Geddis on Euthanasia

June 22nd, 2016 at 9:00 am by David Farrar

Andrew Geddis writes:

First, earlier this month the Victorian Parliament’s Legal and Social Issues Committee tabled an extensive report on on its inquiry into end of life choices. This report proceeded the way that NZ’s Health Committee really should have done – it first examined how the State’s palliative care services are operating and what should be done to better improve this, before then turning to look at the issue of aid in dying. With regards that latter matter, the Committee concluded that:

“Assisted dying should be made available to adults with decision making capacity who are at the end of life and suffering from a serious and incurable condition, which is causing enduring and unbearable suffering that cannot be relieved in a manner they deem tolerable.

Suffering as a result of mental illness only does not satisfy the eligibility criteria.

Assisted dying should be provided in the form of a doctor prescribing a lethal drug which a person may then take themselves, or in the case of a person being physically unable to take the drug themselves, the doctor administering the drug.

The request to access assisted dying must be completely voluntary, properly informed, and satisfy the verbal request, formal written request, repeat verbal request procedure described [in the report].”

There’s a bunch of reasons why we should care what this Committee thinks. First up, it represents the conclusions of a group of MPs from a society that is (like it or not) pretty similar to our own. What is more, the report represents a cross-party near-consensus on the issue. The Committee consisted of three Labor MPs, three Liberal MPs  and one representative each from the Sex Party (yes – really!) and the Greens. Of these eight members, only one (from the Liberal Party) dissented from the recommendation. So you can’t just dismiss this report as the ideologically driven predetermined views of [insert whatever side of the political spectrum you disagree with].

It will be interesting to see what conclusions the MPs on the Health Select Committee reach.

So now that Canada has brought in a regime of legalised aid in dying, we’ve got a near perfect comparator for us as a nation to see if the claimed negative consequences of the practice eventuate. Will Canada’s introduction of aid in dying somehow harm the practice of medicine (or, at least, the practice of medicine in end-of-life situations)? Will it lead to elderly/depressed/disabled people being pushed by relatives or money-saving governments to end their lives? Will the suicide rate, especially for young people, trend upwards because of “mixed messages” about the practice? Etc, etc?

I agree Canada will be a good country to study to see what happens. While I support euthanasia in principle I am always ready to be swayed by evidence.

For the same reason I look forward to the results of Oregon and Washington legalising cannabis. Will it increase harm or make no difference?

More on the Dutch euthanasia case

May 19th, 2016 at 1:58 pm by David Farrar

I blogged on a troubling case in the Netherlands involving a woman in her 20s who was allowed to have an assisted suicide/death due to PTSD.

I’ve been e-mailed by an MP a translation of her case notes, which indicate she had ailments beyond PTSD. The translation is:

Character suffering, information and alternatives By patient, a woman of 20-30 years, had serious mental suffering, including a refractory posttraumatic stress disorder and severe refractory anorexia nervosa. there Also, there was a chronic depression, chronic suicidality, self-mutilation, dissociation / pseudo-hallucinations and obsessions and compulsions. Were her complaints Fifteen years ago started after sexual abuse.

The patient has had various therapies, both ambulatory and in various clinical centers. Also is They treated very intensively with medication. Her suffering was increasing and more and more came somatic problems. She was tube feeding through a PEG tube, suffered from urinary retention, which a suprapubic catheter was placed, and was suffering from constipation, which they got colonics. She also had chronic anemia, electrolyte disturbances and renal impairment.

About two years before the death has taken place for multidisciplinary consultation Following the euthanasia of the patient. There is then a second opinion from an expert asked trauma treatments. On the advice of these expert then has an intense occurred trauma treatment. This treatment was temporarily partially successful.

According to her treating psychiatrist no other treatment options were more present and there was no sight more to improve her quality of life. His vision was confirmed by a another psychiatrist and the medical superintendent of the mental health institution to which he was attached. Healing was no longer possible. The treatment was still only palliative in nature.

The suffering of the patient consisted of continuous mental suffering by continuing mood swings and flashbacks, ongoing abdominal discomfort and the very poor physical condition and deplorable condition in which it had found itself. Despite years of fighting and contributing to the intensive treatments were her mental and physical condition as bad backward that they experienced no quality of life anymore. Patient was cachectic severely weakened and almost completely become bedridden and dependent on the care of others; there was no perspective or hope for her. She had constantly felt that she was dying, but did not die.

They suffered from the hopelessness of her situation.

The patient experienced her suffering as unbearable. The doctor was convinced that suffering for the patient was unbearable and hopeless prevailing medical opinion.

There were no acceptable options for the patient more to relieve the suffering.

So seems it was a more complex case than the media reported.

A troubling case

May 17th, 2016 at 2:00 pm by David Farrar

News.com.au reports:

WHEN we think about euthanasia, many of us picture an elderly person.

They’ve had many good years, but an illness has ruined their quality of life. They’re in pain, and they want to end things on their own terms. For many people, this is an easy concept to accept.

But a recent case in the Netherlands is getting a lot of media attention, and it’s troubling ethicists.

A sexual abuse victim in her 20s was allowed to go ahead with assisted suicide as she was suffering from “incurable” post-traumatic-stress disorder (PTSD), according to the Dutch Euthanasia Commission.

The law in the Netherlands states that doctors may perform euthanasia on anyone with “unbearable suffering”.

The girl had been abused between the age of five and 15. As a result of her abuse, she suffered severe anorexia, chronic depression, and hallucinations.

Doctors said her conditions were “incurable” despite some small improvements in her mental state after intensive therapy. Two years ago, they agreed to her wish to end her life.

The doctors judged her to be “totally competent” and that there was “no major depression or other mood disorder which affected her thinking”.

News of her death has triggered debate around the world about the ethics of assisted dying.

