The first official report on the assisted suicide law in NZ has been released. It only covers the first five months of the law, so it’s difficult to determine any trends. But what has been interesting is the comments made by euthanasia supporters about the law already needing to be expanded to allow for even non-terminal patients to access it. And the media only seems to want to tell us the ‘good’ stories about assisted suicide – but they ignore the ‘not-so-happy’ ones.
Why is it that Euthanasia is fully-funded by the Government, yet Palliative Care is only partially funded and now in serious threat of dying from government neglect? Too many New Zealanders are unable to access acceptable end-of-life care, and thus tragically die in pain and suffering. The situation is dire, and projected to get much worse.
Nobody should suffer unnecessarily towards end of life. Our hospices are an essential service, providing palliative care that prevents and relieves suffering, right through to end of life. Yet, hospices are simply not able to fundraise enough money to survive. Also some hospitals have no specialist palliative care services at all.
Many of us have had family members who needed palliative care, or at least known of someone in palliative care. And the demand for this specialist medical care will only increase significantly in the near future. Our population is ageing, and therefore the number of people requiring palliative care is forecast to increase by approx. 25% over the next 15 years, and will be more than double that by 2061. (Source: Health Workforce NZ)
The Government has made little effort to address this growing problem, and to increase funding for this essential service. Euthanasia is instead given priority and full Government funding. It begs the question – “Is this really a Government of kindness?”
Please read this excellent article by Danielle van Dalen, senior researcher at the Maxim Institute: Palliative care is in danger of dying from government neglect
Danielle is also the author of: The urgent case for palliative care
*This post was written by Family First staff writers.
This is a sad story that illustrates the dangers of liberal euthanasia laws…
A Canadian woman suffering from Long Covid has applied for assisted dying. Tracey Thompson has already received one doctor’s approval and is now awaiting a second specialist’s approval to then proceed with assisted dying.
Extreme fatigue and a lack of financial support caused Thompson to apply for Medical Assistance in Dying (MAiD) – Canada’s voluntary euthanasia program. She is unable to work and expects to run out of money in five months.
“(MAiD) is exclusively a financial consideration,” she said.
“My choices are basically to die slowly and painfully, or quickly. Those are the options that are left.”
Thompson stressed she still enjoys life and doesn’t want to die, but doesn’t think she could survive without an income.
According to the Canadian Government’s own data, there have been 21,589 medically assisted deaths since euthanasia became legal in 2016.
When MAiD first became legal in Canada it was only available for people who were terminally ill. However, last year the criteria changed to “cannot be relieved under conditions that you consider acceptable”. From March 17 2023, the program will be expanded to include people with mental illness as their sole underlying medical condition.
Not only is this story very sad, it also highlights the dangers of liberal euthanasia laws which inevitably get expanded over time.
Read full story here.
Note – ‘Long Covid’ is a term to describe the effects of Covid-19 that continue for weeks or months beyond the initial illness. Symptoms include chronic fatigue, brain fog, and chest pain.
*This post was written by Family First staff writers.
Media Release from #DefendNZ | www.defendnz.co.nz
Death-on-demand soars in NZ: 66 die from new assisted suicide and euthanasia law
The latest insights from the Ministry of Health‘Assisted Dying Service Data and Reporting’ released this week tell of 66 people having been euthanised or assisted to commit suicide in New Zealand up to the 31 March, end of the first quarter of the year, with the ability of the End of Life Choice Act which came into force in on Sunday 7 November 2021.
A total of 206 people have requested to die using the legislation so far.
Applicant processing staff increases 300% due to demand
Registrar for the assisted suicide and euthanasia legislation, Dr Kristin Good, spoke to NZ Doctor magazine about demand to date.
When the law came into force in November 2021, one nurse was employed to answer phonecalls from members of the public enquiring about how to be euthanised or assisted to commit suicide under the End of Life Choice Act.
However, due to increased demand, Dr Good says, “we are now employing a third nurse [answering phone queries].”
Interest remains very high with an average of 46 enquiries each week.
