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This is the first of a number of posts we'll be sharing this year to dispel myths about the End of Life Choice Act and giving you facts you can share with others.
Let’s look at the false negatives put forward by the opposition, starting in this post with the concept of 'vulnerable’ and who our opponents consider vulnerable. These include:
This list shows that our opponents want EVERYONE excluded. In other words - no medically assisted dying for anyone.
One last thought – at the moment terminally ill people are having treatment decisions, such as terminal sedation, made for them by family members and doctors, without any safeguards being considered.
SPREAD THE WORD – and encourage others to visit our website www.eolc.org.nz.
A new study has dispelled concerns people who choose euthanasia are driven by social or economic vulnerability, researchers say.
The average age of people who received euthanasia in Ontario was 74.4, versus 77 for all people who died in the province during the study period.
The research, published in the Canadian Medical Association Journal, found those who accessed euthanasia tended to be younger, wealthier, more likely to be married and far less likely to live in an institution than members of the general public who died during the study period.
Of the 2241 people who chose to die with medical assistance in the Canadian province of Ontario between June 2016 and October 2018, 74 per cent were receiving palliative care from a physician or nurse, according to the study.
This suggested a request for euthanasia was unlikely to be driven by social or economic vulnerability, the researchers said.
New Zealanders will vote in a referendum later this year on whether the End of Life Choice Act should come into force. The Act, put forward by Act MP David Seymour, passed its third reading last November and would give people with a terminal illness the option to access assisted dying subject to certain conditions.
Supporters say people experiencing harrowing pain should have the choice to end their life with dignity, while opponents, including many in the palliative care sector, have argued opening the door to euthanasia could result in the vulnerable, aged and disabled being coerced or feeling pressure to end their lives.
A spokeswoman for Seymour said the Canadian study showed palliative care provision and assisted dying could work together, and the evidence should allay fears vulnerable groups would be at heightened risk.
ACT MP David Seymour has championed the End of Life Choice Bill.
"People who use assisted dying laws are overwhelmingly those who have had choice over their lives, and are now suffering from a terminal illness and seeking choice in how they die."
Nurse Maude Christchurch hospice palliative care service manager Jane Rollings said she strongly opposed the End of Life Choice Act "because I do not wish killing to be legalised in New Zealand".
In her 18 years caring for people with life limiting illness, Rollings could only recall a handful of patients who expressed a desire for euthanasia. "Of these patients, what really drove the desire was fear."
"The acknowledgement of these fears, the acknowledgement of the value and worth of these amazingly brave people's lives and their contribution to society and the gentle guidance through their fears of what might happen to their dying body, alleviated any such desire for intentional death."
There was inequity of access to good palliative care in New Zealand, she said, and there needed to be sufficient funding so it could be provided to everyone who needed it
Medically assisted dying was legalised in Canada in June 2016. As of October, 2018, 6749 Canadians had accessed euthanasia.
For the study, researchers analysed clinical and socioeconomic data from 2241 people in Ontario who received euthanasia and data from all 186,814 people who died during the study period.
Of the people who accessed medically assisted dying, the average age was 74.4 versus 77 in the general population and they were more likely to live in a higher income neighbourhood. Almost two thirds of patients had cancer, 12 per cent had a neurodegenerative disease, 8.5 per cent had cardiovascular disease and 7.5 per cent had respiratory disease.
The researchers said people who chose euthanasia reported physical or psychological suffering as the primary reason, despite three-quarters of patients receiving palliative care. This suggested for many patients requests for euthanasia were not because of poor access to palliative care, they found.
Dr Phil Bagshaw, founder of the Canterbury Charity Hospital but speaking in a personal capacity, said he was not aware of the quality of palliative care or access in Canada but cautioned against drawing any comparisons with New Zealand.
Bagshaw opposed the End of Life of Act. "It's a basic tenant of medicine that doctors are there not to terminate life, but to alleviate distress and cure where they can," he said.
"I think that euthanasia is a mistake, and easy access to good palliative care is the way to go, it's as simple as that."
* An earlier version of this story incorrectly stated this year's referendum question would ask whether euthanasia should be legal in principle. The referendum will ask if the End of Life Choice Act should come into force.
Source: Sydney Morning Herald
It was just after 2pm on October 31 when oncologist Cameron McLaren arrived at Phil Ferrarotto's house on the outskirts of Melbourne to help him die.
Dr McLaren had never administered a fatal drug to a terminally ill patient before. He was struck by the magnitude of what he was about to do.
