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Doctors for Assisted Dying Choice (Drs4ADC) http://drs4assisteddyingchoice.org/
Queensland Convenor Group
Dr Sid Finnigan MBBS, FRANZCO
Professor Malcolm Parker MBBS, M Litt, M Hlth & Med Law, MD Dr Heather McNamee MBChB, MRCGP (UK), FRACGP, DFFP Dr Jenny Brown MBChB, MRCP(UK), FRACP
Dr Peta Higgs MBBS, FRANZCOG, CU
Dr Peter Stephenson MBBS (Lon.)
Dr Sid Finnigan E: S&S Finnigan firstname.lastname@example.org PO Box 3218 BIrkdale Q 4159 M: 0402 798 440
We have read the response from the Religious Leaders to the prospect of the legalisation of voluntary assisted dying (VAD) in Queensland. All will agree with their introductory commitments to human dignity and freedom, the importance of Queenslanders feeling valued, and the ability of all to live meaningful, purposeful and fulfilling lives, including through access to high quality health care and end-of-life care. In particular we agree that “Dying well is an important part of what it means to flourish as individuals and communities”.
Nevertheless, we strongly reject the Religious Leaders’ contention that providing assistance in dying is to fail those with terminal illness who are experiencing the level of suffering that would motivate them to request VAD. Below we paraphrase and refute key claims made by the Religious Leaders.
Claim 1. High quality specialist palliative care ensures that no Queenslander need choose VAD in order to avoid a horrible death. All Queenslanders do not have universal access to high quality specialist palliative care, and this should be provided.
The implication is that once everyone has access to high quality palliative care, requests for VAD would cease. There is very good evidence from around the world that this claim is false. Where VAD and high quality palliative care coexist eg in Belgium and Oregon, there is evidence that not all suffering can be avoided and a small but significant percentage of people request VAD. Parliamentary inquiries in Victoria, Western Australia and here in Queensland have all heard medical expert testimony confirming not all suffering can be managed by high quality palliative care. In addition, some terminally ill people do not wish to utilise palliative care, even if it is of high quality. Insisting that everyone would do so is to abridge the freedom that the religious Leaders claim to support.
The implied insistence that VAD should not be legalised until every citizen is assured of access to high quality palliative care is a false, self-serving strategy. While we strongly support increasing access to high quality palliative care, the aspiration to universal access can function as an unattainable goal that remains forever beyond reach. Use of this argument to oppose VAD Legislation is devoid of compassion for those whose suffering is unable to be relieved despite high quality palliative care.
Claim 2. VAD legally enshrines the idea that some human lives are not worth living. This puts vulnerable people at risk of coercion and abuse. People who feel their lives are worthless are particularly vulnerable. VAD undermines the caring for others and being cared for that contributes to our flourishing.
Like many others, the Religious Leaders conflate the ideas of feeling worthless and feeling that one’s life is no longer worth living. Just like those who request that life-sustaining treatment be withdrawn or who refuse further active treatment (lawful requests), people who request VAD do not feel worthless. The Religious Leaders fail to acknowledge or perhaps simply don’t understand that rational terminally ill people have heightened insight into the value of their life and are certainly capable of determining for themselves if their symptoms and quality of life are no longer adequately managed. In the setting of terminal illness with irremediable suffering, the feeling that your life is no longer worth living and the feeling that you are a very worthy and valued person, are, in fact, perfectly compatible states of mind.
There is no evidence from jurisdictions that have legalised VAD that people who consider that their lives are no longer worth living – in either of the two groups described above – have been either vulnerable or subjected to abuse.
People who choose VAD where it is lawful, and their families and friends, would strongly deny that the availability and the process of VAD undermines the flourishing that comes from caring and being cared for. They would insist on the opposite – that provision of VAD in their case constitutes being cared for in a way that they place great value in. For the Religious Leaders to claim otherwise is to project their own particular view of flourishing on to those who do not share it.
Claim 3. VAD undermines human freedom because it seems to offer the misleading choice of dying a horrible death or taking your own life.
This choice currently operates, even in the setting of high quality palliative care. In Queensland between 2106 and 2017, 168 terminally ill people died as a result of self harm. VAD would offer terminally ill people a choice to peacefully end their lives if they wish rather than being forced to choose a painful or violent and lonely death. What is misleading is the Religious Leaders’ willingness to omit mention of palliative care when they believe it suits their argument. Supporters of VAD are on record as being consistent supporters of the provision of high quality palliative care, improving access to palliative care, and ensuring that people are aware of all end-of-life choices.
