View Article PDF

We hope that hospice/palliative care (H/PC) organisations will take a fresh look at their current stance against medical assistance in dying (MAID). The present approach will disadvantage some patients in a number of ways.

It is clear from many sources and reviews that suffering at the end of life can be overwhelming in a small and significant group of dying patients, in spite of excellent palliative care.1 Also see ‘Dying Badly in New Zealand’.2

H/PC is enough for most people most of the time. The use of terminal sedation for patients whose suffering cannot be managed any other way, is well established. But this, while better than the present alternative, can be gruelling; and for some patients and families MAID will be preferred. The refusal of some of the H/PC leaders to include MAID is likely to be impede the provision of good end-of-life care in the future. Hospice New Zealand has even asked the High Court to give an opinion as to whether they are at liberty under the new law to refuse MAID on their premises.3 This was granted, but the court would not rule that public funding should be provided to hospices which take this stance, and since a significant amount of their funding is from the public purse, one could well argue that if they refuse to allow this legal option for their patients who request MAID, that public funding should be withdrawn. The very end of life is a cruel time to transfer an ill, vulnerable, suffering patient to some other organisation, and will only add to their suffering,

Respecting the importance of autonomy in patient decisions has become increasingly recognised. It is clear from repeated surveys over many years that a majority of the New Zealand public support the option to make a free choice to request MAID for themselves should they be in the position of having unbearable suffering as they are dying. Furthermore, it is also common in patients who are approaching death to state that they are not afraid of being dead, but they are afraid of what they have to endure before they die and the option of MAID gives them great relief, even when they do not need to use it. In addition, a significant group (5–8%) of suicides are terminal patients of sound mind ending their lives earlier to avoid unbearable suffering, while they are still capable.4

One has to ask why some New Zealand H/PC doctors are so opposed to MAID? It is quite clear now from overseas legalised jurisdictions that the vulnerable are not targeted, irrational suicide does not increase, and trust in doctors is enhanced rather than eroded. There are no studies which have revealed coercion as a problem. The NZ EOLC Act is narrow in scope, has passed three readings in Parliament and has many safeguards.

When H/PC first started, many doctors did not think it was needed, many thought that they were handling it even though they were often not giving adequate symptom control. There was opposition from the Catholic Church who feared H/PC would shorten peoples’ lives. Now H/PC is an integral part of our healthcare system, deservedly highly valued, which still deserves better public funding. In other legalised jurisdictions most patients accessing MAID are already receiving H/PC, eg, Ontario5 and, increasingly, there is integration of MAID and traditional H/PC, providing compassionate end-of-life care, eg, Belgium.6

It is relevant to note that if an individual’s personal belief system makes it impossible to accept MAID, nothing need change for them, except that H/PC may well be better funded and more accessible. However, it is interesting that a recent poll in Queensland has shown high support among religious adherents in most of the mainstream churches including Catholic (70%).7 There is a similar study in New Zealand.8

One would expect that in the future, the integration of MAID and HP/C will occur as those involved realise how well they can work together for the good of those patients who currently feel trapped in their suffering. H/PC staff will look back and wonder why their organisations were so reluctant to integrate the services—especially as the most obvious staff to be involved in MAID are GPs and H/PC doctors and nurses. Most patients will use H/PC and the H/PC community will simply use MAID as an occasional and valuable component of end-of-life care.

This comment from VAD Victoria (2020 report)9 encapsulates what we are striving for.

“Feedback and information gathered over the past six months continues to highlight the compassion and relief the Victoria’s voluntary assisted dying scheme is providing to terminally ill people, their friends and family. The Board continues to be humbled and honoured to be part of this, as we review the cases and read the touching testimonials of applicants and those who are by their side as they die.’’

We all want the same thing – to be able to choose, legally, whatever is best for each of us.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Jack Havill, Retired Intensive Care Medicine Specialist, Past President of End of Life Choice Society; Libby Smales, Grief Counsellor and Retired H/PC Physician, Previous Medical Director of Cranford Hospice (Hawkes Bay), Previous President of HBNZMA, Previous President of Hospice NZ.

Acknowledgements

Correspondence

Dr Jack Havill, Retired Intensive Care Medicine Specialist, Past President of End of Life Choice Society.

Correspondence Email

jackhavill@outlook.com

Competing Interests

Nil.

1. Australian Palliative Care Outcomes Collaboration. (2020). Patient outcomes in Palliative Care National report July to December 2019.

2. Barber D, Havill J. (2018). Dying Badly: New Zealand Stories. Upper Hutt: End-of-Life Choice Society of New Zealand Incorporated.