Oncologist Cameron McLaren CREDIT: JUSTIN MCMANUS
“I had no idea if I was going to be OK with it even up to the point where I put the needle to his arm,” Dr McLaren said. “But there was no question that this was the right thing to do for Phil. It was what he wanted. It was kindness and it was a mercy.”
Phil hadn’t eaten for days. No longer able to digest his medication, the 70-year-old was hooked up to an intravenous morphine drip and sustained by spoonfuls of cola-flavoured ice.
He lay in bed with his daughter Katie and wife Dorrie curled up on either side of him. They cuddled his frail body and watched his chest rise and fall with each painful breath.
His son Glen and son-in-law Ryan came into the room with three glasses of aged Glenfiddich whisky; one for each of them and one for Phil.
They toasted Phil as Dr McLaren gently swabbed the father-of-two’s arm with medicinal alcohol.
Phil Ferrarotto died using assisted dying laws this year.
Dr McLaren found a vein and inserted a cannula. He used the thin tube to inject a sedative medication, before administering an anaesthetic and a muscle relaxant.
Phil began to drift off within minutes of the drugs flowing into his bloodstream. The circle of his family closed in around him. They held his hands and told him how much he was loved. “Be happy,” Phil said, before he took two final, deep breaths.
Dr McLaren has helped two dozen terminally ill Victorians apply for permits to end their lives since the state’s voluntary assisted dying laws came into effect on June 19. Eleven of them have since died using the legislation.
All the patients Dr McLaren has assessed so far were in intolerable pain and often bedridden.
“The number one reason people are doing this tends to be more the existential suffering,” Dr McLaren says. “It is the loss of joy, the fear of losing dignity and the fear of losing autonomy and of being a burden to family.”
Cancer-stricken patients surrender their bodies to years of treatment they know will cause them pain and discomfort, Dr McLaren said. He wants to give people control at the end of their life.
“It is one last decision about their body which is entirely theirs,” he said. “This is something we do for animals and when they get too old and they are suffering greatly. We put them out of their misery and we call it humane. Why shouldn’t we afford humans the same humanity?”
When Dr McLaren first met Phil he was sitting in an armchair in his living room hooked up to an oxygen concentrator. The cancer had spread from his bladder to his lungs and had riddled his bones. Then it invaded his liver, causing his belly to swell and fill with fluid. Opioids prescribed to Phil did little to dull his pain. Each breath was agony.
This kind, strong-willed, clever, retired general manager, who had battled four different kinds of cancers over the past 18 years, was frank and direct.
He told Dr McLaren he wanted to end his own life.
Dr McLaren carefully assessed Phil. He ticked off all the strict criteria; over the age of 18, of sound mind, an Australian citizen with less than six months to live. He referred Phil on to a second doctor who also deemed Phil eligible for the scheme.
Before his application was approved an email from Phil arrived in Dr McLaren’s inbox: "This gives me no pleasure in begging you to end my life, but I have no one else to turn to. I’m struggling with every breath I take and I can’t do it anymore.”
A permit for a doctor-administered death was approved the same day by the Voluntary Assisted Dying Board with Dr McLaren agreeing to administer the fatal dose.
For days after Phil died, Dr McLaren was waiting for the “hammer’s fall”.
"I was really concerned about the fallout for me, personally and emotionally,” he said. “I was concerned about being recognised as ‘that’ doctor and the impact it might have on my family and my work.
“I didn’t question what I did, because in Phil’s case, he was in the last days of his life and he was going to die within 48 to 72 hours. I was able to provide him a death that in his mind was dignified. It didn’t cost him anything. It cost him his suffering.”
The fallout never came.
“It was a lonely experience because there’s no literature review you can read on it,” he said. “It still does feel lonely because there's not a lot of us doing it.”
The night Phil died, Dr McLaren picked up his two year-old daughter when he got home and held her in his arms. His love for his child overwhelmed him and he pressed his face against hers.
“As I was holding her I thought of Phil being surrounded by his family as he took his final breath,” he said.
"Nothing that we could have done would have avoided his death, but we were able to make sure Phil died at home in the arms of the people who loved him most. I thought, yeah, that would be a nice way to go.”
Before he died, Phil wrote a letter to Dr McLaren thanking him for what he was doing:
Source: Horizon Poll
4 January 2020
Currently 70% of New Zealanders think they will cast a referendum vote in favour of the End of Life Choice Actl becoming law.
30% will vote No to the actl becoming law, according to the first nationwide poll of eligible voters on referendum voting intentions, since the bill passed in Parliament.
The survey was conducted independently and in the public interest by Horizon Research.
The act would make it legal for people to request assisted dying, or euthanasia, from doctors, and legal for health practitioners to help people die under certain conditions.