Zero applicants referred for a psychiatric assessment
Of the 206 applicants so far, 168 people had a first assessment with a health practitioner, 126 people had a second, yet 0 people were referred for a psychiatric assessment. This is despite international data showing that 1-in-6 people using assisted suicide are clinically depressed – a condition which, if detected, can be treated.
This raises serious questions for us around the protection of vulnerable people.
#DefendNZ calls for increased public safety when it comes to the End of Life Choice Act.
“There are a number of significant concerns that have already been highlighted in the reporting made available by the Ministry of Health this week. Vulnerable New Zealanders are clearly already being put at risk due to the inferior legislation. We can, and must, do better” says #DefendNZ spokesperson, Henoch Kloosterboer.
Many more deaths possible due to applicants already waiting
Of the total 206 applications, 66 have been euthanised or assisted to commit suicide, 59 are still in process, 11 have withdrawn their application, 40 were denied their application due to not meeting criteria, and 30 had died naturally while their application was in process.
Of the 66 people whose lives have been ended so far, the 73 per cent died at home, 17 per cent in aged care facilities, 6 per cent in DHB facilities and 4 per cent in a hospice facility.
Complaints made – details hidden
So far, according to an interview conducted by NZ Doctor, three formal complaints have been laid.
When #DefendNZ contacted the Ministry of Health for details around complaints last month, we were denied information – even with an Official Information Act request.
#DefendNZ was told by an MOH spokesperson, “I have considered the countervailing public interest in release in making this decision and consider that it does not outweigh the need to withhold at this time.”
We were stonewalled.
Senior Pākehā women with cancer most highly represented
Statistics voluntarily provided by the Ministry of Health show that of the initial 206 applicants:
- 162 are NZ European/Pākehā (78.6%)
- 12 are Māori (5.8%)
- 55% are women compared with 45% male
- 9 are 18-44 years old (4.4%)
- 153 are aged 65 years or older (74.3%)
- 133 have a cancer diagnosis (64.6%)
- 21 have a neurological condition (10.2%)
- 38 are recorded as ‘diagnosis not known’ (18.4%)
New Zealand applicants younger than international average
More than 80% of people using euthanasia or assisted suicide internationally are over the age of 65. This means, applicants in New Zealand are already significantly younger than the international average at only 74.3% of those being aged 65 or over. This is concerning, coupled with the unknown and unreported specific ages of those nine people between 18 and 44 years old.
The #DefendNZ movement is calling for much more detailed reporting to remove the cloak of secrecy and increase accountability in its Six to Fix petition.
No required care or support to vulnerable declined applicants
Critics of the legislation have highlighted that the Act does not make any requirements of care towards those whose applications have been declined.
Of the 40 people whose applications have been denied, 16 were not experiencing unbearable suffering unable to be relieved in a tolerable manner, 17 were not in an advanced state of irreversible decline in physical capability, 26 did not suffer from a terminal illness likely to end their lives within six months, and 7 were not competent to make an informed decision.
Note: As a person may be found ineligible for more than one reason, the sums above by reason are greater than the total number of people assessed as ineligible.
These people clearly wanted to die.
Who is supporting them now that they have been declined?
Where is the duty of care to these very vulnerable New Zealanders?
So where to from here?
The next Ministry of Health report for the quarterly period from 1 April to 30 June 2022 is due to be released in July. Based on trajectories, death-on-demand will increase.
Yet we know that of those internationally requesting an assisted suicide or death-by-doctor end to their lives are prone to coercion.
New Zealand has the unenviable ranking of the worst country in the OECD for domestic violence. 1-in-10 elderly in New Zealand suffer abuse, of which the majority is perpetrated by family members, and mostly for financial gain.
We need to get better at supporting each other, and supporting those in our communities at risk of loneliness, elder abuse, depression, and those who feel they are a burden.
Who is in your circle or community that you can reach out to?
#DefendNZ is a movement dedicated to getting a better deal for vulnerable New Zealanders by lobbying to improve the risks created by the current End of Life Choice Act, support those in need, and inform our culture on what’s happening in this conversation.
