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Jim Vause | 24 April 2019 | NZ Doctor
It seems our ethics on this matter are plagued by opinion, beliefs, awed interpretation of evidence and biases of individual professional realms
There is something very paternalistic about the “Doctors say no” letter opposing medically assisted euthanasia (i).
The letter’s rationale that, “to intentionally assist a person to die would fundamentally weaken the doctor-patient relationship which is based on trust and respect” is akier than lo.
For a terminally ill patient to ask their doctor to cease their suffering by assisting them to advance their death usually reflects a deep trust often built up over years of a GP-patient relationship. Any GP worth their salt will know this. I do not buy the letter’s argument.
Similarly, the NZMA using the argument that “the proper provision of such (pain) relief, even when it may hasten the death of the patient, is not unethical” to justify opposing doctor-assisted suicide fails when the patient’s desire for death is due to suffering, but not of pain.
Rationality is further eroded by their statement: “We are of the view that permitting individuals to end their lives with the assistance of a doctor — even when that assistance is limited to assessment, verification or prescribing — is contrary to the ethics.”
Standing on the top of a seven-strand fence or dancing on a pin? This seems a common circumstance when it comes to the NZMA arguments, a situation probably resulting from the clinical experience of those realms of medicine opposed to medically assisted euthanasia and one in which palliative care features very strongly.
Consider: What is the underlying reason for most persons committing suicide? It is due to mental illness. Depression, anxiety and a few other mental states.
If doctor-assisted suicide was available, how many persons contemplating suicide would seek help rather than killing themselves? Don’t know.
Does palliative care treat these persons? No. Are the mental states leading to suicide treatable or do they attenuate with time? Yo.
In some persons, it is irreversible and they continue to suffer until they die, irrespective of medical intervention. Underlying is a neurological disease, usually degenerative, often difficult to detect, if at all.
It is hard to refute the rationale that ending such a life when suffering is unbearable is better than continued futile medical interventions that don’t work, lead to a loss of dignity (see the NZMA Code of ethics) and cause suffering in their own right.
To end such suffering in a manner that preserves that person’s dignity and is painless, is vastly better and humane than the terror, physically and emotionally, of an ill-planned gruesome suicide with all the concomitant distress and social angst it causes family and friends.
Does allowing the latter through doing nothing meet the NZMA’s Code of Ethics that “requires doctors to always bear in mind the obligation to preserve life wherever possible and justiable, while allowing death to occur with dignity and comfort when it appears inevitable”?
Ultimately, I feel that taking this absolute position, one of medical control, has the malodour of a paternalistic profession that comes from a position of believing that it knows everything about the human condition and can treat all its malfunctioning, when in reality it knows so little about how the brain works, and what it does, and is thus so limited.
Terminal patients want to maintain control, especially for dignity.(ii) We advocate for advanced directives while patient rights are articulated explicitly in our H&DC code, yet we seem to nd it too hard to do the difcult thing, exemplified by the NZMA statement that, “It seems that doctors are somewhat reluctant to take on the weight of the burden that we are asked to assume by legalising active euthanasia.”
It seems our ethics on this matter are plagued by opinion, beliefs, awed interpretation of evidence and biases of individual professional realms. A change in our ethics is only a matter of time.
[ii] J Med Ethics. 2006 Dec; 32(12): 706–710.
What people close to death say about euthanasia and assisted suicide: a qualitative study
A Chapple, S Ziebland, A McPherson, and A Herxheimer
Former Prime Minister Sir Bill English and his wife Dr Mary English are fiercely opposed to the End of Life Choice Bill. Photo/Bauer Media/NZ Women's Weekly.
Opponents of David Seymour’s End of Life Choice Bill are pulling out all the stops to kill it on May 22.
If you’re an opponent of assisted dying laws and you want to advance your cause, best not conflate the plight of suicidal young people and that of the terminally ill who are asking to shave a few days or weeks off the end of their lives to avoid the worst of their distress.
It didn’t work well for National MP Simon O’Connor, chairman of the Health select committee inquiry, when he asserted the same false equivalence in 2017 and ran into a storm of criticism. And it’s certainly not working for Dr Mary English right now.
A meme circulating on the internet featuring a photo of the Wellington GP beside the words: “If assisted suicide is a triumph for autonomy and choice, how can youth suicide be a tragedy?” has been howled down.
Libertarian columnist Damien Grant said that while there are good arguments against assisted suicide, that isn’t one of them.
Left-wing blogger Martyn Bradbury, who is staunchly opposed to assisted dying, described it as “ugly”.
Green MP Chloe Swarbrick was similarly outraged, tweeting: “Young people are tragically opting out of their lives because they are not receiving support and they don’t have faith in a better future. They’ve had autonomy and choice stolen from them. Don’t dare equate that to people on their death bed seeking dignity in their final days.”
Others offered false equivalences of their own. As one wag put it: “If a planned heart transplant by a professional surgeon is a triumph of medical science, why is an unplanned heart transplant on a random pedestrian by an untrained amateur with a kitchen knife considered a tragedy?”
You know it’s a howler when even Renee Joubert, from Euthanasia-Free NZ, disowns it. She wrote: “I think it’s important to understand this meme in context. It was not created or published by Dr Mary English but by an Australian anti-euthanasia organisation.
“They took a sentence from her oral submission to Parliament’s Justice Committee, in which she was deliberately using this statement to illustrate a point.”
In fact, if you listen to Dr English’s submission, the words reproduced in the meme represent exactly the point she was making. There was no other context.
And it’s hardly unusual for opponents to make the same odious comparison. On Newstalk ZB in February, her husband, Sir Bill English, told Chris Lynch: “How do we tell young people not to consider suicide as a solution to their depression on the one hand but, on the other, say that if you ask for euthanasia, the state will organise it and provide a doctor?”
You don’t have to be very thoughtful to see the clear difference between a depressed teenager who is going through a rough patch and a rational person who wants help to die to avoid the last, most distressing phase of a terminal illness.
The fact is opponents of assisted dying are pulling out all the stops to derail David Seymour’s End of Life Choice Bill at its second reading on May 22 and the meme featuring Dr English’s statement is just one example of the less-than-admirable tactics they are willing to employ.
On April 27, a group that calls themselves DefendNZ sent a 94-page booklet to every member of Parliament that features a variety of people — from the disabled to doctors — outlining why they don’t want assisted dying legislation passed.
Presumably in an effort to cast its net as wide as possible, the booklet also poses entirely irrelevant questions such as: “Is the End of Life Choice Bill a colonial imposition?”
It states: “The End of Life Choice Bill is largely deaf to Māori conceptions of people and death as well as tikanga Māori” — without acknowledging that the whole point of Seymour’s bill is that it provides only for voluntary assisted dying.
Under the bill’s provisions, Māori — like everyone else — would be entirely free to die in whichever manner they wanted. The bill has no implications for them apart from offering a choice.
On its website, under the heading “The Top 5 Reasons Why MPs Should Vote ‘No’ at the Second Reading”, DefendNZ encourages readers to contact their MP to ask them to vote against the bill.
One of the five reasons suggested to pass on to MPs includes the fact the debate in Parliament will be complex and time-consuming.