I’m in favour of assisted suicide/euthanasia in cases where people are dying, or have a condition (Huntington’s that will make their life intolerable). But declaring PTSD to be incurable seems a step too far to me.

Canada introduces euthanasia law

April 18th, 2016 at 9:00 am by David Farrar

Stuff reports:

Canada’s Liberal government on Thursday (Friday NZ Time) unveiled draft legislation on doctor-assisted suicide which would apply to adults suffering incurable illness or disability but stopped short of extending it to minors or the mentally ill for now.

Legislators will vote on the draft law, which applies only to Canadians and residents in the country, in the next few weeks. The law is expected to pass because Prime Minister Justin Trudeau’s Liberals have a majority in Parliament.

The Supreme Court of Canada overturned a ban on physician-assisted suicide last year but gave the new government extra time to pass legislation, adding Canada to the handful of Western countries that allow the practice.

Trudeau, whose father declined treatment for cancer before his 2000 death, said Canadians were “extremely seized with this issue.”

“It’s a deeply personal issue that affects all of us and our families and all of us individually as we approach the end of our lives,” he told reporters. “The plan we have put forward is one that respects Canadians’ choices while putting in place the kinds of safeguards needed.”

Polls show physician-assisted suicide has broad support in Canada but the issue has divided politicians in Parliament as they grapple with how to protect vulnerable Canadians while respecting their rights and choices at the end of life.

Under the law, patients would have to make a written request for medical assistance in dying or have a designated person do so if they are unable.

There would be a mandatory waiting period of at least 15 days in many cases, and patients would be able to withdraw a request at any time.

Patients would also have to be experiencing “enduring and intolerable suffering” and death would have to be “reasonably foreseeable”.

Useful timing as we have a select committee looking at this issue at the moment.

The Huntington’s case for euthanasia

March 14th, 2016 at 3:00 pm by David Farrar

Stuff reports:

Rachel Rypma​ celebrated her 40th birthday last August, but is adamant she does not want a 41st.

At 24, the Christchurch woman discovered she had the neurodegenerative genetic disorder Huntington’s Disease.

At the time, she lived in Sydney with her partner, Gabe Rypma, pregnant and full of hope.

Today, she lives alone in a care home in Christchurch and wants to die. 

She wants people to know what it is like for her, and hear her plea. 

As Rypma​ makes her way to a small living room she clutches her walking frame and struggles to keep her body on task.

Some people argue the alternative to euthanasia is palliative care. But not everyone is dying of terminal cancer.

Huntington’s destroys the brain and the body. It is sadly a sentence of hell on earth where you could spend many years physically unable to even feed yourself, and also with no mental ability.

Under the current law the only way to avoid this is to commit suicide with no help. But this means killing yourself possibly years before you have to, rather than the alternative of being able to have assistance to do so once your disease gets to a certain point.

Her limbs, torso and head are in constant motion, wildly flailing in different directions. 

The disease has taken control of Rypma’s​ body and speech, but her mind has so far stayed intact. 

Eventually, she will probably slide into dementia. 

With her mother, Denise Forbes, by her side, Rypma​ concentrates to string the words together. 

“I’m not happy, and I want to die.” 

And for the sake of humanity she should be allowed to.

Most of her food has to be pureed and fed to her by carers, but eating is still hazardous. She often chokes or vomits at meal times. 

Tall and willowy, Rypma​ recently opted to shave her light brown hair. A large gold and orange medallion hangs around her neck. Throughout the interview she pauses to smile for the camera.

It is a reminder of her former vitality.

After the diagnosis, Rypma​ and her then partner, Gabe,​ made the painful decision to terminate the pregnancy.

Gabe Rypma said his former wife was an advocate for euthanasia from the time she was diagnosed. 

“She said, ‘let’s go and have an amazing life’, but when the dignity is gone and I can’t walk, then I want the choice to end my life.”

Yet our law denies her such a choice.

In 2007 Rypma​ returned to Christchurch on her own. 

She had reached a low point and suffered from depression, Forbes said. 

After moving in to the care home three years ago she tried to run away and tried to take her life twice, Forbes said.

She supported her daughter’s position on euthanasia. 

“I believe someone in Rachel’s situation should have the right to choose.”

Forbes knew of another woman with Huntington’s Disease who starved herself to death, an agonising process that took nine weeks.

Truly terrible.

Rypma had a “living will” that specified she would not take medication if she was to fall ill. Forbes said it was likely she would succumb to an infection this winter. 

The disease was progressing rapidly. She had lost 14 kilograms over the past six months because of her constant movement. 

Huntington’s Disease nurse Jeanette Wiggins said 80 per cent of patients died when they accidentally inhaled food or drink and it lead to pneumonia. 

So our compassionate society means we have to leave them to choke to death or hope they get pneumonia.

 

We shouldn’t have to guess

February 16th, 2016 at 1:05 pm by David Farrar

The Guardian reports:

A man in his 30s who is in the advanced stages of Huntington’s disease and repeatedly pulls out a feeding tube attached to his stomach should be allowed to die, a judge has ruled.

The man had removed the tube about 120 times, Mr Justice Hayden was told during the hearing at the court of protection in London. The man’s mother and an aunt told the judge they believed he “wants to go”.

A consultant neurologist said it would not be right – and futile – for medics to force the feeding tube on the man.

Hayden concluded that the tube should not be reinserted, even though this would hasten the man’s death.

How sad that they had to go to court and the man involved had to rip out the tube 120 times, for his wishes to be allowed.

The law should allow for people who have Huntington’s to give directives in advance that they don’t want to be treated, and/or that they wish to be assisted to die.

Huntington’s disease is a hereditary disorder of the central nervous system. The condition becomes progressively worse over time and can affect movement, cognition and behaviour. There is no cure and its progress cannot be reversed or slowed.

Symptoms of Huntington’s were first seen when the man was in his teens, the judge heard.

