Stuff co.nz 21 April 2019 Family First Comment: “How we die says a lot about our society. Having held a few hands of the dying, I know that those moments are sacred. I didn’t swear the oath of first doing no harm, to then participate in an activity with multiple harmful effects to both the living and the dying.” #protect #rejectassistedsuicide
OPINION: First, do no harm. This is our medical creed.
When our class graduated I was the student who read out our version of the Hippocratic Oath, “a declaration of professional dedication”, in te reo Māori.
All brand new baby doctors in the old Maidment Theatre, 20 years ago. The kids were there holding my hands. Te Kaanga Skipper, our med school mother hen, gave us all a pounamu heart to wear around our necks. Merimeri Penfold lent me a korowai. Pineaha Murray and Selwyn Muru put the cloak on me. Karakia were spoken, and an ancient oath was made new.
The End of Life bill has brought it all back in vivid, living colour. Reading the legislation – not everyone’s cup of tea – has been exacting my little grey cells this week. I find it fascinating. And with a new bill like this one the preamble and description of the process to date is insightful stuff.
In essence, the judicial committee who reviewed it were “unable to agree that the Bill be passed”. They concluded members of Parliament needed to resolve the matter.
There are a few things that really bother me.
One is that the law is written as if we are all living completely independently of each other, as if we make decisions alone. This is not true. That there is no compulsion to discuss “assisted dying” with any whānau at all strikes me as fundamentally wrong. This is not reflective of how we – Māori and Pākehā – live, or how we may die.
Many aspects of the law that I deal with regularly provide salutary lessons that are relevant here if we don’t want to make the same mistakes.
Stuff co.nz 16 April 2019 Family First Comment: “Whatever form the law took, creating legal assisted suicide would confront every eligible person with an entirely new question: is my life worth living? Should I hang on, or end my life now? It’s a question that becomes an undercurrent in conversations with doctors and family members.”
OPINION: After months of thought and argument, the justice select committee has thrown the End of Life Choice Bill back in Parliament’s lap.
We’re in the strange situation where no-one, not even sponsor David Seymour, is supporting the bill as it is. The select committee couldn’t agree that the bill should pass and made only technical changes to it, deliberately leaving major questions hanging. Supporters are trying to invest the procedure with the illusion of certainty, but the bill is now overshadowed by ambiguity.
Seymour has stated that, if the bill passes its second reading, he will propose an amendment limiting eligibility under it to patients with terminal illnesses. But he has also said his amendment would introduce eligibility for neurodegenerative conditions that are likely to cause death within 12 months, alongside the current provision that has a six-month limit.
This example shows that amending the bill would be messy, with MPs voting on a patchwork of proposals that are unlikely to add up to a coherent, watertight law. Not only would each MP vote based on their individual conscience, but party agendas would be at play too. In particular, NZ First has stated that the issue should be subject to a binding referendum and may refuse to support any bill without it.
But let’s imagine that, somehow, the stars align and a cut-back, workable law is passed. Even a narrow version of the bill creates a risk of wrongful death: deaths that would fall outside the bill’s own criteria. For example, the bill is based on the ideal of free and informed consent, but the select committee noted submissions from doctors that “determining whether a person is competent [to consent] is complex, challenging, and subject to error … a person’s competence can vary daily, particularly if they are suffering from a terminal illness”.
There’s also a risk that some people would choose euthanasia because they felt pressure from others, and fear of being a burden was a reasonfor choosing assisted suicide for 63 per cent of patients in Oregon last year – a trend that has been rising steadily.
There’s also no reason to think the law would be set in stone. For example, Belgium introduced a euthanasia law in 2002, then expanded it to terminally ill children in 2014; and after just over two years, the Canadian Government is considering whether to expand its euthanasia law to “mature minors“. Our attorney-general, in his report on the bill, said that limiting eligibility to over-18s was inconsistent with the New Zealand Bill of Rights Act and that consistency would require lowering the age limit to 16 or removing it altogether.
Radio NZ News 15 April 2019 Family First Comment: Exactly what we warned about in our Submission…. “Mr Howard said the conversation around dying as a way out remained. He said many of the young people he worked with were intelligent and articulate, and followed discussions around the bill. Some were using the justifications of euthanasia advocates to inform their own situations.”
A therapist who specialises in youth suicide is concerned not enough is known about how assisted dying may affect vulnerable youth.
The End of Life Choice Bill allows for people in unbearable suffering or with an incurable, grievous condition to ask a doctor to help end their life.