DefendNZ warns MPs there will be lengthy debates over amendments to the bill and to “expect the conversations to get longer and much more intense… Should the bill pass its second reading, the Committee of the Whole House stage will likely be extremely lengthy, as dozens of MPs try to fix the bill.”
This amounts to asking MPs: “Why not guarantee yourself an easier life by simply voting it down at the second reading?”
If comparing youth suicide and assisted dying for the terminally ill is an underhand tactic, this appeal to MPs’ self-interest must qualify as a new low in the debate.
We can expect a lot more public campaigning by opponents in the three weeks until MPs get to vote on whether to allow Seymour’s bill to proceed further. The last thing they want is for the bill to be allowed to go to a referendum at the next election because they fear — undoubtedly correctly — that they will lose. If the bill is voted down at its second or third reading, there will be no referendum.
Opponents also don’t want the bill to pass its second reading because it would give Parliament a chance to make it more palatable to those MPs who might approve of the terminally ill receiving an assisted death but baulk at the inclusion of people with “grievous and irremediable conditions”. (Seymour has proposed removing that clause as well as specifying that mental illness and disability alone will not satisfy eligibility criteria, among other changes.)
In other words, opponents don’t want the bill to have the chance of being amended in such a way that it answers many of the objections presented in submissions to the Justice select committee. They are determined to kill it as soon as possible.
The other circumstance that adds urgency to the campaign to sink Seymour’s bill quickly is that on June 19 more than a quarter of Australia’s population will get access to assisted dying when Victoria’s legislation takes effect.
Religious activists in New Zealand and Australia see the two nations as effectively one battlefield. They worry that more victories like Victoria’s will create a domino effect across both nations.
And they have reason to worry. Western Australia’s government is presenting its own bill in August or September, after a year-long, cross-party parliamentary inquiry recommended an assisted dying regime that would look very like the one David Seymour has proposed.
The fact it is a government bill and that support for assisted dying is running at well over 80 per cent in polls in Western Australia means there is a strong likelihood it will pass.
Queensland has a parliamentary inquiry under way that is considering assisted dying legislation for the first time in the state’s history. And another bill will be presented in New South Wales this year, after a Voluntary Assisted Dying Bill failed to pass in the NSW Upper House by just one vote in 2017.
The Australian organisation responsible for the Dr English meme is called Hope, an initiative dedicated to opposing assisted dying, which is allied to the Australian Family Association. The AFA is a Christian lobby group set up by Australia’s most famous Catholic political lobbyist, Bob Santamaria, in 1979.
Some New Zealanders will object to an overseas religious group attempting to influence our laws and will be tempted to respond in the same way as Judith Collins did in March when she learned the NRA was trying to meddle in our gun-law debate. She recommended they “Bugger off!”
Hope, however, appears to be hopeless — at creating effective memes, at least.
This recent extension of its mission across the Tasman certainly looks to have been more hindrance than help to those who are keen to kill Seymour’s bill.
New Jersey Governor Philip Murphy / Patch
GOVERNOR’S STATEMENT UPON SIGNING
ASSEMBLY BILL NO. 1504
Today I am signing the “Medical Aid in Dying for the Terminally Ill Act”, Assembly Bill No. 1504 (Second Reprint), which permits terminally ill, adult patients residing in New Jersey to obtain and self-administer medication to end their lives peacefully and humanely. I commend the bill’s sponsors — particularly Assemblyman Burzichelli, for whom this bill has been an extremely passionate and personal mission since he first introduced it seven years ago — for their tireless efforts to craft legislation that respects the dignity and autonomy of capable individuals to make end-of-life decisions.
The legislation I am signing today is the product of a near-decade long debate among policy makers, religious organizations, experts in the medical community, advocates for persons with disabilities, and patients, among many others. Without question, reasonable and well-meaning individuals can, and very often do, hold different moral views on this topic. Through years of legislative hearings, countless witnesses, many of whom shared deeply personal and heart-wrenching testimony, offered compelling arguments both in favor of and against this legislation.
As a lifelong, practicing Catholic, I acknowledge that I have personally grappled with my position on this issue. My faith has informed and enhanced many of my most deeply held progressive values. Indeed, it has influenced my perspectives on issues involving social justice, social welfare, and even those topics traditionally regarded as strictly economic, such as the minimum wage. On this issue, I am torn between certain principles of my faith and my compassion for those who suffer unnecessary, and often intolerable, pain at the end of their lives.
It is undeniable that there are people with terminal illnesses whose lives are reduced to agony and pain. Some of these individuals may thoughtfully and rationally wish to bring an end to their own suffering but cannot do so because the law prevents it and compels them to suffer, unnecessarily and against their will. I have seen such debilitating suffering firsthand in my own family, and I deeply empathize with all individuals and their families who have struggled with end-of-life medical decisions. As things now stand, it is the law, rather than one’s own moral and personal beliefs, that governs such decisions. That is not as it should be. After careful consideration, internal reflection, and prayer, I have concluded that, while my faith may lead me to a particular decision for myself, as a public official I cannot deny this alternative to those who may reach a different conclusion. I believe this choice is a
personal one and, therefore, signing this legislation is the decision that best respects the freedom and humanity of all New Jersey residents.
Date: April 12, 2019
/s/ Philip D. Murphy
by Andrew Geddis
Source: The Dominion Post
David Seymour, sponsor of the End of Life Choice Bill, is looking to will propose changes at a future stage of the debate that will limit the any legislation's scope.
OPINION: Alex Penk, chief executive of the Maxim Institute, has concerns about the End of Life Choice Bill currently awaiting a second reading in Parliament. There's nothing wrong with that, as the issue is one that reasonable people can disagree on.
However, I think some of his concerns are misplaced, and others are missing some important context.
First of all, Penk worries about the parliamentary process being used to pass this proposed law. Its sponsor, David Seymour, will propose changes at a future stage of the debate that will limit its scope. That fact means that the bill's final shape is still somewhat uncertain.
However, what he doesn't note is that this process is required because those MPs on the justice select committee opposed to the bill blocked Seymour's changes from being incorporated into it at that earlier stage. No doubt they worried that other MPs would be more likely to support this limited bill than the original version.
It's then a little rich for the bill's opponents to complain that it is being enacted via a flawed process. And in any case, it seems almost certain that any final bill will require a referendum vote to become law, giving the ultimate say on its merits to the voters themselves.
Penk then raises the spectre that any legislation may be misapplied, leading to "deaths that would fall outside the bill's own criteria". This could occur, he worries, because of the difficulties involved in determining whether someone at the end of life really is competent to consent to a doctor's actions.
Of course, the End of Life Choice Bill requires that anyone requesting aid in dying be fully and directly informed of that decision's consequences. Their doctor also must use best efforts to ensure the request is free from pressure from any other person.
Two doctors would then independently assess the competency of that person to request aid in dying. If either doctor disagrees about this, a third specialist would be brought in to examine the case.
Compare this process to a lucid person with late-stage cancer who says that they want to end treatment and "let nature take its course". Although that decision will result in the patient's death, their doctor simply has to accept it as a competently made choice without any prescribed process being followed.
As such, we see shifting concerns about "competence", depending on what people are choosing to do. My suspicion is that these concerns don't really reflect an underlying judgment about whether people at their end of life are able to properly consent to treatment; after all, they already do so on multiple occasions every day.