The result of the referendum, being held in conjunction with the 2020 general election, will be binding.
The survey of 1,521 adults was conducted between November 17 and 28. Results were weighted to represent the 2018 census adult population. At a 95% confidence level, the maximum margin of error is +/- 2.5%.
The survey shows support for end of life choice has largely held at levels measured before the bill was passed. It was last measured by Horizon at 74% in April. The removal of “not sure” and “don't know” answer options has consolidated opposition, up from 18% in April 2019 to 30% now.
While concern has been expressed about the law potentially exposing some elderly to risk, 72% of those aged 65 to 74 and 61% of those aged 75+ say they intend to vote Yes to enact the act. Among those aged 75+ opposition is highest of any age group at 39%.
By age, the Yes vote peaks at nearly 78% among 45-54-year-olds.
By party vote at the 2017 general election, support is highest among ACT voters (93% yes, 7% No). Results for other parties' voters are: Green 78% Yes/ 23% No, Labour 75% Yes/ 25% No, National 67% Yes/ 33% No and NZ First 68% Yes/ 32% No.
The results are weighted by age, gender, employment status, educational qualifications, personal income and regional to ensure a representative sample of the adult population at the most recent census. At a 95% confidence level, the maximum margin of error is +/- 2.7%.
The enduring majority for end of life choice:
This review of seven years of Horizon polling results shows the enduring majority medically assisted dying has had in New Zealand. It also links to a report showing Horizon's results have been consistent with those of other research firms.
For further information, please contact
Graeme Colman, Principal, Horizon Research Limited, e-mail firstname.lastname@example.org, telephone +64 21 848 576.
Respondents were told:
At the 2020 General Election you will also get to vote on whether the End of Life Choice Act should become law.
The Act would make it legal for people to request assisted dying, or euthanasia, from doctors, and legal for health practitioners to help people die under certain conditions.
It won't become law unless a majority vote yes in next year's binding referendum.
Who can ask?
An option to ask for assisted dying would mainly be open to those who have been diagnosed as terminally ill and with less than six months left to live.
How would assisted dying actually work?
Patients must request it themselves and go through a series of checks with two doctors, including one appointed through the Ministry of Health.
A patient completes a form and if they meet all the criteria, they can pick a time, place and method for how they want to die. They have six months to use it and if they don't, they have to go through the whole process from the start.
Patients can choose whether to have the drugs delivered intravenously, by mouth or tube and whether to trigger it themselves or have a doctor or nurse do it at a place of the patient's choosing, including at home.
Health practitioners are allowed to opt out of participating in any part of the process, though they must advise how to find advice, and the Act states they're not meant to be penalised by their employers for doing so.
Patients are allowed to change their minds at any point.
They were then asked: “At this time do you think you will vote Yes or No in the referendum?”
Wednesday, 11 December 2019, 9:13 am
Western Australia’s move to legalise voluntary assisted dying continues a worldwide trend supported by a clear majority of New Zealanders, the End-of-Life Choice Society’s President, Dr Mary Panko, said on Wednesday.
The Western Australian parliament voted Tuesday to join the state of Victoria in allowing terminally ill adults with less than six months to live who are suffering unbearable pain to get medical assistance to end their misery. The law will come into effect after an 18-month implementation period.
It means nearly nine million Australians will join more than 200 million people in Europe and the Americans with enlightened legislation allowing the ultimate human right of the 21st century – the right to die with dignity.
New Zealanders will vote at a referendum next year on whether to approve the End of Life Choice Act passed by 69 to 51 votes in Parliament on November 13. Scientific opinion polls have consistently shown about two-thirds of New Zealand voters are in favour, Dr Panko said.
She said the Western Australian law was similar to that proposed in New Zealand whereby a doctor can prescribe and administer the lethal medication if the patient wishes. In Victoria, patients must take the dose themselves, but Dr Panko said that in all cases, the key word was “voluntary”, only people who were certified to be actually dying would qualify and there were strict safeguards to protect the vulnerable and participating medical staff.
Source: Perth Now
Western Australia has voted to legalise voluntary assisted dying, bringing to an emotional end a lengthy and often heated parliamentary debate.
An emotional Roger Cook (right) has welcomed WA's assisted dying legislation.
MPs exchanged hugs and onlookers in the public gallery burst into applause as the lower house on Tuesday spent more than five hours approving the last of 55 amendments to the government's bill before rising.
WA is the second Australian state after Victoria to legalise voluntary assisted dying, with the scheme expected to be implemented in 18 months.
