What about the doctors?

August 30, 2016

Proponents of euthanasia argue that people have autonomy over themselves which includes the right to die.

They rarely look at the debate from the point of view of doctors who would prescribe lethal doses of medication or administer them.

At The Spinoff, Medical Association chair Stephen Child gives that perspective:

For many, the key discussion point is whether it is possible to write and administer perfect legislation that permits someone autonomy at the end of life without the secondary negative consequences of:

  • inappropriate deaths
  • reduction in quality of palliative care
  • normalisation of suicide.

Both sides of this debate will emphasise anecdotes, surveys or “research” demonstrating cases of potential intolerable human suffering, or cases of coercion/inappropriate decision making, resulting in potentially unnecessary death. . . 

The ethical standards of a profession often go beyond public opinion, the law and market demands, and may also differ from the personal values held by some individuals within that profession. The role of professional ethics, however, is not only to prevent harm and exploitation of the patient but also to protect the integrity of the profession as a whole. This often requires the professional body to fulfil a leadership role to ensure clarity and provide direction.

The NZMA, along with the World Medical Association and 53 national medical associations, holds the following positions on voluntary euthanasia and assisted dying:

  • We recognise the rights of patient autonomy, so we recognise the right for society to have this discussion. We also acknowledge that people currently have the right to end their own life and that this legislation focuses on third-party assistance with this act.
  • We recognise the rights of patients to refuse treatment or for the removal of lifesaving treatment, and that the natural consequences of an illness may progress to death.
  • We recognise the rights of patients to have good access to high quality palliative care services and we passionately advocate for improved resources, education, workforce and facilities to achieve this goal. We strongly oppose the current necessity for our major hospice facilities in New Zealand to have to raise half their funds themselves.
  • We recognise the patient’s right to have administered analgesia and sedation to relieve pain and suffering – even if a secondary consequence of this is the shortening of life. Morphine is not an agent of euthanasia, and will not by and of itself reliably end the life of a patient. These agents are administered to relieve suffering, applying a risk/benefit analysis similar to all treatments, with a shared understanding of the potential risks in their prescription.

It might look like dancing on the head of a pin but there is a difference between giving something to alleviate pain and suffering in the knowledge it could hasten death and giving to deliberately kill.

. . .  Many people, however, still find confusing the difference between the concept of administering terminal analgesia/sedation to a dying patient, and that of administering voluntary euthanasia to a patient with concurrently stable physiology. The difference between palliative care and assisted dying is well documented and clear. The World Health Organisation definition of palliative care includes the statement that palliative care “intends to neither hasten nor postpone death”.

In jurisdictions where euthanasia and assisted laws exist, concern is growing about the impact on palliative care, where those seeking euthanasia are referred first to palliative care for assessment. This has led to confusion in patients as to the role of palliative care and – in some instances – patients who are opposed to euthanasia declining palliative care services.

The profession as a whole has also echoed concerns about the accuracy of diagnosis and prognosis, as well as the lack of certainty around measuring the capacity of patients facing terminal illness, who often also have reactive depression, altered brain physiology from medications or metastases, as well as potential external coercion factors.

For the profession, as well as ethical considerations, physician-assisted dying raises issues of:

  • potential impacts on palliative care delivery
  • potential changes to a doctor-patient relationship
  • difficulties with adequate training, assessment and regulation of the profession
  • potential negative impact on health providers participating in such acts.

Principles of autonomy and self-determination are, of course, central to this debate. The NZMA respects and supports patient autonomy but is concerned about relying on these principles to enact euthanasia or assisted suicide. Principles of autonomy demand full knowledge of risks and alternatives, and consent must be free of coercion, duress or undue influence.

An absolute guarantee that those who choose assisted dying are doing it voluntarily would be extremely difficult to establish in legislation and ensure in practice. Doctors are often not in a position to detect subtle coercion – as is also the case when trying to identify signs of emotional or financial abuse of elders more generally. Coercion also extends to assumptions of being a burden, giving rise to a sense of an “obligation” to die.

Given the gravity of the risk involved for individuals where autonomy is claimed but cannot be guaranteed, the belief that autonomy should trump all should be viewed with caution. . . 

 

I gave doctors permission not to keep trying to save the life of our first son and seven years later asked them not to call the crash team when our second son stopped breathing.

Both had degenerative brain disorders and any treatment would have only prolonged their suffering and postponed their inevitable deaths.

If I faced the same decisions in the same circumstances I’d do the same thing.

That isn’t euthanasia though.

