Dawn Picken: What does death with dignity mean to you?

Have you had an end-of-life conversation with your loved ones? Photo/Getty

In the early morning hours between groggy and semi-conscious, a doctor placed an A4 sheet of paper in my hands and asked me to sign. "We need to intubate your husband," she said. "He's struggling to breathe."

It was the first time I felt the weight of legal responsibility as a spouse. Sean had become ill with what we'd mistaken for swine flu. Within hours, he had gone from emergency room to hospital ward to intensive care.

Other forms had been sitting in our lounge for months - ones spelling out end-of-life wishes: would either of us want to be kept alive if we were unlikely to regain mental function? Would we want tube feedings? Prolonged intubation? We'd answered no, no, no. An advance directive was an academic exercise. Until it wasn't.

Would either of us go one step further and ask to end our lives early if we were dying anyway? We never got to answer the question. Sean died of complications from surgery in 2010.

A poll out earlier this week found 75 per cent of 1300 Kiwis surveyed favoured a law change allowing terminally ill people with irreversible, unbearable suffering to be helped to end their lives peacefully.

One News/Colmar Brunton and Three News/Reid Research polls in 2015 found similar support. Right to Life groups, religious conservatives and other opponents say state-sanctioned euthanasia is a fast-track to normalising all suicide.

They say it puts vulnerable people such as the poor, the depressed and the elderly at increased risk because the temptation to save government dollars or take grandma's fortune asap is too great to resist.

Their arguments miss the mark - assisted dying is already happening here. A study published in the July, 2015 New Zealand Medical Journal of 650 doctors found nearly 66 per cent who had contact with the patient prior to death reported making a medical decision at the end-of-life in the 12 months before the survey.

Of those, 88 per cent reported increasing alleviation of pain and/or symptoms with the probability death may be hastened. Four and a half per cent of doctors attributed death to a drug that had been given explicitly for the purpose of hastening the patient's death.

I asked a physician friend who has practised medicine around the world about euthanasia. He sat for a decade on a US hospital ethics committee and said many patients with advanced care plans stating "no life support" later changed their minds.

Unlike in Holland or Oregon, where each hospital has an ethics council, he said New Zealand has few safeguards. "NZ healthcare is grossly underfunded, so watch out for managers trying to save a buck..."

If I had a painful terminal illness, I doubt I'd give two bobs about saving government money. I'd want the illusion of control. I'd want to avoid suffering, long-term catheterisation, nappies, rectal tubes, IV feedings and oxygen masks. I wouldn't want any of these things for my loved ones, either. I might get used to interventions. But how long until their physical and psychological toll became unbearable?

Courts in other countries have decided citizens deserve agency over their bodies. Canada last year passed a medical assistance in dying bill following a unanimous Supreme Court decision in 2015. The same year, former Tauranga woman Lecretia Seales lost her battle for physician-assisted death in New Zealand's highest court.

The wealthy and well-connected will always have the most choice in how they live, how they die. They can be terminal disease superheroes, fighting and gurgling until the end. Or they can check out early in Switzerland, Oregon, California...even in Aotearoa, where such things happen quietly in secrecy and shame.

A friend who sat with her dying brother said, "We're horrible if we prolong an animal's suffering, but when it comes to humans, we're hypocrites."

The friend said her brother could barely communicate during his last days, so she asked, "'Do you want us to do whatever we can to alleviate suffering?' He nodded his head adamantly," she said.

His wishes were respected and he died less than a week after that conversation. "I'll never know if the meds to alleviate suffering actually hastened his death," she said, "But the promise of keeping him comfortable was certainly kept. He died with dignity."

No matter your beliefs about prolonging life or quickening death, we must have these tough talks.

Tell your loved ones what kind of end-of-life care you would want. What does death with dignity mean to you? Put it in writing. Do it before a threatening diagnosis. Medicine and machines can keep our bodies alive as vessels of joy, love, suffering and sorrow for a very long time - perhaps longer than some of us might want.

Dawn Picken also writes for the Bay of Plenty Times Weekend and tutors at Toi Ohomai. She's a former TV journalist and marketing director who lives in Papamoa with her husband, two school-aged children and a dog named Ally.