"They treat dogs better than they treat people," said my patient, a dairy farmer in his late 70s. He'd had prostate cancer for years, but now it had spread to his spine, ribs and skull. It had fractured his vertebrae, and was pushing up against his nerves. Despite the best cancer treatment and palliative care, he was suffering.

"If my dog was riddled with cancer and was suffering all the time, I'd take him to the vet and they'd put him off to sleep. But if you're a human, you've got to suffer in pain for months until you die. It makes no sense."

He saw his suffering as unnecessary and unreasonable. I couldn't argue with his logic.
The reality is that even with the very best palliative care, some terminally ill patients will suffer tremendously. And it's not always simply due to pain.

Some patients will feel like they're suffocating as fluid fills up their lungs or abdomen. In other cases, patients will have repeated choking episodes caused by an inability to swallow, cough, and breathe effectively in the final months of motor neurone disease.


I've treated several patients with inflammatory breast cancer with chronically draining, malodorous, and infected tumours that wouldn't heal despite repeated courses of antibiotics, surgery, and specialist care. The odour and the discomfort as the cancer eroded into their chest walls wasn't something that doctors were able to fix.

There's just no getting around the fact that medicine cannot cure all disease and that palliative care cannot control all pain and suffering.

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No patient who is already dying of a terminal illness should be forced to suffer needlessly when doctors have the ability to prescribe a medicine that could end that suffering.

Medical-assistance-in-dying is really about two things: respect for a dying patient's wishes, and true compassion for suffering patients as they reach the end of their lives.

End of Life Choice Act - some facts

Some facts to remember as you get ready to vote on the End of Life Choice Act on October 17:

The law applies only to patients seeking medical assistance in dying from a terminal illness which is likely to cause their death within six months - not for reasons of old age, disability, or mental illness. The only patients who qualify are those who are already dying.

The patient must initiate the request, and the process requires that two doctors confirm the patient is dying and is making the decision freely, and that they're fully informed and competent. If they're not, the process is cancelled.

If they wish to proceed, the doctor speaks with the patient's other health providers and files paperwork with the Ministry of Health. At a later date, the medicine is prescribed, and the doctor remains present with the patient (or in a room next door) as they either drink a liquid medicine, or are administered a medication by the doctor that puts them to sleep, slows and stops their breathing, and ends their suffering.


Worldwide, most patients who utilise medical-assistance-in-dying end are dying of cancer, and on average they are spared roughly the final two weeks of their illness.

That Northland farmer I took care of in the emergency department did not have legal access to medical-assistance-in-dying. He suffered for several more months and died in a way that neither he, nor most people, would have wanted. It was not a good death.

We have a chance on October 17 to change that for other patients. We can vote to pass a law that will give New Zealanders the same legal rights that 100 million people worldwide already have: the right to ask our doctor to help end our suffering if we are dying of a terminal illness and are suffering unbearably.

• Dr Gary Payinda is an emergency and pre-hospital medicine specialist who works in Northland and Auckland.