Euthanasia

How do doctors feel about helping end lives?

The right of a patient to decide on his or her death are at the centre of the End of Life Choice Bill. But it is medical practitioners who have to carry it out. They have to decide if their patient is eligible for euthanasia. A second practitioner has to agree. Then the doctor or practitioner has to administer the lethal medicine, or preside over the patient doing it.

In part three of a five part series, Jeremy Rees looks at what doctors think of the bill? 

The New Zealand Medical Association 

What does the NZMA think of the bill? 

It says it does not support the bill. The NZMA says it opposes euthanasia as unethical and harmful to vulnerable people and society. 

Why are they important? 

The NZMA represents 5000 doctors from a number of specialities in New Zealand. Its Code of Ethics says euthanasia is unethical, though it supports the right of patients to refuse treatment. 

Some of the issues 

At base, the NZMA says that its code of ethics requires doctors to preserve life where possible. Euthanasia runs counter to that and would fundamentally change the patient-doctor relationship. The NZMA does say doctors must allow death to occur with dignity “when it appears inevitable”. Allowing death to occur is fundamentally different, it argues, from the deliberate act of terminating a life. 

The NZMA says New Zealand has world leading palliative care and the country should strive to keep improving it. The body says that allowing euthanasia could diminish the focus on quality end of life care. 

It believes it is impossible to design a law that would be completely effective in stopping “subtle emotional coercion” being put on patients to consider euthanasia, especially if they feel they are a burden on others. 

GPs - The Royal New Zealand College of General Practitioners. 

What do they think of the bill? 

The College of General Practitioners says its members hold a wide range of views on the bill. So it has decided not to comment on whether or not euthanasia and/or physician-assisted suicide are ethically or morally right. It says that is a matter for individuals' own consciences within the law. It says its submission should not be taken as an endorsement of euthanasia. 

Why are they important 

GPs are most likely to treat patients throughout their lives. It is the biggest group of doctors and the College is the largest medical college in the country. 

Some of their issues 

GPs place a lot of emphasis on the need to improve the funding of palliative care. They say euthanasia would need to be part of a wider discussion on looking after patients at the end of their lives. 

Looking after a person at the end of their lives can be costly and that puts a strain on families. There is a shortage of good palliative care in rural areas. GPs argue the government needs to improve funding and access to palliative care so people can experience a dignified death. 

Its members worry that people dying sometimes feel a burden on their families and that may lead to some vulnerable people feeling pressure to consider assisted dying. 

GPs also suggest that the minimum age of 18 to be considered for assisted dying be raised to 25. “The brain is not fully developed until 25 years of age.” 

Geriatricians - The Australian and New Zealand Society for Geriatric Medicine 

What do they think of the bill? 

The Society opposes it. It says that its members have a wide range of views. But it opposes legislation allowing euthanasia or “physician assisted suicide”. 

Why are they important? 

Geriatricians, doctors who look after the health of elderly people, deal with people needing palliative care or approaching death. 

Some of their issues 

The Society says governments can most help by funding palliative and geriatric care adequately, rather than allowing euthanasia. 

It is worried about the conflicting health messages around suicide - that it is acceptable in some circumstances but not others. 

And it feels pressure will fall on older people who feel they are a burden on others. “Such feelings are often due to underlying depression, financial concerns or family dynamics."

Geriatricians are also worry the idea of doctors will change from “treaters”, “life savers” and “healers” to people who provide life-ending services. 

Medical practitioners working in palliative care - The Australian and New Zealand Society of Palliative Medicine  

What do they think of the bill? 

They oppose it. They oppose introducing euthanasia or assisted suicide. 

Why are they important? 

They are a group of specialists who work with people with life-limiting illnesses, and their families. The Society has 127 members in New Zealand. 

Main Points 

This group of specialists thinks the inadequacies of the current system are fuelling much of the debate about alternatives like assisted dying. 

It argues the solution for a person approaching death suffering a loss of dignity lies in improving care. There is always the risk of wrongful deaths, it argues, because of the “inherent uncertainties” of medical diagnosis and determining mental capacity. 

The Society also believes more thought needs to be given to people who change their mind as their illness waxes and wanes. It fears people may make a decision with “irreversible consequences’ when they are at their most vulnerable. 

Nurses - New Zealand Nurses Organisation 

What do they think of the bill? 

They say nurses have widely differing views, even saying some are polarised in their views, for or against assisted dying. But they say they are “extremely disappointed” the bill is silent on how nurses are part of the process, instead focusing on the role of “medical practitioners”. 

Why are they important? 

Nurses are involved in end of life care and a nurse is often the first person a patient will talk to about their wishes. 

Issues 

One of the Nurses Organisation’s most strongly argued points is the lack of any reference in the bill to a Maori worldview or processes. It points out there is no discussion of collective decision making or the inclusion of kaumatua. It urgently “recommends that the committee address this oversight immediately.” 

It also argues the bill is missing key personnel, especially nurse practitioners in rural practices and is silent on what they may be required to do. 

Anaesthetists - the Australian and New Zealand College of Anaesthetists. 

What do they think of the bill? 

The body which represents anaesthetists says it “cannot comment on the need for laws in New Zealand allowing assisted dying…..this is an issue for the government and public to determine.” But it does have concerns about some clauses of the bill. 

Why are they important? 

Anaesthetists are involved in pain management and drug dispensing. 

Some of their issues 

Anaesthetists are concerned at the bill’s requirement for a patient to be suffering a terminal illness which could kill them within six months to be eligible for euthanasia. They point out the time of death is difficult to predict. Rather than putting a time in the legal requirement, they suggest several medical practitioners could predict a “trajectory of deteriorating health” which is “measurable and inexorable”. 

The College of Anaesthetists is also strong on the very different resources that might be available for rural people. “A patient suffering debilitating pain may be unable or unwilling to travel long distances to seek appropriate advice and care and those living in rural and remote areas should have the same rights and choices as an individual living in a metropolitan area.” 

Psychiatrists - The Royal Australian and New Zealand College of Psychiatrists 

What do they think of the bill? 

They say they neither support, nor oppose the bill. But the College says it needs “significant revision” to make sure safeguards are robust. 

Why are they important? 

They deal with dying patients who may be depressed or face mental health issues. One of the key questions around who would be eligible for euthanasia is that the person understands the consequences of what they are doing. Psychiatrists may be important in determining that. 

Some issues 

The College argues some parts of the bill are too scantily defined. It suggests getting feedback and then rewriting the bill. 

It raises the issue of how allowing euthanasia sits with New Zealand’s “epidemic of suicide”. The College says explaining why suicide is acceptable in some cases but not others will be difficult in discussing the bill. 

The psychiatrists’ submission also says there is little discussion of Maori or Pacific perspectives and it hopes there has been enough consultation. “New Zealand also has a growing Asian population. While the relationship between euthanasia and ethnicity is not well researched, experience from Oregon and Washington in the US indicated people who died of physician-assisted dying were predominantly White American.” 

Physicians - The Royal Australasian College of Physicians 

What do they think of the bill? 

They neither support nor oppose. But they have concerns about its lack of detail and what medical practitioners must do under the bill. 

The College says its members have a wide range of views and it is consulting them to form a position on “medical assistance in dying” which should be published this year. 

Why are they important? 

They are specialists who look after people but do not provide surgery. 

Issues 

Physicians are concerned about the under-reporting of people with depression, especially in the elderly. People who develop dementia before 70 are at increased risk of suicide. It argues people suffering depression should not be eligible for assisted dying under the bill but instead given treatment for mental health issues. The College is also worried some groups do not have good access to palliative care. 

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