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The quest for legalised assisted dying has been driven to the steps of Parliament by the families of deceased loved ones who have witnessed deathbed suffering they deem to be cruel and unnecessary.

Ever since David Seymour’s End of Life Choice Bill was drawn from the ballot in June 2017, detractors have mounted a massive misinformation campaign to defeat it.

There was no need to invent strategies of opposition afresh. They could simply follow the blueprint used worldwide wherever an assisted dying bill is proposed. The objective is to sow as many seeds of doubt as possible in the minds of lawmakers, making law reform appear too risky to embark upon.

Claims are typically those of “slippery slope”, an increase in youth suicide and claims that the disabled will feel that their lives are “less worthy”.  These claims are unsubstantiated hypotheses; imaginative predictions only.

What to offer as a sop to those MPs whose knees tremble at the thought of these hypotheses coming true but who feel the pressure of the 70 percent of New Zealanders who want assisted dying legalised? Ah-ha! Palliative care!

And so we come to the most powerful lobby group of all, the hospice movement.  Assisted dying would contravene their iron-clad ideology which is to neither hasten death nor delay it.

Under oath at the High Court case of Lecretia Seales, representatives of Hospice New Zealand and palliative medicine were forced to admit that it is not possible to relieve the suffering of all patients.

The most recent Palliative Care Outcomes Report from Palliative Care Australia shows that up to 6 percent of patients experience “severe” suffering in their terminal phase, either from pain, other symptoms or from spiritual/psychological causes. We would be foolish to imagine the picture is much different here at home.

Last year some 10,000 patients died supported by hospice. Six percent is 600 patients, sometimes dismissed as “just a few hard cases” by detractors of the Seymour Bill.

That palliative care does sometimes hasten death is indisputable. It practices terminal sedation for the very same category of patient as that described by the eligibility criteria of the End of Life Choice Bill.  It is slow assisted dying by another name.  Sometimes death comes two or more weeks after commencement making it impossible to say with certainty that the patient died of the underlying disease rather than of simple dehydration which is an essential part of the practice.

Try this: “I didn’t kill the sick puppy, your Honour. I just left it without food and water for two weeks and when I came back, it had died of natural causes.”

In the minds of theologians, there might be a difference:  causing death by negligence rather than causing death by action. But for the layman in the street, the inescapable conclusion is that death was caused by outside human agency.

We might well wonder why the slow method is acceptable to palliative care but the speedy one, assisted dying, is not. The answer is that the Catholic church approves the slow method but not the speedy one.

The relationship between palliative care and religious organisations has been inextricable since Dame Cicely Saunders first opened St Christopher’s Hospice. There is significant emphasis on spiritual support of the dying and funding goes with it.

But as with all fraternities whether religious, scientific, medical or other, there is a hierarchy and a laity. The iron-clad ideologies are the realm of the authoritarian hierarchy.  On the ground, the practitioners try to reconcile these ideological expectations to the practical realities and sometimes draw the conclusion that the ideology is bunkum.

This is why some palliative care doctors and nurses made submissions to the Justice select committee in support of assisted dying.

Clive Deverall, former president of Palliative Care Western Australia took his own life in March 2017.  He was suffering from non-Hodgkins lymphoma.  A note was found on his body: “Suicide is legal; euthanasia is not”.

Before his death, Deverall had campaigned tirelessly for assisted dying legalisation.  Palliative care was not the answer for between 4 and 8 percent of patients, he said, those “very end stage patients where symptoms cannot be controlled”. He felt that patients in that distressed state should be offered euthanasia.

In April 2019, the British Medical Journal published an article written by five palliative care consultants who requested anonymity. It was titled: “We risk our careers if we discuss assisted dying”.

It caused past president of the British Medical Association Sir John Temple to write in reply.  “I was saddened to read that palliative care doctors feel there is a culture of fear and intimidation within their profession around the assisted dying debate.  In my experience those who specialise in palliative medicine are as caring and compassionate as doctors can be.  For these traits to have surfaced suggests the speciality has somewhat lost its way…

This debate will keep going and the law will change. The question now is whether or not our profession wants to have a say in what that change looks like”.

We return to the current situation at home:

  • Even with the best of palliative care, some end-stage patients suffer “severely”.
  • Palliative care has an ideological objection to assisted dying.
  • Notwithstanding the fact that any medical practitioner can opt out under the terms of the Bill, the hospice movement wishes to go further than that; it wishes to scupper the Bill entirely so that assisted dying cannot be made available to anyone by any doctor.
  • Palliative care is offered to politicians as the only alternative to assisted dying with, of course, increased funding.