Dion Howard, a nurse and therapist who has spent 20 years working with young people and has expertise in adolescent mental health, wrote a submission to MPs considering the bill.
In his submission, he argued the ripple effects on youth had not been adequately explored.
“Really, my question to the select committee is, ‘Can you be certain this would not impact the suicide rates of young people?’ To which the answer I’m certain is, ‘We don’t know that’.
“So, the next question should be, ‘Well, shouldn’t we know or shouldn’t you be certain before supporting a change?’ ”
He said overseas jurisdictions had grappled with the same issue.
“It was quite remarkable that the Scottish Parliament rejected their similar bill on the basis that they didn’t think they could reasonably prevent and educate on the prevention of suicide and present it as a solution at the same time.
TVNZ One News 10 April 2019 Family First Comment: Dr Hickey says the bill is not fit for purpose. “We’ve just done a massive fundraising campaign for Mike King’s campaign and here we are willing to bring in legal suicide basically…” Dr Hickey says the bill threatens vulnerable Māori already being failed by the health system. “In Oregon 63% of those that were euthanised were from poor backgrounds who were on state insurance and who refused treatments to have kept their lives going well. We do have a public health system that is rationing certain things like dialysis and who are the biggest recipients of dialysis? Māori and Pacific peoples.”
The group of lawyers who specialise in protecting vulnerable New Zealanders say the controversial euthanasia bill is fatally flawed.
Former legal academic Dr Huhana Hickey says the bill is a threat for Māori who are already have high rates of suicide, terminal illness, mental health issues and disabilities.
Speaking to Te Karere, Dr Hickey says the bill is not fit for purpose.
“We’ve just done a massive fundraising campaign for Mike King’s campaign and here we are willing to bring in legal suicide basically,” she says.
In its current form, according to Lawyers for Vulnerable New Zealanders, the End of Life Choice Bill has 35 flaws.
“There is a danger in this legislation and it comes with irreversible, irremediable and terminal. You cannot determine what irreversible, irremediable is,” says Dr Hickey.
“I qualify under that and I still got a lot of life left in me. Many of us will quality for that. Depression after your husband, wife dies will quality under that.”
Stuff co.nz 9 April 2019 Family First Comment: “The committee was given 16 months to study the bill, hear submissions, and try to fix it. They simply couldn’t, because it’s a flawed, dangerous bill.” – Family First NZ
It took 16 months, almost 40,000 submissions, and a nationwide tour of 14 cities.
The result was a report that found no agreement on whether the End of Life Choice Bill should be passed, made no substantive recommendations, drew few conclusions and disappointed those on both sides of a hard-fought debate.
Both advocates and opponents of the bill – which seeks to legalise voluntary euthanasia – have resumed their default positions for a familiar battle that will span months to come.
The report, tabled in Parliament on Tuesday, did not address any contentious aspects of the prospective law, with the eight Justice Select Committee MPs declining to “consider substantive policy issues on a conscience bill”.
“On the many substantial issues, we did not decide. However, we do agree that the bill is not workable in its present state,” the report said.
End of Life Choice Society president Maryan Street who, in 2012 as a Labour MP, introduced a similar Member’s Bill to Parliament, to allow terminally-ill people to choose when to die. She was among those left less-than-impressed with the committee’s conclusion.
She said the society was “disappointed” the report was not bolder, “given the overwhelming support for a law change New Zealanders have consistently shown in reputable opinion polls”.
However, she believed it was legitimate for the committee to pass the issue to the full Parliament where it would be decided on a conscience vote by MPs.
“It is encouraging that the committee has left the policy content of the bill largely intact, with only minor, technical, and consequential amendments.”
Family First national director Bob McCoskrie, who is on the opposing side, called the bill “a mess”.
He noted that a significant amount of MPs who voted in favour of the bill in its first reading did so in order to allow the select committee to analyse the proposed legislation and make appropriate changes.
Radio NZ News 9 April 2019 Family First Comment: “One of the speakers at the rally, Dr Luatupu Cleverley, said the legislation compounded poor health outcomes for the Pacific community. Pacific people already suffer the worst statistics in the New Zealand health system and the bill goes against their culture and traditions, Dr Cleverley said. It is traditional for Pacific families to look after their own and the government should focus on improving palliative care, she said.” www.protect.org.nz
People from New Zealand’s Pacific communities have rallied at parliament against a proposal to legalise euthanasia.
The End of Life Choice Bill would give terminally ill people the option of requesting help to die.
About 200 hundred people gathered in parliament grounds to protest against the bill.