A nurse closely involved in the man’s care told the court the quality of his life had deteriorated rapidly in recent years. The man no longer got out of bed, had lost the ability to speak and could not eat normally.

It is an awful disease and you can lose both your body and your mind.

Alwyn Poole on Euthanasia

February 7th, 2016 at 1:00 pm by David Farrar

Alwyn Poole has done a post arguing against legalising euthanasia:

I had two fathers who died two quite different deaths. One, my birth father (who I never met), chose suicide assisted by a shotgun in his back shed. The other, the one who adopted me and brought me up, died of natural causes in his lounge – at home with his wife – in 2006.

Strangely enough, re the debate on euthanasia, it is the death of the second one I want to address. This should not be a nice trendy issue for someone to try and gain electoral support. It has stunning potential to become a slippery slope for a range of groups in society. It also has the potential to confer power to a group of people (doctors) who are highly fallible in a range of ways.

As I said – my adoptive father died naturally at home. His life almost did not end that way. A few months prior to his death I received a phone call at work that my father was “dying that day”. It was a Tuesday and he was in intensive care in a hospital in a small city in NZ. I had spent time there with him on the Sunday and had left him on the improve and​, apparently, ​ in good spirits. 

Ray Poole was 67 years old at the time and had a terminal illness, emphysema, that had progressed. He was not in good shape having been one of those people who had worked incredibly hard (sometimes doing three ​tough ​jobs) to provide for his family and pay his taxes. He most certainly hadn’t helped his health by supporting the NZ ​s​herry industry and overseas owned tobacco companies for a long period of time. His wife, my mother, had just been diagnosed with terminal cancer and told she could go “any time” (which did not actually ​happen ​until ​seven years later​. Luckily she was skeptical of certain timelines too). Her situation clearly was having an impact on him.

Back to the phone call and my dad dying “that day”. I caught a plane and got myself to his fair city. Drove to the hospital and walked into intensive care. With two questions:

  1. What was his condition?
  1. What has happened since Sunday to bring about such a change?

His condition was that he was unconscious and that his oxygen levels were having to be assisted by tubes in his nose. The “what had happened since Sunday” was more startling. Apparently since I had left he had refused food and drink and the staff had allowed him to do so (without notifying family). He was not dying of his disease – he was dehydrated and starving. I asked the nurse in charge how this was allowed. She told me that the “doctors had met and decided that he had no ​’​quality of life​’​ “. This had not been a discussion involving him, my mother, my brother (a nurse), or myself. After I had clearly informed them what I thought of this I then asked what their “plan” was. 

Their plan ​had been to wait until I arrived and then send in a junior nurse with me to “turn off his oxygen and see what happens – then evaluate further.” So I followed her in and she did what she had been told to do by her authority figures. When she turned the oxygen off the saturation levels began to drop off a little. I then informed her that it was time to turn ​it​ back on. She refused telling me it was best that he “slip away now” (my brother, mother and I being treated like uninformed village idiots). She had made that decision but was clearly certain of support from her seniors (who had made sure that they were not there). I was brief and to the point in informing her that she was to turn the oxygen back on and she did so. I then asked for a syringe and a jug of water ​then sat and began to drip water into my father’s mouth. Twenty minutes later he woke up, sat up, and said: “Mate – I would do with another litre of that.”

I then did what I maybe should have done on the Sunday – I stayed and I cared. My dad slowly got better. It was clear that he wasn’t going to live for a long time but he packed life into the next few months. He cared for my mother, he spent time with his grandchildren, he talked with me every day. He passed away naturally when the time came.

Why had he refused food and drink earlier (and been so ably assisted in doing so)? He didn’t want to die but he thought he was being a burden. He thought he deserved it after all he had worked, smoked and drank his health away. He thought he was without hope. He was lonely and afraid of being alone. His wife was sick and, apparently, dying. 

The staff at the hospital took for themselves a “right” and position that does not belong on human shoulders (regardless of what law gets promoted and maybe even passed).​ No human being should be put in a position to decide and assist. ​There are very good reasons that we hold that dying is a natural event and that to the absolute best of our collective ability we care for every human in our society until nature takes its course.

I am always happy to run guest posts for or against an issue.

My submission to the euthanasia inquiry

February 1st, 2016 at 12:00 pm by David Farrar

SUBMISSION OF DAVID FARRAR TO THE
INQUIRY INTO MEDICALLY ASSISTED DYING BY THE HEALTH COMMITTEE

About the Submitter

  1. This submission is made by David Farrar in a personal capacity. I would like to appear before the Committee to speak to my submission.

Status Quo

  1. At present it is legal for people to end their lives, but illegal for anyone to assist with this.
  2. While active euthanasia (an active step to end life) is illegal, passive euthanasia (withholding treatment that could prolong) is legal and not uncommon

Quantity of life vs Quality of life

  1. It is a general aim of individuals, society and government for life to be as long as possible, and as happy as possible. We only live once, so it is absolutely normal to try to have both good quantity and quality of life.
  2. The issue is when quantity and quality of life come into conflict. There are frequent situations where the quality of life can become so intolerable, that decisions have to be made about trade offs.
  3. As a general principle I believe that if someone is of sound mind, they are best placed to decide for themselves whether to trade quantity of life for quality of life. The quantity traded may be just a few days, or it may be longer.

Assistance

  1. If someone of sound mind has decided for valid reasons to end their life, it should not be a criminal offence to assist them, so long as a proper process is followed.

Regulation

  1. Any law to allow assistance should regulate a process to ensure that the person wanting to die is of sound mind, and that this is verified.
  2. Currently passive euthanasia occurs with no regulatory oversight. Based sometimes on just verbal discussions, decisions are made to with-hold treatment that could extend life. I in no way suggest this has ever been abused, or doctors not acted in the best interest of their patients. But having no regulation in this area means that we can’t be certain.