Rather, it comes from a fear that people will choose something those opposed to aid in dying just don't like.
Penk then points to the slippery slope that opponents of aid in dying reliably claim will follow any legislation. In his case, it is to warn that other countries have extended access to people under 18 (which the End of Life Choice Bill would not allow).
It's an interesting argument that we can't possibly change the law today because we cannot trust some future majority of MPs, elected by a future majority of voters, not to change it further.
Laws in New Zealand do not alter by magic; they require Parliament to decide to act.
So, if and when there was some future proposal to widen the range of people who may access aid in dying, that would involve a new bill and full public debate on its merits. If we then collectively think the further change is a good idea, we can do it. If not, then we don't have to.
So, rather than worry about what our future selves may decide to do at some point years from now, we should ask ourselves whether the proposal in front of us today is a good one.
For as Penk notes, allowing aid in dying will mean people approaching the inevitable end of their lives can ask themselves: is my life still worth living? For some people, with their death approaching and experiencing unbearable suffering, the quite understandable answer will be no.
Are we as a society then going to be so cruel as to tell them, in effect, "tough luck"?
* Andrew Geddis a professor of law at Otago University.
Getting his euthanasia Bill to its second reading in Parliament is a big win for David Seymour, according to Newshub's Political Editor Tova O'Brien.
On Tuesday, the Justice Select Committee reported back on the ACT leader's End of Life Choice Bill, which would give people the option to request assisted dying if they have a terminal illness or a "grievous and irremediable medical condition".
As not all committee members agreed it should be passed, all MPs will have a chance to "resolve the broader policy matters" in the House, the committee's report said.
O'Brien said that select committee process had been unprecedented.
"That select committee process was incredibly fraught, it was unprecedented, it went for 16 months, nearly 40,000 submissions," she told The AM Show.
Regardless of if the Bill passes its second reading when it heads back to the House in roughly six weeks, O'Brien said Seymour had accomplished a lot.
"This is huge and I think any MP that gets a Bill plucked out of the member's ballot, it's a lottery in the first place... it is pure serendipitous luck if it comes out," she said.
"To get it plucked out from the ballot and then to not have it shot down immediately is huge.
"Something like euthanasia, which is a major issue in New Zealand and all around the world, this is a conscience vote and to have it kinda progress in the way that it has, this is a big win for David Seymour."
There is still division in Parliament over the Bill, with many MPs, including National's Simeon Brown and Maggie Barry, staunchly against it.
Others outside of Parliament are also opposing it, including the New Zealand Disability Rights Commissioner, the New Zealand Medical Association and Hospice New Zealand.
Former Prime Minister Bill English has come out strong against the Bill, warning that making euthanasia legal in New Zealand would be a "slippery slope" and there weren't enough safeguards in the Bill.
But Prime Minister Jacinda Ardern has signalled her support, something O'Brien said was unusual.
"Often she doesn't really signal which way she is going to go with these things, but she has in this case. I suppose it was going to be public pretty soon, but it can influence people in her party and it can also influence the public."
Public opinion also seems to be on Ardern and Seymour's side, with a Newshub-Reid Research poll last year finding 71 percent of people supported the Bill, with 19.5 percent opposed and 9.5 percent unsure.
But the public will have a more official method of expressing their support if Winston Peters has his way.
"If it does pass, and make its way into law, then it goes out to you, the public, because Winston Peters is only pledging his support for this Bill if there is a referendum," said O'Brien.
"So if it does all pass, and go through in that way, that will be tacked onto the 2020 election."
Media release from the End-of-Life Choice Society of NZ Inc. 9 April 2019
The End-of-Life Choice Society said Tuesday it was disappointed Parliament’s Justice Select Committee’s report into assisted dying was not bolder given the overwhelming support for a law change New Zealanders have consistently shown in reputable opinion polls.
But the society’s president Maryan Street said that it was legitimate to pass the issue to the full Parliament as it will be decided on a conscience vote by MPs. She said the committee was never likely to agree on any significant recommendations on the bill.
“It is encouraging that the committee has left the policy content of the bill largely intact, with only minor, technical and consequential amendments.”
She said not all MPs will have had a chance to hear all the expert submissions on how similar laws with stringent safeguards work overseas where nearly 200 million people in Europe, North and South America – soon to be joined by the Australian state of Victoria – have enlightened assisted dying legislation.
Maryan Street said these laws work without the worst fears of scaremongers being realised. She urged MPs to reflect the majority opinion of New Zealanders, and not be influenced by deliberately misleading information designed to advance a minority agenda.
Maryan Street, President, End-of-Life Choice Society NZ
NOTE: Maryan is overseas until Monday 15 April but available by email and phone
Tel: 64-21 977 555
Released by David Barber, EOLC media adviser 021 072 8760
Over the past 16 months tensions have risen and tempers have flared as a parliamentary committee considers the controversial assisted dying bill. Laura Walters takes a look behind closed doors at the journey of the End of Life Choice Bill.
The end is in sight for David Seymour’s euthanasia bill, after more than a year of public meetings, thousands of oral submissions, and some select committee scraps.
Newsroom understands that during the process, tensions between politicians rose to the point where some members of Parliament's Justice Committee were concerned no report would be produced.
But co-operation within the select committee room has been somewhat restored over the past couple of months, and on Tuesday afternoon the committee will report back to the House with what’s expected to be a revision-tracked report.
Seymour may have hoped the committee process would take the bill slightly further, with the three main changes needed to get the support needed to pass the bill through its second and third reading and onto a public referendum in 2020.
But no matter: if he has to, he will no doubt draft the necessary amendments – with the help of lawyers – and put them to the House during committee stages later this year.
All things being equal, the bill is expected to pass by the end of this year.
Seymour will be hoping that gives Justice Minister Andrew Little and the Electoral Commission enough time to get the question on the ticket in time for the 2020 election.
ACT leader David Seymour entered his own private member’s bill into the ballot in October 2015. Photo: Lynn Grieveson
While it might seem like things are on track now, this is a recent development in what’s been a long and hard-fought battle for the bill.
The proposed law is controversial and lends itself to emotive responses. An added complication is the fact MPs will vote based on their conscience rather than along party lines.
There has also been a coordinated and hardworking opposition campaign, with two leading campaigners sitting on the committee considering the bill in the form of National’s Nick Smith and Maggie Barry.
It all began when former MP Maryan Street presented a petition, asking Parliament to investigate public attitudes to law that would allow medically-assisted dying for people with terminal illnesses or irreversible conditions which were making their life unbearable.
The petition came soon after the court case of Wellington lawyer Lecretia Seales who, diagnosed with a terminal brain tumour, challenged New Zealand's euthanasia laws in the High Court asking for the right to die with the assistance of her GP.
The health committee carried out the inquiry, but then-Prime Minister John Key ruled out the government introducing its own voluntary euthanasia bill.
Seymour’s frustration at the campaign run by the Catholic Church grew.
Seymour’s frustration at the campaign run by the Catholic Church grew.
Meanwhile, ACT’s Seymour entered his own private member’s bill into the ballot in October 2015, and in June 2017 it was introduced to the House.
In December 2017 it passed its first reading in a conscience vote of 76 to 44, with Seymour asking that it be reported back to the House nine months later.
