In a disturbing development affecting our already under-resourced palliative care service, Health New Zealand is looking to sack the only two people focused on improving the already under-funded and under-supported palliative care system. And a new report warns that children are not receiving the palliative care they deserve.
The Post understands a Health New Zealand restructure proposal would disestablish the two national roles that look after the care of the dying – a palliative care system design manager and senior adviser.
Experts say, the plan to axe the two people dedicated to fixing the postcode lottery of care for dying Kiwis is disturbing, retrograde and potentially disastrous.
The national palliative care adviser was appointed in 2022, after palliative care experts called services for dying Kiwis a neglected, underfunded mess.
Hospital Palliative Care Aotearoa chairperson and palliative care specialist Sinead Donnelly said the plan was “disturbing, demoralising, distressing and retrograde”.
Donnelly said specialists were also upset at the staffing imbalance between palliative care and assisted dying, which has a team of around five dedicated staff. Of the 38,000 Kiwis who die every year, less than 2% use assisted dying services.
“It looks as if Te Whatu Ora is interested in developing assisted dying as a service, and they’re not interested in developing palliative care as a service … So that’s profoundly disturbing to us as well.”
Hospice New Zealand chief executive Wayne Naylor said removing palliative care’s national voice was “potentially disastrous” and could jeopardise 18 months of work to improve services for the dying.
“For the people who want to have a safe and supported death, and who don’t choose assisted dying, this is like a kick in the face to them, like the Government and Health New Zealand doesn’t actually care.”
A report last month reiterated the urgent need for a national palliative care service for children, with three out of four dying children missing out on specialist help.
Its author, child palliative care specialist Amanda Evans, was deeply disappointed by the Health NZ proposal and worried it would further delay – or kill off – any hope of a national paediatric palliative care service.
“My concern is that it’s going to be overlooked, and people wind up worse off than where we are now.”
The national palliative care adviser role was a bridge between all the different services caring for the dying, including family doctors, hospitals and hospices, Evans said.
Health Minister Shane Reti said he remained committed to developing a nationally consistent approach to palliative care. Asked whether the planned staff cuts were acceptable, his office said Health NZ was still consulting on proposed changes, and referred queries to them.
Health NZ national director of planning, funding and outcomes, Dale Bramley, said Health NZ was “committed to moving toward a more sustainable future for New Zealand healthcare”.
Original article: https://www.thepost.co.nz/nz-news/360527404/experts-slam-planned-palliative-care-staff-cut
New government data reveals that medically-assisted dying (MAID), also known as voluntary euthanasia, accounted for 4.7% of all deaths in Canada in 2023, marking a significant increase in the number of assisted deaths since euthanasia was legalized in 2016. The report, the fifth annual release since legalization, shows that approximately 15,300 people chose medically-assisted death last year, up nearly 16% from 2022.
The majority of those who opted for assisted dying were elderly, with a median age of over 77. Around 96% of cases involved individuals whose death was deemed “reasonably foreseeable,” usually due to terminal conditions like cancer. A smaller group, however, sought euthanasia despite not being terminally ill, citing long-term, debilitating illnesses that severely affected their quality of life.
Canada remains among a few countries to have introduced assisted dying laws in recent years, alongside nations such as Australia, New Zealand, Spain, and Austria. Under Canadian law, consenting adults with a serious and irremediable medical condition can request assistance in dying, provided two independent healthcare providers confirm their eligibility.
In 2023, over 320,000 people died in Canada, with 15,300 opting for assisted death, about one in every 20 deaths. Despite the increase, the growth rate of assisted deaths slowed considerably in 2023 compared to previous years, with a 16% rise instead of the usual 31%. The reasons for this slowdown remain unclear.
For the first time, the report also provided data on the ethnic and racial makeup of those who chose assisted death. It found that approximately 96% of those who died by euthanasia identified as white, despite white people making up only about 70% of Canada’s population. The second-largest group were East Asians, who represented 1.8% of assisted deaths, compared to their 5.7% share of the total population.
Quebec continued to lead the country in the use of medically-assisted death, accounting for nearly 37% of all euthanasia deaths, even though the province represents only 22% of Canada’s population. Quebec has launched a study to explore why its euthanasia rate is disproportionately high.
While the number of assisted deaths grows in Canada, the country still lags behind the Netherlands, where euthanasia accounted for 5% of total deaths last year. In the UK, MPs recently voted to approve a bill allowing terminally ill adults in England and Wales the right to seek assisted death, though it faces months of further scrutiny before becoming law.
Some critics of Canada’s euthanasia system, such as the Christian think tank Cardus, have raised concerns about the rapid growth of assisted dying, calling it alarming. The report comes as Canadian provinces have expressed reservations about expanding the program to include those with mental illnesses, a move initially scheduled for earlier this year but delayed after concerns about system capacity.