Advanced Directives

  1. While euthanasia is generally associated with those terminally ill, it also has relevance for others who have degenerative conditions.
  2. For example, those who have Huntington’s Disease. HD has no cure and destroys both the mind and body until the person can’t move and has dementia.
  3. The awful choice for people with Huntington’s Disease who wish to avoid being unable to move or think can be to kill themselves at a relatively early stage unaided, as they may lose the ability to do at a later stage.
  4. The result of our current law is that they may (and do) end up killing themselves many years before they start to lose quality of life. A law allowing them to know they can be assisted to die when their quality of life diminishes unacceptably may actually extend their life by many years.

Possible Abuse

  1. Many people are concerned about the potential for abuse of a law which allows people wanting to die to have assistance.
  2. Ideally any system would have safeguards so there are no false positives – that there is no chance of someone being assisted to die, who genuinely doesn’t want to and it isn’t a result of pressure or manipulation.
  3. But there is no system that can give 100% assurance. Just as there is no system that gives us 100% assurance with food safety, with successful operations, with car safety etc.
  4. We have a criminal justice system based on the belief that it is better to let 100 guilty people go free, than one innocent person go to jail. However, we know that sometimes an innocent person is sent to prison. This is not an argument for having no criminal justice system – it is an argument for having rigorous safeguards.
  5. A sensible analysis should look at the risk of abuse vs the benefits a law change will have on those who are genuinely suffering and would welcome assistance if they wish to die.

Helen Kelly on euthanasia

January 27th, 2016 at 2:00 pm by David Farrar

Helen Kelly writes:

I have made my submission to the Health Select Committee which is considering the issue of assisted dying following the brave stand by Lecretia Seales. It’s weird to make a submission like that when you are actually dying – very relevant and confronting. It makes you ask: “What do I want for my death?”

It’s an important question that all of us should ask at some stage.

I could let myself die now. I could refuse treatment quite lawfully and die rather quickly. Instead I am trying to live, which is actually what most terminally ill people want – we don’t actually want to die – but if we have to then we want to do it peacefully and some of us may want tools to help when it is not going to happen naturally. …

While there is lots of awful physical stuff going on, the time I have been given to deal with the social stuff is precious and important to me and I think to others. Dying slowly, I think has a big advantage. But at some point that “party” will have to end and the tough social and physical bit will need to be addressed.

What do I want? Why can’t I continue to choose treatments that allow me to consider my own priorities? If I am at the point where those priorities can no longer be maintained and all I have left is the painful dying bit, why can’t I have the option of assisted dying, given the alternative is to turn up the morphine and hope? A natural death is out of the question.

No one wants to die. But when death is inevitable, people like Helen Kelly should be able to choose to reduce any suffering in the final days.

I hope the Committee looks at this through the eyes of a dying person and their family.  No family wants anyone to suffer and many people would not want to go on living in a state where they are unable to live a reasonable life with genuine choices. It’s time for New Zealand to make this option available in a regulated fashion. 

I agree with Helen Kelly on this.

Guest Post: Reflections on “A Moving Story”

January 20th, 2016 at 7:00 am by David Farrar

A guest post by Matthew Jansen, Secretary of Care Alliance:

Yesterday Kiwiblog posted a link to, and extensive quotes from, The Age story about an elderly Australian couple who last year committed suicide simultaneously.

The story was an affirmation of the decisions made by the couple, and their daughters’ respect for it. (Actually, two of the three daughters. The third daughter’s voice was not present. Hmmm.)

There were a number of details in the story that made me pause. Take this one:

About four years ago, Pat and Peter’s resolve to stay away from hospitals was heightened. While hanging washing in the backyard of their beloved home, Pat, then 83, tripped and broke a bone in her thigh. She was carted off to the emergency department.

“Carted off”. Really?

To me, that small detail reveals the Shaw’s determination to make the facts fit their theory.  Paternalistic medicos are the problem, they had decided, therefore the paramedics treated her without appropriate dignity. They ‘carted her off’.

The story reveals that the Shaws were long-time supporters of Philip Nitschke’s Exit International. They therefore approached growing older with a particular set of expectations and plans. It’s called confirmation bias.

The story makes clear that the Shaws were not terminally ill.  Mr Shaw was concerned that he could not follow the arguments in the Quarterly Essay as he once had. Anny, one of the daughters, thought that her parents “were tired. Even a bit bored, she thought.”

And these are meant to be the reasons for approving state-sanctioned and state-provided assisted suicide? Seriously?

The Shaw’s story is entirely consistent with the experience of assisted suicide in Oregon: wealthy, well-educated people who have had all the advantages of a good life, convince themselves that they could not, or simply do not want to, bear anything less than what they have had. So they want a law that suits their circumstances, and to hell with the consequences for other people who have been less fortunate.

Or as Mr Shaw is quoted as saying “I am not afraid of dying but I am afraid of pain and incompetence.” 

The international experience in Oregon, the Netherlands, Belgium and Switzerland is absolutely clear: the vast majority of assisted suicide cases are not for physical pain, but for social and psychological reasons. They are about fear: the fear of becoming less than we have been, less than we want to be, and of being abandoned.

This is the heart of this debate: people who say “I’d rather be dead than live like that” are implicitly (and in Matthew Parris’s case explicitly) saying that it is right and appropriate and legitimate to believe that some people – the “incompetent”, the disabled, the ill, the elderly, the different – are simply better off dead.

I think that’s wrong. I think the better response to such fears is to address them directly, and to support the person and their whānau to live their life fully. It’s more difficult, it’s certainly more expensive, but it is better.

There was one concluding irony at the end of both The Age and Stuff websites: they published contact details for suicide prevention services.

Why?