It fast became clear this was a hot topic, and the Justice Committee received more than 35,000 written submissions. Seymour has repeatedly likened the debate to other contentious issues like prostitution law reform, and marriage equality.
Many of the submissions were short – sometimes as little as one sentence – and in line with other submissions from groups opposed to the bill. Seymour’s frustration at the campaign run by the Catholic Church grew.
Well-known Catholics, and the country’s former first couple, Mary and Bill English, were happy to put in the hard yards for the ‘against’ campaign.
Mary English, who is a GP, has spoken at the select committee and at town hall meetings across the country. Her husband, who holds the same view, has also opposed the bill, but it's clear Mary is the more fervent of the two.
National’s Maggie Barry, who was also raised Catholic, has stepped in where the the couple have not been present. Barry has fronted at debates against Seymour, and spoken against the bill at public meetings.
It’s understood she was also the mastermind behind the plan to push for every Kiwis’ right to have their submission heard orally by the committee, if they desired.
This led to an impressive form of filibustering and kept the committee busy for five months.
During the consultation process, about 3500 people asked to speak directly to the committee, but not all who expressed an interest showed up to say their bit. A rough calculation puts oral submissions between 1500 and 2000, spread across 40 hearings. The average length of a submission was nine minutes, and hearings ran an average of six hours.
It is important to hear a range of oral submissions when select committees are considering legislation, as it gives people a chance to speak to their written submission, and for the committee to ask specific questions, or draw on the person’s expertise and experience. But many of the oral submitters expressed the same point of view, and did not suggest ways to change the substance of the bill, rather to state they were morally and spiritually opposed.
Questions were also raised about Barry's demeanour and treatment of submitters during the hearings. Last year, euthanasia advocate Dr Jack Havill lodged a complaint against Barry, saying she was showing bias and was “disparaging to submitters”.
In the end, both written and oral submissions were overwhelmingly opposed to the proposed law.
Analysis by anti-euthanasia group Euthanasia Free, found about 85 percent of published oral submissions were opposed. About 13 percent were in support and 3 percent were either unclear or neutral.
Meanwhile, the Care Alliance analysed almost all of the submissions made on the bill and found 90.2 percent were opposed, 8.1 percent were in favour and 1.7 percent were neutral or unclear. The alliance is also made up of conservative groups opposed to the bill.
However, Otago University research from last year found on average, 68.3 percent of all New Zealanders supported euthanasia with 14.9 percent opposed. The rest were neutral or unsure.
The survey analysed existing research investigating New Zealanders’ attitudes to euthanasia or assisted dying over the past 20 years. It included views of 36,304 Kiwis.
Once the countrywide roadshow wrapped up in November, the select committee came back to Wellington to work on its report to the House, including any changes and recommendations.
This was easier said than done, with a split committee of four Labour MPs and four National MPs, including Maggie Barry and Nick Smith.
The committee’s four Labour MPs voted for the bill in its first reading, and National’s Chris Bishop and Mark Mitchell also voted in favour.
But Newsroom understands National has stuck together inside the committee room, with Smith and Barry continuing to lead the charge against the bill. As recently as February, one member said there was a risk of the committee not producing a report.
By March it looked like National would only support some small technical changes, rather than any substantive amendments, which would be ultimately be needed to get the support of the Green Party and New Zealand First.
But recently, the eight, plus Seymour who has been joining the group as a non-voting member, have improved relations to produce what’s expected to be a revision-tracked report, accompanied by substantial commentary.
That commentary will likely address the amendments necessary to get it through the next two votes.
To be on the safe side, Seymour has produced his own sponsor’s report, which he says outlines recommendations on how the bill might be improved.
This would usually be the job of the select committee, but given the mood of the room, Seymour obviously wanted to be sure he was being as clear as possible about what he thought could be changed, while maintaining the essence and intent of his bill.
It’s understood to also be about half the length of what will be released by the select committee on Tuesday afternoon.
In his report, Seymour suggests including a binding referendum on the commencement of the bill at the 2020 election (in order to lock in New Zealand First’s nine votes). He also suggests amending the eligibility criteria to limit eligibility to terminal illness and, for avoidance of doubt, stating that access to assisted dying cannot be by reason of mental health conditions or disabilities only (to ensure eight votes from the Green Party caucus). He suggests incorporating the Access to Palliative Care Bill sponsored by Barry (in the hope of securing the nine votes needed from National to move it through second and third reading). These changes would be added to the bill at committee stage.
Seymour has told media he is happy with how things have ended, and “quietly confident”.
Now it’s onto the home stretch, with the bill most likely to come up for second reading after Budget speeches conclude in July, and pass by the end of the year, in what's expected to be a chaotic scene in the House, with MPs walking through the doors to vote for each change, as well as to show their final position.
Then the politicians' work is done, and all will be in the hands of voters come polling day, 2020.
Source: Aged Care Insite
Traumatised families and nurses have swamped an inquiry with accounts of harrowing deaths in a bid to convince Queensland to introduce voluntary assisted dying laws.
More than 170 submissions have so far been lodged as the state government attempts to gauge the level of public support for euthanasia.
Early results indicate a groundswell of support for change, with about 140 of the submissions urging a shift to medically-assisted dying with the right safeguards in place.
Just 40 submissions have argued against any reforms, variously describing right-to-die laws as dangerous, state-sanctioned murder and a grave violation of God’s law.
One of the most powerful submissions for change was written by Carol Cronk, who is planning to go to Switzerland to end her life and avoid the kind of deaths her parents experienced in high-dependency dementia wards.
She describes her 93-year-old mother’s death, after she suffered “unfixable” broken shoulders and ribs during a nursing home fall before she was sent to her final “death ward”.
“[She] was forced to live in this death ward in 24hr pain and intense shame, toilet issues, all in her nappy, fed like a baby and machine hoisted, naked, by strangers into a shower. Her everyday screams were for God to take her,” Cronk wrote.
“Personal experiences change our beliefs systems. I have a terminal illness, and have already contacted Dignitas Switzerland re my need to be forced into going over there, to be spared.”
Another supporter, Linda Roberts, has told the government inquiry that she almost gave in when her ailing mother begged for help to die.
Living with cancer and in terrible pain, her mum pleaded for extra doses of heavy-duty pain medication, after telling her family she’d “had enough” and urging them: ‘Please help me’.
“I was shocked that she asked this of me and it took me a period to digest what she asked me to do,” Roberts wrote.
She reached the point where she was seriously considering doing what her mother had asked.
“The only thing that prevented me from granting my mother’s wish was that I had to consider my own two children and the consequences of my actions had I gone through with this.”
One week later, her mother’s pain was no longer manageable at home, and she was put into a palliative care facility. There, Roberts said, doctors approved massive doses to her pain medication and hastened her death.
Former police officer Laurie Paul told the inquiry of attending countless suicides in his long career, but one in Townsville has stayed with him.
“We were directed to the back yard shed. There lay an elderly gentleman who had suicided – his elderly wife and family grieved for him upstairs,” he wrote.
“He had recently been advised that he had cancer and in his loving note to his wife of many years, outlined that he was of the view that he did not wish for her to suffer as he slowly died in front of her, and that she would have to nurse him in the last years of their lives.
“This was wrong and a sad indictment on our society.”