In Ontario, a controversial report highlighted cases where individuals were granted assisted dying despite not being terminally ill. One case involved a woman in her 50s with depression and a chemical sensitivity who requested euthanasia after struggling to find housing that met her medical needs. In another instance, a Nova Scotia cancer patient revealed that she was repeatedly asked if she considered assisted dying during her mastectomy surgeries, which she described as “inappropriate.”
Concerns have also emerged over the potential for people with disabilities to consider euthanasia due to inadequate housing or disability benefits. As the number of medically-assisted deaths continues to rise, the slippery slope of euthanasia is seen in the debate over the ethics and the seemingly increasing erosion of safeguards around assisted dying.
Article source
A recommendation from the Ministry of Health’s latest review of the End of Life Choice Act is calling for the gag clause, i.e. the protective measure that restricts doctors from raising assisted dying with patients to be changed. This is one of 23 recommendations made by MOH to strengthen the current law. The ministry recommended that the law be amended so health practitioners could raise assisted dying — but only as part of discussions about a person’s treatment and end-of-life care options. Euthanasia advocates in favour of this law change argue that doctors managing a patient’s palliative care should be able to discuss assisted dying with patients as it aligns with giving patients information and is different to a doctor making recommendations. International evidence would say otherwise regarding coercion and decision at such a vulnerable time in a patient’s life.
On the contrary, groups and individuals such as the Disability Rights Commissioner and the Australia and NZ Society of Palliative Medicine want this law to remain unchanged as it addresses the power imbalance between a doctor and patient and reduces any perception of coercion.
The ministry’s statutory review, presented to Parliament last week, made 23 recommendations, citing the law was generally working well and that there had been no wrongful deaths among the 978 people who had gone ahead with the procedure. Ironically, the Herald reported last month that two former members of the committee felt the oversight process was so inadequate they would not have known if someone had died wrongly.
The MOH report also recommended more powers for the End of Life Review Committee, which is tasked with ensuring each assisted death complied with the law. It said the committee should be able to access a broader range of information and be able to raise any concerning cases with relevant authorities.
Act MP Todd Stephenson has drafted a member’s bill which focuses on one aspect of the law — a requirement that a patient have six months to live to get access to assisted dying. Stephenson said he would consider re-drafting his bill to include some of the ministry’s recommendations, including the removal of the “gag clause” – i.e. a protective measure that safeguards both doctors and patients.
Original article
New research highlights significant gaps in paediatric palliative care services in New Zealand, with children facing inequitable and inadequate support. Currently, Starship Children’s Hospital in Auckland is the only provider of a publicly funded specialist paediatric palliative care service, and the service is small and vulnerable due to workforce pressures and a lack of additional funding.
Each year, about 350 children (aged 19 and under) die of serious illness in New Zealand, and a much larger group could benefit from specialist palliative care. International research suggests that with advanced medical technology, the number of children living with life-limiting conditions is expected to triple in the next decade. However, the workforce of trained paediatric palliative care professionals is insufficient to meet the growing need. As a result, many children and families are missing out on essential care, which has serious consequences for their well-being.
A report commissioned by the Ministry of Health in 2012 recommended the establishment of a nationwide service supported by Starship, with funded clinicans in each district. A group in Wellington has started a donation-funded paediatric palliative care service, but the researchers emphasize that a nationwide, publicly funded service is needed to ensure all children, including Māori, receive quality, compassionate care. They call for more investment in training and resources to build a workforce capable of meeting the demand.
Full story found here https://www.rnz.co.nz/news/national/533164/poor-care-for-dying-children-in-most-regions-report-shows
Data shows that individuals from lower-income backgrounds are more likely to opt for MAiD, raising alarm about the influence of socioeconomic factors. Notably, a case involving a grandmother offered assisted dying instead of a life-saving mastectomy exemplifies these concerns. Legal experts warn that once assisted dying is legalized, there is a risk of expanding eligibility criteria, which could lead to more vulnerable individuals feeling targeted. Cardus, a Canadian Christian think-tank published a revealing report earlier this year on the state of MAID in Canada, noting that MAID is now the fifth leading cause of Canadian deaths and has now gone from exceptional to routine medical practice.
Canadian medical and legal experts have warned that opening the door to assisted dying could lead to the limitations on who is eligible being stripped away. “One of the most worrying aspects of the Canadian experiment is it shows that once you start legalising, there is a risk that a significant number of physicians normalise this practice,” said Trudo Lemmens, a professor of law at the university of Toronto who has testified before Canadian parliamentary committees on the introduction of assisted dying. The growing visibility of a slippery slope continues as advocates of euthanasia are pushing for mental health illnesses and social determinants to be included in the MAID eligibility criteria.