It’s also very different from an adult in full control of their minds who requests the right to die and I understand how the fear of  what might be ahead could lead someone to that decision.

But legalising euthanasia isn’t only about fully competent individuals who want the right to control their lives and deaths.

It’s also about others who might feel pressured to choose a premature end or who might forgo high quality palliative care for fear euthanasia will be an inevitable consequence.

And it’s about medical professionals and what it asks of them too.

In abridging the article from which I’ve quoted, I missed a paragraph on surveys carried out in Canada, New Zealand and the United Kingdom. Each survey showed while roughly 30% of doctors agree “in principle” with the concept of assisted dying only 10% would feel comfortable in participating.

That’s what is often missed in the debate. It’s not just about the right to die and the patients, it’s also about the right to kill and the doctors.

P.S.

There’s an assisted suicide table-talk in Auckland tonight:

Broadcaster and comedian Jeremy Elwood hosts the Ika-Spinoff.co.nz current affairs cabaret, Table Talk, on the subject of Assisted Suicide. Join panelists David Seymour MP, promoter of the End-of-Life Choice Bill; Dr Jan Crosthwaite, University of Auckland Proctor and formerly Department of Philosophy; and Dr Stephen Child, Chair of the NZ Medical Association for a free-ranging discussion of a topic that defies politics.

Enjoy the full & delicious Ika menu, join a table or book for a group. Doors open and bar and dinner service from 5.30 pm, the discussion will start at 7.30 pm.

Follow the discussion on the TheSpinoff.co.nz

WHEN
August 30, 2016 at 5:30pm – 10:30pm

WHERE

Ika Seafood Bar and Grill
3 Mt Eden Rd
Auckland 1023


366 days of gratitude

August 30, 2016

Whoops this is yesterday’s post again.

The reason I’ve been tardy with the gratitude posts isn’t that there’s nothing to be grateful for, it’s that I’ve been following the advice to keep away from screens in the evening in the quest of better sleep.

That and going to bed early with a book is working and I”m grateful for it.


Quote of the day

August 30, 2016

Of all created comforts, God is the lender; you are the borrower, not the owner. Ernest Rutherford who was born on this day in 1871.


August 30 in history

August 30, 2016

1363 Beginning date of the Battle of Lake Poyang; the forces of two Chinese rebel leaders— Chen Youliang and Zhu Yuanzhang—were pitted against each other in what is one of the largest naval battles in history, during the last decade of the ailing, Mongol-led Yuan Dynasty.

1574  Guru Ram Das became the Fourth Sikh Guru/Master.

1590  Tokugawa Ieyasu entered Edo Castle.

1720 Samuel Whitbread, English brewer, was born (d. 1796).

1791 HMS Pandora sank after running aground on a reef the previous day.

1797 Mary Wollstonecraft Shelley, English writer, was born (d. 1851).

1799 Capture of the entire Dutch fleet by British forces under the command of Sir Ralph Abercromby and Admiral Sir Charles Mitchell during the Second Coalition of the French Revolutionary Wars.

1800 Gabriel Prosser led a slave rebellion in Richmond, Virginia.

1813  Battle of Kulm: French forces defeated by Austrian-Prussian-Russian alliance.

1813  Creek War: Creek Red Sticks carried out the Fort Mims Massacre.

1835 Melbourne was founded.

1836 The city of Houston was founded by Augustus Chapman Allen and John Kirby Allen.

1862  American Civil War: Battle of Richmond: Confederates under Edmund Kirby Smith routed a Union army under General Horatio Wright.

1862 – American Civil War: Union forces were defeated in Second Battle of Bull Run.

1871 Ernest Rutherford,  Nobel Prize in Chemistry laureate, was born (d. 1937).

Ernest Rutherford LOC.jpg

1873 – Austrian explorers Julius von Payer and Karl Weyprecht discovered the archipelago of Franz Joseph Land in the Arctic Sea.

1903 Guide Joseph Warbrick and three tourists were killed instantly whenRoturua’s Waimangu geyser erupted unexpectedly.

Four killed by Rotorua geyser

1907 – John Mauchly, American physicist and co-founder of the first computer company, was born (d. 1980).

1908 Fred MacMurray, American actor, was born (d. 1991).

1909  Burgess Shale fossils discovered by Charles Doolittle Walcott.

1909 – Virginia Lee Burton, American author and illustrator, waws born (d. 1968).

