health & science

Doctors at war over euthanasia claims

As the End of Life Choice Bill creeps towards its next messy debate in the Committee of the Whole House, the division between doctors is widening. Laura Walters reports.

A Hawke’s Bay cardiologist and general physician has written an open letter to the New Zealand Medical Association, comparing the professional body to anti-vaxxers and the anti-1080 lobby.

Miles Williams has written to Medical Association chairperson Kate Baddock criticising the association’s anti-euthanasia stance, which Williams believes is informed by beliefs rather than evidence.

The letter was signed by 18 other doctors, including GPs, palliative care specialists, intensive care specialists, psychiatrists, and surgeons, among others. Also on the list is retired sexual health physician Dame Margaret Sparrow.

Williams - a vocal pro-euthanasia campaigner - said the association’s submission on the End of Life Choice Bill, and unmoving anti-euthanasia stance, was based on a specific “dogma” or “belief-based doctrine” that no longer represented the views of the wider public in progressive societies.

While the overwhelming majority of the submissions made to the Justice select Committee on the End of Life Choice Bill were negative, Otago University research from last year found on average, 68.3 percent of all New Zealanders supported euthanasia with 14.9 percent opposed. The rest were neutral or unsure.

The survey analysed existing research investigating New Zealanders’ attitudes to euthanasia or assisted dying over the past 20 years. It included views of 36,304 Kiwis.

“The New Zealand Medical Association has a reputation among many doctors that it is conservative, moralistic, paternalistic even.”

Williams accused the association of using its status to put forward a deceptive “belief-based doctrine”.

“I would like them to face up to the charge that they are deceiving the Government and the people of New Zealand by the stance that they’re taking,” he said.

“The New Zealand Medical Association has a reputation among many doctors that it is conservative, moralistic, paternalistic even.”

Williams said he found it an affront that the association, including a board with doctors and academic researchers, would put forward views on national television, and in its submission, that were not based on evidence.

In his letter, he rebutted the points made by Baddock in a TVNZ Breakfast interview, including the ethical argument of the Declaration of Geneva, or the ‘physician’s pledge’.

The declaration comprised of 13 pledges, including the statements that doctors “must maintain the utmost respect for human life”, and “that the health and wellbeing of our patients will be our first consideration”. Baddock quoted these pledges in her TVNZ interview.

But respect for human life did not necessarily mean a life of suffering should be prolonged against the sufferer’s will, Williams said.

He added the spirit of a further pledge: “I will respect the autonomy and dignity of my patient”, was not being honoured if a doctor ignored the pleas of a competent individual who was experiencing intolerable suffering.

The New Zealand Medical Association is part of a group of doctors staunchly opposed to euthanasia. Photo: Lynn Grieveson

Williams accepted ethical arguments were difficult to have, or to win, but remained firm in his criticism the Medical Association had not based its arguments, stance or submissions on current facts and evidence.

He said the quality and accuracy of the association’s statement fell short of the standards of integrity, honesty, and evidence-based medicine it aspired to.

Similar letters and concerns raised with the association had gone unanswered. This time the association had responded by referring him to its 2018 submission to the select committee.

While he said he would be glad for engagement from the association, it was clear there was little likelihood either side would change its mind. The purpose of the open letter was to put the challenges in the public arena, so MPs and the public were able to hear another side to the story and seek out the evidence themselves.

“It is difficult to avoid the conclusion therefore that on this issue at least, despite being aware that there is evidence in favour of EOLC, disciplined rational evidence-based scientific medicine has been abandoned in favour of conservative cultural and personal beliefs,” Williams wrote in the letter.

“As such you and the Board could be accused of being no more advanced than the ‘anti-vaxxers’ or the ‘anti-1080 lobby’, whose beliefs cannot be impinged upon by science, fact, or rational thinking.”

Baddock told Newsroom the association took an evidence-based position, supported by ethical principles, after consultation with members.

“I respect the fact they have their opinion. As I said, the NZMA’s position is always evidence-based.”

The association carried out a survey of its 5000 to 6000 members - including medical students – and found members overwhelming supported the association’s position.

Furthermore, the association’s report was independently reviewed by Otago University bioethicist Grant Gillett. (Williams disputes the independence of Gillett’s views.)

“There will always be individuals who may have a different view. That’s their right,” Baddock said.

Like abortion and drug reform, this is an area people feel passionately about.

“I respect the fact they have their opinion. As I said, the NZMA’s position is always evidence-based.”

Baddock said she would prefer the association not to be compared to anti-vaxxers, but did not take great exception to the letter.

“They’re speaking from an impassioned perspective.”

Like Williams, Baddock did not think either group would budge in terms of their point of view, and did not think engaging with him or the other signatories would achieve anything.

The association - represented by Baddock - is part of a group of doctors, lawyers and public policy experts who had taken a public stance against the End of Life Choice Bill. The group is backed by former Prime Minister Bill English and his GP wife Mary.

ACT leader David Seymour's End of Life Choice Bill passed its second reading by a wider-than-expected margin of 70 to 50 last month. Photo: Lynn Grieveson

The End of Life Choice Bill passed its second reading, with 70 votes to 50. The bill will now go to the Committee of the Whole House – potentially as early as Wednesday. The third reading will not happen until August at the earliest, but likely much later.

The whole House stage is expected to be messy and confusing, with the National party’s Maggie Barry planning to bring as many as 120 supplementary order papers in an attempt to kill the bill.

There will also be substantive changes introduced through David Seymour’s supplementary order paper, which would include restricting eligibility to those with a terminal illness and a six-month prognosis, removing the current test of those who were suffering a “grievous and irremediable medical condition”, in order to get the Green Party’s support.

(While it has been determined a conscience vote, the Greens and New Zealand First plan to vote as a bloc, if they get their desired amendments.)

This week, New Zealand First has submitted its own supplementary order paper to provide for a binding referendum on the End of Life Choice Bill, during next year’s election.

The only way this bill will pass into law is if the majority of Kiwis vote in favour, meaning the quality and accuracy of the information and evidence in the public arena will be paramount.

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