If you’re also concerned about the very real risks the End of Life Choice Act has created, visit our Six to Fix petition, which highlights six amendments that can be made to the law to considerably improve public safety.
Euthanasia has only been legal in New Zealand for less than three months, but already we are seeing some disturbing trends, including the speed with which someone can request and then receive it (despite claims that this was unlikely to happen). And check out the Ministry of Health’s (and Newshub’s) spectacular own goal! For more info on the new law, visit www.Protect.org.nz
Euthanasia is now legal in New Zealand. In this episode of “Family Matters”, Bob McCoskrie spoke to Professor David Kissane, an Australian cancer psychiatrist whose career has focused on the interface of mental illness with cancer and palliative care. He is the chair of Palliative Care Research at the University of Notre Dame Australia and the Cunningham Centre for Palliative Care Research at St Vincent’s Sydney, and the Department of Psychiatry, Monash University.
Dr David Kissane talks about the dangers of euthanasia – the way that suffering, undiagnosed depression, unrecognised family distress and communication breakdown creates vulnerability for those with an illness. Dr Kissane also explains the types of vulnerable patients and how a loss of sense of worth, meaning, hope or if you become ashamed can lead to losing the will to live and a desire to end your life. He also warns about the hidden nature of family coercion. Dr Kissane offers advice to medical professionals, and also to families facing this issue with relatives who are facing a terminal illness.
1News 7 Nov 2021
Palliative care professor Rod MacLeod said despite the Act being called “End of Life Choice”, there would be some people who didn’t have a choice because they couldn’t opt to access palliative care. He said it was a lottery because hospice services rely heavily on charity. “It depends on where you live, it depends on the disease that you might be experiencing, it depends on your ethnicity sometimes,” he said. “So, I think at the moment, although we have good palliative care services in the country, it’s not evenly distributed in any way.” MacLeod said the Government should boost its funding of the services.
Based on overseas experiences, the Ministry of Health estimates up to 950 people could apply for assisted dying each year, with up to 350 being assisted to die. But there is uncertainty about what the actual demand will be.
In Victoria, Oregon, and Canada, assisted dying accounts for between 0.3 and 2 per cent of all deaths; with 124 confirmed assisted deaths in the first 12 months Victoria offered the service.
As of October 27, 96 doctors across the country have expressed interest in being included on the Support and Consultation for End of Life in New Zealand (SCENZ) group list to act as an attending medical practitioner in the assisted dying process. Eight nurse practitioners have put their hand up to be on the list; 13 psychiatrists have expressed their interest to perform assessments if requested; and 93 have expressed interest in independent practitioner second assessments.
The ministry expects assisted dying services will be provided mainly by general practitioners, in a person’s home or other community settings. What impact this will have on an already stretched health workforce is unknown. More than 6000 health professionals have completed the training module available to health workers, and 129 medical and nurse practitioners have accessed training. Sixty-four per cent of practicers happy to be involved are in the North Island, and 36 per cent in the South Island.
In the lead-up to the referendum, close to 1600 doctors signed an open letter opposing assisted dying; arguing proper palliative care makes euthanasia unnecessary. The move to fully fund assisted dying but not palliative care has also come under recent criticism.
A palliative care doctor who opposes euthanasia says robust information must be collected about why terminally ill people choose to end their lives under the new law. Care Alliance deputy chair Sinead Donnelly said health officials should be asking people who meet the act’s criteria whether they’re choosing euthanasia because of pain, a lack of palliative care options or other reasons. It needs to be asked “if people are choosing euthanasia because, for example, there’s lack of access to palliative care for specific groups in specific regions,” she said. “We’re very concerned about equity at the moment, and Māori and Pasifika, for example, are they choosing euthanasia? … We need to identify if it is due to a lack of access to services.” Donnelly said failing to collect meaningful information could make it harder to recognise issues of access to healthcare.
Last month the government announced the appointment of three experts to monitor assisted dying. They are: medical ethicist Dr Dana Wensley, nursing executive Brenda Close and palliative care consultant Dr Jane Grenville.
