Ed

NZ Herald 1 May 2021
Family First Comment: We never will be – because its fundamentally unsafe. But here are additional concerns:
* We lack clarity around how health practitioner training will roll out, who or how many will take part, how training will be funded, or what support will be available.
* Questions are also being raised about how a doctor can detect coercion.
* Concerns have been raised about whether NZ will follow in Victoria, Australia’s footsteps (where assisted dying became legal in 2019) and limit training to a six-hour online tutorial.
* Only 10% of the almost 2000 health practitioners who responded indicated definite willingness to be involved. Another 20% indicated it was a ‘possibility’.
* there needs to be equal support and input into palliative care, so people have options.
* New Zealand universities still need to increase palliative care education for medical students.

Last year almost two-thirds of New Zealanders voted to legalise assisted dying. So come November 7, euthanasia will be legal. The Ministry of Health expects about 1100 people to request it in the first year and about a third to follow through.

But plenty of questions remain about whether the processes and infrastructure will be in place for it to happen.

Six months out, the ministry that is responsible for implementing the End of Life Choice Act and making any regulations is still in the process of appointing people to the three statutory positions to oversee the regime.

We lack clarity around how health practitioner training will roll out, who or how many will take part, how training will be funded, or what support will be available. People are already asking health practitioners and advocacy groups for guidance and advice, but nobody is any closer to being able to provide answers.

Despite the criticisms, Health Minister Andrew Little says the ministry has assured him everything will be ready and he’s holding them to that.

“They’re giving me regular updates … I’m very confident things will be in place,” he told the Weekend Herald.

So what needs to happen to reassure patients, medical practitioners and safety watchdogs that euthanasia will be fair and safe? Here are some of the main concerns and the state of play so far.
READ MORE: https://www.nzherald.co.nz/nz/euthanasia-are-we-ready-for-legalised-assisted-dying-in-new-zealand/L2DFV5ZKWPDYVAXVLD5NPS4O5M/

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Radio NZ News 22 April 2021
Family First Comment: No surprises in this. It’s a bit like very few doctors wanting to perform abortions. Medical professionals never entered the profession to kill people.
“The demand for assisted dying will have to be met by a workforce overwhelmingly opposed to being involved and a health system some doctors say is already struggling with a lack of resources. Only 10% of health practitioners described themselves as “definitely willing” to provide assisted dying with a further 20% saying they are “possibly willing,” according to a Ministry of Health workforce survey.”

More than a 1000 people are expected to request to end their lives in the first year of New Zealand’s assisted dying regime.

Chief medical officer Andrew Connolly said the Ministry of Health was expecting about 1100 patients to make the request, although it was predicting only about a third of those would carry through with euthanasia.

The demand for assisted dying will have to be met by a workforce overwhelmingly opposed to being involved and a health system some doctors say is already struggling with a lack of resources.

Only 10 percent of health practitioners described themselves as “definitely willing” to provide assisted dying with a further 20 percent saying they are “possibly willing,” according to a Ministry of Health workforce survey.

The lack of doctors willing to carry out assisted dying may lead to those doctors who are willing to have to travel the country administering euthanasia if the service is not available in all areas.

Connolly said having a ready and willing workforce was the biggest challenge to setting up the assisted dying regime, which comes in on 7 November.

The Ministry of Health initially said its survey of nearly 2000 health practitioners showed 30 percent were definitely or possibly willing – a number the Minister of Health Andrew Little said gave him confidence the workforce to deliver euthanasia would be available.

But the breakdown now provided to RNZ describes a less enthusiastic workforce, with just 10 percent saying they were “definitely” willing and a further 20 percent saying they were “possibly” willing.
READ MORE: https://www.rnz.co.nz/news/in-depth/440976/only-10-percent-of-health-workers-definitely-willing-to-carry-out-euthanasia-survey

Radio NZ News 20 April 2021
Family First Comment: Here comes a flawed dangerous regime with unintended adverse consequences (which the public weren’t fully informed about)…
“There have been concerns expressed internationally over … the concoction of medication that is used, that in some cases, has led to traumatic end of life experiences,” 

Patients requesting euthanasia will be given unapproved, unregulated and “off label” medicines, sparking warnings of prolonged and distressing deaths.

People who chose to swallow or ingest the fatal medicines, rather than taking them intravenously, would be given drugs that were compounded (mixed up) by a pharmacist and provided to the patient without being approved by regulator Medsafe.

