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Care not nullified by choice

Opinion Piece

The false dichotomy is an old but effective scaremongering tactic, now dusted off for use by the lobby opposed to the End of Life Choice Act.

Their familiar argument goes thus: We should vote No to assisted dying and instead put more resources into palliative/hospice care.

The first implication of this false dichotomy is that we cannot have both — it must be one or the other. This is simply not true.

There is absolutely no reason not to have both. In countries like Holland, Belgium and now increasingly in Canada, hospice care and assisted-dying services work as a seamless continuum, with assisted-dying doctors taking over at the patient's request when hospice care is ineffective. This cooperation of services is what most patients want.

Even in countries where palliative care declines to cooperate with assisted-dying physicians, it nevertheless continues to improve and expand.

Palliative Care Australia commissioned an arms-length investigation into the potential adverse impact on itself of assisted-dying legalisation last year. The study found that: “If anything, in jurisdictions where assisted dying is available, the palliative care sector has further advanced.”

The second implication is that all problems of end-stage suffering could be eliminated if only palliative care services were better funded, better resourced and more widely extended. It would be comforting to believe that, but sadly it is also not true.

In Oregon last year, 90 percent of patients granted an assisted death were already receiving hospice care. In Canada, 82 percent of patients were receiving hospice care. Why would these patients request a medically assisted death if palliative and hospice care could adequately address their suffering?

The limitations of palliative care are further confirmed by official reports such as those routinely compiled on behalf of Palliative Care Australia by the University of Wollongong, NSW, showing that up to six percent of its patients experience “severe” suffering in their terminal phase.

So, does the international push for the legalisation of medically assisted dying constitute a failure of palliative care? Not at all. A death with palliative care is an enormous improvement on a death without palliative care and the suffering of patients (and their families) is significantly, if not entirely, relieved by its expertise. It is a service well-deserving of better funding, better resourcing and of extension.

But there is a component of the human being that sits outside the sphere of influence of palliative care. It is whatever does not pertain to the purely anatomical — call it mind, personality, spirit or other. Or just call it “the person”. The person comes into hospice care with a set of values.

Among these may be the most commonly cited reasons for requesting an assisted death, namely the desire to retain autonomy, physical independence, control of bodily dignity. These are difficult to hang on to if the disease causes vomiting of faeces through the mouth or fungating tumours whose stench is so unbearable that family gag to approach. Double incontinence, loss of function, paralysis, breathlessness causing terror, thrashing fits and hallucinations are not soothed by better funding, better training or kindly intention.

The false dichotomy should be rejected. We can and should continue to extend our already excellent palliative care services by applying ever-increasing funding for them.

In addition, we can and should legalise assisted dying for that small percentage whose suffering can only be relieved by the hastening of death. Of the 33,000 people who die in New Zealand each year, that might be around 300 medically assisted, peaceful deaths annually.

Read the safeguards in the End of Life Choice Act at www.referendums.govt.nz

Ann David

Leave a Reply to John Porter Cancel reply

  1. John Porter says:

    Thank you Ann. Well presented argument.

  2. Renee Joubert says:

    No, we do not have to “legalise assisted dying for that small percentage whose suffering can only be relived by the hastening of death.”

    It’s already legal for a doctor to give a person as much medication as needed to address distressing symptoms, even if it could hasten their death as a side effect. It’s not necessary to change the law.

    As a last resort a person can receive palliative sedation, which means the person is sedated for a few hours and then brought out of it to be reassessed. I understand that a repeat is almost never necessary. In extremely rare cases it may be necessary for a person to also receive terminal sedation (continuous deep sedation until death).

    Assisted dying is a euphemism for both voluntary euthanasia (the administration of a lethal dose) and assisted suicide (receiving a lethal dose to self-administer).

    The lethal medication consist of drugs that induce sedation, followed by a drug that induces cardiac and respiratory arrest.

    If a person were to be sedated deeply enough, they would not experience any suffering. It’s therefore unnecessary to administer the last drug which induces a heart attack.

    In any case, the End of Life Choice Act is not limited to people who allegedly can’t be helped by palliative care. The Act does not require a person to receive palliative care before request a lethal dose.

    1. Martin Hanson, Nelson says:

      One thing that many of the most vocally active opponents of the End Of Life Choice Act carefully avoid, is whether they oppose the very principle of Voluntary Assisted Dying (VAD). Instead, they point to what they claim to be weaknesses or flaws in the Act.
      So I have a question for Renee: Do you consider that VAD to be morally wrong in principle? A ‘yes’ or ‘no’ will do.

    2. Esther Richards, Tauranga says:

      Obviously you miss the whole point of this Act, which is all about the patient being in control of their death. Remember they haven’t chosen to die, they are dying. They are asking to do it as we would like to die, peacefully while we sleep. What happens currently is chosen by the doctor and/or family, not the patient. Additionally, by the time the Doctor makes this choice, they have already suffered pain, when the choice to use the Act would mean they wouldn’t have to experience that pain as they could choose to take their medication when it gets too bad. An additional issue with Palliative Sedation, is the patient is knocked out, and can take time for the patient to die, often not even aware they are not alone. With the choice, there is a set date and time, so there have been times when family issues have been resolved and forgiveness happens, leaving a sense of peace which makes the grieving process lighter. It allows family/friends a chance to catch up, share the love and support each other, and say their final words with the patient who is fully aware of them being there, and not dying alone.