Dr Carmen Chan – Assisted dying’s inequity problem

By September 14, 2020 Recent News

NewsRoom 11 September 2020
Family First Comment: “If you had asked me as a medical student some years ago, I would have told you that I supported the proposed End of Life Choice Act. We put down our animals when they are suffering. Who’s to say that we can’t have the right to control how we end our own lives when we live with a terminal illness? But now as a practising clinician, I have many doubts about the proposed law on euthanasia. The conversation is much more complex and nuanced than what you’ll commonly read in the media – which is why I feel the need to speak out…

“..Euthanasia is an equity problem. It broadens the gap in health outcomes for those already having trouble getting fair access to care – for example, Māori and Pacific populations, rural communities, those impoverished and anyone already marginalised by the healthcare system. For me, it’s obvious who would be more likely to opt to end their lives early through euthanasia because they cannot access the medical care and support that they need. We need to think very carefully about what this legislation might end up doing… Rather than endorsing euthanasia, I want to call upon our government to strengthen palliative care, social services and support systems.

Emergency medicine resident medical officer Carmen Chan shares her concerns about euthanasia as an equity problem and explains how it broadens the gap in health outcomes for those already having trouble getting fair access to care

I’m awake at 5am and writing this before my shift starts. As a doctor, euthanasia weighs on my mind. Death’s not an easy topic to broach but we need to start talking about it – now. In a few weeks, along with voting in a government, we’ll be making some hefty decisions around how we approach the end of life as a society.

If you had asked me as a medical student some years ago, I would have told you that I supported the proposed End of Life Choice Act. We put down our animals when they are suffering. Who’s to say that we can’t have the right to control how we end our own lives when we live with a terminal illness? But now as a practising clinician, I have many doubts about the proposed law on euthanasia. The conversation is much more complex and nuanced than what you’ll commonly read in the media – which is why I feel the need to speak out.

I have witnessed many deaths. I have watched my own grandmother die in ICU, and my uncle die from end stage lung cancer. I have seen people dying on the wards, and I have seen the results of botched attempts at suicide in the emergency department.

Being called to certify the death of someone who has been long suffering through an illness, knowing that they have finally passed away and are no longer suffering is sometimes a relief. Watching someone die can be really hard. By the time someone is at their deathbed – agonal breathing and unconscious, the most difficult thing in the world is being the loved one sitting at the bedside watching it all happen. But think carefully. Who are we most benefiting with this legislation? We need our minds and our hearts open: euthanasia is an irreversible procedure.

I’ve seen this happen: Reginald* is diagnosed with end-stage lung cancer in Auckland. He is rapidly linked with an oncologist, referred to palliative care doctors and they help him to arrange his plans. They offer counselling, arrange family meetings, help him sort out his affairs, and arrange for him to have a hospital-in-the-home bed and oxygen kit. When he reaches his final days, there’s a clear Advanced Care Plan organised with Reginald for when to withdraw active treatment. Medicine is used only to ease his discomfort and pain.

A palliative care team or his GP visit him regularly at hospice or at home to make sure that his needs are met. If during that process where his breathing makes home too hard to manage, he can choose to be admitted to hospice to be cared for by nurses for respite so that his family can rest. His needs and comfort are the priority until the day he dies. This is palliative care.
Dr Carmen Chan is a full time resident medical officer currently working in the country’s emergency frontline services.
READ MORE: https://www.newsroom.co.nz/assisted-dyings-inequity-problem

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