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.