1912 Nancy Wake AC GM, New Zealand-born World War II secret agent, was born (d. 2011).

1914  Battle of Tannenberg.

1918 Fanny Kaplan shot and seriously injured Bolshevik leader Vladimir Lenin.

1922 Battle of Dumlupinar, final battle in Greco-Turkish War (1919-1922).

1926 – Kawarau Falls dam became operational.

1930 Warren Buffett, American entrepreneur, was born.

1935 John Phillips, American singer/songwriter (The Mamas & the Papas), was born (d. 2001).

1942  World War II: Battle of Alam Halfa began.

1943 Jean-Claude Killy, French skier, was born.

1945 Hong Kong was liberated from Japan by British Armed Forces.

1945 – Supreme Commander of the Allied Forces, General Douglas MacArthur landed at Atsugi Air Force Base.

1946 Peggy Lipton, American actress, was born.

1951 Dana, Irish singer and politician, was born.

1956 Lake Pontchartrain Causeway opened.

1962  Japan conducted a test of the NAMC YS-11, its first aircraft since the war and its only successful commercial aircraft.

1963 Hotline between the leaders of the U.S.A. and the Soviet Union went into operation.

1967  Thurgood Marshall was confirmed as the first African American Justice of the United States Supreme Court.

1972  Cameron Diaz, American actress, was born.

1974  A BelgradeDortmund express train derailed at the main train station in Zagreb killing 153 passengers.

1974 – A powerful bomb exploded at the Mitsubishi Heavy Industries headquarters in Marunouchi, Tokyo – 8 killed, 378 injured.

1984   The Space Shuttle Discovery took off on its maiden voyage.

1995 – NATO launches Operation Deliberate Force against Bosnian Serb forces.

1999 – East Timor voted for independence from Indonesia in a referendum.

2003 – While being towed across the Barents Sea, the de-commissioned Russian submarine K-159 sank, taking 9 of her crew and 800 kg of spent nuclear fuel with her.

Sourced from NZ History Online & Wikipedia


Word of the day

August 29, 2016

Piddler  – one who trifles or putters;  person who engages ineffectually or superficially in an occupation or pastime; a dilettante; something small and inconsequential.


Rural round-up

August 29, 2016

Farmers enable us to reach our potential. Let’s celebrate that – Federated Farmers:

Farmers get their hands dirty so we can pursue goals and livelihoods beyond growing and harvesting the food we need to survive.

With food plentiful, and lifestyle expectations high, we seem to have forgotten the role of farmers in the modern world.

Why is it farmers in developing countries only farm around a hectare of land each?  It is because that is how much land one person can cultivate in one season by hand.  The food production in many developing countries is not limited by land, but by labour and productivity.  That is why big families are necessary – more hands to till more land.

Have you ever stopped to think how many potentially great doctors, engineers or scientists spend their lives on the end of a hand-hoe in these countries?  Never to see their potential fulfilled.  In many developing countries subsistence farmers make up more than 80 per cent of the population.

Delegating farmers to provide our food gives the rest of us freedom and choice to do what we are good at. . . 

Drought warning – Annette Scott:

Low or no flow in many of Canterbury’s streams and rivers could lead to early water restrictions this season, Environment Canterbury warns.

Canterbury has entered its third successive drought season with 86% of water bores affected and some wells at their lowest in 30 years.  Only significant snow and rain could make a difference now, ECan chief Executive Bill Bayfield said.  

Weather forecasters reported one of the wimpiest winters in recent years and had already announced spring’s early arrival. Significant rain or a decent snow-dump were not on the radar. .  .

Feral cats reaching plague proportions – Robin Martin:

Feral cats are reaching plague proportions in New Zealand’s back country and no-one seems to want to take responsibility for the problem, says a Taranaki beekeeper.

Sarah Hart and her partner Steven Henwood say they often drive through – what they describe as – “herds” of wild cats while out retrieving hives.

The couple live in the remote Okoki valley, about 20 kilometres inland from Urenui in North Taranaki.

Ms Hart said at dusk the rugged beef and sheep country was alive with feline forms – some of the estimated 2.5 million feral cats in New Zealand. . . 

We aren’t that couple – Uptown Farms:

Dear America, 

It struck me this morning, as my husband and I were walking out the door – there is something I need to tell you.  Something I need you to know.  

We aren’t that couple.  In fact, I’m not even sure if we own a pitchfork.  

A lot has changed since the 1930’s.  Our corn yields have increased six times over.  We use computers, GPS, seed technology. We grow more, on less water and land. Our farms are bigger, our equipment is bigger, even our animals are bigger.  We do all of this with fewer people than ever before in history. 