The government inquiry is broader than assisted dying. It’s also delving into the adequacy of aged care, and end-of-life and palliative care.
A large number of submissions supporting assisted dying have been lodged by nurses who work in palliative care, and say the idea that drugs can always manage pain and deal with suffering is nonsense.
“Sometimes there is never a high enough dose of medication to ease the pain,” retired nurse Jill Glover wrote.
Verena Sidler said she’d witnessed countless horrible deaths in her 30 years as a registered nurse.
“I can recall numerous patients with terminal illnesses who spent their valuable energy literally begging myself and other nurses ‘to be put out of their misery, indignation and pain’… until dying.”
When her own father was diagnosed with pancreatic cancer, she was grateful he lived in Switzerland and used that country’s laws to end his life peacefully in his own home.
“Two weeks prior to my father’s death, I asked him what had helped him most to improve his quality of life since being diagnosed with this terminal illness and he answered, the knowledge that he did not have to die a terrible death without having any control.
“I entreat you to consider voluntary assisted dying.”
Of the 40 submissions arguing against change, many said better palliative care options would negate the need for assisted dying laws.
“What the terminally ill who are in pain want and need is proper care and pain relief, not an end to life. Theirs is a cry for help that better and proper palliative care can certainly deliver on,” Karen Mitchell wrote.
Anne Coyle warned voluntary euthanasia would lead to murder.
“It is impossible to control euthanasia once it has been legalised. All countries who have legal euthanasia have records of patients being euthanised against their will,” she said, without citing any specific examples.
Other opponents said God gave life and only he could take it away, a view shared by Donald and Glenice Larsen, who both lost their previous spouses to cancer.
“[They] were afforded the best possible palliative/end-of-life care, in as much as pain control and being made comfortable… As Christians we believe what God has told us in His Word – He is the giver of Life and we have no authority to take it away.”
Public submissions to the inquiry close on April 15.
Media release From the End-of-Life Choice Society 2 April 2019
MP Maggie Barry has resorted to lying in her campaign to prevent a law change that would allow terminally ill patients to die peacefully in dignity with medical assistance, the End-of-Life Choice Society said on Tuesday.
Barry, who is on Parliament’s Justice Select Committee considering the change, told TVNZ’s Q&A programme Monday night that people in Canada with “dementia, anorexia and arthritis” were being euthanased. She also claimed that children were being euthanased without their parents’ knowledge or consent.
None of that is true, EOLC vice-president Mary Panko, of Auckland, said Tuesday. To qualify for medical assistance in dying (MAID) under Canada’s law, people must be 18 years of age or older and have a grievous and irremediable condition.
They must have made a voluntary request, not under any external pressure, be evaluated by two independent doctors and give informed consent to MAID after being informed of means to relieve their suffering, including palliative care.
They must have a serious and incurable illness, disease or disability, be in an advanced state of irreversible decline, endure physical and psychological suffering that is intolerable and their natural death has become reasonably foreseeable. They must be mentally competent of providing informed consent at the time they receive MAID.
Ms Panko said: “It does not serve democracy when an MP deliberately seeks to foil a law change that 70% of voters want - despite a vigorous misinformation campaign based on blind dogma - with tactics designed to frighten the uninformed.
“She slurred the medical profession by asserting that some doctors would ignore the extensive safeguards in David Seymour’s Bill, accused the disabled of not being able to make their own decisions and claimed that a large segment of the population would want their parents or grandparents dead.
“Her tactics, seeking to stop New Zealanders getting an enlightened law of choice that nearly 200 million around the globe now have, are dishonest and dishonourable for someone who claims the title Honourable.”
Mary Panko – firstname.lastname@example.org Tel: 027-419-7802
Released by David Barber, EOLC media adviser 021-072-8760
How interesting that Michael Vanderpump (Letters, April 8) should mention "common sense and the truth" when opposing the End of Life Choice Bill.
These qualities have been singularly missing in the dogma-based opposition to the measure. It is common sense that people should not have to suffer in their dying days - and there is ample evidence that currently some do.
And the Honourable Maggie Barry has repeatedly dishonourably and dishonestly told lies in her rabid opposition to a law change that a clear majority of New Zealand voters want.
by Matt Vickers
After being diagnosed with a brain tumour, lawyer Lecretia Seales took a case to the High Court challenging for her right to die with the assistance of her GP. Photo/Listener/Hagen Hopkins.
As Parliament’s Justice Select Committee prepares to report back on David Seymour’s controversial End of Life Choice Bill, Matt Vickers – the widower of assisted dying advocate Lecretia Seales – makes his case for death with dignity.
Most of us take few one-way journeys in our lives. No matter how far we venture from home, whether for a day, a week, a month or for years, we usually return. Leaving home for good is generally paired with a major life event: university, a new job, marriage. A new start in a new place.
But not every one-way journey is about starting a new life. Every year, around 200 people make a journey to end one. They travel from their homes in Britain, Australia and New Zealand, to go to Zurich, Switzerland to die.
An appointment in Zurich does not have the same connotations as the fabled meeting with “Death” in Samarra. It’s a beautiful, scrupulously clean city stocked with watchmakers, wine bars and chocolatiers. In September, its narrow cobbled streets smell faintly of candy-floss. Bankers and tourists sit outdoors at the restaurants and bars lining the Limmat River, their minds more inclined toward skiing than mortality.
It’s here that Dignitas does its work, giving people suffering from dreadful illnesses or terminal prognoses a way to cut their lives short. Switzerland is not the only country in the world to offer assisted dying, but if you want assisted dying and you don’t live in a country that offers it, Switzerland is the only country in the world willing to help a foreign citizen like you.
Silvan Luley, a tall, grey-haired Swiss board member of Dignitas, is not happy about that. “It’s an atrocity that someone from Australia, New Zealand, the UK or anywhere on this planet has to travel to Switzerland if the only thing that he or she wants is to have a peaceful end to their suffering in life. How can a state treat people, who pay taxes all their lives, this way; to say, ‘If you want to end your life self-determinedly, I don’t care, go to Switzerland.’
“We shouldn’t be here. Dignitas shouldn’t exist. And this is actually our goal: to disappear. This is what we have been working for, for 18 years. Because when other countries allow sensible choices for their people, then they don’t need to travel here. And if we have implemented that around the world, then we can close down.”
New Zealand’s latest debate on assisted dying was partly initiated by my late wife, Lecretia Seales, who sought to have the right to be assisted to die if she chose to. She wanted to be able to access services such as those offered by Dignitas, but not to have to leave her country to get them. Like almost everyone, she wanted to be close to her home and her family when she died. But she also wanted control over how and when it happened.
My wife died in 2015 without winning that choice, but New Zealanders may end up with more options about how they die very soon. The End of Life Choice Bill, a members’ bill sponsored by Act MP David Seymour, which aims to offer assisted dying, is due to come back to parliament for a second reading sometime in the next few months.
Luley has no doubts about the importance of having assisted dying as an option. “It’s not about doing it or not doing it. It’s a choice. There’s an emergency exit door if the worst comes to the worst. I don’t need to go through that door, but it’s good that it’s there.”
