Dr Fiona Stewart: Yes. Community wants it and doctors do it
John Key ought to be congratulated. It's not often that a Prime Minister has the courage or conviction to call it as it is. In Key's case, he said the unspeakable. That is, that every day doctors practice slow euthanasia to put dying people out of their misery.
For those who know little of the semantics of the voluntary euthanasia/ assisted suicide debate, slow euthanasia is where a doctor uses an opiate such as morphine to treat a dying person's pain.
As long as they maintain that it is not their intention to kill, that they are simply "keeping them comfortable", they don't break the law.
This is even though doctors know full well that too much morphine will always cause death.
Sure, the morphine will treat the patient's pain, but it will also, in the right dose, and at the right time, kill them.
But is this good enough? Is this all a civilised country like New Zealand can come up with? Surely we can do better.
In the context of voluntary euthanasia, doing better means facing up with honesty to what the community wants and what doctors are prepared to give.
A point that is often lost in the polemicised debate is that we are all going to die.
Some of us will die easily in our sleep. These are the lucky ones.
But others will contract cancer or some other God-awful condition and be confronted with the question of how they will die.
This wasn't always the case. Once, a short acute infectious illness usually meant a quick death followed.
Our ancestors didn't have time to sit around and navel-gaze about how to live out their final days. They didn't have the existential dilemma which knowing one's days are numbered brings.
They didn't suffer the terror which comes from hearing the doctor's final words: "We can't cure you but we can 'make you comfortable'. But only on the following conditions. Don't ask me to help you die. Don't tell me when you'd prefer to go. Don't tell me how long your dying should take. Oh, and you'll likely need to be bedridden in this or that hospice or hospital.
"What? You want to die at home? On a given day? With your friends and family raising a toast to your wondrous self and the memories you have shared? No, we don't do that in New Zealand."
But we can do that in New Zealand.
Maryan Street is working towards this right now with the the End of Life Choices Bill.
They do it now in other countries. No one slips through the net.
There are no instances of depressed teens or demented grannies being put down against their will. All laws are stringent and with safeguards. There is no slippery slope.
And there is another upside. A law keeps everyone safe.
Loving husbands like Evans Mott and sons like Sean Davison wouldn't be dragged through the courts for doing the "right thing".
Instead, what there is where voluntary euthanasia is lawful, is a degree of civility which while not removing, goes towards addressing the panic of existential nothingness.
While there will always be some whose age or illness has worn them down to make death a welcome release, for many others our circumstances will cause us to have to leave before we are ready.
Granting self-determination at the end seems a small but intensely compassionate concession to make in the face of such powerlessness.
As Bob Dent - the first man to use Australia's Rights of the Terminally Ill Act on September 22, 1996 - said shortly before his death, "If you disagree with voluntary euthanasia, don't use it, but don't deny me the right to use it if and when I want to".
* Dr Fiona Stewart is executive director of Exit International, an information and advocacy service for voluntary euthanasia / assisted suicide.
Dr Grant Gillett. No. It is not something we need to provide
We are allowed to withdraw life saving or life prolonging treatment when that is justified There is a series of arguments used against active voluntary euthanasia.
Some argue that it undermines the sanctity of life, an important linchpin of human rights legislation.
Others argue that voluntary active euthanasia is open to abuse as the desire to have one's life ended might shade into an acceptance of ending the life of those we find uncomfortable (because of their suffering), inconvenient, or expensive.
Yet others argue that active euthanasia changes the nature of doctors - from being life-savers and healers to being possible death bringers.
Those in favour of euthanasia respond that doctors need more compassion and flexibility so they can listen to their patients' requests rather than applying the often elitist and privileged standards of the profession.
Some argue that to allow killing, as opposed to just letting die, changes the nature of the dying process. Others argue that coping with hard decisions is part of becoming a mature human being and a mature society.
Voluntary active euthanasia is often portrayed as the beginning of a slippery slope similar to that seen in the Nazi era.
But those in favour will point out that the social conditions to sanction genocide or the killing of the differently abled no longer exist and are unlikely to recur.
However we might retort that in an age when control of one's life is lauded as a good, and planning for all aspects of life is seen as a rational course of action, we do stand in danger of losing sight of the unexpected things that happen when we cannot plan definitive solutions in the face of mortality and tragedy.
In New Zealand we are allowed to withdraw life saving or life prolonging treatment when that is justified because treatment is futile or offers no substantial benefit to the patient.
We have, since the Cartwright report, been much more inclusive of patient perspectives in clinical practice and codes of healthcare.
Effectively, the benefits and burdens we are talking about are outcomes which the patient would regard as worthwhile or unable to be tolerated.
This patient-centred, rather than narrowly biomedical, judgment goes beyond the current moment and looks at prognosis in the patient's terms.
Although some doctors worry about depriving a person of the necessaries of life (a crime under the Crimes Act) when they withhold or withdraw treatment, existing court decisions imply that we can withdraw treatments which are life sustaining when:
a) it seems that objectively there is a very poor quality of life
b) the prognosis by qualified specialists is for there to be no improvement;
c) the decision to let the patient die accords with an estimate of what that patient would have wanted.
But we are still not allowed to assist suicide, give drugs to hasten death, or administer a lethal combination of drugs to bring about death.
However what ethicists call "the doctrine of double effect" applies in New Zealand law so we can and do give drugs which may hasten death provided that we give them as needed to relieve suffering.
Some ethicists and doctors argue that it is worse to withdraw treatment because you have entered into an implicit commitment to the patient and also withdrawing treatment once it has been started is more like actively doing something to cause the patient's death.
But many of us believe that you cannot tell when you can produce substantial benefit until you try and have the chance to see if the patient is responding so that decisions to stop after you have "given it your best shot" are better in terms of your medical duty of care to your patient.
In any event a patient in New Zealand should never be pointlessly kept alive when life is meaningless or left to suffer without adequate care when life has become too burdensome. In that kind of situation, many of us believe that voluntary euthanasia is not something we need to have provided and may alter the climate of end-of-life care in quite unwelcome ways.
* Grant Gillett is a doctor and professor of medical ethics at Otago University.
A doctor's story: How I ended the life of one of my patients. Tomorrow in the Weekend Herald