Claim 4. VAD undermines efforts to address the crisis of suicide in Queensland. We should not affirm the idea that some lives are not worth living.
Aside from repeating the error of VAD affirming the idea that some lives are not worth living, the claim about suicide is false. There is no evidence that suicide rates have increased in jurisdictions that have legalised VAD. Nor is there any evidence that in these jurisdictions, efforts to address the problem of suicide (other than lawful assisted suicide) have been weakened.
Sid Finnigan is a recently retired Ophthalmic Surgeon with subspecialty interest in Ocular Oncology, having previously spent four years in Queensland Country Hospital Service followed by ten years in General Practice prior to specialist ophthalmic training.
Malcolm Parker is Emeritus Professor of Medical Ethics at the UQ and Adjunct Professor at the Australian Centre for Health Law Research at QUT. He was in general medical practice for over thirty years. He has published widely in medical education, philosophy of medicine, medical ethics and law and bioethics, including end-of-life ethics and law.
Heather McNamee is a GP in regional Queensland with special interests in reproductive health, adolescent and HIV medicine and telehealth. She has prior experience in paediatrics including paediatric oncology.
Jenny Brown is a specialist physician in internal medicine with over 30 years’ experience. She set up the palliative care service at Mater Health Services Brisbane, where she was Director of Medicine and Chief of Medical Staff. Dr Brown was previously Clinical Associate Professor of Medicine at UQ, training many medical students and junior staff, and was an examiner for the Royal Australasian College of Physicians.
Peta Higgs is a Subspecialist Urogynaecologist in private and public practice on the Sunshine Coast. She is the immediate past Chair of the Urogynaecology Subcommittee for RANZCOG and an examiner in Urogynaecology.
Peter Stephenson has been a family doctor since 1977 in the Moreton Bay Region,
Source: NZ Herald
Parliament has passed a fiercely debated bill legalising assisted dying, with the public to now make the final decision on the legislation next year.
The End of Life Choice Bill passed 69 votes to 51 at its third and final vote in the House on Wednesday night and will now to go to referendum alongside the 2020 general election.
So how would assisted dying work and what happens now?
It's a piece of legislation introduced by Act leader David Seymour that 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 option would be open to those who have been diagnosed as terminally ill and with less than six months left to live. It originally also covered people with "grievous and irremediable" conditions, but got narrowed down to get more support in Parliament.
Doctors and nurses are banned from starting conversations about euthanasia under the law, so a patient has to request it themselves.
They would have to go through a series of checks with two doctors, including one appointed through the Ministry of Health.
If the patient meets all the criteria, they get given a form to return, if and when they've picked 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 and the bill states they're not meant to penalised by their employers for doing so.
Yes. Patients are allowed to change their minds at any point.
Opponents of the legislation have raised several issues but the most common has been about coercion.
They say the bill lacks the proper safeguards to protect vulnerable people from pressure to take up assisted dying. They argue it would put subtle pressures on the ill or elderly, particularly if they are made to feel like a burden, and open them up dangers from more overt forms of coercion.
The bill includes clauses saying doctors have to stop the process if they suspect coercion, but critics argue physicians may not know patients well enough or be properly trained to make the call.
All assisted deaths would leave a paper-trail that would be collected by a Ministry of Health-appointed registrar. They would check every death, keep data and report any concerns to medical oversight bodies or even the police.
A public referendum will now be held alongside next year's general election to decide whether the bill should become law.
The bill has been subjected to heated debate in and outside of Parliament for nearly two years and it's expected campaigning will ramp up even further next year.
Many MPs who supported the legislation only grudgingly backed it going to a referendum because it was the only way to get enough support in Parliament.
Historically, polls have showed there's majority support for some form of assisted dying in New Zealand. But the referendum will ask people whether they specifically support the End of Life Choice Bill and it's not clear what effect that might have.
Justice Minister Andrew Little has said the Government will try to provide objective information to the public ahead of the vote.
The Minister of Justice has plans in place to combat misinformation and manipulation in any campaigns leading up to, potentially, two divisive referendums at next year's election.
Justice Minister Andrew Little Photo: RNZ / Rebekah Parsons-King
That includes a special team within the Ministry of Justice to direct people to information aimed to be as accurate and neutral as possible, and to be on the look-out for any attempts to deliberately mislead the public.