The Dignitas office is about 30 minutes from the centre of Zurich by train, in a nondescript building with no signs on the door. Inside is a quietly efficient workplace with around 10 staff. In one room, there are four floor-to-ceiling file carousels, each filled with coloured folders. Each colour means something different: a blue folder means a case is under assessment; red, a person is no longer a member of Dignitas; yellow, a case has been approved but the individual has not yet chosen to come to Zurich (and may never come; approval provides the option to travel to Zurich, but not the obligation); and green, an individual completed the vetting process and was assisted to die at his or her home, or at one of the homes provided by Dignitas.
Swiss citizens strongly support the existence of Dignitas and organisations like it: in 2011, two religiously motivated political parties initiated two referendums, one to prohibit assisted dying and the other to end what they called “suicide tourism”. But 85% of Zurich citizens voted to keep assisted dying legal, and 78% voted to continue to allow foreign nationals to access it.
I ask Luley what the people who come to Switzerland are like. “Very autonomous, self-determined people,” he says. “In fact, that’s what most people write in their requests. ‘Look, I’m now 80, I’ve survived the war, I survived the Depression times after the war, I’ve worked all my life and I’ve done what a man needs to do and I’ve brought up my family and so on. It’s my life, it’s my choice... I’m going to [keep deciding] until the very last moment, and it’s my decision to end my suffering when I want.’”
This is consistent with findings in Oregon, the first US state to legalise assisted dying, in 1997. Studies have shown applicants tend to be disproportionately well-educated, wealthy and white: the very opposite of what society and critics would consider vulnerable.
Does Luley worry about coercion, or that a person’s motivations may be inauthentic? “I’ve never seen that. Maybe it has to do with the procedure and how the system works, especially with people coming from abroad. They go through at least a three- to four-month preparation procedure, and repeatedly have to show they want to go this way and that no one is pushing them. Apply for membership, fill out the advanced directive, write the formal request, write the life report, the CV, gather the medical reports, proof of identity and documentation and send it all to us. It’s a lot of paperwork they have to do, and they have to take the initiative themselves again and again.
“People who have thought about their situation and consider the options and then decide rationally to end their life… it takes a lot of courage. I don’t know whether I would be able to do that. I think we humans are just like animals, we cling on to life because that’s all we have in this world. Our brain stem tells us to live and to prosper and to have kids and to live on and longer. Deciding against that very basic driving force within us, and to say ‘No, with my intellect, I decide to overrule that, and end everything’ – that’s very brave.”
Read more: Why is altruism left out of the euthanasia debate? | Euthanasia: Exposing the tactics used by the Catholic Church
The Swiss assisted-dying clinic Dignitas, in Pfaeffikon, near Zurich. In Switzerland, providing the means for a person to take their own life is legal if done from non-selfish motives.
In New Zealand, the Swiss example – where doctors may only “assist” by providing the means to die – is rarely mentioned. Opponents focus on what they perceive as the broad remit of the Dutch and Belgian regimes, or the unsupervised example of the Oregonian model.
“In Switzerland, the assisted dying system has been working almost perfectly fine for 35 years, supported by physicians and with the assistance of non-profits like Dignitas,” says Luley. “We are not a good example for opponents, because... they would have to admit the most progressive-liberal system works fine, without abuse, without people being pushed to commit suicide. Without so-called vulnerable groups being under threat, without the value of life being eroded.”
In Oregon, a patient must be terminally ill with a prognosis of less than six months to live, but once that criterion is met and the doctors satisfied through a series of consultations that the patient is acting rationally, they are prescribed a medication they take home with them, and that they are free to take any time. However, they must take it without assistance.
In the Netherlands, a patient must have grievous suffering and be able to satisfy doctors they genuinely wish to be assisted to die. However, the drug is administered by a doctor under medical supervision; they are not permitted to take the drug themselves. In Belgium, doctors can help patients to end their lives when they freely express a wish to die because they are suffering intractable and unbearable pain.
Seymour’s bill, with the support of parliament, may settle on criteria similar to Oregon’s, but with a more Dutch- or Swiss-style system of supervision. This greatly restricts the ability for people to get assistance to die, but it also ensures that complications with taking the life-ending drug – a criticism of the unsupervised Oregonian system – are minimised, as a professional is on hand to ensure it is administered correctly.
For me, a terminal illness is what clearly distinguishes an assisted death from suicide. When death is imminent and inevitable and there is no choice to live, dying without suffering is inarguably humane. In New Zealand, where suicide statistics are a national tragedy, being able to make a clear distinction between assisted dying and suicide is important.
Opponents argue that six months is very subjective, and a patient could live for many months more. And that’s true. But six months simply gate-keeps the long, administrative process of winning access to assistance – it is not the timeframe in which the drug must be taken. The data suggests patients who do end their lives early do so by an average of fewer than 10 days.
But Dignitas does not think a six-month prognosis is a good place to draw a line. In this, it agrees with groups such as New Zealand’s End of Life Choice Society (until recently the Voluntary Euthanasia Society), run by former Labour MP Maryan Street. “Discrimination is not the way to go, and a six-month terminally ill model is definitely discrimination against people with long-term ailments who suffer badly but are not expected to die in a few months,” says Luley.
However, he acknowledges the line has to be drawn somewhere. “There is probably always a certain category of people who really suffer, but how do you want to make it objective? One thing is for sure: people wish for real freedom of choice in end-of-life issues. A restrictive law, such as in Oregon, does not live up to what all supporters want. It leaves many suffering people in despair, having to take to drastic measures, such as a lonely, risky suicide attempt, with dire effects on themselves, their loved ones and society in general. Or they travel to Dignitas, if they still can.”
Luley and I emphatically agree on one point: “Giving access to assisted dying is, in fact, suicide prevention and suicide-attempt prevention.” In Seales v Attorney General, this was upheld by Justice David Collins, based on 100 years of evidence from New Zealand’s coronial records. About 5-8% of all suicides here are people attempting to escape the worst of their medical conditions, killing themselves in awful, lonely and often violent ways.
These people might live longer if they could talk freely to their doctor about assisted dying, whether they go through with it or not. Under the current law, a huge part of the problem is people not talking to medical professionals about a wish to end their life early.
The writer, Matt Vickers, holds a photograph of his late wife Lecretia Seales while making a submission to the Justice select committee considering the End of Life Choice Bill in August 2018. Photo/Mark Mitchell/NewspixNZ.
Dr Juan Mendoza-Vega was the president of Fundación Pro Derecho a Morir Dignamente (DMD), a Colombian right-to-die organisation, and until 2015 the only substantial organisation of its type in Latin America. Sadly, Mendoza-Vega died in 2017 of natural causes, but I had the opportunity to meet him in Bogotá before he passed. There, he worked with his team to facilitate assisted dying for Colombians, supported by a constitutional ruling won two decades earlier.
Colombia is an anomaly in the short but growing list of countries that allow assisted dying. Generally such countries are Western, democratic and secular. Colombia is a Catholic-majority country (73% of its citizens are Catholic), surrounded by five other Catholic-majority countries. Its population is primarily made up of the soccer-playing sons and daughters of Spaniards, indigenous Americans, and Africans. In fact, the legality of assisted dying in Colombia is due only to a legal own goal.