An email link has just come through.  The heading is: “Canada’s bishops allow Catholic hospitals to host consultations for euthanasia.”  Catholic ethicists are furious.  It seems the bishops have moved ahead even of the ethicists.  Maybe palliative care will follow suit eventually.  Until then, the iron-clad ideology will show no chink.

But is that morally right?

Ann David is a retired human resources professional.  She has been a campaigner for the right to die with dignity since her mother died under terminal sedation in 2005.

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7 COMMENTS

  1. What sticks in my mind is the analogy about the sick puppy. So true, and if it were a puppy, I would be guilty of animal abuse. I know some people would argue that people aren’t animals, but does that mean that we shouldn’t be accorded the compassionate release we would give an animal. The main difference, of course, is that the animal cannot ask for death to be hastened, where we humans can. Some palliative care nurses tell terrible stories of patients in agony which even the best palliative care cannot relieve, but they would not dare to speak out in favour of the End of Life Choice Bill, because they work in a hospice. I think it’s a terrible shame that the official line is a division between palliative care and assisted dying. Why cannot it be a continuum with assisted dying available as a last resort for the few (6 – 10%) whose suffering cannot be relieved.

  2. This is by far the best opinion piece regarding assisted dying I have read.
    Clear, honest and stating the facts. So glad a quality essay is written and published in this medical/ legal magazine. It becomes very clear that opposition against assisted dying in any country engaging in flexing its ethical muscle for the benefit of the patients , always finds the opposition coming from the same source: a now decreasing in seize but still powerful faith based minority with extremely deep pockets. The intelligent majority in our country will not be fooled by them any longer. I look forward to a full interview with the lady who wrote this excellent article : Ms Ann David. Thank you.

  3. As someone with terminal cancer and a history of resistance to pain relief thereby putting me in that 6-10% of people, it lifts my heart to read support for this bill. To have this choice available would give me relief and a chance to enjoy every day I have left, knowing at the end when it gets bad, I could end it peacefully surrounded by loved ones, listening to my favourite music and holding my much loved son’s hand. I hope the MP’s pass this bill through, so I can have that choice before it’s too late.

  4. I totally agree – in many, perhaps most, hierarchical organisations there is a disconnect between the top brass and the foot soldiers, the latter with their feet more firmly on the ground and concerned with matters important to ordinary people than with politics and power – how else does one explain the gap between opinion polls and statements by bishops? If we get a referendum on Assisted Dying, I’d like to think that it will silence the bigots, but I doubt if it will.

  5. Ann David points out a critical aspect in the debate over our EOLC bill – the very best of palliative care cannot always help – by their own admission, six percent of patients in their care suffer extreme pain at the end of their lives. The public of New Zealand did not need to be told this – they have watched family members and friends suffer harrowing deaths and in recent and repeated polls by reputable market research organisations, seventy-five of them support the EOLC bill. Philosophic and dogmatic arguments carry little weight when witnessing, as I have, a loved one suffocating, choking, drowning in their own lung fluids.

    Why opponents of this bill should be so determined to condemn some of their fellows to such a death is a mystery to the vast majority of us impatient to have it passed.

  6. As a nurse of over 30 plus years I have unfortunately watched many patients and friends die a long slow harrowing death. It upsets me that we are so focused on the living we have totally left terminal patients behind. I for the life of me do not understand how a grown person with all their faculties that has been given a terminal diagnosis is not allowed to be in charge of how they would like to die. It is not only soul destroying for the patient but their loved ones as well.

  7. A great article Ann but don’t let the politicians off the hook. This is an ethical issue about humanity and telling the truth but it is also a political issue about democracy. It is politicians who have a vote on whether the assisted dying legislation is passed, not palliative care workers or church leaders. Some MPs are certainly doing the right thing but not the majority. Politicians get paid to do the work of becoming informed and not to accept fear-mongering manipulative and deceitful misinformation and disinformation on other issues, so let’s see them do it on this one. They are the ones who tell us every election how good they are so let’s see them respond with compassion and respect for their constituents not mouth the pathologically callous slogans of the suffering deniers. Politicians get paid to provide democratic representation for their constituents not to kowtow to the tiny minority of religious supremacists who not only oppose assisted dying for themselves (which is the only right they have) but want politicians to take away the democratic rights of the rest of us.

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