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.
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
August 30, 2016 at 5:30pm – 10:30pm
Ika Seafood Bar and Grill
3 Mt Eden Rd