estimated to only shorten their lives by 10 days, not long in the context of a whole life, but an eternity if you are suffering unbearably. Of those who qualify, about one quarter, do not need to use it, they talk movingly of the relief of knowing that they can.
A ‘yes’ vote is the compassionate choice
When my patients were dying, I wanted to be able to care for them in the way they choose. Dying patients deserve the benefit of our skill and experience in providing expert symptom control, emotional support for the patient and their family, and much needed reassurance through the challenges of a terminal illness, with the input of hospice as required. We know that our patients ought to have autonomy and choice over their lives. To emphasise patient self-determination and patient-centreredness and then refuse to honour it is inconsistent.
Voting yes in the referendum will give Kiwis of sound mind, over 18, dying, with less than 6 months to live and irremediable suffering, the choice I have been unable to give some of my patients, the hope that they may die in peace and dignity. Voting yes is my way of facilitating the gift of a Good Death to patients who need it.
1.Emanuel EJ, Onwuteaka-Philipsen BD, Urwin JW, et al. Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. Journal of the American Medical Association. 2016;316(1):79-90.
2.Battin MP, van der Heide A, Ganzini L, et al. Legal physician‐assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in “vulnerable” groups. Journal of Medical Ethics. 2007;33(10):591-7.
3.Chambaere K, Bilsen J, Cohen J, et al. Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey. Canadian Medical Association Journal. 2010;182(9):895.
4.Australian Palliative Care Outcomes Collaboration. Patient outcomes in Palliative Care National report July to December 2019. https://documents.uow.edu.au/content/groups/public/@web/@chsd/@pcoc/documents/doc/uow264401.pdf; 2020.
5.Weaver JC. Sorrows of a Century Interpreting Suicide in New Zealand, 1900-2000. Wellington: Bridget Williams Books; 2014.
6.Cheung G, Douwes G, Sundram F. Late-life suicide in terminal cancer: A rational act or underdiagnosed depression? Journal of Pain and Symptom Management. 2017;54(6):835-42.
7.Malpas PJ, Mitchell K, Koschwanez H. End-of-life medical decision making in general practice in New Zealand-13 years on. The New Zealand medical journal. 2015;128(1418):27.
8.Mitchell K, Owens RG. End of life decision-making by New Zealand general practitioners: A national survey. The New Zealand medical journal. 2004;117(1196):U934.
9.Young J, Egan R, Walker S, et al. The euthanasia debate: Synthesising the evidence on New Zealander's attitudes. Kōtuitui: New Zealand Journal of Social Sciences Online. 2019;14(1):1-21.
During his 36 years as a Presbyterian minister, Craig Kilgour spent many days dealing with death, dying and funerals.
He has witnessed what he believes was unnecessary suffering. He has also seen a loved one permitted to “die with dignity” surrounded by family, through assisted dying, when they decided it was time to go.
Read more »
"It's not good news, Stu."
Those were the words Stuart Armstrong's GP, a long-time friend who had delivered his daughter, spoke through tears in May 2014 as she confirmed the worst - his illness was incurable.
Source: NZ Herald
Last year, after more than two years of scrutiny, the End of Life Choice Act was passed into law. By the third reading, our elected lawmakers were confident the final wording was safe, humane, and well-drafted. With National's recent leadership changes, all of our party leaders from the last Parliament now support this Act.
As a result, New Zealanders should feel very confident voting Yes at the referendum. And yet, it has been frustrating to see attempts to chip away at that confidence through fear, uncertainty and doubt.
Australian journalist Andrew Denton wrote about attending an international conference hosted by HOPE, an anti-assisted dying organisation. He listened to former legislator Nancy Elliott spell out the tactics that had worked for her in the United States. "
When you have lots of arguments," she said, "if one argument gets blown out of the water, you still have more, and each argument will reach somebody else." Nancy enthused: "Right now the disability argument is really kicking it. It's very powerful. Will it always be powerful? We don't know. Two, three, four years from now that may have holes kicked in it, just for different reasons, so we have to be flexible."
She also cited elder abuse and suicide contagion as possible arguments, and went on to say: "You only have to convince legislators that they don't want this bill. You don't have to win their hearts and minds; all you have to do is get them to say, Not this and then you have got your win."
Opponents of the End of Life Choice Bill tried to use these tactics on our politicians in New Zealand. They claimed the Bill would be a slippery slope, invite elder abuse and devalue the lives of the disabled. But our politicians looked past these speculations to the evidence — 20 years of history in some countries — and to the wording of the bill. MPs were satisfied that the evidence, reasserted in Seales v Attorney General, showed:
The majority who access these laws overseas are dying of cancer, and in the last weeks, even days of their lives; the groups most in need of protection from abuse under these laws — the elderly and the disabled — have faced no increased risk overseas; and these laws have not adversely affected the relationship between patients and doctors, in fact, the opposite; there is a powerful palliative effect in simply giving people the means of ending the horror. Some sense of control, even if they choose not to use it.
