The decision to allow for the termination of life has some interesting legal and ethical implications which require precise legislation. I suspect that with of the order of more than six out of ten New Zealanders supporting an end of life Choice for those who qualify and request it (Polls of public opinion relating to assisted dying appear to consistently show widespread public support for a change in the law).
As far back as 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.
Mind you, although 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, this was only provided it was a doctor who assisted. NOTE Support dropped to 49% for suicide assisted by someone else, such as a close relative. Massey University (2003)
Such polls suggests the main issue is most certainly not one of gaining general support. Most, if not all, extended families would have been able to point to relatives who had specifically asked for a termination of life to be supported and in many such cases patients have only been able to avoid what appears to them to be avoidable suffering with quiet but technically illegal medical assistance. Most will also know of patients who have died after many months suffering.
Having personally known doctors who have become involved with such cases I understand that the termination method is usually to provide legally prescribed drugs at a maximum allowed level that is likely to lead to enhanced chances of termination eg maximum doses of morphine. In terms of the alternative, it seems to me that to allow relatives to assist in what is currently considered to be a suicide carries considerable risks if only because such non professional assistance may have unintended consequences.
In fact the situation where a hospice is able to provide terminal care, such is the level of support for the patient, that even the Hospice Association does not see the need for assisted termination.
Unfortunately to provide such specialized care is currently not what happens in the majority of end of life cases, and accordingly assisted termination should therefore be seen as a default option if the Government is going to remain unable to require the financial support to provide optimum care for the dying patient. In an ideal world then I would personally favour vastly improved levels of palliative care and would point to the apparent success of the Hospice care system. I suspect the Government will not come up with the required funding and accordingly suggest the next best fall-back position is to allow a medically controlled option of assisted termination but only where expert opinion is that a death with dignity option is not feasible, and where the patient believes assisted termination is the preferred option.
In actuality if it were only the patient’s views to be considered, in the current situation most terminally ill patients face, assuming they were still sufficiently in control of their thoughts and emotions to make such a decision, it would seem that such an assisted termination option seems quite reasonable.
Where an ethical problem arises, is when the patient is unduly influenced by relatives, medical staff or self appointed moral judges. In my recent past I was indirectly involved with the administration of a Retirement Village where I noticed that some relatives basically wanting the deteriorating patient to die as soon as possible to enable them to get their hands on an estate or to reduce the expenses on an eventual estate. This should not be glossed over, particularly as in the Netherlands, where mercy killing is allowed, there has been a disturbing rise in the proportion of patients with Alzheimer’s disease, where presumably the decision is made with less concern for the patient’s wishes.
It also seems to me that, not unsurprisingly, some medical staff, are concerned for their personal standing, and in their need to follow the letter of the law, will often put the legality issues first and the well being of the patient’s ability to withstand suffering second.
It seems to me that with the variability that already exists between hospitals and parts of the same of hospitals and the resulting differences in the actions of different doctors and other medical staff I would wonder why legislation does not already allow for what happens in practice. I have also witnessed Church communities assuming their belief system should be the overriding consideration. Where Church views seem lacking in compassion, I suspect that this needs to be pointed out and if necessary, placed in front of some suitably qualified ethical committee for arbitration.
Some deteriorating patients have a horror of becoming totally dependent on carers to attend to personal needs and it is certainly true, that for some conditions, there is a substantial loss of dignity towards the end. Any new legislation should take this issue into consideration and in my view should be part of the assessment of a patient’s request for termination.