If suicide is okay, and assisted suicide is even better, who would decide who deserves suicide prevention services?

suicide

A moving story

January 18th, 2016 at 2:00 pm by David Farrar

A very moving story from the Melbourne Age.

The two scientists relished life. They skied, went bushwalking and climbed mountains, often taking their three young daughters with them. Their cultural and intellectual pursuits were many – classical music, opera, literature, wine, arguments over dinner with their many friends. They donated 10 per cent of their annual income to political and environmental movements. Family events were spent thoroughly debating the topics of the day.

As their capacity declined, the conversation about ending their own lives became more serious and their rejection of what Peter called “religious do-gooders” became more fierce.

“It was also a way into their favourite topics; philosophy, ethics, politics, the law…,” says their youngest daughter, Kate. “The idea that their end-of-life decisions could be interfered with by people with the superstitions of medieval inquisitors astounded them, and alarmed them.” …

Once they were aged 87:

They set a date. Peter said it was time and Pat agreed. They would enter the “big sleep” together on October 27, the day after Pat’s 87th birthday.

Anny got on a plane. When she arrived in Melbourne on October 21, she was shocked at how frail her parents looked. She would often find her father slumped in his chair. Her mother was struggling to move in the purposeful way she used to. Anny showed them a DVD of concerts she had performed with the Munich Radio Orchestra. But she could see that her parents had changed. They were tired. Even a bit bored, she thought.

On their final night together, the family shared a last supper of sorts. The sisters prepared a plate of cheeses, avocado and smoked salmon to eat with wine. Peter and Pat pecked at it. They didn’t seem very interested in food. Anny picked up their grandmother’s violin and played for her parents. They went to bed around 10pm.

The next morning, Peter and Pat got up early. They showered, dressed and made their bed. Peter had breakfast, a fried egg and coffee. Pat did not eat. She wanted to keep her stomach empty for what was to come.

The family sat in their backyard in the soft morning sun, enjoying the native garden that had flourished around their Robin Boyd-style home. Peter had designed the house himself in the 1960s.

“They were more cheerful than I had seen them since I arrived,” Anny said.

Everybody knew the plan. The sisters were to leave around noon. They felt they had no choice. Assisting, aiding or abetting a suicide carries a penalty of up to five years’ jail in Victoria. Their mother would have liked them to stay, but not at the risk of prosecution.

Pat did not want to die by herself, so she would take a lethal drug first. After leaving her in their bed, Peter would walk alone down the hall of their home and into the living room where they had shared so many hours. He would open the back door and trek one last time through his yard and into his shed where his equipment was set up.

Wouldn’t it have been simpler if they could have had their loved ones present when they chose to go?

Somewhere in Antarctica, there is a mountain named after Peter Shaw. He conquered it in 1955 on a pioneering mission with the Australian National Antarctic Research Expeditions.

The following year, he was awarded a Polar Medal for the mission and he was immortalised on a postage stamp. The trip had been tough. He and his companions had endured at least one terrifying storm that was so traumatic no one ever spoke about it again. They relied on candles for light and layers of wool for warmth. There were no fancy gadgets.

The year that Peter stuck an Australian flag in that peak was the same year he fell in love with his sweetheart.

Patricia was the “it girl” in their mountaineering club. Dazzling blue eyes and blonde hair. But Pat – or Patsy as she was sometimes called – was more comfortable in shorts and hiking boots than dresses and baby-doll heels. She was whip smart, too. Had plenty to say and knew what she was talking about.

The first time Peter ever saw Pat, he later told the girls, he had turned to a friend at the club gathering and asked who she was. The attraction was mutual. They married when they were 27.

Sounds like they had a great life, and they got to leave it on their terms.

Now their daughters waited on the beach. Their greatest fear was not that their beloved parents would die, but that they – or worse, one of them – would not.

The Shaw sisters trusted their parents and had faith in their plan but they were still aware of the many things that could go wrong.

What if the drug their mother had buried in her garden for fear of a police raid had lost its potency? What if one of them survived to be accused of killing the other?

Real fears.

There is no good way to lose your parents. When the three sisters returned to their parents’ house, they were orphans. The plan had worked and there was no sign of suffering. Peter and Pat had set out to end their lives in a meticulous, scientific fashion without any fuss, just as they had lived. And they had done it.

Quality of life can be as important as quantity.

SuicideNote

Peter and Pat should have been able to do what they did, without the need for secrecy, and with tightly regulated procedures for assistance.

Geddis on why you should submit to the euthanasia inquiry

January 15th, 2016 at 6:46 am by David Farrar

Andrew Geddis blogs:

Last year, somewhat to my own surprise, I became quite vocal around the issue of “aid in dying” (or, if you are trying to scare the horses, “euthanasia”/”assisted suicide”). It happened almost by accident. It certainly wasn’t an issue I had given a huge amount of thought to previously; my knee-jerk socially liberal response was that I thought it ought to be permitted with appropriate safeguards and that’s about as far as things went.

However, the case of Lecretia Seales really focused my attention onto the issue. Not only did it raise a number of very important legal issues that fall within my area of academic study, but I could strongly identify with her determination that decisions about how her death should come about should be hers alone to make. That resonated with me at a quite fundamental level.

Likewise.

Having sat in on some of the High Court proceedings, I can only second the Herald’s choice. Seeing Ms Seales being wheeled into the court, clearly drawing to the end of her time on earth, was deeply affecting. It brought home strongly that the judicial proceedings weren’t just an abstract debate about theoretical matters. They were (literally) a life and death issue for a real, identifiable person … who stood for other real, identifiable people in similar situations.

As I’ve got involved with this issue, I’ve also found how real this is for so many people. Some issues only affect a small number of people, but this issue has a real impact on so many.

