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Open Letter to Totara Hospice re: End of Life Choice Act

By | Recent News

OPEN LETTER

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?

Why not?

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.

Auckland hospice prepares for assisted dying

By | Latest News, Recent News

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.”

https://www.1news.co.nz/2021/10/30/auckland-hospice-prepares-for-assisted-dying/

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 …

Assisted dying services to be ‘limited’

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Assisted dying services to be ‘limited’ when legalised, legal action expected
Stuff co.nz 3 August 2021
Family First Comment: Good. People can live without it.
But this is disturbing…
“The briefing paper, provided to the health minister by Director-General of Health Dr Ashley Bloomfield in January, showed there remained numerous unresolved questions and risks surround assisted dying services.”

Assisted dying services for the terminally ill will be “limited” when the End of Life Choice Act comes into force in November, and health officials say legal action over the law is “almost certain”.

Ministry of Health officials have highlighted “complex and sensitive elements” to the End of Life Choice Act and incoming assisted dying regime in a briefing paper to Health Minister Andrew Little, obtained under the Official Information Act.

Among the issues canvassed in the briefing: “uncertainty” over how many people will seek assisted death, terminally ill patients having to travel for services when the law comes into effect, competing pressures in the health system, and a possible need to rewrite parts of the law to resolve “legislative issues”.

The Ministry of Health moved forward on enacting the End of Life Choice Act on Monday, appointing 11 medical experts to a statutory body, Support and Consultation for End of Life in New Zealand (SCENZ), that will manage the incoming assisted dying regime.

Under the law, which the country voted to be passed in a referendum at the 2020 election, SCENZ will develop and oversee the standards for terminally ill patients should receive when they seek an assisted death.

The ministry said in a statement that planning for the November 7 deadline to implement the End of Life Choice Act was “well underway”.

The briefing paper, provided to the health minister by Director-General of Health Dr Ashley Bloomfield in January, showed there remained numerous unresolved questions and risks surround assisted dying services.
READ MORE: https://www.stuff.co.nz/national/politics/125945156/assisted-dying-services-to-be-limited-when-legalised-legal-action-expected?cid=app-iPhone

Euthanasia: Are we ready for legalised assisted dying in New Zealand?

By | Recent News

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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Only 10 percent of health workers ‘definitely willing’ to carry out euthanasia – survey

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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
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Distressing death warning for ‘unregulated’ euthanasia drugs

By | Recent News

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
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Government agrees people with mental illness should have access to euthanasia (Canada)

By | Recent News, Videos

The Canadian Press 23 February 2021
Family First Comment: No slippery slope?
Dream on.

The Trudeau government has agreed with the Senate that Canadians suffering solely from grievous and irremediable mental illnesses should be entitled to receive medical assistance in dying — but not for another two years.

The two-year interlude is six months longer than what was proposed by senators.

It is one of a number of changes to Bill C-7 proposed by the government in response to amendments approved last week by the Senate.

The government has rejected another Senate amendment that would have allowed people who fear being diagnosed with dementia or other cognitive-impairing conditions to make advance requests for an assisted death.

It has also rejected one other amendment and modified two others in a motion that was debated Tuesday in the House of Commons.

Justice Minister David Lametti told the Commons he believes the response to the Senate amendments is “fair and realistic.”
READ MORE: https://www.msn.com/en-ca/news/canada/government-agrees-people-with-mental-illness-should-have-access-to-maid-%E2%80%94-in-2-years/ar-BB1dW37m

This is video three of a series of messages directed at jurisdictions debating the legalization of euthanasia and assisted suicide. Consider Canada’s experience.

Alex Schadenberg, Executive Director of the Euthanasia Prevention Coalition, speaks about the Truchon decision (2019) and Bill C-7 (passed into law on March 17, 2021) and how they changed the euthanasia law.

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Euthanasia: What happens if the drugs don’t work?

By | Recent News

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
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Fears euthanasia training will just be online course

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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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Med students become more opposed to euthanasia while at uni

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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

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