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Legalising assisted dying can actually increase suicides

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MercatorNet 17 September 2020
Family First Comment: “I used to believe that it was possible to regulate and restrict killing to terminally ill mentally competent adults with less than six months to live. I also thought that regulating suicide and death in this way would curtail those tragic cases where someone ends their own life. I was wrong. If there is one thing I learnt in my country, it is that legalising assisted dying will not constrain the numbers. Deep down, many campaigners consider the legalisation of assisted dying for terminal patients merely as a stepping stone towards further liberalisation.”

Recently I addressed a group of Parliamentarians in London about assisted suicide and euthanasia. My talk, which coincided with World Suicide Prevention day, sought to address the unintended consequences of legalising assisted suicide and euthanasia in the Netherlands.

One of the arguments we hear is that assisted dying will bring down the number of violent suicides. It will provide a more peaceful death to patients in unbearable suffering who would otherwise have violently killed themselves. For other patients, the mere option of assisted dying (even if it will never be effectuated) is said to be a reassuring thought that will keep them from killing themselves.

I admit that these arguments may hold in individual cases. However, on the whole, the argument is mistaken.

In the Netherlands, assisted dying gradually became available for patients commonly considered to be at risk of committing suicide: psychiatric patients, people with chronic illnesses, dementia patients, and elderly people without a terminal disease.

But instead, the suicide numbers went up: from 1,353 in 2007, they went up to 1,811 in 2019, a rise of 33.8 percent. In surrounding countries, most of which have no assisted dying practice, the suicide numbers went down. Germany, with a population much like the Dutch in terms of age, economy, and religion, saw its suicide numbers decrease by 10 percent in the same period.

One hypothesis I increasingly accept as an academic and as someone who worked for almost ten years in monitoring and reviewing assisted dying cases for the Dutch authorities is the normalising effect that legalising assisted dying has had on the general population.

We already know from the literature that when one person takes their own life, it can be a catalyst for others. Indeed, there are over 50 peer-reviewed studies reaching the same conclusion in what has been dubbed suicide contagion, copycat suicides or the Werther Effect. Not without reason, and based on advice from the World Health Organisation, the media go to great lengths to censor details that could trigger further suicides. Unfortunately, the same can’t be said about their carefulness when reporting assisted suicide stories, the great majority of which express an ill-informed and naïve sympathy for assisted dying.

The Netherlands should act as a cautionary tale to those in power in the UK. Like many of the current supporters of assisted dying, I used to believe that it was possible to regulate and restrict killing to terminally ill mentally competent adults with less than six months to live. I also thought that regulating suicide and death in this way would curtail those tragic cases where someone ends their own life.

Theo Boer is Professor of Health Care Ethics, Protestant Theological University, Groningen, the Netherlands, and visiting Professor of History of Ethics, University of Sunderland
READ MORE: https://mercatornet.com/legalising-assisted-dying-can-actually-increase-suicides/66597/
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Experts discuss arguments for and against assisted dying ahead of election referendum

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TVNZ One News 18 September 2020
Family First Comment: One is a ‘researcher’. The other is a real doctor – a palliative care specialist with real world experience and dealing daily with the care of actual people.
WATCH as she DESTROYS the argument of the pro-euthanasia academic!

“We care for people who are facing their death every day. … We live in the real world. When we read this act as it’s written and apply it to the real world, it leaks. It’s not waterproof or safe in any way. There are multiple reasons and multiple risks we’ve identified.” She said it could be difficult to judge whether a person was being coerced into assisted dying because coercion can be subtle.

“We care for people who are facing their death every day. … We live in the real world. When we read this act as it’s written and apply it to the real world, it leaks. It’s not waterproof or safe in any way. There are multiple reasons and multiple risks we’ve identified.” She said it could be difficult to judge whether a person was being coerced into assisted dying because coercion can be subtle.

Two euthanasia experts spoke to TVNZ1’s Breakfast about their views on assisted dying ahead of the End of Life Choice Act referendum in this year’s election.

Care Alliance’s Dr Sinead Donnelly, a palliative care doctor and senior lecturer at the University of Otago, outlined the arguments against the act. Care Alliance is made up of a range of organisations, including providers of end-of-life palliative care in New Zealand.