Health Minister Roger Cook, who oversaw the bill's introduction and was applauded by MPs on both sides for his handling of the process, choked back tears as he welcomed the passing of the legislation.
"We are at the end of a very long process, a momentous process for the West Australian parliament and West Australian public," he told the chamber.
"It's not a time for jubilation.
"Everyone knows what this legislation is about. It's about reflection. And to reflect that we've chosen compassion and the right to choose."
More than 180 hours were spent debating the legislation in parliament, mostly in the upper house where it was heavily amended.
Terminally ill adults in pain and likely to have less than six months to live - or one year if they have a neurodegenerative condition - will be able to take a drug to end their lives if approved by two medical practitioners.
"This is an extraordinary piece of legislation," Mr Cook said.
"Western Australia is not known for its progressiveness in terms of its legislative reform.
"I'd like to think we've come a respectable second (to Victoria)."
The parliamentary debate was often heated, with many MPs critical of Premier Mark McGowan for pressuring the upper house to get on with passing the bill.
MPs were granted a conscience vote and Labor backbencher Adele Farina was among the final dissenters in the upper house.
The premier hailed the passing of the bill as a significant moment for the state.
"Today we showed that at least in Western Australia, we can do big things," Mr McGowan said.
"And in this parliament we have big, compassionate hearts and we're willing to take some political risks to do the right thing.
"For those of you who are worried about your own futures and don't want to die that way ... we thank you for your unwavering support.
"Thank you for your patience. We did it for you."
The NZ Government has released the following information:
This referendum will give the public the opportunity to vote on whether the End of Life Choice Act 2019 should come into force.
The question is:
Do you support the End of Life Choice Act 2019 coming into force?
For consistency, and to ensure that references to the Act are accurate, this website uses the terminology of the Act. But this does not signal a preference for this terminology over any other. There is no Government position for or against the End of Life Choice Act 2019.
Assisted dying. In the End of life Choice Act 2019, this means:
Medication. In the End of Life Choice Act 2019, this means the lethal dose of the medication.
The Act is built on three core elements:
To be eligible for assisted dying, a person must meet ALL of these criteria:
A person will not be eligible for assisted dying because they are suffering from any form of mental disorder or mental illness, have a disability of any kind, or are elderly.
A person is competent to make an informed decision about assisted dying if they can:
A medical practitioner must do their best to ensure that a person's choice to access assisted dying is made of their own free will. The End of Life Choice Act 2019 contains several provisions that seek to ensure this. This includes requiring that the medical practitioner:
If the medical practitioner suspects a person is being pressured about their decision, they must stop the process.
A health practitioner does not have to assist a person with assisted dying if they have a conscientious objection.
The process begins with an initial request from the person to their medical practitioner. A medical practitioner is not allowed to suggest to a person that they consider assisted dying.
Two medical practitioners must agree that the person meets all the criteria for assisted dying and is competent to make the request. If either medical practitioner is unsure of the person's competence, a third opinion from a psychiatrist is required. If a person is ineligible or not competent, the process ends. The person may not access assisted dying.
If the person is eligible and competent, they select a method for receiving the medication, and when they want to receive it.
At the chosen time of administration, their medical practitioner or nurse practitioner must ask the person if they choose to receive the medication. If the person chooses to receive it, the medical practitioner administers it. They must be available to the person until they die. If the person does not want to receive the medication, it must be taken away.
If more than 50% of voters vote 'Yes' in the referendum, the End of life Choice Act 2019 will come into force 12 months after the date the final votes are announced. If more than 50% of voters vote ‘No' in the referendum, the End of life Choice Act 2019 will not come into force and the current law will remain.
End of Life Choice Act 2019's information on the Parliament's website
End of Life Choice Act 2019
Final report of the Justice Committee to Parliament on the End of Life Choice Bill (PDF, 452KB)
As reported in stuff.co.nz 15/11/19 - 'Rest homes struggling to care for patients admitted to die'.
To my knowledge, as a nurse who has practised for the last ten years in aged care at the level of hospital care in a rest home, these facilities are the next option for those with a terminal illness discharged from Hospice or DHB, if care is not available at home.
For many of those whose life has become limited in time and function, hospital-level care at a rest home is where they will have their final days of life.
Hospices and DHB's provide care, inclusive assessment and treatment. When this is completed, the person must seek appropriate accommodation either in their home or in a rest home/hospital environment.
This option is available for the 'next stage' in the process of the end of their life. These facilities are contracted to and paid for in part by the DHB and so care continues.
