Concern over fearmongering on RNZ
Doctors for End-of-Life Choice New Zealand are dismayed and frustrated to see ongoing efforts to misinform the public about the November 7 introduction of legally-available voluntary assisted dying (VAD).
Taxpayer-funded national broadcaster RNZ's investigative journalist Guyon Espiner has put forward a series of unfounded “concerns” on behalf of a group described as “palliative care”.
He raises fears that insufficient doctors will be found to deliver assisted dying services and that doctors will be poorly trained “as in Victoria”. The Ministry of Health found recently that nearly 30 percent of doctors surveyed were willing or potentially willing to provide assisted dying services. That's about 5000 doctors. Given our strict eligibility criteria, very few patients will qualify for assisted dying. By way of comparison, Victoria which has a population 28 percent larger than that of New Zealand, completed 124 assisted deaths in the first year of availability.
Regarding Espiner's relayed criticisms on training, upskilling in the 21st century is routinely undertaken via online courses and is generally thought to be a satisfactory means of delivery. We cannot imagine why this should be different for assisted dying.
The Ministry's medical advisers are currently working out which drugs to use for greatest safety and efficacy. Espiner reports that, if oral ingestion is chosen by the patient, this will be a compound of “unapproved” drugs. The compounding (mixing) of drugs is common pharmaceutical practice and is undertaken using familiar components that are used in everyday medical practice. Victoria solved the problem by opting for a single point of compounding and distribution: the Alfred Hospital in Melbourne. Their compounded medication works as intended. New Zealand could simply do likewise.
After two years of VAD practice in Victoria, there have been no failed administrations, even though most patients there self-administer orally. The June-December 2020 report tells us that 94 percent of the loved ones of patients who died a VAD death described the service as excellent, and the remainder described it as good.
Doctors generally prefer the intravenous delivery of any drug that has the potential to be poorly tolerated if orally ingested. It is salutary, then, that our End-of-Life Choice Act offers the option of intravenous delivery.
Espiner's interviewees anticipate “ethical and legal” conundrums in the extremely rare case of failed administration. They suggest that consent should be reconfirmed if a second attempt needs to be made.
Palliative care's own answer to assisted dying is terminal sedation, the practice of deeply sedating the patient while discontinuing all nutrition and fluids. It can take two or more weeks to die in this way. While consent to continue is sometimes sought after the first few days, it would be downright unethical to re-awaken the patient in the later stages of starvation and dehydration. Yet palliative care feels comfortable to continue terminal sedation without re-confirmed consent.
In jurisdictions culturally close to New Zealand, assisted dying has been overwhelmingly described by doctors, patients and families as a swift and peaceful release.
Spain and the state of Tasmania passed assisted dying legislation in March. South Australia, Queensland and NSW will be debating similar legislation this year. The clock will not be turned back on assisted dying in the world of Westernised medicine. Patients want it. Doctors see the need for it.
We respect our palliative care colleagues and fully support the expansion of their services. Some of them are members of our group. We do not support evangelisation of the anti-assisted dying rhetoric by a group purporting to speak for all palliative care practitioners. Above all, we do not support our national broadcaster being used to sow seeds of doubt where there need be none.
■ Dr Jack Havill is spokesman for Doctors for End-of-Life Choice NZ. He is a retired intensive care medicine specialist and lives in Hamilton.