The Ministry of Health said those who opted for an injection would be given drugs which had been approved by Medsafe but for a different purpose – so the medicines will be provided for an unapproved, or “off label”, use.

Hundreds of pages of documentation, much of it heavily redacted, has been released under the Official Information Act to RNZ as part of an investigation into how prepared New Zealand is to introduce assisted dying.

Among the documents is an email from Dr Bryan Betty, medical director at the Royal New Zealand College of GPs, warning that mixing concoctions of drugs had led to traumatic deaths.

Dr Betty’s warning to the Ministry of Health used the example of American states not being able to access death penalty drugs due to cost and availability.

“So they made up their own concoctions initially, with examples of prolonged processes until fine-tuned. Belgium had a standard process but (this was) not used by many doctors for some years, also resulting in prolonged, distressing deaths.”

Betty said it was important to develop strong guidelines to avoid these situations.

“There have been concerns expressed internationally over … the concoction of medication that is used, that in some cases, has led to traumatic end of life experiences,” he said.

“I think we need to mitigate those risks upfront and be very prescriptive about what could be used and an end of life situation,” he said.
READ MORE: https://www.rnz.co.nz/news/in-depth/440824/distressing-death-warning-for-unregulated-euthanasia-drugs

Radio NZ News 30 March 2021
Family First Comment: This is the danger of putting politicians in charge of a medical issue….
Palliative care professor Rod MacLeod said ending a life was not always a simple matter. “I think the public has this idea that assisted dying is quite clear cut – you take the drugs and you’re dead. But death doesn’t necessarily follow within minutes or even hours, it can take a lot longer and well documented cases of stuff not working.”

What happens if a patient doesn’t die during a euthanasia attempt? That’s one of a number of ethical and legal questions being asked by palliative care experts who say we are woefully unprepared to introduce assisted dying.

Senior nursing leaders are also concerned New Zealand won’t be ready when the law takes effect on 7 November.

The nurses union said its request for legal advice had been ignored by the Ministry of Health and nurses fear they could face disciplinary action and be struck off if they go too far discussing euthanasia with a patient.

Palliative care professor Rod MacLeod said ending a life was not always a simple matter.

“I think the public has this idea that assisted dying is quite clear cut – you take the drugs and you’re dead,” MacLeod said.

“But death doesn’t necessarily follow within minutes or even hours, it can take a lot longer and well documented cases of stuff not working.”

It was not yet known which drugs would be used for euthanasia in New Zealand and under the law it would be an offence punishable by a fine of up to $20,000 to reveal the method by which the drugs were administered to the patient.

“You assume that it’s the same as the United States [which] uses for lethal injections for the death penalty,” MacLeod said.

“We know that doesn’t always work. It’s not always that comfortable. It’s not like flicking a switch.”
READ MORE: https://www.rnz.co.nz/news/in-depth/439441/euthanasia-what-happens-if-the-drugs-don-t-work

Radio NZ News 29 March 2021
Family First Comment: “Palliative care specialists fear health practitioners with as little as six hours online training could end up providing euthanasia for patients who would have wanted to live if they had proper care and pain relief. And a new Ministry of Health survey reveals fewer than a third of health practitioners are prepared to participate in the assisted dying regime.”
Euthanasia. Not needed. Not safe. Not supported.

Palliative care specialists fear health practitioners with as little as six hours online training could end up providing euthanasia for patients who would have wanted to live if they had proper care and pain relief.

Their concerns come as a new Ministry of Health survey reveals fewer than a third of health practitioners are prepared to participate in the assisted dying regime.

Palliative care specialists say that might mean euthanasia is unavailable in some areas and a small band of itinerant doctors with no connection to their patients may do the bulk of the cases.

Palliative Care professor Rod MacLeod said nearly every week that he spent working in hospice care he was approached by someone who wanted to end their life – but during his 32-year career all but one of those people changed their minds.

“I’ve had lots and lots of people ask me for assisted dying. But with palliative care provided those requests melt away.”

He said that meant that under the euthanasia regime people who would have changed their minds could be put to death.

Palliative care specialists say most people skilled in end of life care don’t want to be involved in euthanasia.

But a Ministry of Health survey of nearly 2000 health practitioners shows that, while almost half supported assisted dying in principle, fewer than 30 percent were “possibly or definitely” willing to provide the service.
READ MORE: https://www.rnz.co.nz/news/national/439361/fears-euthanasia-training-will-just-be-online-course

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Stuff co.nz 15 March 2021
Family First Comment: No surprises in this trend…
Support for euthanasia fell over each year of medical training: 64% in support in second year plummeting to 39% in fifth year.
“Ending a life was “contrary” to what med students were trying to become… Their whole orientation is to try and make things better, and ending a person’s life doesn’t feel that way.”
Exactly.