Of course, Ms Seales didn’t get what she wanted from the Court. Ihad hoped that she might be more successful, but perhaps it is for the best that (as Justice Collins concluded) our elected, accountable representatives must make the call on when and how aid in dying may be provided in this country. Clearly these issues are something that many of us have strong and contrasting views on, so let’s let those views be considered and acted on by people we choose to make laws for us instead of by an appointed ex-lawyer who happens to have been rostered onto a particular case.

That’s all OK, as far as it goes. However, if we’re going down that line of thinking, it then puts the onus back onto us. Because democratic representative government only works like it is meant to if we, the people who live under the laws our representatives choose, take the time and make the effort to participate in it. If we don’t, then it really doesn’t work at all.

So here’s the challenge to anyone with views on how, when and if individuals should be able to choose the time and means of their own death.

Tell Parliament’s Health Select Committee what you think about this issue.

You only have a little over two weeks left to do so – submissions close on 1 February.

This is an issue worth submitting on. Andrew gives some advice:

  • Making a submission is really, really, really easy! Just go here, verify that you are a real person, provide some personal details and then type what you think into the text box. Once you hit the submit button, you’ve done your bit (unless you want to go in front of the Committee to give oral evidence, that is.)
  • You don’t need to be an expert or to know everything (or even all that much) about the topic – part of the purpose of this inquiry is to find out what ordinary New Zealanders think on the issues. So just speak from the heart!
  • If you have a personal story to tell about the hard choices that come at the end of life, so much the better. As Ms Seales showed, this isn’t an abstract issue – real people and real suffering underlie it. But just be aware that a submissions is made public unless you ask (and the Committee agrees) to keep it private.
  • There is no magic formula or wording to use in your submission – just try to write clearly and make your point early in the piece. Remember that MPs are really busy folks who have to give their time and attention to lots of different matters. The more you can help them know what you want, the better.
  • Finally, if you are interested in what those who are still carrying Lecretia Seales’ flame aloft think, you can read it here.

I’m working on my submission in the next week and a bit.

Lecretia Seales is Herald’s NZers of the Year

December 19th, 2015 at 11:15 am by David Farrar

The Herald writes:

She was brave and inspiring, sharing something as personal and private as her death for the advancement of a human right.

Instead of spending her last months quietly with family and friends, she spent them in a legal battle – fighting for the right to choose how she died.

For that courageous effort, the late Wellington lawyer Lecretia Seales is theHerald’s New Zealander of the Year. She died, aged 42, on June 5 from brain cancer. Her death came just days after learning she had been unsuccessful in her High Court bid for the legal right for a doctor to help her end her life. She wanted the right to not die a painful death.

As the result of the debate she prompted, Parliament began the first public inquiry into the issue of medically assisted dying.

Her husband, Matt Vickers, fights on – determined to ensure her personal sacrifice wasn’t for nothing.

Her family and friends say Lecretia was a private person. Mr Vickers said she would have found this accolade “over the top, because she was only doing what was right”.

But, as her friend Cate Honore Brett writes today, it is utterly fitting.

A good choice.  She used her death to try and give other New Zealanders a choice about what they would do in her circumstances. Even if you disagree with her on the issue, you should respect her willingness to try and have some good come from her situation.

End of Life choice site

October 25th, 2015 at 2:00 pm by David Farrar

David Seymour has put together a website in support of his End of Life choice bill.

There are a number of personal stories on there which are very moving.

The need for disclosure

October 22nd, 2015 at 3:00 pm by David Farrar

TVNZ reports:

The Government is under fire for funding a study on euthanasia that’s being run by researchers who support assisted dying.

Opponents are angry, claiming the study asking doctors and nurses for their views on euthanasia is biased and flawed.

The study is being led by two Auckland researchers, Dr Phillipa Malpas and Dr Pam Oliver, who told participants “we are independent”.

But they didn’t reveal they’re members of the Voluntary Euthanasia Society which is pushing for a law change to let doctors help patients die.

I would have thought that was important information to disclose.

The survey is meant for doctors and nurses only. 

But ONE News accessed it online and found it easy to submit fake responses.

Oh dear. Not very robust. Were participants asked to supply details that can be verified?

 

Seymour lodges voluntary euthanasia bill

October 14th, 2015 at 12:00 pm by David Farrar

Stuff reports:

A bill that would legalise voluntary euthanasia has been launched by ACT leader David Seymour.  …

“The End of Life Choice Bill is a response to the anguish faced by a small but significant minority of people with terminal illness or who are grievously and irremediably ill, as they anticipate the prospect of intolerable suffering and the indignity of the final few days and weeks of their lives.

“The motivation for this Bill is compassion. It allows people who so choose and are eligible under this Bill to end their life in peace and dignity, surrounded by loved ones,” he said.

Part of the Key’s reluctance to put the issue on the Government’s books is the number of the grey areas the issue presents. 

He has said its very difficult to get the legislation right. 

Seymour said his bill “carefully defined those eligible for assisted dying”. 

“It details a comprehensive set of provisions to ensure this is a free choice made without coercion, and outlines a stringent series of steps to ensure the person is mentally capable of understanding the nature and consequences of assisted dying.”

The details around safeguards will be an important focus.

The bill is online here. The eligibility criteria are:

  • is aged 18 years or over
  • has New Zealand citizenship or is a permanent resident
  • suffers from a terminal illness likely to end their life within 6 months or has a grievous and irremediable medical condition
  • is in an advanced state of irreversible decline in capability
  • experiences unbearable suffering that cannot be relieved in a manner that he or she considers tolerable
  • has the ability to understand the nature and consequences of assisted dying

The process would be:

  • A person requests assisted dying
  • Two medical practitioners will have to be satisfied that the person meets the criteria required. 
  • The medical practitioner must also encourage the person to talk about his or her choice with family, friends, and counsellors, ensure that the person has had the opportunity to talk to his or her choice of people, and do his or her best to ensure that the person has chosen assisted dying free of any pressure or coercion.
  • The medical practitioner must then contact the SCENZ Group, which will refer the person requesting assisted dying to a second medical practitioner, who must be independent of the person and of the initial medical practitioner.
  • After the reading of the person’s files and the examination of the person have occurred, should either medical practitioner be uncertain about whether the person requesting assisted dying is competent, the two medical practitioners must jointly refer the person to a specialist with a relevant scope in mental health.