Palliative Medicine Doesn’t Include Euthanasia – ANZSPM
The peak body for palliative medicine in New Zealand and Australia has released an updated Position Statement entitled The Practice of Euthanasia and Physician-Assisted Suicide just days before euthanasia and assisted suicide becomes legal in New Zealand.
The Statement by ANZSPM (Australian and New Zealand Society of Palliative Medicine) says that “In accordance with best practice guidelines internationally, the discipline of Palliative Medicine does not include the practices of euthanasia and physician-assisted suicide.”
It also unequivocally states that “ANZSPM does not support the legalisation of euthanasia and physician-assisted suicide” and “endorses international guidelines reaffirming that these practices are not part of palliative care.”
ANZSPM members are medical practitioners who provide care for people with a life-threatening illness.
It also says that
- “Patients have the right to refuse life-sustaining treatments including the provision of medically assisted nutrition and/or hydration. Refusing such treatment does not constitute euthanasia or physician-assisted suicide.”
- “Withholding or withdrawing treatments that are not benefitting the patient, is not euthanasia or physician-assisted suicide.”
- “Treatment that is appropriately titrated to relieve symptoms and has a secondary and unintended consequence of hastening death, is not euthanasia or physician-assisted suicide.”
- “Palliative sedation for the management of refractory symptoms is not euthanasia.”
Most people simply want to ensure that the administration of pain relief and the withdrawal of burdensome treatment are not treated as illegal. That is already the case.
The Position Statement also warns that attention should be given to “symptoms that research has highlighted may commonly be associated with a serious and sustained “desire for death” (e.g. depressive disorders and poorly controlled pain).”
“Nothing in this new law guarantees the protection required for vulnerable people, including the elderly, depressed or anxious, and those who feel themselves to be a burden or who are under financial pressure. It is also impossible to fully measure levels of coercion on a patient,” says Bob McCoskrie, National Director of Family First NZ.
“It is reassuring for patients and families to know that most Hospices and most palliative care specialists and other medical professionals want nothing to do with euthanasia or assisted suicide.”
To: Totara Hospice re End of Life Choice Act
We are writing to express our concern that you will be one of the only hospices in New Zealand offering euthanasia and assisted suicide under the new law to come into force on Sunday 7 November. As a loved and trusted service which has served the South Auckland community for 40 years, we respectfully ask that you reconsider your decision in light of the following key points.
We already have “choice”.
A person may already refuse medical treatment.
- turning off life support
- ‘do not resuscitate’ (no CPR) requests
- stopping of treatment or food
Those things are legal. And they’re not euthanasia.
Most people simply want to ensure that the administration of pain relief and the withdrawal of burdensome treatment are not treated as illegal. Allowing the natural process to take place with appropriate palliative care including pain management is completely different to intentionally bringing about the patient’s death.
Mistakes could be made
Some people will request assisted suicide or euthanasia on account of a diagnosis/prognosis. But as you are aware, there can be no absolute certainty around that. The new law relies on a diagnosis that a person suffers from a terminal illness which is “likely” to end his or her life within six months.
How will you measure “likely”? And can you guarantee that you will be right each and every time. Patients will be relying on that assurance.
Coercion is a significant issue.
Many will request assisted suicide because of coercion either internally or from relatives, or concerns around costs of treatment. Others will be struggling and possibly even be depressed.
The new law is seriously deficient in so far that it only requires doctors to “do their best” to ensure that the person is free from pressure – an extremely low legal threshold. Moreover, it fails to outline any process for ensuring patients are free from coercion. Can you guarantee that every patient who is euthanised will be completely free of coercion.
As the NZ Medical Association told the Select Committee considering the new law: “The provisions in the Bill will not ensure that a decision to seek assisted dying will always be made freely and without subtle coercion.”
In Oregon, Washington state and Canada which already allow euthanasia, the statistics show that the feeling of being a burden is one of the key reasons that terminal patients requested euthanasia.
Also of concern is that elder abuse is already a significant problem in New Zealand. About 80% of it remains hidden and unreported. We cannot ignore the possibility that dependent elderly people may be coerced into assisted suicide in their final weeks and months. That feeling of being a burden on loved ones, and the knowledge of that expensive rest home and geriatric care and medical bills, are all subtle forms of coercion pushing an already vulnerable person towards a quick cheap solution.