Donnelly said she was opposing the act as it was written.

“We’re concerned about the risk and we don’t believe that it’s safe,” she said.

When asked why she believed the act was unsafe, despite the High Court and lawyers saying there were more than 45 safeguards, Donnelly said the Care Alliance was looking at it from a practical view.

“We [at Care Alliance] care for people who are facing their death every day. … We live in the real world.

“When we read this act as it’s written and apply it to the real world, it leaks. It’s not waterproof or safe in any way. There are multiple reasons and multiple risks we’ve identified.”

She said it could be difficult to judge whether a person was being coerced into assisted dying because coersion can be subtle.

There are also challenges to making a prognosis that someone only has six months left to live, Donnelly said.

“Prognosis is an estimate. International literature and our own daily experience shows we’re often wrong about prognosis.

“How can you create a safe law when the consequences are the death of a person with such imprecise so-called safeguards?”

Donnelly said, in her experience, it was common for people to feel as if they were a burden.

“I feel they’re actually going to feel a greater burden. They now have to choose, ‘Do I ask for this or not?’”

She said it was already legal for people to ask for treatment to be stopped.

She said the palliative care system is rapidly developing but it is “chronically underfunded” in New Zealand, and there are inequities to accessing quality care.

This means people may not have a true choice between palliative care and euthanasia, Donnelly said.
READ MORE: https://www.tvnz.co.nz/one-news/new-zealand/experts-discuss-arguments-and-against-assisted-dying-ahead-election-referendum

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Euthanasia referendum: Should it be a health priority for New Zealand at present?

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Stuff co.nz 19 September 2020
Family First Comment: Important questions:
“If the referendum is passed, money and time will be put into establishing a bureaucracy to deliver aid in dying, and doctors will have to provide the service. This represents an opportunity cost, as these resources cannot be spent on other aspects of the health system. To comply with the law there is a lot to do. There are committees to be formed and policies to be written. All doctors will need to decide if they want to take part. All practices and hospitals will have to respond to someone who seeks assisted dying”

OPINION: Discussion of the euthanasia referendum has mostly been around the ethical question of whether euthanasia should be allowed. There has been little discussion about whether this is a priority for action now.

If the referendum is passed, money and time will be put into establishing a bureaucracy to deliver aid in dying, and doctors will have to provide the service. This represents an opportunity cost, as these resources cannot be spent on other aspects of the health system.

To comply with the law there is a lot to do. There are committees to be formed and policies to be written. All doctors will need to decide if they want to take part. All practices and hospitals will have to respond to someone who seeks assisted dying and that is likely to lead to a lot of discussion and debate.

Hospices have already said they will not do this but what about all the other providers? Whilst the financial costs will be balanced by the money saved in someone dying earlier and not requiring some pension or some care costs, the personnel resource and the time spent setting systems up needed to do all this is still problematic.

What is the size of the potential quality of life benefit?
If the referendum passes, we don’t know how many people would seek aid in dying. A reasonable comparison would be with Oregon.

Oregon has a population of 4.2 million (New Zealand 5 million) and has had a Death with Dignity Act in force for the past 22 years. Their Act is similar to ours. Their experience is that patients are older, on average 74 years (range 33-98 years).

Just over 50 per cent of patients had a university degree and 96 per cent of patients were white. In 2019 a total of 188 people were assisted to die, 0.51 per cent of total deaths.

During the first five years of the Act around 25 people a year (around 0.08% of total deaths) were assisted to die. Whilst there are differences between Oregon and New Zealand, we are alike enough for this to give us some idea of what might happen here.

If this level of demand is reflected in New Zealand, then it will benefit a few people from a group who can afford the costs and who already get significant benefit from our health system.
– Ben Gray is a senior lecturer in Primary Health Care and General Practice at University of Otago, Wellington.
READ MORE: https://www.stuff.co.nz/national/health/euthanasia-debate/300107980/euthanasia-referendum-should-it-be-a-health-priority-for-new-zealand-at-present?cid=app-iPhone

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NZMA – End of Life Choice Act Referendum What New Zealanders need to think about

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NZMA September 2020
Family First Comment: An important document from the medical profession that you should read before voting in the euthanasia referendum.
Key points:

  • Who will be able to end their life under the End of Life Choice Act?
  • What are some of the problems with the eligibility criteria?
  • Are there safeguards for vulnerable people in the Act?
  • If the Act comes into force, will misuse be detected?
  • What has happened in Canada after it enacted laws to enable euthanasia?