The House may deal with as many as four members’ bills today, which means potentially four to be drawn from the ballot tomorrow. The odd for this bill being picked will be around 4/70 or around 6%. So it is unlikely to come before Parliament for a fair while.

California legalises euthanasia

October 6th, 2015 at 3:00 pm by David Farrar

The Guardian reports:

California will become the fifth state to allow terminally ill patients to legally end their lives using doctor-prescribed drugs after Governor Jerry Brown announced Monday he signed one of the most emotionally charged bills of the year.

Brown, a lifelong Catholic and former Jesuit seminarian, announced he signed the legislation after thoroughly considering all opinions and discussing the issue with many people, including a Catholic bishop and two of Brown’s doctors.

“In the end, I was left to reflect on what I would want in the face of my own death,” the governor wrote in a signing statement that accompanied his signature on the legislation. “I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill.

Fascinating that a staunch Catholic decided not to veto the bill.

I’ll predict that within two decades, most states in the US will allow euthanasia.

Euthanasia already happening in NZ

July 27th, 2015 at 3:00 pm by David Farrar

Stuff reports:

Doctors and nurses are playing increasing roles in prescribing, supplying or administering drugs that may hasten a patient’s death, according to new research.

A University of Auckland study anonymously surveyed 650 GPs.

Sixteen reported prescribing, supplying or administering a drug with the explicit intention of bringing death about more quickly.

But in 15 of those cases, it was nurses who administered the drugs. 

Researchers acknowledged the actions of the GPs would generally be understood as euthanasia, but the survey did not use that term. 

In the survey, led by Auckland University senior lecturer Dr Phillipa Malpas, GPs were asked about the last death at which they were the attending doctor.

Of the 650 to respond, 359 (65.6 per cent) reported that they had made decisions, such as withdrawing treatment or alleviating pain, taking into account the probability that they may hasten death.

Some made explicit decisions about hastening death.

Of the 359, 16.2 per cent withheld treatments with the “explicit purpose of not prolonging life or hastening the end of life”.

So euthanasia is already quite widespread – but with no legal protections for patients. If we legalise euthanasia, then we put in place a legal process where we can be sure any actions taken are with the consent of the patient, and is necessary tostop their suffering.

Polls on euthanasia

July 13th, 2015 at 3:00 pm by David Farrar

John Armstrong wrote:

The large ratio of National MPs to Labour’s means this Parliament is more conservative in composition. What seems odd is that Parliament has long been out of kilter with public opinion on this particular conscience issue. Opinion polls have consistently shown between 60 and 70 per cent of the public back voluntary euthanasia. But two private member’s bills brought before Parliament during the past two decades failed to make it even to the select committee stage.

Actually support has grown significantly for voluntary euthanasia in the last decade. I’ve got an archive of polls here. They have asked differently worded questions, so take that that into account. However the data says in terms of support:

  • 2010 – 47%
  • 2013 – 60%
  • 2015 – 74%

 

Euthanasia select committee inquiry

June 29th, 2015 at 7:00 am by David Farrar

Stuff reports:

MPs will carry out an inquiry into voluntary euthanasia.

Announcing an inquiry on Wednesday, chairman of the health select committee, Simon O’Connor, said members were “ready to engage” on what was an “important conversation that needs to be had”. …

It would take a couple of weeks to come up with a plan for the inquiry, O’Connor said.

The inquiry would consider how best to involve the public and what questions and terms of reference need to be included, he said.

This is a good step forward. It is no substitute for a bill, but can be complementary.

 

McIvor on euthanasia

June 11th, 2015 at 4:00 pm by David Farrar

Kerre McIvor writes:

But if the law doesn’t change, if Lecretia Seales’ fight has been for nought, then people will continue to take their own lives when they feel they have no other option. Others will continue to help a person begging them for relief. And they will continue to risk a prison term for committing the ultimate kindness.

If you believe life is sacred as long as you have breath in your body, I accept that. But as far as I’m concerned, my life is over when I no longer have the ability to appreciate life around me.

Once I’ve lost joy and wonder in the world, then I want to be able to quit my place and make room for someone else. And surely that’s my right to decide.

Well articulated.

Key supports Lecretia’s choice

June 10th, 2015 at 12:00 pm by David Farrar

The Herald reports:

The Prime Minister says he would probably support a euthanasia law change of the type Lecretia Seales wanted. …

John Key said this morning MPs would have to treat any proposed euthanasia law as “a conscience issue” but it was inevitable the topic would re-emerge in Parliament.

“I personally would probably support legislation aimed in the way Lecretia wanted it,” Mr Key said on TV One’s Breakfast this morning.

He said everyone had a “slightly different view” on the possible wording or interpretation of euthanasia laws but he expected several MPs to propose bills and he did not believe the Government needed to put the topic on its agenda.

“It will eventually get debated again.”

It would be nice to have a Government bill, as that can get a law change considered quicker in most cases. However the advantage of a members’ bill is that they don’t have to jostle for position with other bills on the Government’s order paper. The disadvantage of a members’ bill is you have to wait for it to win in the ballot.

The last bill failed by just two votes at its first reading. And that is possibly because the MP in charge was not a great parliamentary tactician. I’ve yet to start counting votes in this Parliament, but I have looked at how MPs still here voted in 2003.

