Let’s think about what makes a good death

New Zealanders have an important opportunity to think about what they would want for themselves and others at the end of life, writes Phillipa Malpas

Although we know we will die one day, it’s probably true that most of us don’t give much thought to how we might die and what a good death entails.

If asked many people would probably say they hope they will go to bed when they are old and simply not wake up. If pushed to consider this, some might add that a good death for them would include being able to say goodbye to loved ones, being able to put one’s affairs in order, and not suffering unduly during the dying process.

For many individuals, being able to discuss assisted dying with their doctor is a legal choice they want so that they can make informed decisions about what is right for them and their whānau. Being able to discuss with their doctor or nurse practitioner the context of their dying may result in them requesting an assisted death at some imminent point in time. For other individuals, such a choice is not something they would contemplate for themselves or for others.

Over the past two decades, four parliamentary Members’ Bills have proposed various frameworks that would permit doctors to discuss, and provide assisted dying under certain circumstances (Death with Dignity Bill 1995 and 2003, and the End of Life Choice Bill 2012 and 2019). At the same time, we have witnessed many individuals who have called for a change in law to allow assisted dying because they wanted a choice about how and when they die. Individuals such as Lecretia Seales, John Pollock and Margaret Page.

At the general election in September, voters will be asked to consider whether they support the End of Life Choice Act 2019 in a referendum that will ask ‘Do you support the End of Life Choice Act 2019 coming into force?'

Voters will answer yes, or no. Although the Government has already passed the End of Life Choice Act 2019 (69 votes to 51), it cannot come into legal force unless more than 50 percent of voters say ‘yes’ in the referendum.

So, what questions do you need to consider in respect of the referendum? What do you need to know to cast an informed vote? The following may help:

What is the End of Life Choice Act 2019 calling for?

The Act will provide people with a terminal illness the option of requesting assisted dying from their doctor or nurse practitioner. This may entail providing an eligible person with the lethal means to end their suffering and their own life, or the administration of a lethal medication that will end their suffering and cause the person’s death. These practices are termed ‘assisted dying’ and are currently illegal in Aotearoa New Zealand. A number of countries and jurisdictions permit assisted dying, including the Netherlands, Belgium, Luxembourg, Switzerland, Canada, Colombia, many states within the US, and most recently our neighbours in Victoria, Australia.

Who will be able to access assisted dying if the Act was legally available?

Strict criteria will restrict who can access assisted dying. They include that the person must be aged 18 years or older; be a citizen or permanent resident of Aotearoa New Zealand; suffer from a terminal illness for which they have a life expectancy of less than six months; be experiencing significant and ongoing decline in physical capability; be suffering unbearably which cannot be eased; and be able to make an informed decision about assisted dying.

Who supports a change in the law?

Evidence from a number of studies and polls suggests that many Kiwis, including doctors and nurses, support assisted dying for individuals who are terminally ill.

What does international research find?

A study of Dutch and Belgian data (1947-2016) in the Journal of the American Medical Association (JAMA) concluded that “euthanasia and physician-assisted suicide [assisted dying] are increasingly being legalized, remain relatively rare, and primarily involve patients with cancer. Existing data do not indicate widespread abuse of these practices”.

In Jessica Young’s recent study of 14 New Zealanders who were dying, and their whānau, she concluded that, having the availability of an assisted death if they needed it, “would bring them some personal control over dying because there was a risk they would die badly. While the End of Life Choice Act allows doctors to have the final say if someone meets the strict criteria for assisted dying or not, the participants thought that being able to choose the timing and the way they died was important. They saw the tight controls on assisted dying as a good thing, they wanted it to be safe for everyone.”

New Zealanders now have an important opportunity to think about what they would want for themselves and others at the very end of life.

Disclosure: Phillipa Malpas is on public record as supporting a change to the law that would allow assisted dying in qualified circumstances, and with appropriate safeguards and accountability processes in place. She is a member of the End of Life Choice Society of NZ.

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