There is a bill before the justice select committee, the End of Life Choice Bill, which articulates a right of adult New Zealanders faced with terminal, untreatable illness and unbearable suffering to request physician assistance in ending their lives. At present such actions fall under the criminal code.
Criminalising any behaviour articulates society's strong disapproval. It stigmatises that behaviour, isolates the one who acts contrary to that norm and may have unintended consequence of fostering a shadow skirting of the law.
In Seales v Attorney-General (2015), Lecretia Seales, suffering from terminal brain cancer, sought relief, asking that her doctor not be criminally sanctioned for murder or manslaughter were he to assist her in her dying.
In effect, Ms Seales sought a right to die with assistance. Justice Collins found her arguments generally persuasive but denied her suit and suggested a legislative change was necessary. Hence this bill.
Last Wednesday, Whanganui councillor and district health board member Kate Joblin convened a meeting about the bill, advertised as informational, with a panel of three palliative care doctors.
Ms Joblin is a friend whose work as health board chairwoman was praiseworthy. The doctors, all well-respected palliative care physicians, have over a hundred years of medical experience between them. Yet I came away disappointed.
It was eventually made clear that the information presented was the doctors' views in opposition to the bill. Moreover, with no pretence at debate, their interpretation of the bill was flawed in my view.
Physician-assisted suicide is not offered as competitive with, or a preferred alternative to, palliative care. No doctor is required to participate.
A misreading of the law which proscribes wilful abuse of its provisions with fines and possible imprisonment was interpreted as applying to conscientious objection by doctors. In fact, the latter are simply required to refer the patient making an end of life choice to a Health Ministry-appointed panel.
The present system of criminalised suicide isn't working. Nowhere is this better illustrated than the position taken by these palliative care doctors who argue it's unethical for doctors to assist in suicide, a position in conflict with the terms of the modern Hippocratic Oath and the Medical Ethics Standards of the US and of Canada.
Yet they acknowledge that it's okay to prescribe large doses of medication for pain for dying patients even though that may result in hastening death.
The complete bill can be found here: http://bit.ly/2tcJNPV. Its intention is to create a mechanism in law whereby a person faced with imminent death can request of their doctor that they assist the patient in ending their life.
The emphasis is on providing a patient with a dignified death where the choices remain with the patient as to the time, means, and manner of death. The dying person remains empowered, not the medical system as is often the case. As war is too important to be left to the generals, so death is too important to be left to the medical establishment.
If dignity, choice, and empowerment are at the heart of the bill, its 28 provisions set out the circumstances under which a person, older than 18, suffering a terminal illness or an untreatable one, in advanced or irreversible decline in capability, suffering unbearably and intolerably, but with ability to understand the nature and consequences, may request assisted dying.
Most of the provisions set up a complex mechanism to ensure the voluntariness of the patient. They must make a continuing, willing choice including the means and time of the assisted suicide (my word). It involves examinations by two independent doctors and by a psychiatrist if capacity is in doubt.
A shortcoming of the bill is the question of advanced directives. A person with full capacity now, and intention to die with full choice and dignity, might not have that capacity as their illness worsens. There are probably other questions to be addressed by the select committee.
In my experience of people dying — patients, friends and relatives — it's not death that's frightening but the manner of it. Most physicians I know would opt for themselves a death away from hospitals, at home, surrounded by loved ones, at a time and manner of their choosing. Many patients would want the same.
Submissions to the select committee need be made before midnight tomorrow. Here's the link: http://bit.ly/2ywOy5Y. It's about life and death and all of us should have a say.
Jay Kuten
Jay Kuten is an American-trained forensic psychiatrist who emigrated to New Zealand for the fly fishing. He spent 40 years comforting the afflicted and intends to spend the rest afflicting the comfortable.