It's the first time core public servants have taken on this role, and they'll have to walk a tightrope between providing credible public information and getting drawn into any partisan debates.
Voters will not only have to choose the government come 2020, but will also have their say on legalising recreational cannabis, and potentially, voluntary euthanasia.
The latter still has to pass its final reading on 13 November. If it does the referendum will be held.
Minister of Justice Andrew Little said the Electoral Commission would look after the nuts and bolts of running the referendums, whereas the justice team would manage the public information, websites, and respond to public queries.
The team would also have a monitoring role, he said.
"That if someone claims to have a highly authoritative piece of research - it is that, not some sort of highly partisan, highly sceptical or dubious piece of information," Mr Little said.
The Electoral Commission would also keep watch so people did not go "so far wide of the mark" that it crossed over into "misinformation".
The debate was prone to "fairly emotional and irrational responses" but should focus on "real facts, real issues" and in the end the electorate would make its choice, Mr Little said.
Officials operate under strict public sector rules that require them to be politically neutral and non-partisan.
Nick Smith. Photo: RNZ / Alexander Robertson
National MP Nick Smith questioned the ability of justice officials to be able to stay within those rules, saying for the most part the government wanted voluntary euthanasia to become law.
"It's really inappropriate for the justice ministry to have this role ... when the Cabinet manual and the State Services Commission is very clear they are there to follow the instructions of the minister and deliver government policy."
Mr Little acknowledged it would be "a very difficult balancing act" for public servants to avoid being seen as pushing one side or the other or being drawn into the debate.
"I think they are very alert to that, I think we have a very good culture in our state sector ... those in this unit in justice providing this oversight are totally aware of how they may be drawn in to answering questions and queries - I'm totally confident they will discharge their public service responsibilities with great care," he said.
The sponsor of the End of Life Choice Bill, ACT leader David Seymour, put his trust in the "wisdom of crowds" to identify misinformation or manipulation when they saw it.
"A massive information campaign, or should I say misinformation campaign, has failed to shift public opinion."
Part of that was many people based their views on personal experience, said Mr Seymour.
"They've seen bad death, and they've said 'when my time comes that's not for me, I want choice' ... it's very difficult to overturn people's heartfelt feelings with Facebook advertising."
Vocal opponent and National MP Maggie Barry said she was still hopeful the Bill would fail its third reading, as many MPs still held concerns about the lack of safeguards.
If the referendum did go ahead, she and others with similar views would continue to point out what they saw as the "dangers of the Bill and its flaws" so people could make an informed decision.
She hoped any election year debate would be conducted in a "civilised way".
An MP's job was to stand up for what they believed, but also to act with sensitivity, Ms Barry said.
"And I don't think either side has exactly covered itself with glory, upon occasion, but that said it's important everyone realises how important this issue is and we get a formula whereby the public can have as thorough as view of this legislation as possible."
But Dr Smith said the name of the legislation was in itself a form of misinformation.
"The 'End of Life' phrase makes it more acceptable to pass ... 'choice' has got a nice, fuzzy feel about it but if you talk about, actually, providing injections of poisons to kill people, you get a very different response."
Mr Little said government websites would feature what he described as "independently prepared information relevant to the issues".
Part of the advertising and marketing campaign would be directing people to those sites.
The government would be "looking out carefully" for signs social media or other platforms were being used to mislead people as had happened in political campaigns overseas, Mr Little said.
"There will be some things claimed in each case that will be highly questionable and and it's a question that in the course of the debate that stuff gets called out, and we do our best to keep the debate clean."
Source: Dignity in Dying
A big development this week as 18 police and crime commissioners have written to the Secretary of State for Justice calling for an inquiry into the the current law on assisted dying. This ground breaking intervention shows the current law is unsafe and virtually unenforceable.
This follows the news that Durham Police and Crime Commissioner, Rob Hogg, has been diagnosed with terminal motor neurone disease and is campaigning for a more compassionate law.
We've always known the current law is failing people, forcing some to suffer against their wishes and others to take drastic action to control their death. But we've constantly been told by some MPs that the law is sympathetic and compassionate!
This announcement by police and crime commissioners shatters that illusion.
We all agree that vulnerable people must be protected, that is not happening under the status quo. The ban on assisted dying merely drives the practice behind closed doors and abroad, with seriously ill people often ending their lives prematurely for fear of becoming too ill to act.