Medical students become more opposed to euthanasia as they progress through medical school, a new study has found.

Almost 65 per cent of second year medical students at Otago University supported euthanasia or assisted dying, compared with 39 per cent in fifth year, the researchers found.

Support for the practice fell over each year of training: 64.8 per cent in support in second year, 62.6 per cent in third year, 51.5 per cent in fourth year and 39.1 per cent in fifth year.

“We suggest that this difference is most likely due to their time in medical education,” concluded Luke Nie​ and Simon Walker​, along with two other Otago researchers.

First and second year students see few patients and their views mirrored the results of the End of Life Choice referendum held last November – 65 per cent in favour of legalisation, 34 per cent opposed.

By fifth year, however, med students are seeing lots of patients and are “confronted… by the complexities” that can come up in end-of-life situations, he said.

Otago med students are taught palliative medicine and end-of-life care as a “vertical module” throughout most of their education. They also get bioethics courses, although those are mostly identifying issues and enabling students to think for themselves, Walker said. He is a bioethicist and teaches some of these neutral classes.

Professors, doctors and nurses with strong views on euthanasia also probably made impressions on the students, he said.
READ MORE: https://www.stuff.co.nz/science/124506016/med-students-become-more-opposed-to-euthanasia-while-at-uni

Euthanasia Prevention Coalition –  5 February 2021 – Alex Schadenberg
Family First Comment: Belgium’s experience warns us of what is likely to happen here:
“The study points out that there is a yearly increase in the number of euthanasia deaths, but the number of actual euthanasia deaths is unknown due to high percentage of unreported euthanasia deaths… Euthanasia has become more common for people over the age of 80 who live in nursing homes.… All people should be concerned about how the legal requirements of the euthanasia law that are intended to operate as safeguards and procedural guarantees in reality often fail to operate.”
Disturbing.

A study by Belgian researchers and published in the Journal of Medicine and Philosophy on January 25, 2021, examines the practise of euthanasia in Belgium and concludes that legal requirements are being undermined and safeguards ignored. The study concludes that:

there are shortcomings in the Belgian euthanasia law, the application of that law, and the monitoring of euthanasia practice. This leads us to conclude that several of these shortcomings are structural and thus require more than simply increased oversight.

The study was conducted by Kasper Raus, Bert Vanderhaegen and Sigrid Sterckx from Ghent University and examines the official Belgian euthanasia data within the context of other studies that examine the application of the Belgian euthanasia law. This study is done by Belgian researchers who have been examining the Belgian euthanasia data for many years. One may disagree with the conclusion of the study but the data is impeccable.

Looking at key issues.
The study points out that since euthanasia was legalized in 2002 in Belgium, the debate on the issue has continued. There has been several legislative proposals to change the law since 2002. The study states:

All but two proposed amendments were voted down. The Euthanasia Law was first amended in 2005 to provide legal protection for pharmacists dispensing the lethal medication for the performance of euthanasia (Law of 10 November 2005). In 2014, the Euthanasia Law was amended again, this time to allow euthanasia for minors who are judged to have “capacity for discernment,” without setting an age limit (Law of 28 February 2014).

The study points out that there is a yearly increase in the number of euthanasia deaths, but the number of actual euthanasia deaths is unknown due to high percentage of unreported euthanasia deaths.
READ MORE: http://alexschadenberg.blogspot.com/2021/02/study-belgian-euthanasia-law-is-out-of.html

National Post 24 November 2020
Family First Comment: Apparently, there is no slippery slope – or so we are told.
Better rethink that one!
“[Canada’s Justice Minister David] Lametti also said he hopes the medical assistance in dying (MAID) regime will eventually be further expanded to people who are suffering solely from mental illness”

Justice Minister David Lametti told a Senate committee on Monday that he’s heard the fierce criticism of the government’s new assisted dying bill, which expands the regime to include people who don’t have a terminal illness.

The critics include disability rights organizations, palliative care experts, and even Jody Wilson-Raybould — the former justice minister who introduced the original assisted dying bill in 2016.

But Lametti said he believes the government has found the right balance in respecting the dignity of people with disabilities, and also their right to end their life if their suffering is too great.