Cost may drive decisions
The new law only provides a ‘right’ to one choice – premature death. There is no corresponding right to palliative care. But as you are well aware, good palliative care and hospice services are resource intensive & can be expensive; euthanasia would be cheaper. This law change could introduce a new element of ‘financial calculation’ into decisions about end-of-life care for families and for vulnerable patients.
Our specific law is a flawed and dangerous one
Even a cautious approach from Totara Hospice will not offer complete reassurance to vulnerable patients. These are the specific concerns in the operation of the law:
- unlike other jurisdictions, no independent witnesses are required at any stage of the process, including at the death
- the person’s mental competence doesn’t have to be assessed at the time the lethal dose is administered. Can you guarantee that you will know their intention at the time that they are at their most vulnerable?
- There is no mandatory cooling-off period or ‘thinking time’ – unlike overseas where there are specific cooling off periods of 9 days and up to 15 days.
- There is no requirement for an existing doctor / patient relationship. As we now know, there are very few medical professionals who want to be part of this process. Patients will ‘shop around’ for the doctor that gives you the answer a patient wants – but who doesn’t know their background – or more importantly, the family dynamics and whether there is obvious coercion going on – which a family doctor will have knowledge of.
- Once of the worst provisions is that the patient can block family members from being aware of their decision to have euthanasia. There is no requirement that the person discuss their request for assisted suicide with any other person. This is a serious flaw in the Act. But family members may be fully aware of why the request is being made – and may have alternative solutions that don’t involve killing the patient. Are you concerned that you may euthanise patients without any family involvement or support?
How many mistakes?
One of the arguments used for not having the death penalty in NZ was – what if we get one wrong. It was that fear of a mistake that was a good justification for not having the death penalty in law.
How many euthanasia mistakes are we willing to accept? How many euthanasia mistakes are you willing to accept?
The most concerning aspect is that “legalised” means normalised.
Euthanasia is no longer illegal and ‘off the table’. It is an actual legal and approved option.
Patients may come to feel euthanasia would be ‘the right thing to do’. They’ve ‘had a good innings’ and do not want to be a ‘burden’ to their nearest and dearest. They don’t want to be a drain on their family’s resources and time.
This law now means that vulnerable people facing a terminal illness will be asking themselves – why should I not be accessing euthanasia / assisted suicide?
And this underlying obligation will be felt even greater when they utilise the services of Totara Hospice.
It’s now a clear option on the table at Totara Hospice – sadly.
We believe patients facing death have a fundamental human right – a right to receive the very best palliative care, love and support that we can give to alleviate what they may be naturally scared of, surrounded and supported by loved ones,
Hospice NZ defines Palliative Care as “active total care… [F]or people whose illness is no longer curable, the goal is around providing quality of life, managing pain and symptoms to enable people to live every moment in whatever way is important to them.”
We ask the Totara Hospice to take euthanasia / assisted suicide off the table.
Assisting suicide at a hospice is never an appropriate solution.
On TVNZ Q&A over the weekend, they featured the euthanasia issue which comes into law in a week. But rather than speaking to both sides of the debate – oh no – they just sought out the one and only one Hospice in the whole of New Zealand that was allowing assisted suicide on their premises. That’s what TVNZ call ‘balance’ 🙁
The head of the Hospice said “We believe that each of our patients is a unique human being, a unique individual, and as such they should be free to make the choices that are fight for them because we deliver patient-centred care where our approach is that the patient is always the driver of their own journey, we don’t conscientiously object.”
But what if the patient is not free to choose? What if there is coercion? What if the patient is vulnerable and simply needs reassurance and support?
Here’s the definition of PALLIATIVE CARE which Hospice NZ uses. It is
“active total care… for people whose illness is no longer curable, the goal is around providing quality of life, managing pain and symptoms to enable people to live every moment in whatever way is important to them.”
Killing a patient doesn’t fit that definition.
Learn more about the law here …