3. Reference http://www.hospice.org.nz/wp-content/uploads/2020/08/Hospice-New-Zealand-v-Attorney-General-EOLC-Act-Judgement-June-2020.pdf

4. Weaver JC (2014) Sorrows of Century – Interpreting Suicide in New Zealand 1900–2000. Bridget Willams Books;Wellington. (also avaialable at ‘Affidavit to High Court of NZ Wellington Registry CIV-2015-485-235 Lucretia seales Case.’)

5. Downar J, Fowler RA, Halko R, Davenport L, Hill A, Gibson JL. Early experience with medical assistance to dying in Ontario, Canada: a cohort study CMAJ. Feb 24 2020; 192(8):E173–E181.

6. Bernheim JL, Deschepper R, Mullie A, Bilsen J, Deliens L. Development of palliative care and legalisation of euthanasia: antagonism or synergy. BMJ, 19 April 2008; 336:864–867.

7. Most Queenslander churchgoers say they support voluntary assisted dying. http://www.theguardian.com.australia-news/2020/aug/08/most-queensland-churchgoers-say-they-support-voluntary-assisted-dying

8. Rae N, Johnson MH, Malpas PJ. NZ Attitudes towards Physician Assisted Dying. Pall Care Med v9, no2, 2015.

9. Voluntary Assisted Dying Review Board, Victoria, Australia. Report on Operations January–June 2020. Available at bettersafercare.vic.gov.au/vad

Contact diana@nzma.org.nz
for the PDF of this article

View Article PDF

We hope that hospice/palliative care (H/PC) organisations will take a fresh look at their current stance against medical assistance in dying (MAID). The present approach will disadvantage some patients in a number of ways.

It is clear from many sources and reviews that suffering at the end of life can be overwhelming in a small and significant group of dying patients, in spite of excellent palliative care.1 Also see ‘Dying Badly in New Zealand’.2

H/PC is enough for most people most of the time. The use of terminal sedation for patients whose suffering cannot be managed any other way, is well established. But this, while better than the present alternative, can be gruelling; and for some patients and families MAID will be preferred. The refusal of some of the H/PC leaders to include MAID is likely to be impede the provision of good end-of-life care in the future. Hospice New Zealand has even asked the High Court to give an opinion as to whether they are at liberty under the new law to refuse MAID on their premises.3 This was granted, but the court would not rule that public funding should be provided to hospices which take this stance, and since a significant amount of their funding is from the public purse, one could well argue that if they refuse to allow this legal option for their patients who request MAID, that public funding should be withdrawn. The very end of life is a cruel time to transfer an ill, vulnerable, suffering patient to some other organisation, and will only add to their suffering,

Respecting the importance of autonomy in patient decisions has become increasingly recognised. It is clear from repeated surveys over many years that a majority of the New Zealand public support the option to make a free choice to request MAID for themselves should they be in the position of having unbearable suffering as they are dying. Furthermore, it is also common in patients who are approaching death to state that they are not afraid of being dead, but they are afraid of what they have to endure before they die and the option of MAID gives them great relief, even when they do not need to use it. In addition, a significant group (5–8%) of suicides are terminal patients of sound mind ending their lives earlier to avoid unbearable suffering, while they are still capable.4

One has to ask why some New Zealand H/PC doctors are so opposed to MAID? It is quite clear now from overseas legalised jurisdictions that the vulnerable are not targeted, irrational suicide does not increase, and trust in doctors is enhanced rather than eroded. There are no studies which have revealed coercion as a problem. The NZ EOLC Act is narrow in scope, has passed three readings in Parliament and has many safeguards.

When H/PC first started, many doctors did not think it was needed, many thought that they were handling it even though they were often not giving adequate symptom control. There was opposition from the Catholic Church who feared H/PC would shorten peoples’ lives. Now H/PC is an integral part of our healthcare system, deservedly highly valued, which still deserves better public funding. In other legalised jurisdictions most patients accessing MAID are already receiving H/PC, eg, Ontario5 and, increasingly, there is integration of MAID and traditional H/PC, providing compassionate end-of-life care, eg, Belgium.6

It is relevant to note that if an individual’s personal belief system makes it impossible to accept MAID, nothing need change for them, except that H/PC may well be better funded and more accessible. However, it is interesting that a recent poll in Queensland has shown high support among religious adherents in most of the mainstream churches including Catholic (70%).7 There is a similar study in New Zealand.8

One would expect that in the future, the integration of MAID and HP/C will occur as those involved realise how well they can work together for the good of those patients who currently feel trapped in their suffering. H/PC staff will look back and wonder why their organisations were so reluctant to integrate the services—especially as the most obvious staff to be involved in MAID are GPs and H/PC doctors and nurses. Most patients will use H/PC and the H/PC community will simply use MAID as an occasional and valuable component of end-of-life care.