At the 2020 General Election on 17 October, New Zealanders will be asked whether they support the End of Life Choice Act 2019 coming into force. It is important that voters are well informed before making their choice. If a majority support the End of Life Choice Act coming into force, euthanasia and doctor-assisted suicide will become legal in New Zealand. This would have profound impacts on the doctor-patient relationship, risks for vulnerable people, and could result in wrongful deaths. We are concerned that there is limited awareness of some of the issues relating to this Act, ambiguity in some of the wording in the Act, and confusion about euthanasia and doctor-assisted suicide, generally. We also believe there are important lessons to be learned from other jurisdictions where euthanasia has been legalised, such as Canada.

Who is NZMA? NZMA is New Zealand’s largest medical organisation, with over 5,000 members from all areas of medicine. What is our position on the End of Life Choice Act? We do not support the End of Life Choice Act 2019 coming into force. This reflects our opposition to euthanasia and doctor-assisted suicide on the grounds they are unethical, but also our belief that the Act has serious shortcomings that put vulnerable people at risk of wrongful death. In addition, experience from Canada shows that what starts out as narrow eligibility criteria for accessing euthanasia and doctor-assisted suicide can widen over time. While we acknowledge that there is a range of opinions within the medical community, our position represents the views of a strong majority of our membership.

Key points:

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NZMA – End of Life Choice Act Referendum What New Zealanders need to think about

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NZMA September 2020
Family First Comment: An important document from the medical profession that you should read before voting in the euthanasia referendum.
Key points:

  • Who will be able to end their life under the End of Life Choice Act?
  • What are some of the problems with the eligibility criteria?
  • Are there safeguards for vulnerable people in the Act?
  • If the Act comes into force, will misuse be detected?
  • What has happened in Canada after it enacted laws to enable euthanasia?

At the 2020 General Election on 17 October, New Zealanders will be asked whether they support the End of Life Choice Act 2019 coming into force. It is important that voters are well informed before making their choice. If a majority support the End of Life Choice Act coming into force, euthanasia and doctor-assisted suicide will become legal in New Zealand. This would have profound impacts on the doctor-patient relationship, risks for vulnerable people, and could result in wrongful deaths. We are concerned that there is limited awareness of some of the issues relating to this Act, ambiguity in some of the wording in the Act, and confusion about euthanasia and doctor-assisted suicide, generally. We also believe there are important lessons to be learned from other jurisdictions where euthanasia has been legalised, such as Canada.

Who is NZMA? NZMA is New Zealand’s largest medical organisation, with over 5,000 members from all areas of medicine. What is our position on the End of Life Choice Act? We do not support the End of Life Choice Act 2019 coming into force. This reflects our opposition to euthanasia and doctor-assisted suicide on the grounds they are unethical, but also our belief that the Act has serious shortcomings that put vulnerable people at risk of wrongful death. In addition, experience from Canada shows that what starts out as narrow eligibility criteria for accessing euthanasia and doctor-assisted suicide can widen over time. While we acknowledge that there is a range of opinions within the medical community, our position represents the views of a strong majority of our membership.

Key points:

  • Who will be able to end their life under the End of Life Choice Act?
  • What are some of the problems with the eligibility criteria?
  • Are there safeguards for vulnerable people in the Act?
  • If the Act comes into force, will misuse be detected?
  • What has happened in Canada after it enacted laws to enable euthanasia?
    READ MORE: https://www.nzma.org.nz/documents/end-of-life-choice-act-referendum-fact-sheet

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John Tamihere to vote against legalising euthanasia, dubs legislation the ‘Kill the Māori Bill’

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NewsHub 16 September 2020
Family First Comment: Well said, John.
“Our people are unskilled, uninformed, and as soon as they get driven into it – right now, people are having non-resus [do-not-resuscitate] applications put before them under great stress, without whanau support. Non-resus. If that’s what they’re doing to us now, can you imagine what they’re going to do to us under this piece of legislation? So we need greater protections before this Bill goes through anywhere.”
Protect.org.nz

Māori Party co-leader John Tamihere won’t be voting ‘yes’ in the euthanasia referendum, dubbing the proposed legislation the ‘Kill the Māori Bill’.