Original article source https://www.nzherald.co.nz/world/assisted-dying-abused-in-canada-admits-group-that-helped-legalise-it/VYINCFKFHND2VMDQUIKGT46TFU/
Family First NZ is welcoming the Private Members Bill from NZ First MP Tanya Unkovich – ‘Improving Access to Palliative Care Bill’ – which seeks to guarantee that every New Zealander has the right to receive high-quality and compassionate palliative care whenever it is needed.
Authorities in northern Switzerland have detained several individuals and opened a criminal investigation following a suspected assisted suicide involving a controversial device known as the “Sarco” capsule. This 3D-printed capsule is designed to allow a person to self-administer a lethal dose of nitrogen gas in a sealed chamber, leading to death by suffocation.
Exit International, the organization behind the Sarco, reported that a 64-year-old woman from the U.S. died using the device near a forest cabin in Merishausen. The group claimed her death was “peaceful, fast and dignified.” However, Swiss law stipulates that assisted suicide must be carried out without external assistance, and authorities are investigating possible incitement and accessory to suicide.
Prosecutors in Schaffhausen had previously warned the operators of the Sarco that using the device could lead to criminal charges, and regional officials indicated that its operation might violate product safety and chemicals laws.
The Swiss Interior Minister Baume-Schneider, taking questions in parliament on Monday, said:
“The Sarco suicide capsule is not legally compliant. Firstly, it does not meet the requirements of product safety law and therefore cannot be placed on the market. Secondly, the corresponding use of nitrogen is not compatible with the purpose article of the Chemicals Act,” she said.
The situation has sparked debate over the legality of such devices in Switzerland, which allows assisted suicide but does not permit euthanasia. In 2020, approximately 1,300 assisted suicides were recorded in the country, highlighting its unique position in the world regarding end-of-life choices.
Original story published here
Disturbing Data In Latest “Assisted Dying” Report
Media Release: 5 September 2024
The latest review of assisted suicide / euthanasia was quietly released last month by the Ministry of Health – but it should sound significant and loud warning bells about the law, especially at a time when proponents want it to be liberalised even further.
Family First has analysed the Registrar (assisted dying) Annual Report June 2024. Key findings include:
What is most disturbing is that one in four applicants weren’t receiving palliative care. The End of Life Choice Act only provides a ‘right’ to one choice – premature death. There is no corresponding right to palliative care. Good palliative care and hospice services are resource intensive; euthanasia would be cheaper. As has also been observed overseas, notably in Canada, there is a new element of ‘financial calculation’ into decisions about end-of-life care. This is harsh reality. At an individual level, the economically disadvantaged who don’t have access to better healthcare could feel pressured to end their lives because of the cost factor or because other better choices are not available to them. Some hospitals have no specialist palliative care services at all.
The NZ Herald recently reported: “A specialist paediatric palliative care (PPC) doctor says New Zealand is falling behind other nations in its care of terminally ill children and the Government must step up to help.” 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 approximately 25% over the next 15 years and will be more than double that by 2061.
Previous Governments have made little effort to address this growing problem and to increase funding for palliative care, and essential service. Euthanasia is instead given priority and full Government funding.
The other significant red flag in the report is that just 1% of applicants had a psychiatric assessment to check for both competence to make the decision, and for any presence of coercion. 99% of applicants were not assessed for these.
That so few patients are referred raises serious questions around the competency of doctors involved in euthanasia, and also implies either key psychological signs are being ignored – or missed.
Many patients who are facing death or battling an irreversible, debilitating disease are depressed at some point. However, many people with depression who request euthanasia overseas revoke that request if their depression and pain are satisfactorily treated. If euthanasia or assisted suicide is approved, many patients who would have otherwise traversed this dark, difficult phase and gone on to find meaning in their remaining months of life will die prematurely.
The unspoken reality is also that terminally ill people are vulnerable to direct and indirect pressure from family, caregivers and medical professionals, as well as self-imposed pressure. They 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. It is virtually impossible to detect subtle emotional coercion, let alone overt coercion, at the best of times.
This latest data simply confirms that nothing in the law guarantees the protection required for vulnerable people facing their death, including the disabled, elderly, depressed or anxious, and those who feel themselves to be a burden or who are under financial pressure.
Family First is also deeply concerned by comments by Associate Minister of Health David Seymour who is overseeing the review of the law. He recently stated on RNZ:
“The statutory review is being the Ministry of Health right now. I believe, without pre-empting what it will say, that it will give a lot of weight to making change.”
It is deeply disturbing that a Minister would campaign and potentially unduly influence an independent review with this type of commentary.
It’s time we focused on and fully funded world-class palliative care – and not a lethal injection.
We can live without euthanasia.
DOWNLOAD OUR FACT SHEET ON THE LAW https://familyfirst.org.nz/wp-content/uploads/2021/06/Euthanasia-Fact-Sheet.pdf
Here is our review and analysis of the End of Life Choice Act Survey