This comment from VAD Victoria (2020 report)9 encapsulates what we are striving for.

“Feedback and information gathered over the past six months continues to highlight the compassion and relief the Victoria’s voluntary assisted dying scheme is providing to terminally ill people, their friends and family. The Board continues to be humbled and honoured to be part of this, as we review the cases and read the touching testimonials of applicants and those who are by their side as they die.’’

We all want the same thing – to be able to choose, legally, whatever is best for each of us.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Jack Havill, Retired Intensive Care Medicine Specialist, Past President of End of Life Choice Society; Libby Smales, Grief Counsellor and Retired H/PC Physician, Previous Medical Director of Cranford Hospice (Hawkes Bay), Previous President of HBNZMA, Previous President of Hospice NZ.

Acknowledgements

Correspondence

Dr Jack Havill, Retired Intensive Care Medicine Specialist, Past President of End of Life Choice Society.

Correspondence Email

jackhavill@outlook.com

Competing Interests

Nil.

1. Australian Palliative Care Outcomes Collaboration. (2020). Patient outcomes in Palliative Care National report July to December 2019.

2. Barber D, Havill J. (2018). Dying Badly: New Zealand Stories. Upper Hutt: End-of-Life Choice Society of New Zealand Incorporated.

3. Reference http://www.hospice.org.nz/wp-content/uploads/2020/08/Hospice-New-Zealand-v-Attorney-General-EOLC-Act-Judgement-June-2020.pdf

4. Weaver JC (2014) Sorrows of Century – Interpreting Suicide in New Zealand 1900–2000. Bridget Willams Books;Wellington. (also avaialable at ‘Affidavit to High Court of NZ Wellington Registry CIV-2015-485-235 Lucretia seales Case.’)

5. Downar J, Fowler RA, Halko R, Davenport L, Hill A, Gibson JL. Early experience with medical assistance to dying in Ontario, Canada: a cohort study CMAJ. Feb 24 2020; 192(8):E173–E181.

6. Bernheim JL, Deschepper R, Mullie A, Bilsen J, Deliens L. Development of palliative care and legalisation of euthanasia: antagonism or synergy. BMJ, 19 April 2008; 336:864–867.

7. Most Queenslander churchgoers say they support voluntary assisted dying. http://www.theguardian.com.australia-news/2020/aug/08/most-queensland-churchgoers-say-they-support-voluntary-assisted-dying

8. Rae N, Johnson MH, Malpas PJ. NZ Attitudes towards Physician Assisted Dying. Pall Care Med v9, no2, 2015.

9. Voluntary Assisted Dying Review Board, Victoria, Australia. Report on Operations January–June 2020. Available at bettersafercare.vic.gov.au/vad

Contact diana@nzma.org.nz
for the PDF of this article

View Article PDF

We hope that hospice/palliative care (H/PC) organisations will take a fresh look at their current stance against medical assistance in dying (MAID). The present approach will disadvantage some patients in a number of ways.

It is clear from many sources and reviews that suffering at the end of life can be overwhelming in a small and significant group of dying patients, in spite of excellent palliative care.1 Also see ‘Dying Badly in New Zealand’.2

H/PC is enough for most people most of the time. The use of terminal sedation for patients whose suffering cannot be managed any other way, is well established. But this, while better than the present alternative, can be gruelling; and for some patients and families MAID will be preferred. The refusal of some of the H/PC leaders to include MAID is likely to be impede the provision of good end-of-life care in the future. Hospice New Zealand has even asked the High Court to give an opinion as to whether they are at liberty under the new law to refuse MAID on their premises.3 This was granted, but the court would not rule that public funding should be provided to hospices which take this stance, and since a significant amount of their funding is from the public purse, one could well argue that if they refuse to allow this legal option for their patients who request MAID, that public funding should be withdrawn. The very end of life is a cruel time to transfer an ill, vulnerable, suffering patient to some other organisation, and will only add to their suffering,

Respecting the importance of autonomy in patient decisions has become increasingly recognised. It is clear from repeated surveys over many years that a majority of the New Zealand public support the option to make a free choice to request MAID for themselves should they be in the position of having unbearable suffering as they are dying. Furthermore, it is also common in patients who are approaching death to state that they are not afraid of being dead, but they are afraid of what they have to endure before they die and the option of MAID gives them great relief, even when they do not need to use it. In addition, a significant group (5–8%) of suicides are terminal patients of sound mind ending their lives earlier to avoid unbearable suffering, while they are still capable.4

One has to ask why some New Zealand H/PC doctors are so opposed to MAID? It is quite clear now from overseas legalised jurisdictions that the vulnerable are not targeted, irrational suicide does not increase, and trust in doctors is enhanced rather than eroded. There are no studies which have revealed coercion as a problem. The NZ EOLC Act is narrow in scope, has passed three readings in Parliament and has many safeguards.