The End of Life Choice Bill passed its third reading in November, and will become law 12 months after the result of the referendum is declared, if the ‘yes’ vote is victorious.

Supporters say it will allow those suffering without hope of survival to choose to end their lives with dignity, while opponents fear it lacks the safeguards to ensure it’s not abused.

The topic came up during an election debate hosted by Māori current affairs show The Hui on Tuesday night, featuring Labour’s Peeni Henare, Green Party co-leader Marama Davidson and Tamihere, who are all running for the seat of Tāmaki Makaurau.

Tamihere was the only dissenter. He said Davidson gave good reasons to oppose the Bill, rather than support it – saying Māori will be pressured into choosing to end their own lives.

“For the reasons just expressed, it’s actually the ‘Kill the Māori Bill’ if you don’t watch it. There’s not enough belts and braces around it,” he told host Mihingarangi Forbes.

“Our people are unskilled, uninformed, and as soon as they get driven into it – right now, people are having non-resus [do-not-resuscitate] applications put before them under great stress, without whanau support.

“Non-resus. If that’s what they’re doing to us now, can you imagine what they’re going to do to us under this piece of legislation? So we need greater protections before this Bill goes through anywhere.”
READ MORE: https://www.newshub.co.nz/home/politics/2020/09/john-tamihere-to-vote-against-legalising-euthanasia-dubs-legislation-the-kill-the-m-ori-bill.html

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Ken Orr: End of Life Choice Act legalising euthanasia is a licence to kill

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NZ Herald 15 September 2020
Family First Comment: A well summed up argument by Ken Orr
“This Act would exacerbate elder abuse, which is difficult to detect and which is already rampant. The reality is that some individuals or families do not always have the best interests of their parents and others at heart. This Act does not protect vulnerable New Zealanders from being manipulated or pressured into requesting euthanasia. Through subtle pressures, difficult to detect, the right to die will become a duty to die.”
Protect.org.nz

An article by Matt Vickers promoting the End of Life Choice Act (NZ Herald, September 4) attempts to denigrate those who understand the threat that this Act represents to the vulnerable in our community.

Totally ignored in his article is that the majority of our medical professionals oppose it, including; The New Zealand Medical Association, the Royal New Zealand College of General Practitioners, and Hospice NZ.

For the most part, Vickers resorted to ad hominem attacks, peripheral to the real issue, and on the points where he talks about the issue of euthanasia and assisted suicide, he fails to address any of the real concerns many have expressed.

The EOLC Act is dangerous in that it seeks to establish two principles. The first is that Parliament has the authority to decide who may be killed and the second that doctors have the right to kill their patients.

This Act coming into force would represent an unprecedented change to the current total prohibition against taking the life of another innocent human being. Our current statutes, established by the 1961 Crimes Act, are there to protect the vulnerable in our society and are foundational to our laws and the practice of medicine. We change these statues at our peril.

This Act has many significant flaws, not addressed during its passage through Parliament. These include that no independent witnesses are required at any stage of the process; there is no requirement for a person to be mentally competent at the time of the lethal dose; there is no cooling-off period before the lethal dose. Unlike other countries, which have a significant safety time-frame, this Act means the patient can be dead 48 hours after a prescription is written.

Richard McLeod, the spokesperson for a group of 200 lawyers has this to say. “It gives the illusion of choice and that while there will be choice for the powerful and the privileged, it is not the same for the poor, the weak, the defenceless and the vulnerable.”
– Ken Orr is the spokesperson for Right to Life NZ.
READ MORE: https://www.nzherald.co.nz/opinion/news/article.cfm?c_id=466&objectid=12364691

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Dutch euthanasia supporter warns UK to be wary of ‘slippery slope to random killing of defenceless people’

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Daily Mail 14 September 2020
Family First Comment: Dr Bert Keizer, one of his country’s most prominent practitioners of euthanasia, said that the type of patients whose lives are ended in the Netherlands has spread far beyond the terminally ill and now includes physically and mentally healthy old people who ‘find that their life no longer has content’.
#slipperyslope

A champion of the Dutch euthanasia system has admitted that British critics are right to warn that assisted dying is a slippery slope to ‘random killing of the defenceless’.