Under the Colombian penal code (the equivalent of our Crimes Act), murder and assisted suicide are illegal. Unlike our Crimes Act, the code explicitly spells out that a murder or assisted suicide with a motivation of pity, to end intense suffering from bodily injury or disease, is also a serious crime. However, this category of crime – a crime of compassion – has a slightly lesser sentence.
A crusading young Bogotá lawyer, José Eurípides Parra Parra, believed that having lesser penalties for murder and assisted suicide based on motivation violated the right to equality in the Colombian constitution. He believed that no matter the motive of the criminal, a victim of murder or assisted suicide deserves equal justice, and thus an equal sentence for the offender.
However, his case had the opposite outcome to the one he intended. The Colombian Constitutional Court instead ruled that if a terminally ill patient had given authority to have their life ended, then a physician helping them could not be held criminally responsible. Not only did this contradict the penal code: as superior law, it overruled it. With one decision, the court legalised assisted dying for the entire country. Assisting a suicide was still illegal, but voluntary euthanasia performed by a physician on a willing patient was no longer a crime.
In 2014, Ovidio Gonzalez, a 79-year-old Colombian man suffering from throat cancer, sought to be assisted to die, but couldn’t find a physician who would help him. Most doctors believed it was still illegal despite the constitutional ruling. Gonzalez petitioned the court, and the court not only reaffirmed the patient’s right but instructed the Colombian Ministry of Health to provide norms and practices for assisted dying. Since then, assisted dying has been unambiguously legal.
Have the floodgates opened since then? Mendoza-Vega told me they hadn’t. In the most recent year he monitored, there were no more than six assisted deaths recorded in the whole country. “It’s not very frequent,” he said.
But for him, the number wasn’t important. He echoed Luley on the importance of choice. “Dignity in dying is really respecting the person who is dying until their last moment; respecting his or her will and decisions... If that person decides to suffer, that’s dying with dignity also. If this person says, ‘I want palliative care,’ that’s dignity in dying. We respect a person choosing euthanasia, and we respect all other forms of dying that he or she decides.”
Unlike the Dutch and Belgian models, the Colombian model has not had a great deal of public scrutiny in Western media. A patient who wishes to be assisted to die will contact DMD, which will aid the person, but with the same checks found in Western countries, including a review by two doctors and a psychological assessment. The person has to have a terminal diagnosis, with no corrective treatment available.
By working quietly, DMD aims to avoid scandal and protect the privacy of the family of the deceased. Colombia is prone to having the public details of any cases excoriated by an unsympathetic media, despite both doctors and the general public supporting the right of patients to access assisted dying. With his blessing, Gonzalez became a cause célèbre, but others are less inclined to go public with their plight. “Sensationalism is the worst for our work,” said Mendoza-Vega. “It tends to make what we do a spectacle and a circus. That’s the worst for objective discussions.”
I asked him for his views on the Dutch and Belgian models.
“I think in Belgium and the Netherlands they are acting according to their society’s beliefs and attitudes. Those attitudes are not the same as in the society of Colombia or in Latin America. So we must have our own ways and positions about this. We must have in mind the beliefs of our people and their attitudes.”
I often wonder what New Zealand’s attitudes are in relation to assisted dying. To me, assisted dying appears completely consistent with the stereotypical Kiwi values of rugged independence, tolerance, fairness, personal responsibility, and individual freedom and choice. In fact, those values are not too far from the ones listed in the manifestos of our two major political parties.
After spending time reviewing Seymour’s bill, I believe it is consistent with those values, while being a sensible Kiwi approach that learns from overseas experience. In particular, the proposed legislation doesn’t favour one method of assisted dying over another, leaving that entirely up to the individual, and what the doctor is willing to do. There are five permitted methods in Seymour’s bill: ingesting the medication oneself, orally, via a tube or intravenously; or a doctor supplying the medication via a tube or injection. By allowing all of these approaches, the legislation avoids hair-splitting about what is moral and what is not, and leaves it up to the patient and the doctor as to what their conscience will bear.
But no matter the method, the legislation is in keeping with New Zealand’s identity as caring and compassionate, by requiring an individual to be under medical supervision when any steps are taken to have their life ended.
Dr Anne Turner is helped by her son Edward from the Dignitas clinic in Forch, Switzerland. The retired British doctor had been diagnosed with progressive supranuclear palsy, a degenerative neurological disease for which there is no treatment. Her late husband, Jack, died of a similar condition, multiple systems atrophy, in 2002. Turner travelled to Switzerland from the UK, where assisted dying is illegal, and ended her life with medical assistance from Dignitas in March 2006. Photo/Getty.
Alongside the End of Life Choice Bill, New Zealand has been tightening its laws around assisted suicide. The Harmful Digital Communications Act was passed in 2015, amending parts of the Crimes Act to make inciting, counselling or procuring another person to commit suicide illegal, even if that person doesn’t end their life. The amendment doesn’t distinguish whether this is done electronically, as has been alleged in the case of MP Sarah Dowie’s text message to Jami-Lee Ross, or in person.
The conversation between doctor and patient around end-of-life choice is a tightrope. Under the previous law, a doctor coercing a patient into assisted dying would be unambiguously illegal. Now, under the amended act, a patient doesn’t even have to act on the suggestion for a doctor to be liable. Opponents fear that making assisted dying legal will have doctors pushing it on vulnerable patients, but it stands to reason that if a patient hasn’t asked, then it doesn’t fall under the End of Life Choice Act and may be a prosecutable crime under the Crimes Act, particularly if the suggestion is unwelcome and made persistently.
Even in a socially liberal country like the Netherlands, the conversation is a very careful one. Dr Rob Jonquiere is a former GP and current executive director of World Federation of Right to Die Societies. I met him in Amsterdam in a quiet cafe on the edge of the harbour. He has had these conversations with dying patients a few times.
“It is still, for most doctors, the most difficult request they can get, the patient asking the doctor for his help. Every doctor will immediately get in a kind of fighting stance and say, ‘Let’s see what we can do to make things more bearable.’”
I mention the arguments from some sectors of the disabled community: that doctors may unilaterally decide that a life is not worth living and may encourage someone suffering a severe disability to seek assisted dying. (Seymour has recently suggested amending his bill to state explicitly that disability is not a sufficient criterion on its own for assisted dying, although this was always implied.)
“I cannot imagine a decent Dutch doctor talking a disabled person into euthanasia. There is, of course, a possibility that in the communication between a doctor and a disabled person, which many times is a very close relationship, the doctor gets more and more the impression that actually the disabled person doesn’t accept his or her life anymore, and wants to do something about it but doesn’t want to talk about it. Then I can imagine that somewhere in that communication as a doctor, you carefully bring up the subject – not as a fact of ‘I’m going to do it’, but as a possibility they can think about.
“I would imagine that if you applied euthanasia to a patient who was disabled and reported it to the review committee, you would be immediately picked out and your case seriously scrutinised for possible referral to a prosecutor.”
Opponents have pointed to a lack of prosecutions in the Netherlands as suspicious: either the law is working perfectly with its system of oversight and review, and doctors are working within the law, or it isn’t, and doctors are quite literally getting away with murder.
But despite a lack of court hearings, cases have certainly been referred to prosecutors and health inspectors. Jonquiere estimates between 10 and 15 cases were referred every year for the past 10 years for violations of the carefully detailed procedure. However, despite the referrals, prosecutors have not elected to bring a case against the doctors named, usually because the infractions were bureaucratic oversights, not because something had gone drastically wrong.