There is a scattergun approach to enforcing the law. Either there is no scrutiny at all or loving family members are criminalised for acts of compassion. How can the law be working well when it forces people to endure distressing and intrusive investigations at great cost to the tax payer?
When half of police and crime commissioners across the country recognise that a law is not working, law-makers have a duty to listen.
It is time for a Ministry of Justice-led inquiry into the blanket ban on assisted dying.
New Zealanders will likely be asked to decide whether euthanasia should be legal in a referendum at the 2020 election after a tight vote in Parliament.
David Seymour's End of Life Choice Bill was amended on Wednesday night to include a binding referendum on whether it should come into force, by a knife-edge vote of 66 to 54. (See also the Hansard report on Parliament's website.)The referendum is not certain as the bill still has to make it through a third reading vote next month.
But the referendum gives it a much higher chance of passing as it keeps NZ First on board with the legislation.
The bill would allow the terminally ill to request assisted dying from their doctors under specific circumstances.
Seymour mostly kept together his coalition that helped him pass the second reading of the bill, although 10 previous "yes" votes voted against the referendum, while three previous "no" votes voted for it.
A majority of Labour MPs (28) voted for the referendum, including leader Jacinda Ardern. A majority of National MPs (39) voted against it, including leader Simon Bridges.
Seymour struck a deal with NZ First early in the bill's passage to get the party's support for the bill in exchange for the referendum.
He and many other supporters of the bill are not generally supportive of the bill being a referendum, but understood the need for it to go to one in order to pass the next vote.
"This referendum clause is critical to keeping a coalition of MPs to be able to give people choice at the end of their life," Seymour said at the opening of the debate.
Labour MP and supporter of the bill Kieran McAnulty said he didn't support the referendum but would support it to give the bill a shot at becoming law.
"I think of other issues that have faced this country over time: the right to give women the vote, for example. If that was put to a referendum, that probably wouldn't have passed. The Homosexual Law Reform Act: if that was put to a referendum, that probably wouldn't have passed," McAnulty said.
"In a perfect world, I would have voted "no" on a referendum. But what I need to weigh up is in sticking to that principle which I believe in, can I then, in good conscience, see this bill fail? I cannot. So I will be voting for this referendum, because I am a bookmaker and I know how to count, and I know that if the referendum Supplementary Order Paper fails, so too does the bill, and in good conscience I can't let that happen."
National and Labour MPs are allowed to vote freely on the bill as a conscience issue, while Green and NZ First MPs voted as a bloc to support it.
Since the referendum question will simply ask if "the End of Life Choice Bill" should become law many opponents of the bill argued that its name should be changed to make what the bill legalised clearer.
National MP Tim Macindoe drafted a failed amendment that would rename the bill the "Euthanasia and Assisted Suicide Act 2019".
National's Chris Penk, a strong opponent of the bill, said the title needed to be free from euphemism.
"So if there is ever a situation in which it would make sense to have a bill with a title that does what it says on the tin—notwithstanding the provisions within the Act or the bill—then this would be that situation," Penk said.
Maggie Barry, another National MP strongly against the bill, said the title was "misleading and euphemistic".
NZ First MP Jenny Marcroft, whose amendment added the referendum, said it was key that such a change to the "fabric of society" should go to the public.
"We believe that temporarily empowered politicians, which we all are in this chamber, alone should not decide on this bill, but we should have the courage to allow the voting public to participate in this conversation," Marcroft said.
Supporter of the bill Labour MP Willie Jackson said he was struggling to work out whether to support the referendum or not.
"Referendums do not treat minorities well," Jackson said.
Labour MP Louisa Wall directly criticised NZ First for putting MPs who supported the bill but were against a referendum in an "untenable" position.
"I can't in good conscience, even though I 100 per cent support the bill," Wall said.
"My principles will not let me vote for the referendum. Even if it means the bill fails."
"It seems inconceivable that [NZ First] would say to this House that 'Unless you vote for this referendum we will vote this down at third reading.' I think that is appalling. That is abhorrent. We have been engaging in a good faith discussion on this since 1995."
Seymour said he was relieved after the vote but a big battle remained at third reading next month.
Long-time proponent of the bill and former Labour MP Maryan Street said she wasn't scared of the bill going to a referendum as many polls showed the public would support it.
"I don't fear a referendum. Every poll in New Zealand has had 70-75 per cent support in favour. I have no fear,' Street said.