Lametti also said he hopes the medical assistance in dying (MAID) regime will eventually be further expanded to people who are suffering solely from mental illness, but the government doesn’t have enough time to do it before a court-ordered deadline of Dec. 18 for this bill to pass.

Bill C-7 was introduced in response to a Quebec Superior Court ruling that found the original law, passed in 2016, unconstitutionally restricted MAID to those whose death was “reasonably foreseeable” — in other words, to patients with a terminal illness.

The bill creates a new MAID eligibility requirement for people who are deeply suffering, but who are not expected to die from their illness.
READ MORE: https://nationalpost.com/news/politics/justice-minister-defends-assisted-dying-bill-from-critics-as-senate-committee-starts-hearings

NewsHub 9 November 2020
Family First Comment: Significant concerns from the Muslim community
“A Facebook post by FIANZ in the lead-up to the referendum identifies nine concerns in regard to the End of Life Choice Act – including that it may disproportionately affect Kiwi Muslims, many of whom are refugees and comparatively poor. “In cases of severe illness where health care costs are high and carers are scarce, members of the community could request euthanasia out of guilt… as a way of relieving the society of their burden,” FIANZ President Ibrar Sheik writes. “Persons in our community who are in extreme pain and clouded by depression, shock and grief could make irrational decisions… not giving themselves time for possible recovery or coming to terms with their condition. “Passing this legislation will be tantamount to saying to our terminally ill and disabled that their lives are less valuable to society than the youthful.””

Many religious Kiwis oppose the End of Life Choice Act for ethical reasons, citing concerns with a perceived lack of reverence for life and its implications for our most vulnerable citizens, while others support it on the grounds it relieves suffering. For Catholics and Muslims, however, the response to the referendum result has been almost unequivocal, as both religions explicitly condemn assisted dying. The Catholic Church issued a ‘Declaration of Euthanasia’ in 1980, condemning the procedure as a crime against both life and God, while a recent letter written by the Vatican’s doctrinal watchdog and endorsed by Pope Francis describes it as “intrinsically evil”. Meanwhile Islamic literature asserts that God decides how long each person lives, and explicitly prohibits planning or knowing one’s time of death in advance.

…’They will dwell in Hell forever’: Islamic leader says Qur’an is clear on euthanasia

One of New Zealand’s most senior Islamic leaders says while Muslims accept the referendum result, they’re disappointed in the country’s decision and will continue to oppose euthanasia. Mustafa Farouk, the executive of the Federation of Islamic Associations of New Zealand (FIANZ), said Muslims have the right to choose euthanasia – but they shouldn’t expect to be honoured at death by their faith community if they do so. In Islam, there are many rituals at the time of death. The deceased is bathed and shrouded in cloth, before receiving the Ṣalāt al-Janāzah – a funeral prayer that seeks pardon for the dead. The body is then buried with the head facing Mecca. Farouk said there still remains an obligation to ensure the deceased is buried if they opt for assisted dying, but indicated they would forfeit an Islamic funeral by doing so, telling Newshub a lot of people simply “would not attend”. “The Qur’an is very clear that we cannot take life – not only take the life of someone, but we can’t even take our own life. If anybody takes their own life, they will dwell in Hell forever. There is no grey area there whatsoever,” he said.

…. A Facebook post by FIANZ in the lead-up to the referendum identifies nine concerns in regard to the End of Life Choice Act – including that it may disproportionately affect Kiwi Muslims, many of whom are refugees and comparatively poor. “In cases of severe illness where health care costs are high and carers are scarce, members of the community could request euthanasia out of guilt… as a way of relieving the society of their burden,” FIANZ President Ibrar Sheik writes. “Persons in our community who are in extreme pain and clouded by depression, shock and grief could make irrational decisions… not giving themselves time for possible recovery or coming to terms with their condition. “Passing this legislation will be tantamount to saying to our terminally ill and disabled that their lives are less valuable to society than the youthful.”

Other religions are split on whether euthanasia is to be avoided or embraced.
For many other Christian denominations – as well as for those who practice Hinduism, Judaism, Jainism or Shinto – there is no consensus on euthanasia.
Some Hindus believe helping end a painful life is a fulfilment of their moral obligation, while for others it’s seen as a disturbance of the natural separation of body and spirit and a threat to the cycle of reincarnation.
READ MORE: https://www.newshub.co.nz/home/new-zealand/2020/11/euthanasia-referendum-catholic-clergy-say-assisted-dying-runs-against-core-values-islamic-leader-threatens-muslims-who-choose-it-with-hell.amp.html