Just last year, however, a doctor was prosecuted for not following the procedure outlined by the law – the first Dutch prosecution since assisted dying became legal in 2002. It’s alleged an elderly dementia patient had previously asked for assistance to die, but when the time came, was unable to clearly express her wish to the attending doctor. According to the claim, the doctor enlisted the help of the patient’s family to gently restrain the patient, in order for the life-ending medication to be administered. Dutch procedure states the patient must reaffirm their wish clearly at the time they are being assisted to die.
The case highlights the complexity of allowing advanced directives: a written document that specifies what you want from your end-of-life carers ahead of time. Do you respect the wishes of the previously competent individual, or the non-competent individual suffering from dementia, whose instinct to survive has set in?
“This is one of the big issues in the Netherlands... The first thing is we put in our law that an advanced directive is legally equal to an oral request when you are not able to put forward an oral request. Which means at the moment of euthanasia, you don’t need the patient to say, ‘I want euthanasia’ if there is this advanced directive saying, ‘I want euthanasia.’ You can say things have been completed in the proper way.
“[But] the doctor giving euthanasia wants to look his patient in the eye and say, ‘Is this really what you want, because if I push the needle, it’s over. No return.’ And the big issue is, if you have a demented person, is this what they want? What is the value of the answer?
“We introduced in the Netherlands the concept of five minutes to 12... As a doctor and patient, you have to talk regularly, and you have to find out actually the point where the dementia is far enough but not yet too far, so that you still can say, ‘I want euthanasia.’ And it is so far that the doctor can still clearly identify the situation as suffering, that is the moment, at five to 12, one to 12, just before 12. If you are after 12, it is too late.”
I tell Jonquiere that I think this is a very fine line, and it is part of the reason I don’t support advanced directives for euthanasia. Seymour’s bill doesn’t, either. For me, there can be no question of competency, no question that there is a real, genuine request.
“It is a balancing act,” he concedes.
Still, the recent prosecution supports the case that there is sufficient oversight. Jonquiere agrees: “Things happen which should not happen, but that happens everywhere. And I even dare to say they happen more often in countries that do not have a law.”
The evidence supports Jonquiere’s claim, especially in New Zealand. In 2000, Dr Glynn Owens, a professor (now emeritus) of psychology at Auckland University, conducted a survey of 1000 New Zealand GPs to determine the prevalence of physician-assisted dying in this country.
The research found that 3.5% had provided at least one physician-aided death at some point in their career, a similar percentage to the Netherlands, where aid in dying is lawful. Also, in the New Zealand survey, 2.7% of physicians admitted to having aided death without the explicit request of the patient. This may have been through palliative sedation, withdrawal of life support, or possibly something more ominous. Strictly speaking, terminating life without consent is involuntary or non-voluntary euthanasia, i.e. murder. And that is not legal anywhere in the world – not in the Netherlands, not in Belgium, not in Switzerland and certainly not in New Zealand.
Worse, the proportion of these types of cases was higher in New Zealand than reported in the Netherlands. The survey also found the availability or non-availability of palliative care had no effect on the physicians’ decisions to act with intent to hasten death.
The incidence of these involuntary physician-assisted deaths has reduced in the Netherlands and Belgium since legalisation of assisted dying. Are life-ending acts without patient request still happening in New Zealand? We don’t know. We don’t do any sort of reporting that would tell us. It’s the sort of thing doctors will only admit to in an anonymous survey.
Even opponents would have to concede that the End of Life Choice Bill, with its system of checks, balances and reviews, would give us much more information about end-of-life practices in New Zealand than we have now.
Trust in Dutch doctors is similar, if not a little higher, relative to other countries. An International Social Survey Programme collected data between 2011 and 2013 and found public trust in doctors was the highest in Switzerland, at 83%. In the Netherlands, the figure was 78%, while in Belgium it was 74%. In the United Kingdom and France, where assisted dying is not permitted, the figures were 76% and 75% respectively.
Dr Rob Jonquiere, a former GP and current executive director of the World Federation of Right to Die Societies. Photo/Andrew Warner/NewspixNZ.
Despite being the face of the right-to-die movement, Jonquiere has only helped a handful of people to die as part of his role as a general practitioner.
“I have assisted only two. I know three more I didn’t need to assist, because they died before the final request came, and I think about five or six did not even go into that phase. They had a request, but I could make the suffering bearable, or I had other reasons to say no. I had discussions with those two patients for three to six months before euthanasia was complied with.”
Did anyone ever change their mind? How did you feel about that?
“I feel okay. Because I act from the principle that you are the one who wants it, not me. I’ve had it happen only once. I can’t remember that I was happy about it or not. I know from that one time, two days later I practised euthanasia [on the patient]. It was just a moment where the patient said, ‘I’m not yet ready.’ They needed a moment of contemplation or realisation about what was really happening. That is why I want to know just before giving the injection – is this what they want?”
I asked how it felt to help someone to die.
“In none of the cases have I had any feeling of regret. One of the moments, I can even remember the smell of when it happened. It makes a big impression. I’ve always felt afterward, on the one side sorrow, because I lost a dear friend. Because talking to a patient about this kind of intimate, very personal issue, you get a kind of relationship, and you lose that relationship because the patient died. On the other hand, [I felt] a kind of happiness, that I could provide my friend with the last intimate wish they had. I had a couple of times where I dreamt about it. But I didn’t have sleepless nights. I had no second thoughts afterward.”
I wondered aloud whether some doctors do. “Certainly there are doctors who do and for that reason stop practising euthanasia. But they don’t say it’s a bad thing, they just say they cannot cope with that situation.
“You have to know someone. If you come to me, I’ll say, let’s talk about it. Come back tomorrow and we’ll sit down and have a serious talk. In a harsh way, you have to convince me that you are really suffering and I’m going to try and convince you that you’re not hopelessly suffering.”
I wonder whether those conversations are missing in New Zealand, and whether people who are contemplating a hastened death, for rational or irrational reasons, are talking to their doctors about it.
One of the reasons I’m in support of this law is so these conversations might happen more often. We are all afraid of dying, and when faced with it, we have wishes about how it might happen, and where it might happen, and with whom. But if your doctor isn’t going to listen to your desires – all of them – and take them seriously, why would you even have the conversation?
It’s my hope that with assisted dying as an option, the most desperate of us will discuss those wishes with their doctor, rather than doing something drastic and impulsive, which can only hurt our loved ones and our communities. Given 5-8% of suicides in New Zealand are people with grievous illnesses, perhaps with assisted dying we can help them live a little longer. Perhaps we can actually reduce the incidence of suicide in New Zealand. I believe it’s worth a try.
In a few months, we will find out whether our elected representatives will support that view. It is clear that current efforts to address suicide in New Zealand haven’t been working. It’s our national shame. But anything that encourages more people to talk to their doctors about death has got to help. And in my view, the End of Life Choice Bill will encourage exactly that.
Let’s hope our MPs boldly walk toward the light – and the bill passes.
Matt Vickers is the author of Lecretia’s Choice (Text Publishing). For more information, visit lecretia.org.
This article was first published in the April 2019 issue of North & South.
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