The End of Life Choice bill was first put into the ballot by Seymour in 2015 and has had a tortured journey through Parliament, including a 16-month select committee process.
WHO VOTED HOW:
Labour (29): ARDERN Jacinda, DAVIS Kelvin, LITTLE Andrew, ROBERTSON Grant, WOODS Megan, HIPKINS Chris, SEPULONI Carmel Jean, PARKER David, NASH Stuart, HUO Raymond, LEES-GALLOWAY Iain Francis, TINETTI Jan, PRIME Willow-Jean, FAAFOI Kris, ALLAN Kiri, CURRAN Clare, DYSON Ruth, ANDERSEN Ginny, LUXTON Jo RUSSELL Deborah, CRAIG Liz, LUBECK Marja, EAGLE Paul, McANULTY Kieran, RADHAKRISHNAN Priyanca, WARREN-CLARK Angie, O'CONNOR Greg, HENARE Peeni, WEBB Duncan.
National (15): BENNETT Paula, ADAMS Amy, KAYE Nikki, COLLINS Judith, MITCHELL Mark, BENNETT David, SIMPSON Scott, KURIGER Barbara, DOOCEY Matt, YANG Jian, BISHOP Chris, KING Matt, FALLOON Andrew, STANFORD Erica, YULE Lawrence.
NZ First (9): PETERS Winston, MARK Ron, MARTIN Tracey, TABUTEAU Fletcher, BALL Darroch, MITCHELL Clayton, PATTERSON Mark JONES Shane, MARCROFT Jenny.
Green (8): SHAW James DAVIDSON Marama, GENTER Julie Anne, SAGE Eugenie, HUGHES Gareth, LOGIE Jan, SWARBRICK Chlöe, GHAHRAMAN Golriz.
ACT (1): SEYMOUR David.
Independent (1): ROSS Jami-Lee.
Labour (17): TWYFORD Phil, CLARK David,=sum SIO Aupito Tofae Sua William, O'CONNOR Damien, SALESA Jenny, JACKSON Willie, WILLIAMS Poto, WALL Louisa, WOOD Michael Philip, MALLARD Trevor, COFFEY Tamati, STRANGE Jamie, KANONGATA'A-SUISUIKI Anahila, MAHUTA Nanaia, WHATIRI Meka, RURAWHE Adrian, TIRIKATENE Rino.
National (40): CARTER David, PUGH Maureen, BROWNLEE Gerry, BRIDGES Simon, LOHENI Agnes, WOODHOUSE Michael, TOLLEY Anne, GUY Nathan, McCLAY Todd, SMITH Nick, BARRY Maggie, GOLDSMITH Paul, UPSTON Louise, NGARO Alfred, WAGNER Nicky, DEAN Jacqui, HUDSON Brett, LEE Melissa, BAKSHI Kanwaljit Singh, PARMAR Parmjeet, YOUNG Jonathan, HAYES Jo, McKELVIE Ian, O'CONNOR Simon, BAYY Andrew, DOWIE Sarah, MULLER Todd, RETI Shane, SCOTT Alastair, SMITH Stuart, BROWN Simeon, HIPANGO Harete, LEE Denise, PENK Chris, VAN de MOLEN Tim, WALKER Hamish, GARCIA Paulo, WILLIS Nicola, BIDOIS Dan.
The bill has faced strong opposition from a number of MPs, including National's Chris Penk.
A crucial vote on whether to hold a referendum on legalising voluntary euthanasia looks set to go down to the wire, according to a poll of all MPs.
Act Leader David Seymour's End of Life Choice Bill will return to Parliament on Wednesday 23 October and politicians will have to decide whether the final decision should be put to the public if it passes a third reading.
If the referendum is rejected, the entire bill – which would let terminally-ill adults request assisted dying – will struggle to pass into law at the third vote, with New Zealand First looking like it may pull its support unless there's a referendum.
The Herald has polled every MP in Parliament and found 56 now say they will vote for the legislation to go to a referendum or are leaning towards it.
That counts a number of MPs, including Prime Minister Jacinda Ardern and Finance Minister Grant Robertson, have who indicated they will only back a plebiscite it there's no other way to get the bill through.
There's 46 MPs who have said they'll oppose it or are leaning against it. It needs 61 votes in the House to pass. The decision will be as a conscience vote, meaning MPs will vote individually, rather than along party lines.
But there's 18 MPs who have not said how they're voting.
