Act offers choice, not compulsion
The numbers of people dying will not increase if the End of Life Choice Act is enacted, but fewer will suffer, say Libby Smales and Jack Havill.
Data from the Chief Coroner’s office tells us that at least 50 rational New Zealanders with terminal illnesses take their own lives, alone, often violently, to end their suffering every year. Some die prematurely, because they have to act while they are able, and they leave an agonising legacy of suffering for bereaved, unprepared, families.
Compare that to stories from overseas where more than 200 million people live in jurisdictions that allow mentally competent, terminally ill patients to get medical assistance to end their lives peacefully in the company of their loved ones.
That is the choice offered in the coming referendum being denied by nursing lecturer Aileen Collier, who rejected the call to vote ‘‘Yes for Compassion’’ in an opinion column on June 29.
Collier, who is obviously strongly opposed to assisted dying, in line with some – but certainly not all – of her palliative care and hospice colleagues, questioned the use of the word compassion.
But surely it is a very compassionate act to stop extreme suffering near the end of life, at the request of a terminally ill person. Overseas experience shows that the patient, and usually the family, is supremely grateful for the help.
While acknowledging the good work done in palliative care in New Zealand, it has been underfunded from the start and access and quality are patchy.
Australian research suggests that even with excellent hospice/palliative care 2 to 5 per cent of dying patients experience unbearable suffering as they die. Why should they sufferwhen they could have the option of a painless and peaceful death?
Further, it is recognised overseas that, where assisted dying is legal, funding and standards of palliative care have improved.
Most people say they want to die peacefully in their own beds. Sadly, most of us don’t. More New Zealanders now die in rest homes, which have a new category called ATD (admitted to die), than anywhere else. While their staff do an amazing job, they are overworked and often poorly trained in palliative care for the dying.
Staffing ratios tell the story. In hospices, there is usually one staff member to every three patients; in hospitals one to six. In rest homes, it is one to 20 or 30 residents, a ratio that does not permit much palliative care, however sympathetic the carers are.
Collier questions the ability of doctors and nurses to predict the six-month life expectancy of the terminally ill required to qualify for an assisted death.
But where a patient has major unrelieved suffering, has reached an advanced stage of incapacity and has been declared terminal by their specialist medical carers, there is very little doubt about what is going to happen.
It is common practice for patients in that situation to be moved to a hospice and palliative care because they have reached a stage where treatment to prolong life is no longer an option.
The End of Life Choice Act is one of the safest in the world and we havemore than 20 years of international experience to guide us in its operation. Nomore people will die with its enactment, but fewer will suffer.
Reliable opinion polls have consistently shown that about 70 per cent of voters want to be able to choose to avoid unbearable suffering as they are dying.
The referendum on the End of Life Choice Act 2019 offers precisely that – choice. No compulsion, no coercion. If you do not want this choice, nothing will change for you – except perhaps a concomitant improvement in hospice and palliative care services.
Dr Jack Havill, of Hamilton, is a retired intensive caremedicine specialist. Dr Libby Smales, of Hawke’s Bay, is a retired palliative care and hospice physician.