None of these facts have changed. But now, we're seeing opponents attempt to use fear, uncertainty and doubt on the New Zealand public in the lead-up to the referendum. Whether it's the self-published "journalist", who claims to be objective but structured a book primarily made up of opponents to Lecretia's court case in order to advance her arguments, who claimed to interview Lecretia's mother, but never did, and has appeared to have duped naive journalists that she provides an objective voice.
Whether it's Votesafe, who cherry-pick details of the bill and present them in the worst possible light to scare voters. Or whether it's the often-church-backed doctors and lawyers who falsely claim to speak for all in their profession, but use their platform to advance an agenda to deny their patient's rights to make informed decisions for themselves.
Voters need unbiased information, and deserve to know the agenda of the people who are seeking to provide information on either side of the debate.
We provide information to the public through our Yes for Compassion campaign, but we're not shy about our agenda or who we are. We're ordinary New Zealanders who have lost family and friends to terminal illness, or who are terminally ill ourselves, who can see how this law would be a comfort. We want New Zealanders to vote Yes.
If anyone took the time to compare Yes for Compassion's campaign with the information on the government's referendum website, they'd find it's basically the same information. There's a reason for that. We don't need to deviate from the truth.
The bill provides a way for terminally ill people, in the last days of their lives, to foreshorten their suffering should they need it, and should they choose to. That's all it does. I hope you never find yourself in that situation. But if you do, I hope you have the choices that my wife was denied. Please vote Yes in October.
Matt Vickers is the former husband of Lecretia Seales and a spokesman for Yes for Compassion.
This story discusses assisted dying and suicide, and could be distressing for some readers.
A woman whose terminally-ill husband chose suicide over a prolonged painful death is urging New Zealanders to allow people the option to die with dignity.
The public will be asked to vote yes or no to the End of Life Choice Act 2019, at this year's 17 October referendum on the day of the national election.
*See all RNZ coverage of the Euthanasia Referendum 2020
The act would allow terminally ill people who are given six months or less to live and who are experiencing unbearable suffering the option of medically assisted dying.
Richard, Heather Gregory's husband of 30 years and father to their five children, was diagnosed with carcinoid cancer at 58 years old.
He had lived with the slow-growing cancer for years, but in 2014 his health rapidly declined.
"The tumour exudes hormones, and it damaged his heart. He wasn't getting enough oxygen, his body was breaking down," Heather said.
Heather Gregory, with a wedding photo showing her late husband Richard. Photo: RNZ/ Anusha Bradley
"When it happened, it was very sudden and very severe."
She said Richard was thin and she had to dress his weeping leg wounds in adult nappies every day. He had a bed sore on his back, and his personality had changed.
"He felt he was losing control. The day he died, he had a nap in the sun and when he went to push himself up, he couldn't, he wasn't strong enough."
On that August night in 2014, Heather went off to her quiz night in her home town of Hastings.
But she had bad feeling she couldn't shake. She contacted her daughter at 8.30pm, and that's when she heard the news.
Heather Gregory with her family before the death of husband Richard. Photo: RNZ
Richard had taken his own life.
The fallout from Richard's suicide was distressing. Two of their adult children were left traumatised after finding him, and the three who weren't there felt displaced, Heather said.
"It was a devastating end to a very good life, and it could have been so much better."
She said she had not prepared for it. It was not the ending she and their five children had hoped for.
"We got the double whammy - the long ending and then the sudden death. I thought we would be sitting around a bed talking about things."
Richard's suffering was unbearable and there was little that could truly relieve it, Heather said.
Had euthanasia been an option, he would have taken it, she said.
"If this had been in place it would have changed the whole dynamics of the whole situation leading up to it, and the final moments, and the time afterwards."
"There's nothing like a plan, is there, to put yourself at ease."
The public has a very medically assisted life, and that should be extended to a medically assisted death, she said.
"It's not going to cause extra people to die, these people are dying anyway. But the manner of their death will be so much more supportive, compassionate and kind."
Heather Gregory wants voters to take the End of Life referendum choice seriously this election. Photo: RNZ
Heather hopes the law will be passed.
"I don't want anyone to have to go through what Richard went through."
RNZ will continue its coverage of the End of Life Choice Act leading up to the new referendum date - 17 October.
Back to the top
© End-Of-Life Choice • PO Box 321, Gisborne 4040 • Email: email@example.com