And 10 of those undeclared politicians voted for the End of Life Choice Bill at its second reading. It's likely at least five or six of them will back the referendum to ensure the bill can pass into law, like their colleagues.
Under that situation, the referendum will pass, but only narrowly.
It means even a few MPs changing their minds could swing the vote against a referendum. Some members were understood to still be changing sides on Tuesday.
There is, however, a number of MPs who oppose the bill – such as Labour's Deborah Russell – who say it's a close decision and feel more comfortable with putting the issue to a public.
The group could possibly be joined by one or two more who were "no" at the second reading, but still haven't declared how they'll vote on Wednesday.
The referendum failing would spell serious trouble for the legislation as a whole.
The bill passed its second reading 70 votes to 50, but the referendum has been demanded by NZ First, which says the issue is too serious to leave to politicians.
Several of the party's MPs have previously said all nine of the party's members will vote against the End of Life Choice Bill if the public aren't allowed to decide.
Leader Winston Peters wouldn't confirm this week whether NZ First members would be allowed to back to the bill without a referendum.
Without their votes, Seymour would have to retain every other "yes" vote from second reading into the third – a major ask, given a number of MPs publicly expressed reservations even while backing the bill last time.
Seymour has made a series of changes to the bill since the second vote in a hope of securing further votes, but it's not yet clear whether that's won him any more votes.
That's why the Act leader has been trying to rally support for the referendum for months now, even though it would slow his legislation.
And it's why the End of Life Choice's opponents may be more likely to vote against a referendum.
Publicly, a number have also raised the same concern as the bill's supporters – that the issue is simply too complex to leave to a yes-no referendum question.
Polling would also suggest a referendum would get the public's backing.
Victoria University research fellow Jessica Young, an expert on the issue of assisted dying, saying over the past 20 years public support for some form of assisted dying has averaged about 68 per cent.
Public campaigns surrounding the End of Life Choice Bill this year don't appear to have shifted the mood much either, with a 1 NEWS Colmar Brunton Poll in July – ahead of the second reading – saying about 72 per cent of the public supported assisted dying.
Click here for a list of MPs who have indicated they'll only back the referendum if necessary to get the bill passed – it does not necessarily reflect their support for a referendum.
Source: Jersey Evening Post
Even when doctors have just been surveyed on the subject, it still feels awkward to ask a GP about ending the life of a patient.
Dr Nigel Minihane, Saturday interview on assisted dying. Picture: JON GUEGAN. (25973012)
Despite the way that the results of a recent survey, answered by around a third of local doctors, have been used by those on both sides of the debate, they do not provide conclusive assistance. Was the notable thing the majority who thought it, sometimes or always, acceptable in given circumstances to assist someone with an incurable condition to end their life? Or was it the minority – a significant proportion, nonetheless – who thought it never acceptable in any circumstances?
Dr Nigel Minihane, chairman of the Jersey Primary Care Body, accepts that views within the profession are as polarised as those held by the public. Yet he detects a shift in the centre ground of public opinion to which the profession is starting to respond at national level.
‘We have to listen to our patients and it would appear that the public at large actually feels that a patient’s autonomy is something that has largely been ignored by the medical profession. Something like 80%-plus of the public are saying that we should be considering assisted dying and it would perhaps be rather arrogant of the profession not to listen’, he said.
Certainly, the signs nationally are that the official opposition to assisted dying may be being replaced by a more nuanced position. The Royal College of Physicians decided in March this year that it would take a ‘neutral’ position on the question, while the Royal College of GPs, which is currently opposed, is due to ballot its 53,000 members again shortly.
One of the things that makes the assisted dying debate so difficult is that the often distressing circumstances envisaged by the desire to escape life come into conflict with safeguarding the interests of the potentially vulnerable. But to talk about those circumstances with a doctor concentrates the mind.
‘In some situations, it is not so much the pain but the mode of death that might be severe. For example, there are rare conditions where a tumour might erode into an artery and there’s nothing you can do. It is going to burst and people are literally going to bleed to death.
‘It’s one of those circumstances where it’s ethically acceptable now to give terminal sedation [a substantial dose of morphine beyond that required for pain relief], but at the moment that’s only acceptable when that situation actually occurs. If someone knows that is the mode of death, would you look at it differently?’ Dr Minihane asks.
MISSING CAPTION (25981576)
Such dilemmas appear to transcend the normal boundaries of palliative – or supportive, as it is now known – care where the doctor ensures that the patient has access to appropriate symptom control throughout their illness. ‘Some of that is curative but some of it is about making sure life is bearable,’ Dr Minhane said.
