What about the doctors?

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

13 Responses to What about the doctors?

  1. Andrei says:

    This is a case where we should “let sleeping dogs lie” and something we should definitely not allow our politicians to get involved in.

    Medical decisions taken at the end of life should be a matter left to patients, their families, the doctors and nurses involved in their care – trying to tie it down by legislation is the road to perdition

  2. Andrei says:

    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.

    And so would I

    That isn’t euthanasia though.

    No it isn’t – it is a sane, humane and common sense choice to make

    God Bless you and you children

  3. It is my human right to decide when I may die, no one else’s. Doctors covenant to first do no harm. It may be harm to me if I am not assisted in my human right elective…..

  4. homepaddock says:

    Neville – once something involves someone else it’s not just your rights. In this case it is also a doctor’s right to adhere to a belief it’s wrong to kill.

  5. Andrei says:

    Dear Neville;
              Your argument is sophistry of the first order

    To be sure it it is your “human right” to decide when to depart this mortal coil but others have their own “human rights” not to be complicit in your choices.

    And the argument put forward in this post is that the overwhelming majority of Doctors do not want to be complicit in this – and you would over ride their “human rights”?

    You can end your life any time you want, my friend, and nobody can stop you if you are determined on this course of action but we don’t have to be involved or give it our blessing

  6. I don’t find sophistry in Neville’s arguments

    The proper role for law in this case, if there is one, would be to establish an objective process to validate that the request for assisted suicide is uncoerced and that the patient is of sufficiently sound mind to understand what he is asking for. The purpose would be to identify up front that the doctor’s act was not an initiation of force, to provide a ‘safe harbor’ against a subsequent murder charge. Doctors can do what the late Dr. Jack Kevorkian did and not take on all patients and go through a process to ensure a patient was of sound mind, facing little hope, and new of the alternatives.

    the talk about ‘perfect legislation’ in this regards is sophistry.

  7. and the talk about a “doctor’s right to adhere to a belief it’s wrong to kill.” is a big piece of sophistry. No such “right” exists except in the imagination of some. You need to put your beliefs to one side and perhaps in this case leave them in the bottom of the ocean.

  8. Andrei says:

    and the talk about a “doctor’s right to adhere to a belief it’s wrong to kill.” is a big piece of sophistry. No such “right” exists except in the imagination of some.

    Oh dear, oh dear – Michael Philip would have us compel people do something against their own conscience by force of law

    That is called Tyranny my friend, almost a textbook definition of it

  9. Andrei says:

    I see that silly old duffer Geoffrey Palmer has injected himself into this debate

    Needless to say the process he envisages is complex with multiple layers of bureaucracy – verbosity and bureaucracy being Sir Geoffrey’s special areas of expertise rather than care of the terminally ill

    • (a) the person is of at least 18 years of age and capable of making decisions;
    • (b) the person is a permanent resident of New Zealand;
    • (c) the person has consented in writing to receive such assistance before two independent witnesses;
    • (d) two medical practitioners have certified that the person has a grievous and incurable medical condition;
    • (e) the medical condition is causing enduring suffering that is intolerable to the person in his or her circumstances and condition;
    • (f) the facts have been reviewed by the Family Court and a judge has certified that the criteria laid down in the law have been met; and
    • (g) there is a medical practitioner prepared to provide the assistance approved by the court.

    And about a nano second after enacted a heart wrenching case will come up that falls outside these criteria which will then demand they be modified

  10. Paul Scott says:

    I have for some time, had a slum dwelling in Bangkok ready for Sir Geoffrey Palmer’s expulsion from New Zealand . It has genetically modified cockroaches in plenty. On various matters, David Seymour has let down a generation of Act supporters.
    His single near minded purpose in Parliament, is concerning.
    I made submissions for the petition of Maryan Street.

    Now I whole heartedly agree with Andrei, quote

    This is a case where we should “let sleeping dogs lie” and something we should definitely not allow our politicians to get involved in.

    Medical decisions taken at the end of life should be a matter left to patients, their families, the doctors and nurses involved in their care – trying to tie it down by legislation is the road to perdition.

    I had discussion with my brother Professor of Medicine, Cantebury over this business. You will see that Andrei refers to the decision making capacity.
    I was concerned over the dismissal of Christian petitions by Lindsay Mitchell, on the grounds they were simple, and bolstered by church encouragement and without high intellectual support.

    The Brexit argument. They disagree with the elite , professional, educated progressives and therefore are fools, undeserving of a vote.

  11. macdoctor01 says:

    I am in form agreement with the medical council. In my view, euthanasia legislation at this time will have an extremely deleterious effect on Palliative care funding and resources as the government surreptitiously moves its emphasis away from expensive palliation across to assisted suicide. It will be subtle, but it will be there as it is in countries such as Belgium, where an elderly person being admitted to hospital will be assumed to be “not for resus” without being asked.

    In addition, all terminally ill patients become temporarily depressed. This is the natural progression at end of life. Why these people do not deserve our normal treatment for depression, as opposed to assisted suicide, is not clear to me.

    Prognosis is not an exact science. I have seen patients with cancers that should have killed them within weeks, last for years. It is very dubious medicine to terminate someone’s life on the grounds that a patient has a certain amount of time left or that they may suffer.

    There are simply too many factors here to make this a subject for legislation. And given the general propensity for governments to stuff up social legislation, I am dubious as to the ramifications of said law. Certainly, the bill currently in the ballot is deeply flawed and would be a disaster to implement, from a doctor’s point of view. The lawyers will probably like it.

  12. People should be able to look to their doctors as people who will strive to improve both the quantity and quality of life. What we need is better medical care and better pain relief. We can all say no to over treatment and unwanted treatment but we can be powerless to do anything about under treatment. Economic pressures on health services can make under treatment look like a good option but this is not good medicine. Euthanasia is medical failure.

  13. The dangers are very real. Already I see the poor being encouraged to have less treatment. When people are given the impression that they are a burden to the system and to their families, they are not in a position to make a free choice. The palliative care offered to the poor and the elderly is often of a very low standard. I have written a blog , Poor Palliative Care Encourages Euthanasia

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