Hospice New Zealand

Euthanasia - our opinion

Presentation from Baroness Ilora Finlay 

In June 2017 we facilited the below teleconference presentation from Baroness Finlay, with input from Robert Preston.  

You can access an audio recording of this presentation by clicking below.  

Presentation: “End of life or ending life? An analysis of the medical implications of legalised 'assisted dying'”

Presented by: Professor the Baroness Finlay of Llandaff FRCP, FRCGP, FMedSci, FHEA, FLSW, FCEM

Ilora Finlay is professor of palliative medicine at Cardiff University. She has been president of the Medical Women’s Federation, President of the British Medical Association, President of the Royal Society of Medicine and is President of the Chartered Society for Physiotherapy. She also chaired the Association for Palliative Medicine of Great Britain and Ireland, and since 2014 has chaired the National Council for Palliative Care.

 

Hospice Position Statement

With the right palliative care a person with a life limiting condition can live a good quality of life with their dignity maintained and symptoms managed. 

Assisted dying is a complex subject that raises challenging ethical questions for hospice care. Hospice New Zealand recognises that across society there is a range of different views, and respects the right of everyone to take an individual position. It is our view that the question of whether there should be a change in the law is one for society to consider and for the parliament to decide.

The term 'assisted dying' is often used to describe circumstances in which a person is either helped to end their own life (physician-assisted suicide) or where there is a deliberate act to end a person's life (euthanasia)

Our view

Hospice New Zealand does not support a change in the law to legalise assisted dying in any form. Nor do we consider that a change in the law would be in the best interests of the people we care for.

It is important to stress that hospices' always work strictly within the law, which currently means it is a criminal action to help someone commit suicide and may result in prosecution.

We believe Government should be investing in palliative care, increasing access to care and support not legalising euthanasia. Only when all New Zealanders have ready access to expert end-of-life care can a balanced debate begin. We support that all New Zealanders have the right to choose where they die.

All people with a life limiting condition should be made aware of options for hospice and palliative care, and should be offered an individual assessment of their needs to ensure that appropriate palliative care is being provided. This should be an integral part of advanced care planning.

We believe that palliative care should be routinely available to all who need it, and Government should ensure that public funding is made available to increase the availability of palliative care, whether provided by the hospital, at home (by the primary health care team), in residential aged care facilities or in hospices.

Greater education and training is needed to dispel the myths surrounding pain and symptom relief, and encourage all those prescribing medication for symptoms near the end of life to consult with hospice specialist clinicians and other palliative care experts where necessary.

The ethos of hospice and palliative care, as defined by the World Health Organisation, is that it ‘intends neither to hasten nor postpone death’. This philosophy is a cornerstone of hospice care in New Zealand.

Our aim is to see the very best care for everyone facing the end of life. This means that:

  • people who are dying can still live life well
  • no one has to die in avoidable pain and suffering
  • care is given to whoever needs it, whenever and wherever it is needed
  • carers and the bereaved get the help and support they need
  • people accept that dying is part of the experience of living.

Hospice and palliative care must be provided according to the principles of equity, irrespective of age, race, gender, sexual preference, ethnicity, faith, social status, national origin and the ability to pay for services. Palliative care must be available to all populations including vulnerable groups such as prisoners, sex workers and drug users.

Hospice and palliative care goes beyond managing the physical needs of people approaching the end of their lives. It places equal weight on their social, psychological, spiritual and emotional needs. It helps people to die with dignity.

Good palliative care is founded on a trusting relationship between patient, family and the health care provider, which is undermined by euthanasia. 

As a result, good palliative care can greatly improve most people’s experience of living with and dying from a life limiting condition. Many people using hospice services, whether it is the patient, family or friend find that they have a further positive phase of life which they never expected to have – perhaps coming to terms with their situation and experiencing a greater quality of life than they had imagined possible during their final weeks or months.

Professional opinion

The NZ Medical Association, Palliative Care Nurses New Zealand and ANZSPM also do not support a law change. 

Informing the debate

There are many unanswered questions which require clarification before there could be any change in the law.

Hospice New Zealand believes that more research is needed to inform the public debate and future policy by government in particular:

  • the extent to which palliative care can address the non physical aspects of suffering, through psychological, spiritual and social care, as well as physical care
  • the quality and availability of palliative care in jurisdictions elsewhere in the world where physician-assisted suicide or euthanasia are permitted
  • how patient views on assisted dying may change as people approach death and the impact of the psychological effects of approaching the end of life.

If there was to be a future change in the law, consideration would have to be given to:

  • the full impact of a change in the law, considering evidence from other countries and jurisdictions which have made such a change, and the effects of different models of assisted dying
  • how physician-assisted suicide or euthanasia would be implemented were it to be legalised. Many hospices take the view that this should not be a hospice role, because of the potential conflict with the values of hospice and palliative care, the impact on the perception of the hospice, and the possible implications for patient care. Research indicates that many health professionals would be reluctant to participate in assisted suicide or euthanasia
  • the potential risk that vulnerable people might feel they should choose the option of assisted suicide, rather than being a ‘burden’ to their family or society or a drain on the health care system

Compassionate communities value and care for the most vulnerable people - the elderly, those living with disabilities or mental health issues - to ensure they do not feel like emotional, financial or care burdens.

Making decisions at the end of life

In recent years, there have been significant improvements in health care decision making, which give people greater control over decisions about their treatment and care.

It has also been identified that there is a lack of open discussion between health and social care staff and those approaching the end of life and those who care for them; this is one of the key barriers to the delivery of good end of life care. The New Zealand Palliative Care Strategy (2001)  sets an expectation of all palliative care providers; that they must provide information to the public around expectations of a palliative care service.

There is an emphasis in the palliative care sector on ensuring that services provided to people approaching the end of their lives are, as far as possible, responsive to their needs and preferences.  This is evident through the introduction of advanced care plans where people are given the opportunity to consider what care they wish to receive, based on the best available information about what may lie ahead of them and what services are available.

Public opinion - historically

  • Polls of public opinion relating to assisted dying appear to consistently show widespread public support for a change in the law. In August 1995 a majority of MPs (61 to 29) voted against the introduction into Parliament of Michael Laws Death with Dignity Bill.
  • A 1995 One Network News-Colmar Brunton poll issued found 62% of respondents were in favour of voluntary euthanasia, with 27% opposed and 10% undecided. Bellamy, P (2003)
  • A Massey University Department of Marketing mail survey of 1000 New Zealanders, conducted in August and September 2002, found 73% supported assisted suicide for someone with a painful, incurable disease, provided it was a doctor who assisted. Support dropped to 49% for suicide assisted by someone else, such as a close relative.  Massey University (2003)
  • The Death with Dignity Bill was introduced by New Zealand First MP Peter Brown into Parliament on 6 March 2003. The Bill’s purpose was to:
    Allow persons who are terminally and/or incurably ill the opportunity of requesting assistance from a medically qualified person to end their lives in a humane and dignified way and to provide for that to occur after medical confirmation, a psychiatric assessment, counselling, and personal reflection
  • Different opinions were expressed on euthanasia in Parliament. In July 2003 MPs voted 60 to 58 against the Death with Dignity Bill going to a Select Committee.
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