One of the speakers at the rally, Dr Luatupu Cleverley, said the legislation compounded poor health outcomes for the Pacific community.
Pacific people already suffer the worst statistics in the New Zealand health system and the bill goes against their culture and traditions, Dr Cleverley said.
It is traditional for Pacific families to look after their own and the government should focus on improving palliative care, she said.
Stuff co.nz 8 April 2019 Family First Comment: “Now understanding it was the depression that is a natural bedfellow for terminal illness that made her ever think it was a good idea to hasten her death, she is making a last-ditch plea to stop the End of Life Choice Bill progressing.” www.Protect.org.nz
Tokomaru woman Vicki Walsh has well and truly out-lived her life insurance payout.
Diagnosed with the brain cancer glioblastoma multiforme nearly eight years ago, the prognosis was that she would be dead in 12 to 148 months.
She nearly was.
Not from the cancer, but by her own hand.
She had the pills laid out on the kitchen bench, ready to end the suffering, but changed her mind over a cup of tea.
Now understanding it was the depression that is a natural bedfellow for terminal illness that made her ever think it was a good idea to hasten her death, she is making a last-ditch plea to stop the End of Life Choice Bill progressing.
On Tuesday, the day Parliament’s Justice Committee is due to report back ahead of a likely vote on May 1, the DefendNZ lobby group’s documentary about her remarkable survival will be released.
NZ Herald 7 April 2019 Family First Comment: “The Canadian law has created confusion about what patient’s lives are worth living and what lives aren’t. This is directly, negatively affecting medical care. Canada has abandoned one of the most important aspects of patient-centred care.”
• Dr Sinead Donnelly is a palliative medicine specialist in Wellington. COMMENT: As the time approaches for Parliament’s Justice Committee to report back on David Seymour’s euthanasia and assisted suicide bill, it is timely to carefully review the impact of legalisation in countries like Canada, often cited by Seymour as exemplary.
Seven Canadian doctors published a 2018 World Medical Journal article, “Euthanasia in Canada: a cautionary tale”, endorsed by 57 other Canadian doctors. They wrote, “As Canadians, we are saddened by this situation, but we hope that our experience and observations will serve as a warning for our colleagues in other countries, and their patients”.
The Canadian Supreme Court ruled in Carter v. Canada (2015) that physicians may provide euthanasia or assisted suicide (EAS) to competent adults who clearly consent, who have a grievous and irremediable medical condition (including illness, disease, or disability) that causes enduring and intolerable physical or psychological suffering, and that cannot be relieved by means acceptable to the individual.
The Canadian law’s sponsor claimed that EAS would remain “very exceptional”. However, the law also said “qualified patients had a right to euthanasia, and the exercise of a right cannot be exceptional”.
Within a year of the ruling, pressure for “Carter Plus” became so great that the federal Government legally committed to considering EAS for adolescents and children, for mental illness alone, and by advance directive (for those who lack capacity, like dementia patients). Two and a half years after legalisation, strong lobbies are intensifying their push towards expanding euthanasia as a response to those cases.
As Seymour states often in support of his own Bill, the Canadian Supreme Court believed “a carefully designed and monitored system of safeguards” would limit risks associated with allowing physicians to kill patients or help them commit suicide. Canada’s EAS death rate in the first year, about 0.9 per cent of all deaths (1,982), was not reached by Belgium for seven to eight years.
Even supplemented by provincial and professional guidelines, current criteria are so broad it permitted lethal injection of an elderly couple who preferred to die together rather than at different times by natural causes.
Other disturbing stories emerge. A 25-year-old disabled woman in acute crisis in an emergency ward was pressured to consider assisted suicide by an attending physician, who called her mother “selfish” for protecting her. Hospital authorities denied a chronically ill, severely disabled patient the care he needed, suggesting euthanasia or assisted suicide instead.
When the Quebec euthanasia law was being instituted, some Quebec emergency physicians, for a time, were letting suicide victims die even though they could have saved their lives. The president of the Association of Quebec Emergency Physicians stated that the law and accompanying publicity may have “confused” the physicians about their role.
Quebec physicians and health care practitioners now work in environments characterised by an emphasis on euthanasia as a purported “right”. The onus is increasingly on physicians to show why euthanasia should be refused, with health care administrators more anxious about being accused of “obstructing access” than about “killing people who really ought not to be killed”. This is the reality of a supposedly carefully designed system.
The Canadian law has created confusion about what patient’s lives are worth living and what lives aren’t. This is directly, negatively affecting medical care. Canada has abandoned one of the most important aspects of patient-centred care.