We have college degrees, my husband actually has two. One of us works off the farm full time which is the new norm for farm families – just like non-farm families.  We are professionals.  . . 

Cavalier Corporation returns to profit:

New Zealand carpet maker Cavalier Corporation has returned to a profitable position posting a net profit after tax of $3.1 million for the financial year ended 30 June 2016.

This represents a significant turnaround from the company’s write downs and recorded loss of $25.7 million in 2015.

Both net profit and normalised profit of $6.3 million after tax were slightly up on the earnings guidance Cavalier issued in June.

Cavalier Corporation CEO Paul Alston says the company’s performance is encouraging and representative of the transformation it is undertaking with debt reduction and a dual focus on revenue and cost. . . 

Milk production plummets 10.3%:

Australian milk production plummeted 10.3 per cent in July compared with last year, with massive drops in Tasmania, South Australia and northern Victoria, according to the latest figures from Dairy Australia.

Farmers have slashed production in response to the big cut in milk prices, initially by Murray Goulburn and Fonterra in May and then by most processors in July.

Tasmanian production is hardest hit, down 19.6 per compared with July 2015. . . 

Seeka hikes interim dividend as first-half profit almost doubles Paul McBeth

(BusinessDesk) – Seeka Kiwifruit Industries hiked its interim dividend to shareholders as the first harvest from its recent Australian acquisition and record crops contributed to a first-half profit that almost doubled.

Net profit rose to $7.1 million, or 43 cents per share, in the six months ended June 30 from $3.7 million, or 24 cents, a year earlier, the Te Puke-based company said in a statement. Revenue climbed 39 percent to $134.2 million, and the board declared an interim dividend of 10 cents per share, payable on Sept. 29 to shareholders on the register on Sept. 22. That’s up from 9 cents a share a year earlier. . . 

Delegat to pay bigger dividend after posting record annual operating profit – Paul McBeth

(BusinessDesk) – Delegat Group will pay a bigger dividend to shareholders after reporting a record operating profit for the 2016 financial year, with North American sales driving revenue growth.

The Auckland-based company’s board declared a dividend of 12 cents per share payable on Oct. 14 to shareholders on the register on Sept. 30, up from 11 cents it’s paid in the past two years. The winemaker reported a record operating profit of $37 million, on a 9 percent increase in global case sales to a record 2.41 million, including 1 million cases sold in North America.

“The directors consider that the underlying operational performance and strong cash flows justify an increase in dividends this year,” executive chairman Jim Delegat said. . . 

Central Otago winery nails Decanter tasting in UK – “Outstanding”:

Central Otago winegrowers Roger and Jean Gibson are elated that a wine from their Lowburn Ferry vineyard has ranked Number One in high profile Decanter magazine in the UK. The in-depth tasting of more than 170 pinot noirs from across New Zealand in Decanter’s September 2016 issue was carried out by a panel of three prominent UK industry wine judges. Lowburn Ferry Home Block Pinot Noir 2014 scored 96 points out of a possible 100, giving it “Outstanding” status in the tasting.

In the covering feature article reviewing the tasting, New Zealand is described as being “the best Pinot-producing country outside of France.” . . 

Dunedin owners of Central Otago winery win their first wine trophy:

Central Otago’s Black Quail Estate vineyard and truffière is victorious after being awarded the Mike Wolter Memorial Trophy and Champion Pinot Noir at the Bragato Wine Awards in Marlborough last night.

Black Quail Estate 2013 Pinot Noir is a true boutique, single vineyard wine. All the Pinot Noir is from this single vineyard on Felton Road, Bannockburn and only 400 cases are made every year.

Sitting on 25 hectares of prime grape growing land on Felton Road, Bannockburn Dunedin’s Keillor family purchased the land in 1999. Owners Rod and Mirani Keillor immediately planted ten hectares with Pinot Noir and now have planted the rest with olives, fruit and hazelnut trees. . . 


How did it get so bad before someone acted?

August 29, 2016

A farmer faces a possible prison sentence and ban from farming after admitting his inaction caused the death of hundreds of sheep and widespread suffering.

The story says the Ministry of Primary Industries was alerted by an anonymous tip-off which means someone noticed something and did the right thing even if it was far too late for too many animals.

There’s no mention of family or neighbours and it’s possible there was no-one close.

But neglect like this doesn’t happen overnight.

Even though it’s not like it used to be in the country where everyone knew their neighbours well, farmers still usually have an idea of  what’s going on over other people’s fences.

How could the situation get so bad without someone seeing something amiss and doing something sooner?


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