In the past, I have known circumstances when this care has not been ideal. This is due largely to the nurse who must care for three Palliative patients. At the same time, she also has responsibility for 20-30 other residents. Not forgetting relatives who need reassurance and advice. Close relatives may well be providing hands-on for their loved-ones care, so supplementing what the nurse can do. The nurse has to constantly prioritise her tasks, knowing that she cannot fulfil all that is required of her.
I have been in such a position. It is disheartening when you are working through your shift with a method you have practised many times and you are intent on doing a 'good job'. Your constantly modified 'to do' list does not diminish. Comments are not always complimentary as in the situation of dying, emotions can naturally run high. It is a critical time for those involved and as the nurse, you want to give the best care. The memories of this time are sharp. They are recalled long after the event for all those involved. I want those memories to be great. Not 'All I remember of my mothers' death was the unrelieved pain'.
Years of underfunding have led to this situation. The imbalance of our current situation is obvious. At the present level of funding, there is no better solution.
Source: The Guardian, by Juliet Rix
Giving people control over how and when they die would reduce unavoidable suffering, says the chief of one of the largest hospices in England.
Mark Jarman-Howe: ‘Even the very best palliative care has its limits. That isn’t failure – that’s reality.’ Photograph: Martin Godwin/The Guardian
“We are failing our patients by not engaging openly and honestly with the issue of assisted dying,” says Mark Jarman-Howe, chief executive of St Helena, the largest hospice in the east of England. “We have to end the climate of fear that surrounds discussion of this in the hospice and palliative care sectors, or more than 6,000 people a year will continue to die in avoidable suffering.”
Read more »
In the aftermath of the successful passage of the End of Life Choice bill and its progress toward a national referendum, Maggie Barrie, leader of the bill’s opposition declared, “This means war!” a dramatic and puzzling declaration.
It’s almost axiomatic, that the first casualty of war is the truth. That certainly seems to apply here as the truth about the bill and its aim to provide a legal basis for medically assisted dying for the terminally ill has, in my opinion, been pummeled, sidelined, distorted and ignored by the religious zealots whom I believe Ms. Barry leads and represents. On that basis, Maggie Barry’s cabal has been at war with the New Zealand public since August 6, 2017, the day that David Seymour introduced the bill to Parliament.
While I am a reluctant warrior, these antics have made it my solemn duty to address their fear-mongering, which only hurts the very people they claim to be concerned about, the elderly and the disabled.
What makes this “war” so completely reprehensible is that it is unnecessary. What I mean by that is this. Some opponents of the bill are inspired by their adherence to a religious viewpoint.
That viewpoint would be defensible if it were honestly presented. Then it could be subject to debate. The argument in its simplest terms is this. Life is a gift from God that cannot be returned by the individual, only taken by God—more like a loan. To interrupt its natural course is a sin, thus an offense against God. Some variation of this same theme is present in the religious teachings of Catholics, Protestants, Jews, and Moslems. Variations include the Catholic concept of suffering as virtue endured as Jesus did on the cross.
But these opponents have not presented their case forthrightly, which would start with an open acknowledgment of the religious basis of that opposition which—in instances here -- happens to be Catholic. Instead they have, when pressed, denied such adherence and claimed a bogus concern for the possible misuse of such a bill, if enacted will result in some measure of coercion, forcing death involuntarily upon the susceptible, which they claim are the aged, the infirm and the disabled.
Never mind that the provisions of the bill and its regulatory provisions make such individuals, those primarily with infirmities ineligible. The bill rests upon the competent, autonomous decision of a person with a terminal illness and a life expectancy of six months. The wish for assisted dying must be initiated by the patient, and, while she may be encouraged to discuss this with family and others, the continuing emphasis is on the individual whose consent to the process must be clearly established and be continuous. An eligible person can change their mind at any time before the final acceptance of a lethal prescription.
The EOLC bill is, as its name suggests, about choice. And choice about the time of one’s death and the means for bringing that death about, surrounded as one might wish, by loved ones, and aided by a trusted conscientious medical person, brings a great deal of relief to a terminally ill person who, otherwise, faces the likelihood of a painful ending and an anxiety about the loss of autonomy and of the dignity of ultimate control.
That ultimate empowerment of a terminally ill person recognises a right of an individual to the free exercise of their own judgment about the time and manner of their death, a right consistent with the freedoms granted to those citizens and residents responsible for their own lives.
It’s obvious this view is different than the religiously inspired one. In a democratic society, religious freedom means that religious practice deserves respect and protection but no religion can be permitted to impose its views on those who believe otherwise. In terms of the autonomy and dignity of dying, such imposition of religion determining the manner of death for the non-religious, would be the ultimate coercion.
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