As Professor Margaret Somerville explains: “The informing philosophies of euthanasia and palliative care are in conflict. Palliative care is based on a commitment to help people to live as fully as possible until they die a natural death. The informing principle of euthanasia is that it is ethical to intentionally inflict death to relieve suffering or even the fear of future suffering.”
Peer-reviewed, published evidence shows most euthanasia requests are motivated by existential issues, including fear of loss of control, of what comes after death, of being a burden on others, demoralisation, and questioning the meaning, purpose and value of life. None of these can be properly addressed by euthanasia. This is hardly “patient-centred” care.
So what can we learn? “The introduction of euthanasia in Canada has caused doubt, conflict and crisis”. The authors suggest an alternative that new disciplines, new professions and new methods may arise to satisfy new social goals but not in the name of medicine. https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12219801
Stuff co.nz 4 April 2019 Family First Comment: “As someone who works with people in pain every day, I can’t support the End of Life Choice Bill. It takes a vulnerable population, one that experiences depression and anxiety and already worries that their lives hold no value to society, and offers them suicide as a solution to their pain and suffering. It would destroy the trust that some of my patients have in me, as their pain doctor, to be a safe space where they can discuss the causes of their suffering.” #rejectassistedsuicide www.protect.org.nz
Dr Conrad Engelbrecht is a doctor in anaesthesia and pain medicine for Waikato DHB and co-head of the Braemar Pain Clinic in Hamilton. OPINION: In debate around the End of Life Choice Bill, there is a lot of talk about pain and suffering. Is it possible to stop all pain and suffering? Can pain and suffering make a life no longer valuable, and make death a better option than life? What should a doctor’s role be when a patient is experiencing intense pain and suffering?
As an anaesthetist and pain physician working at a pain clinic, it’s my job to help people who are in pain. On a day-to-day basis, I see patients who are suffering, and my job is provide them with an avenue to alleviate their suffering.
I can tell you that pain and suffering are complex experiences. Of course pain can be physical, but it can also be emotional, existential, spiritual or psychological. It can be caused by medical and physical conditions, as well as by emotions and issues held deeply inside a person. Pain often affects people on multiple levels. It affects their moods, their ability to function, their physical activity, how they sleep, their mental well-being, and their social interactions and engagements.
When people experience pain over long periods of time, and when that pain is relentless, people can suffer from low moods and even develop depression and anxiety. They lose things that are important to them: jobs, hobbies, the ability to work, and a sense of self-worth. I have met many patients with chronic or intense pain who feel like they are no longer valuable to their families, their community, or to society – that they’re more of a burden than a blessing.
NZ Herald 2 April 2019 Family First Comment: Superb words from Dame Tariana “It’s a really important time in all of our lives when we are farewelling somebody we love and care for. It is the responsibility of all of us to be at one with one another. The End of Life Choice Bill would invade this sacred space. The bill would allow a person to request a euthanasia death without talking to their family, and a person could be killed without the family knowing. In treating the dying person only as an individual and not as a whānau member, the bill misunderstands what it means to live and to die.” Protect.org.nz
Life and death are not individual events. There are very few people who are on the Earth by themselves. We exist as part of our families, our whānau and our communities. For many Māori, death is a process the whole whānau goes through together because the whānau is farewelling a part of itself.
It’s a really important time in all of our lives when we are farewelling somebody we love and care for. It is the responsibility of all of us to be at one with one another.
The End of Life Choice Bill would invade this sacred space. The bill would allow a person to request a euthanasia death without talking to their family, and a person could be killed without the family knowing. In treating the dying person only as an individual and not as a whānau member, the bill misunderstands what it means to live and to die.
I feel quite sad about this bill because it undermines the essential things we believe in as tangata whenua, saying that that’s of no consequence. People, whether they be terminally ill, disabled, or old, are still members of families. It doesn’t matter what their circumstances are.
About three years ago my husband George had a heart attack and a stroke. He was in intensive care, and a doctor said to me that she would hope I wouldn’t expect them to resuscitate him. And I thought , “Wow.”
So I said to her, “I don’t think I would expect you to do anything for my husband. In fact, as soon as he is well enough, we will go home, and we will decide what treatment he will receive.”
So we took George home, and right through that first year, we’re being told he could go at any time.
But, you know, he’s still alive. We all care for him. A grandson gave his job up in Wellington and came to Whanganui to help me look after his grandfather. People need to live in a safe, happy environment, to be loved within their family, to have the family there to help them do what they need to do.
READ MORE: https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12218130
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