For – Cunliffe, Dyson, Goff, Key, McCully, Paraone, Peters, Turei, Williamson (9)

Against – Brownlee, Carter, Collins, Cosgrove, Dunne, King, Mahuta, Mallard, Mark, O’Connor, Parker, Smith, Tisch, English (14)

Based on public statements, Collins is in favour (subject to wording) and I suspect King and Mallard may be persuadable also.

But the key will be 98 MPs since 2003.

Collins and Goff on euthanasia

June 8th, 2015 at 10:00 am by David Farrar

Judith Collins and Phil Goff in Stuff on euthanasia. First Collins:

I, like other Kiwis, watched as Lucretia Seales fought bravely in court for her right to die at a time of her choosing, with help from her GP.

Like many others, I wondered why it got this far.  I wonder how many other Kiwis have died of a terminal illness and been helped – a lot – with morphine on their way out of this world.

Seales fought for the right to die without fear that her GP might be hauled before the courts because of her wishes.

In the past, Parliament has voted against voluntary euthanasia.  Primarily, this is because the private member’s bills that have put it to Parliament have been full of holes and could have opened the elderly, in particular, to abuse.

Maybe it’s time for Parliament to revisit this with a carefully thought out bill that protects those doctors who carry out the well-considered wishes of their terminally ill patients.

Any such legislation should protect against any pressure brought on a terminally ill or disabled person.  Many MPs rightly worry about the ill and aged believing themselves to be a burden on their families and feeling obliged to ask their doctors for help.  Exactly who would be able to take this route or why are vexed questions.

By her sheer determination and courage, Seales showed   it was her wish to pass when and how she wanted.  It’s very clear that no one was pressuring her. She made a plea for dignity and control over her own death.

 

Goff agrees:

Why did Lecretia Seales have to fight in vain for the right to decide how she died?

Stricken with a terminal brain tumour, she did not want to die in pain or after having  lost control of her body. She wanted to say her farewells with human dignity.  If she felt her condition was too much to bear, she wanted the right to say enough.

There is nothing in law that says we cannot take our own lives but for a doctor to assist another to die even in these circumstances is a crime.  It shouldn’t be.

With palliative care, most of us can die without pain and with dignity, letting nature take its course.  Where this is not possible, people should have the right to choose for themselves when to bring suffering to an end.

What we need is a bill to be introduced. I believe it would have overwhelming public support, and so long as there were strong safeguards, would get a significant majority in Parliament to pass it.

Parliament will debate euthanasia

June 6th, 2015 at 10:00 am by David Farrar

Stuff reports:

The right-to-die debate is poised to be thrust back on the political agenda as support mounts for a parliamentary inquiry.

More than a decade after Parliament was divided by a vote on voluntary euthanasia, there is cross-party support that the public deserves a fresh debate through a select committee inquiry.

It follows the death on Friday from natural causes of Wellington lawyer Lecretia Seales on the same day that it was made public she had lost her bid lost her bid for the courts to rule in favour of assisted suicide.

A petition due to be presented to Parliament could be the catalyst for a fresh debate on voluntary euthanasia – but the Government is refusing to say whether it would back a wide ranging inquiry.

ACT leader David Seymour has confirmed he is drafting a member’s bill calling for a debate on euthanaisa and will urge the Government to adopt the bill.

Good to see that a bill will be put forward. The challenge will be to get it drawn from the ballot, or adopted by the Government (less likely).

I believe any bill, if drafted carefully with safeguards, will pass Parliament with a substantial majority.

Public opinion is massively in favour of a law change. The last public poll saw 74% in favour and just 20% opposed.

A select committee inquiry in response to the petition is a useful thing to do, but not as a substitute to a bill. It can get the arguments on the table, but it can’t lead to a law change, a vote in the House or even a debate in the House. As it is uncertain when a bill might be drawn out of the ballot, it is a good thing to do to keep attention on the issue, and hear arguments on what safeguards there should be. But a bill should go into the ballot as soon as possible, to maximise the chance of it being considered this term.

Seales v Attorney-General

June 5th, 2015 at 3:26 pm by David Farrar

The court ruling is below. Her applications were not granted.

Some key quotes:

I cannot declare that Ms Seales’ doctor would be acting lawfully if she administered a fatal drug to Ms Seales within the terms sought.  Nor can I declare that it would be lawful for Ms Seales’ doctor to provide her with a fatal drug knowing that Ms Seales intended to use that drug to end her own life and did so.  Because Ms Seales’ health is rapidly deteriorating, I informed the parties of this aspect of my decision on 2 June 2015

It’s good the court communicated this aspect as early as possible, three days ago.

I have decided that Ms Seales’ right not to be deprived of life is engaged, but not breached in her case. I have also concluded that Ms Seales’ right not to be subjected to cruel, degrading or disproportionately severe treatment is not engaged by her tragic circumstances. I have therefore concluded the relevant provisions of the Crimes Act are consistent with the rights and freedoms contained in the NZBORA.

Basically that is a loss on all grounds. It was always going to be a stretch for the court to rule assisted suicide was legal, but I thought there was a pretty good chance they would at least rule the current law is inconsistent with the NZBORA.

First, palliative care cannot necessarily provide relief from suffering in all cases. 

Palliative care helps greatly, but it doesn’t mean you don’t suffer both physically and mentally.

That research suggests that between three and eight per cent of suicides in New Zealand during the last century were by persons who were rational, competent, and suffering a terminal illness. 

That 3% to 8% may have lived longer if assistance was a legal option.

Although Ms Seales has not obtained the outcomes she sought, she has selflessly provided a forum to clarify important aspects of New Zealand law.  The complex legal, philosophical, moral and clinical issues raised by Ms Seales’ proceedings can only be addressed by Parliament passing legislation to amend the effect of the Crimes Act. 

It is time for Parliament to act. And by act I mean a law change, not a select committee inquiry. A select committee inquiry is better than nothing, but should not be seen as a substitute for a bill.

Seales v Attorney-General