When H/PC first started, many doctors did not think it was needed, many thought that they were handling it even though they were often not giving adequate symptom control. There was opposition from the Catholic Church who feared H/PC would shorten peoples’ lives. Now H/PC is an integral part of our healthcare system, deservedly highly valued, which still deserves better public funding. In other legalised jurisdictions most patients accessing MAID are already receiving H/PC, eg, Ontario5 and, increasingly, there is integration of MAID and traditional H/PC, providing compassionate end-of-life care, eg, Belgium.6

It is relevant to note that if an individual’s personal belief system makes it impossible to accept MAID, nothing need change for them, except that H/PC may well be better funded and more accessible. However, it is interesting that a recent poll in Queensland has shown high support among religious adherents in most of the mainstream churches including Catholic (70%).7 There is a similar study in New Zealand.8

One would expect that in the future, the integration of MAID and HP/C will occur as those involved realise how well they can work together for the good of those patients who currently feel trapped in their suffering. H/PC staff will look back and wonder why their organisations were so reluctant to integrate the services—especially as the most obvious staff to be involved in MAID are GPs and H/PC doctors and nurses. Most patients will use H/PC and the H/PC community will simply use MAID as an occasional and valuable component of end-of-life care.

This comment from VAD Victoria (2020 report)9 encapsulates what we are striving for.

“Feedback and information gathered over the past six months continues to highlight the compassion and relief the Victoria’s voluntary assisted dying scheme is providing to terminally ill people, their friends and family. The Board continues to be humbled and honoured to be part of this, as we review the cases and read the touching testimonials of applicants and those who are by their side as they die.’’

We all want the same thing – to be able to choose, legally, whatever is best for each of us.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Jack Havill, Retired Intensive Care Medicine Specialist, Past President of End of Life Choice Society; Libby Smales, Grief Counsellor and Retired H/PC Physician, Previous Medical Director of Cranford Hospice (Hawkes Bay), Previous President of HBNZMA, Previous President of Hospice NZ.

Acknowledgements

Correspondence

Dr Jack Havill, Retired Intensive Care Medicine Specialist, Past President of End of Life Choice Society.

Correspondence Email

jackhavill@outlook.com

Competing Interests

Nil.

1. Australian Palliative Care Outcomes Collaboration. (2020). Patient outcomes in Palliative Care National report July to December 2019.

2. Barber D, Havill J. (2018). Dying Badly: New Zealand Stories. Upper Hutt: End-of-Life Choice Society of New Zealand Incorporated.

3. Reference http://www.hospice.org.nz/wp-content/uploads/2020/08/Hospice-New-Zealand-v-Attorney-General-EOLC-Act-Judgement-June-2020.pdf

4. Weaver JC (2014) Sorrows of Century – Interpreting Suicide in New Zealand 1900–2000. Bridget Willams Books;Wellington. (also avaialable at ‘Affidavit to High Court of NZ Wellington Registry CIV-2015-485-235 Lucretia seales Case.’)

5. Downar J, Fowler RA, Halko R, Davenport L, Hill A, Gibson JL. Early experience with medical assistance to dying in Ontario, Canada: a cohort study CMAJ. Feb 24 2020; 192(8):E173–E181.

6. Bernheim JL, Deschepper R, Mullie A, Bilsen J, Deliens L. Development of palliative care and legalisation of euthanasia: antagonism or synergy. BMJ, 19 April 2008; 336:864–867.

7. Most Queenslander churchgoers say they support voluntary assisted dying. http://www.theguardian.com.australia-news/2020/aug/08/most-queensland-churchgoers-say-they-support-voluntary-assisted-dying

8. Rae N, Johnson MH, Malpas PJ. NZ Attitudes towards Physician Assisted Dying. Pall Care Med v9, no2, 2015.

9. Voluntary Assisted Dying Review Board, Victoria, Australia. Report on Operations January–June 2020. Available at bettersafercare.vic.gov.au/vad

Contact diana@nzma.org.nz
for the PDF of this article

Subscriber Content

The full contents of this pages only available to subscribers.

LOGINSUBSCRIBE