Dr Bert Keizer said that the type of patients whose lives are ended in the Netherlands has spread far beyond the terminally ill and now includes physically and mentally healthy old people who ‘find that their life no longer has content’.

Dr Keizer, one of his country’s most prominent practitioners of euthanasia, said that, in future, assisted dying in the Netherlands is likely to be extended to prisoners serving life sentences ‘who desperately long for death’ and disabled children whose parents believe their suffering is hopeless.

He said that after assisted dying was legalised in the Netherlands in 2002 ‘what our British colleagues had predicted years earlier, with unconcealed complacency, happened: those who embark on euthanasia venture down a slippery slope along which you irrevocably slide down to the random killing of defenceless sick people’.

Is Euthanasia a health priority for New Zealand at present?

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University of Otago 9 September 2020
Family First Comment: “Judging by the experience in Oregon it is likely that this may only benefit a small number of older educated white people. The health system is currently significantly stretched by the extra demands and changes required because of Covid-19… Hospices currently have to fundraise for 60% of their costs. Only one in three people dying in New Zealand are supported by a hospice. There are 33 hospice services in New Zealand but there is inevitably limited service to rural areas and smaller centres. Given this limitation of access, and the extent of fundraising required, there is a strong argument to prioritise funding to hospices as an effective and non-contentious strategy to decrease suffering at the end of life. This may also decrease the demand for euthanasia.”

At the next election voters will be asked to answer the referendum question “Do you support the End of Life Choice Act 20191 coming into force?” If a majority vote Yes then this Act will come into force without further amendment.

The focus of discussion has almost exclusively been around the ethical question of whether, in the circumstances described in the Act, it is ethical to proceed with medically assisted aid in dying. There has been little discussion about whether, if we accept this is ethical, introducing a regimen to enable this is a sufficient current health priority to justify the funding required to operationalise the Act.

If this level of demand is reflected in New Zealand, then it will benefit a small but increasing number of people over time likely from a group who can afford the costs and who already get significant benefit from our health system. The result of enacting this Act will be to increase health outcome disparities…we will be providing an additional service to educated white people. The opportunity cost to the State will be higher if this is State funded. If privately funded there will be a smaller opportunity cost to the State of running the accountability bureaucracy, but the service will only be available to those who can afford it.

A lot of effort has already gone into this debate. No matter what the outcome, the opposing sides are both likely to continue to be active. If it is passed, those opposed will probably lobby to try to limit the application of the Act. If it is not passed, then proponents will probably continue to lobby to re-litigate at a future date. In the meantime political parties are likely to pay more attention to issues at the end of life. Hospices currently have to fundraise for 60% of their costs.7 Only one in three people dying in New Zealand are supported by a hospice.8 There are 33 hospice services in New Zealand but there is inevitably limited service to rural areas and smaller centres. Given this limitation of access, and the extent of fundraising required, there is a strong argument to prioritise funding to hospices as an effective and non-contentious strategy to decrease suffering at the end of life. This may also decrease the demand for euthanasia.

Changing the status quo now will require focus on this issue and take attention away from the much more serious issues of responding to the Covid-19 pandemic and to the Simpson review of the health system.

The ethical debate is unlikely to reach consensus. However, this referendum is also about allocating scarce health care resources on providing an assisted dying service (assuming it has an element of state funding), which will disproportionately be used by the affluent and educated. As well as considering the ethics of euthanasia we also need to consider whether the funding needed to set up and run an assisted dying service would be better spent on other priorities such as reducing disparities in cancer screening, diagnosis and care services or supporting and improving the provision of palliative care.
READ MORE: https://blogs.otago.ac.nz/pubhealthexpert/2020/09/09/is-euthanasia-a-health-priority-for-new-zealand-at-present/
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Dr Carmen Chan – Assisted dying’s inequity problem

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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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