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

July 27, 2016

Last week’s funeral was for a man in his 90s, sad but the natural order of things.

Today’s was for a man who was only 58, sad.

But he was a man who packed more into those 58 years than many others would have in twice that time, including saving several lives while risking his own as a helicopter pilot.

Today I am sad that his life is over far too soon but grateful that he lived in a way that made the world so much better for his being in it.

 


366 days of gratitude

July 20, 2016

Had you walked into his funeral this morning not knowing him you would have walked out feeling you knew him well.

His family shared their memories of a loving family man; a hard worker; a good man who lived his faith and acted on his belief that you must give children something constructive to do to save them from the temptation to do something destructive.

Today I’m grateful for the long life of a good man who left the world a better place for his contribution to it.


Alan Young 19.11.19 – 19.5.16

May 21, 2016

Alan Young, who starred as Mr Ed’s human side kick in the eponymous television programme, has died.

Alan Young, famous for his role as the human companion to a talking horse in sitcom Mister Ed, died on Thursday (local time), at the Motion Picture and Television Home in Woodland Hills, California. He was aged 96.

The UK-born, Canadian-raised actor had lived in a retirement community for four years. His children were with him when he died of natural causes.

In the series, which ran from 1961-1966 on US network CBS, Young played architect Wilbur Post, who owned the wacky talking horse with his wife, Carol.  Mr Ed would only talk for Wilbur, and could occasionally get him into trouble.

Young was also the voice of Disney character Scrooge McDuck on Duck Tales and voiced several other animated characters. He had made numerous cameos on dozens of TV shows. . . 


366 days of gratitude

May 17, 2016

Our second son would have been celebrating a birthday today.

But he died just 10 days after his fifth birthday. He had a brain disorder that left him with multiple handicaps and had led to the death of his older brother, Tom, when he was only 20 weeks-old.

When Dan died I was sad, but I was also relieved. Looking after a five year-old who could do no more than a new-born child was demanding and I knew our lives would be easier without him but I also know they are better because he lived.

His death freed us up to do things which were difficult to do with him but his life made us realise we shouldn’t take them for granted.

It was easy to say he couldn’t do anything but he taught us to appreciate simple pleasures, to lose the ignorance we had about intellectual disability, how fortunate we are to be part of a close extended family and circle of friends, that ability isn’t a right but a privilege and that love really is stronger than death.

Today I’m grateful for all of that.


The other side

April 25, 2016

Last year we went to Germany in search of the farm my farmer’s great-grandfather left in the 1800s.

He and his brother left to avoid conscription during the Prussian warand never returned.

We found the farm and in the village close by we came across a war memorial on which there were the names of those who had died in World Wars I and II.

Among the names was the German version of Ludemann.

He could have been fighting Ludemanns from New Zealand and Australia who were related to him.

It brought home to me the arbitrary nature of life and death and the tragedy of war which pits ordinary people against other ordinary people who are on one side or the other because of where they happened to be at a time and place.

Today, on Anzac Day, we rightly remember and honour those who served with the allies at home and abroad and especially those wounded or killed.

But at this distance from the awfulness of those wars and in the hope of peace, it’s not inappropriate to also remember that there were people like us on the other side.


Victoria Wood 19.5.53 – 20.4.16

April 22, 2016

The multi-talented Victoria Wood has died.

Victoria Wood – who has died at the age of 62 – was one of the UK’s best-loved entertainers with a career spanning more than four decades.

A Bafta award-winning comedian, actor, singer and writer, Wood was probably best known for her 1980s comedy series Victoria Wood: As Seen On TV and for her on-screen partnership with Julie Walters in the comedy sketch series Wood and Walters.

She wrote and starred in the hit BBC sitcom Dinnerladies and branched out into drama – writing and starring in the 2006 World War Two ITV drama Housewife, 49 – an adaptation of the diaries of Nella Last – which earned her two Baftas.

Wood was also popular for her live stand-up comedy shows, which were interspersed with her own compositions accompanied on the piano.

Made an OBE in 1997 and then a CBE later in 2008, Wood’s much-admired talent lay in her brand of humour which was grounded in everyday life – full of astute observations of popular culture and the mundane elements of life. . . 

The Poke has 21 of her best one liners which include:

 

  • We’d like to apologise to our viewers in the north…………it must be awful for them.
  • A man is designed to walk three miles in the rain to phone for help when the car breaks down, and a woman is designed to say, “You took your time” when he comes back dripping wet. . .
  • I haven’t got a waist. I’ve just got a sort of place, a bit like an unmarked level crossing.
  • I once went to one of those parties where everyone throws their car keys into the middle of the room. I don’t know who got my moped but I’ve been driving that Peugeot for years.
  • The first day I met my producer, she said, “I’m a radical feminist lesbian.” I thought what would the Queen Mum do? So I just smiled and said, “We shall have fog by tea-time.” . .
  • I’ve got a degree, does that mean I have to spend my life with intellectuals? I’ve also got a life-saving certificate, but I don’t spend my evenings diving for a rubber brick with my pyjamas on. . .

 


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