Central to the debate is the patient’s right to choose. Whereas in the past you might have visited a doctor expecting to be told what do to, the assumption today is that, equipped with the relevant information – what Dr Minihane calls the doctor’s ‘braindump’ on a particular condition – a patient will make his or her own informed decision about their best interests.
Yet problems arise with patient autonomy when supportive care simply does not work and the patient’s pain cannot be controlled by the prescribed drugs, or when they do not want to endure their illness and the palliative treatment.
‘If they know they are on a trajectory to death or unbearable suffering what about their decision then? It is, after all, their body.’
For Dr Minihane the patient-doctor dialogue which takes place in relation to a minor complaint – whether, for example, to take antibiotics for the condition – should also take place in relation to serious illness.
‘At the cancer end of life the same should apply. We tell a patient: this is what we can do. We can’t cure you but this is how we can make life better for you. But perhaps the autonomy which we have made the central pillar of what we do isn’t being addressed in the same way at the end of life as it might be,’ he said.
The present position is clear legally. Both assisted dying, where patients are given a cocktail of drugs to take that will end their life, or euthanasia when their death is brought about by a third party are not paths available here.
‘In these situations we have to point out that it is illegal and we point out all the alternatives. What we are trying to ensure is that people have their symptoms controlled so that we can give them the best quality of life for as long as possible.
‘For me that’s no different from what we do everyday as a doctor so, whether someone comes into the surgery with a cold or cancer, I often say to them my job is to make life as good as I can for you for as long as I can. There may be other circumstances that prevent me from doing so but that’s my job.’
However, it is precisely those ‘other circumstances’ which lie at the heart of the current debate, situations when the suffering of the patient or the patient’s attitude to their situation mean that they cannot exercise their own control in the way they might wish.
‘I remember seeing one gentleman years ago with a cancer of the lower bowel which had eroded through the bowel and went into part of his spinal cord and the peripheral nerves, and he died in severe pain. His mother came to me afterwards and her words echo in my head, “My son died in pain” and I had to agree that he did.’
Central to the debate about assisted dying is the question of safeguards. How to ensure, if the law were changed, that only those in agreed circumstances, governed by their medical condition and its prognosis, and free from coercion would be able to obtain help to die.
The difficulty was brought into sharp focus during one of this year’s BBC Reith Lectures given by former Supreme Court – and former Jersey Court of Appeal – judge Lord Jonathan Sumption who was challenged by a member of the audience to say whether he would support changing the law to permit assisted dying.
The lady who posed the question had been investigated by the police, having returned from Switzerland where she had taken her terminally ill husband to die. She was understandably distressed by the experience.
But Lord Sumption told her that the law should continue to make helping someone die a criminal offence, even if there was also acceptance that, in certain circumstances, it was right for people to break that law.
For Dr Minihane, the exchange has to be understood in the wider context of the lecture’s theme: the need for the courts not to intrude into affairs which are properly the territory of political decision-making. It is for the legislature rather than the judiciary to decide whether assisted dying is legal and, if it is, the circumstances in which it should be permitted.
What he calls those ‘specific delineated safeguards’ might include the patient’s terminal prognosis, their view that it was in their own best interests and the fact that they had capacity to make the decision.
Yet the recent local survey of doctors’ opinions highlights a further issue if the law were to be changed – the freedom of the doctor to opt out if they entertained honest objections.
‘If the law were changed I think one would have to look at it in a similar way to the abortion debate where there are “conscientious objectors” among the medical profession who will not deal with abortion because of their religious convictions and it’s entirely appropriate that that remains’.
Dr Minihane sees an interesting distinction between the abortion debate which is about the mother’s choice in relation to an unborn child – within limits set out by the law – and the debate about assisted dying which involves dealing with a person who has the capacity to make a decision about themselves with appropriate safeguards.
So what about the view of Dr Nigel Minihane, not as a spokesperson for the Primary Care Body but as a general practitioner himself?
‘I think I would say that the important aspect is autonomy. I have changed my practice over the years and it’s all about the patient, the person in front of you and what they want.
‘If things are within the law and it’s something which in all conscience I can do then it’s something that I would consider. However, until the law is passed and the safeguards are established I couldn’t give a full opinion,’ he said.
The End of Life Choice Bill has moved through another phase of its committee stage in Parliament and opponents' efforts to change the bill have again been voted down.
