Euthanasia

Tales of death and dying, unplugged

It began with a rifle and a dying man.

Dr Stuart Tiller, a GP with 40 years in practice, can remember clearly when he began to ponder whether euthanasia should be allowed.

In a moving submission to Parliament on David Seymour’s End of Life Choice Bill he sets out the story of how he has come to support assisted dying and the man who was dying of cancer who made him consider it.

“I arrived at his home one day to find him alone in the back yard with a rifle he was about to use upon himself. He had planned this end of his life and did not want to cause his family further distress or grief. He pleaded for me to leave and let him proceed as he wished. He was entirely rational and clear with regard to his intended action of suicide.

“I was unable to comply with his request as I might be subject to allegation of knowingly assisting or failing to prevent a suicide. My patient was a physically strong man in his late 60s. He had enjoyed a significant career as an engineer and had subsequently become a leader in New Zealand working for the rights of workers. He held no religious belief and wished the right to make his own end of life decisions. He had made great achievements for the rights of workers but at the end of his life was powerless to assert his right to die as he wished.”

He was in palliative care for five weeks. As his body weakened, he needed help with his bodily functions.

"He hated the indignity of his invalid state and dependency.

“He let me, as his doctor, and his wife know that we had betrayed him and failed him in preventing his choice to end his life at a time of his choosing by suicide. His emotional suffering through that time was palpable.

“Death when it finally came was a relief. A manner of death he did not choose.”

Dr Tiller talked to colleagues about it. He read about assisted dying.

“I was greatly troubled by the outcome for my patient.”

His research led him to a book, I’ll see Myself Out, Thank You, essays edited by Colin Brewer and Michael Irwin two British medical specialists who have campaigned for medically-assisted suicide in the UK.

Dr Tiller believes its message is “powerful and persuasive”.

“I am of the view that a majority of New Zealanders are ready to accept legal medically assisted dying for those terminally ill persons who would wish this option.”

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An historian who has written on New Zealand’s welfare system and the Red Cross has told Parliament Kiwis are reasonable and moderate and would respond to a euthanasia law sensibly.

Dr Margaret Tennant, an Emeritus Professor in History at Massey University, is one of a record 35,000 people who have written to the Justice Select Committee to give their views on euthanasia or assisted dying in the End of Life Choice Bill.

Dr Tennant, a Fellow of the Royal Society of New Zealand, says she was “forcibly reminded” of the language used by opponents of women’s suffrage in the 1880s and 1890s and critics of homosexual law reform when she read submissions against the bill.

“In the case of women’s suffrage, New Zealand was the first nation state to enact change, and it did so without the social and moral decline that opponents predicted. New Zealanders are reasonable and moderate people on the whole, and they respond to such changes in sensible and humane ways.”

Dr Tennant said she “strongly” supports the bill, which sets out a regime for administering fatal medication to a person who applies and meets a number of requirements, such as terminal illness likely to lead to death in six months.

“As the population ages and medical advances extend life, the prospect of suffering from slow degenerative diseases increases,” she said.

“I, like many other New Zealanders have observed others forced to endure an inhumane, unnecessarily prolonged and undignified ending to their lives from conditions such as cancer and motor neurone disease. That humans should be forced to ensure a degree of physical suffering which would result in prosecution if animals were involved is unconscionable; and humans have additional mental suffering from the associated loss of dignity.”

Dr Tennant said that as the length of life increases, the possibilities of a “good death” in a familiar environment are decreasing. She witnessed her grandmother die in the 1960s, at home, in her bed, surrounded by family and looked after by a long-term family doctor who suggested she stay at home rather than go to hospital and be “pumped full of tubes and drugs”.

“Today, even if there were a family doctor willing to pay visits to a family home in the country, she would be sent to hospital and treated, the doctor fearful of the consequences of not taking action, and certainly more concerned today about investigation if he covertly upped the dose of morphine or any other potentially life-ending drug.”

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A young doctor trainee has written to MPs urging them not to enact euthanasia legislation saying it would “forever disturb the relationship with patients”.

Dr Samantha Benson-Pope is a medical registrar in Christchurch and graduated from Otago Medical School in 2014. She has written a detailed and, at times, passionate submission asking Parliament to reject the End of Life Choice Bill.

“I understand that as a doctor relatively early in my career, my words may not hold as much weight as others. I therefore ask that you listen to the submissions of geriatricians who advocate for the elderly, frail and, at times, cognitively impaired who are faced with vulnerabilities as a result of this bill.

“I ask that you listen to the submissions of palliative care physicians who are best placed to advise on the care of a person who is dying.

“I ask that you answer their calls for better funding so their fantastic service can be spread further.

“I ask that you reject this bill in its entirety to protect our most vulnerable.”

She calls on the government to fund services that address “isolation, hopelessness and disconnectedness” of some ill patients rather than promoting euthanasia or assisted dying.

“I don’t deny that there will be people who have experienced or will experience suffering in the dying stages of their lives, and I have no doubt you will receive many personal submissions from loved ones who have had to witness and have been understandably very distressed by this.”

But she argues better end of life conditions through palliative care and mental health services would be preferable.

Dr Benson-Pope is among a number of doctors who question how they could apply the requirements in the bill around a patient’s eligibility. The option to apply for assisted dying is open to people who meet certain requirements, such as being terminally and likely to die in six months or whose suffering is unbearable and cannot be relieved.

“I ask how any medical practitioner could accurately assess a patient’s level of suffering,” she says. She points out that suffering could refer to pain but also less measurable things like loneliness or disconnectedness.

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A medical scientist who specialises in data modelling of patients with diseases has also criticised the criteria as arbitrary and possibly unworkable.

John Pickering, is Associate Professor in the Department of Medicine, University of Otago Christchurch, and a Senior Research Fellow in Acute Care in the Emergency Department at Christchurch Hospital.

He zeroes in on the requirement that a person has a terminal illness likely to end their life within six months.

“‘Likely’ is an imprecise and arbitrary term,” he wrote. “Does it mean 51 percent or 91 percent or 99.9991 percent probability?”

Professor Pickering said that even statistical models drawing on hundreds of thousands of patients can be inaccurate in predicting the outcome for an individual.

“I tell you this so that you get a small taste of how difficult it is to determine progress of a disease. Therefore, to say that someone is likely to die within 6 months, even with the best data available, is difficult and will inevitably be a wrong judgment in many people no matter where the threshold for “likely" is drawn.”

A Christchurch geriatrician, Dr John Geddes, said diagnosis can be difficult and making a prognosis of six months to live can be even more difficult. Equally, he argued that criteria like having a “grievous medical condition” or suffering “irreversible decline” are based on very vague terms and it was possible any patient with a chronic or terminal illness could qualify at some point.

Newsroom is analysing the submissions as they are released onto the Justice select committee website.  Earlier articles in this series:

End of Life Choice Bill: what does it say?

Euthanasia views splinter over dementia

Allow people a choice over their manner of dying

Euthanasia bill should not go ahead: law firm

Assisted dying's risk of coercion

What to call ending your life?

Assisted dying divides Anglican bishops

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