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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Key points:

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

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

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

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

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

Key points:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Is Euthanasia a health priority for New Zealand at present?

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

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

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

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

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

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

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

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NewsRoom 11 September 2020
READ MORE: https://www.newsroom.co.nz/assisted-dyings-inequity-problem\
Emergency medicine resident medical officer Carmen Chan shares her concerns about euthanasia as an equity problem and explains how it broadens the gap in health outcomes for those already having trouble getting fair access to care


Family First notes these comments by Carmen Chan:

“If you had asked me as a medical student some years ago, I would have told you that I supported the proposed End of Life Choice Act. We put down our animals when they are suffering. Who’s to say that we can’t have the right to control how we end our own lives when we live with a terminal illness? But now as a practising clinician, I have many doubts about the proposed law on euthanasia. The conversation is much more complex and nuanced than what you’ll commonly read in the media – which is why I feel the need to speak out…

“..Euthanasia is an equity problem. It broadens the gap in health outcomes for those already having trouble getting fair access to care – for example, Māori and Pacific populations, rural communities, those impoverished and anyone already marginalised by the healthcare system. For me, it’s obvious who would be more likely to opt to end their lives early through euthanasia because they cannot access the medical care and support that they need. We need to think very carefully about what this legislation might end up doing… Rather than endorsing euthanasia, I want to call upon our government to strengthen palliative care, social services and support systems.

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Jeff Tallon: End of Life Choice Act should ‘spark a fire of compassion’

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NZ Herald 9 September 2020
Family First Comment: Superbly written….
“I want to see this Bill spark a fire of compassion in our nation. Let us engage more with the dying. Let us create true personal dignity for the dying – not by abandoning them, not by killing them prematurely – but by simply journeying with them day after day until the end; sustaining their mana… [T]o change the law to license medical professionals to kill is a fundamental ground shift in the profession, a radical change in medical ethos that is both unnecessary and deplorable. People of New Zealand, do not place this burden on our doctors. Instead get out there and do the mahi – the hard slog of being human and extending love and human encounter to our most vulnerable in their last days. Compassion is not delivered by proxy of legislation. Compassion is personal. Compassion is up to you and me.”
Yes!

The upcoming referendum on the End of Life Choice Act 2019 is by far the most important decision we as a nation will make in the October elections. Much has been written and much stated before the select committee – more than 90 per cent of submissions in opposition to the Bill. I am one of those opponents.

The most recent contribution to this very complex issue is an opinion piece by Matt Vickers (former husband of Lucretia Seales). Not surprisingly he supports the Bill. I can understand his stance but sadly it is expressed in terms that are both simplistic and false.

It is grossly false to suggest that only supporters of the Bill are compassionate and those against are not. It is false to imply that it is only supporters of the Bill who are truthful. Indeed, in his opening sentence he states that “the End of Life Choice Act was passed into law”. That is not true. It has yet to receive Royal Assent and that remains dependent on the referendum.

Like all issues in public discourse, assisted dying is complex. There are reasons for and reasons against. Inevitably there is a distribution of opinion – let’s call it a bell-shaped curve, a so-called normal distribution. So, the first point is that viewpoints on either side are valid in principle and we are duty bound on either side to respect that. But I have been to many public meetings on this issue where attacks on opponents to the Bill have been vociferous and venomous.

It needs to be recognised that a significant part of the attack on opponents has been an odd confusion between the issue at hand and religion. And the hatred of religion in some quarters has always spilled over in these meetings. Vickers comes very close to holding hands with these anti-religionists in his sweeping generalisations about “church-backed doctors and lawyers”.

To state my position clearly, I happen to be a scientist and a Christian but I doubt any considered person would refer to me as a “church-backed scientist”. For one thing, which church? Churches, too, have a distribution of opinion.

I will float a very non-scientific guess here (but its worth undertaking a proper survey). I am thinking that more opponents to the Bill have sat through the long hours and days with a dying friend, relative or stranger than proponents. Sat there holding a hand, talking quietly and lovingly often to an unresponsive patient, perhaps singing soothingly; human contact which might seem one-way only, but inevitably is mutual; savouring the sacred moments as life fades. Who knows? But I say this with passion: “opponents of this Bill are deeply compassionate” and to claim otherwise is the grossest of falsehoods.
• Dr Jeff Tallon is a physicist. The views expressed here are personal and not to be associated in any way with his employer.
READ MORE: https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12363459

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Euthanasia referendum: The right to die or a licence to kill?

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Stuff co.nz 8 September 2020
Family First Comment:“As a specialist geriatrician for the past 25 years I have cared for older people with a wide range of acute and chronic illnesses and I want you to understand why this Act is so dangerous.
You see this Act is not about allowing people choice to end their life, decline resuscitation or turn off life support because these are all already legal in New Zealand. No, this Act is about making it legal for someone else to take your life – and at a moment in time when you are at your most fragile.”
Protect.org.nz

OPINION: I’ve never been political but have become increasingly vocal with the End of Life Act looming. If you haven’t read this Act then I strongly urge you to do so.

As a specialist geriatrician for the past 25 years I have cared for older people with a wide range of acute and chronic illnesses and I want you to understand why this Act is so dangerous.

You see this Act is not about allowing people choice to end their life, decline resuscitation or turn off life support because these are all already legal in New Zealand.

No, this Act is about making it legal for someone else to take your life – and at a moment in time when you are at your most fragile.

And that someone just happens to be your doctor – just a quick rewrite of the Hippocratic Oath (just that bit about never harming you). Talk about mixed messages for our patients!

For doctors like me, it’s a quantum leap from caring for someone as they die … to actively killing someone who may not be dying at all. You see this Act talks about the state of being terminal. But doctors have never been able to predict death accurately. Who doesn’t know someone, given six months to live, proudly re-telling the story years later down at the local pub.

The reasons promoting euthanasia are sometimes because of distressing cases. And yes, I’ve lost family and friends to cancer and neurological disease and one day it will be me.  But, no matter how much insurance and control we may want over our deaths, how can this Act be supported when it takes away the legal protection when we are at our most vulnerable. Having control and choice is all very appealing but not when it places our most vulnerable at risk, and bullies doctors into the bargain.

In Aotearoa, we already score poorly with many of our social indices for both young and old compared to other countries. Elder abuse currently affects 10 per cent of older people in New Zealand although this figure is thought to be much higher in reality due to underreporting.
Dr John Thwaites is a consultant physician and geriatrician and a member of the Vote No to the End of Life Act group.
READ MORE: https://www.stuff.co.nz/national/health/euthanasia-debate/300102192/euthanasia-referendum-the-right-to-die-or-a-licence-to-kill

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