David Seymour Photo: RNZ / Ana Tovey
National MPs put forward around 20 amendments to ACT leader David Seymour's bill last night - but unlike the last session, where MPs stayed voting until 1am, the voting wrapped up at 10.30pm.
Mr Seymour's chief opponent Maggie Barry, who apologised for yelling at Labour's assistant speaker Ruth Dyson during the last debate was not in the House last night.
However, her proposed amendment still got a lot of air time through her colleagues.
Ms Barry wanted the death certificate of someone who dies from assisted dying, for the purposes of any life insurance contract, to state that the person died as a result of the administration of medication.
National MP Melissa Lee told the House legislation shouldn't compel someone to misreport or misrepresent a cause of death.
"We should not try and hoodwink the actual reason why someone had in fact died ... this bill of David Seymour's is trying to actually say they did not in fact die from a lethal dose of a poison.
"That to me is actually a lie and I do not think that legislation should facilitate the falsehood," Ms Lee said.
But Mr Seymour said there's no deceit or deception going on.
"Under the requirements of this legislation, the death certificate says that the person died of the illness that qualified them to be eligible for assisted dying, also the fact that they died from assisted dying.
"So anybody reading that certificate I think can figure out that this was done under the law.
"There's no subterfuge, it's very easy for anybody to read and understand what that's saying", Mr Seymour said.
The amendment was voted down 38 votes to 81.
Alfred Ngaro Photo: RNZ / Dom Thomas
National's Māori, Pasifika, and ethnic MPs also tried to push for cultural considerations and the Treaty of Waitangi to be properly addressed by the bill.
MPs Harete Hipango and Alfred Ngaro put forward amendments that Deputy Speaker Anne Tolley ruled out of order because they related to other parts of the legislation that were debated weeks ago.
But Ms Hipango submitted another amendment during the debate and put forward her case.
"It is well known that the legislation of this land requires that commitment [to the Treaty] which has been mandated.
"I implore members of this House, I implore members of the public, that we have a duty of care and responsibility to our most vulnerable. This bill that's proposed has no lens, no optics whatsoever in terms of addressing that," she said.
Mr Ngaro accused Mr Seymour of being dismissive of the importance of cultural considerations.
"The question that has to go to the member of the Bill who talks about the importance of choice, what about the importance of ensuring that people know what choices they are making?
"Many times when we think about it in different cases with different cultures people may be asked a question, and if I talk about the Pasifika community, people will nod and say yes do you understand.
"The truth and the reality is they do not understand the technical implications in this regard," Mr Ngaro said.
But Mr Seymour said putting in a specific requirement around cultural considerations would be problematic.
"Of course we expect all medical professionals in New Zealand to be respectful of who their patients are, it would be quite extraordinary if that wasn't the case.
"And I think it would be a terrible signal for Parliament to send that in specific instances they're required to carry out those kinds of duties because the implication might be that they weren't expected to carry out duties of cultural competency in other settings," Mr Seymour said.
The End of Life Choice Bill will be up in the House again late next month when New Zealand First's proposal that the bill be put to the public in a referendum is expected to be debated.
Wednesday, 18 September 2019, 3:02 pm
Press Release: ACT New Zealand
ACT Party Leader David Seymour has welcomed New Zealand First’s release of the question to be put to the public at a referendum on the End of Life Choice Bill.
“The wording of the question put forward by New Zealand First today will allow MPs to vote for a referendum knowing exactly what two options the public will be given to choose from at the election booths next year.
“SOP [Supplementary Order Paper] 361 in the name of Jenny Marcroft will give certainty to MPs that the wording of the question put before the public on the End of Life Choice Bill will be decided collectively by all of Parliament during debate on the Bill in Committee of the Whole House, rather than at a later stage by Cabinet.
“I support this SOP put forward by New Zealand First.
“I am confident that this question proposed by New Zealand First will ensure the fairest outcome at a referendum for both those for and against the Bill and ask all MPs to support its passage in the House.
The SOP can be found here »
Act Party leader David Seymour's voluntary euthanasia bill has cleared another stage in Parliament.
MPs voted 70 to 50 in favour of the End of Life Choice being given a third and final reading. But that was only after Mr Seymour introduced several amendments, including a requirement that doctors will not be able to suggest to patients they consider ending their lives.
David Seymour joined RNZ's Wellington studio to discuss the bill.
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