Euthanasia: The debate that won't die

Dr John Pollock. Photo / Paul Estcourt

Dying Auckland GP John Pollock says he will be "long gone" by the time the fiery debate on euthanasia has reached a resolution.

Pollock, 61, ignited the issue last month when he went public calling for a review of the law which prohibits euthanasia for dying and suffering Kiwis.

Pollock, who is suffering from metastatic melanoma, is now shying away from the spotlight, not wanting to spend his final days in a glare of publicity.

But, he says, he has done what he set out to do - start an open and vigorous debate on a subject which has been more-or-less taboo up until now.

"My part in all this is over," says Pollock. "I set out to ignite debate, and the fire has now been lit - in fact it's blazing. I'm not going to be the centrepiece for the fight. It's going to take donkey's years and I'll be long gone."

The key, he says, is to get the medical profession on board.

Last Sunday, a group of doctors and nurses met to plan a campaign to have the law changed but are saying little about how they propose to do that.

Pollock: "Patients and citizens are overwhelmingly for euthanasia, and the profession has got to serve the patients. So we [the campaign group] are answering that call. But the campaign is very much in its formative stages at the moment."

Two 2008 surveys show strong public support for medically assisted death. A Massey University poll found 70 per cent of people thought that doctors should be allowed to end a patient's life if the patient has a painful incurable disease and requests it. A Colmar Brunton poll found 71 per cent of people supported a medically assisted death if they had an illness or condition that resulted in them having a quality of life which was totally unacceptable to them.

However, medical professionals maintain there have been great advances in palliative care during the past two decades and a law change is not necessary as they are able to provide good support and comfort for terminally ill patients until the end.

New Zealand Medical Association chairman Dr Peter Foley says nobody wants to die a horrible death, but good care is available. "In my experience as a GP working with many people in palliative care, I've never had a patient die in pain and suffering. If this is happening in New Zealand, that is what needs to be sorted out."

Dr Simon Allan, clinical director for Palmerston North Hospital's Regional Cancer Treatment Service and a hospice adviser, says one of the big areas of complaints in hospitals and rest homes is the way people die. If it is dealt with badly, the calls for euthanasia get louder.

Dying is never easy to deal with and doctors, like anyone, can find it incredibly hard, he says.

"We tend to be about cure and not about saying, 'Oh dear, maybe we're not going to do it here'," says Allan. "It's almost like you pass on that rather than confronting it."

Palliative care has improved dramatically over the past 20 years, particularly the past decade, says Allan. He attributes this to the growth of palliative care as a specialty, more doctors and nurses working in the field and greater education and training.

"The general public, as we meet them through hospice and palliative care, might be asking for euthanasia right at the outset, but once they come under care that problem almost disappears completely.

"I think in today's society we would like to have that choice and that control but actually when the chips are down we still prefer to yield ourselves to care."

Euthanasia campaigner Lesley Martin, the founder of Dignity New Zealand and a former nurse who was jailed for helping her mother die, is calling for a safeguarded, accessible and open system for medically assisted death, which she says is already being done covertly in this country.

Allan acknowledges there is some anecdotal evidence and anonymous surveys that indicate doctors are carrying out medically assisted deaths but says he would be appalled if doctors are surreptitiously carrying out euthanasia.

Medical practitioners have various ways of managing death, including passive euthanasia. "That's the withdrawal of medicine or treatment when it's not increasing the value of life," says Foley. "We call it common sense."

There is also the principle of double effect. "When a person is at the end of their life they are usually on a cocktail of pain relievers," says Foley. "At times a patient will be given medication for the main purpose of alleviating suffering, but as an unintended consequence death is hastened. This is common and completely ethical. Absolutely all good palliative care providers should be having that conversation with patients and families."

Martin wants to take treatment a step further, through "Dignity Havens", facilities offering palliative care and assisted death.

She says there should be strict criteria to ensure euthanasia is only given to people who are on their deathbed.

"Psychologists should be involved to get to the bottom of why the person wants to die, to be sure they aren't being coerced in any way."

But wouldn't people feel pressure to ask for euthanasia to take the financial and emotional burden off their family? Martin says these cases would be obvious and would not proceed.

"That pressure is already in place. Elderly people quite often refuse food and fluid and medication."

Martin believes if the law changes, it will be a minority of terminally ill patients electing to have euthanasia.

"But having that option will be absolutely profound. For them it will be peace of mind to know that they don't have to use a plastic bag."

DignityNZ is hosting New Zealand's first conference specifically on assisted dying on October 14 and 15 at the Michael Fowler Centre in Wellington, Open not only to the medical profession but to the public. Pollock expects he will be too ill to participate.

"For him to feel that he won't be well enough by then is very sad," says Martin. "It makes us appreciate just how much time and energy he's spending on this issue at such a critical time for his family."

Martin says the conference will be an opportunity for medical professionals to put legitimate concerns on paper, not just knee-jerk reactions and personal perspectives.

"What we're seeing in New Zealand in the medical profession is the executive issue statements in opposition to assisted dying but we know anecdotally that within the ranks of members, there are people in those professions who do support it [euthanasia]," says Martin.

The last time the euthanasia debate appeared in Parliamentwas2003when New Zealand First MP Peter Brown's bill to set up a national referendum on the issue was narrowly defeated, 60-58.

Euthanasia Society of New Zealand president Kevin Brennan wants a law that allows a document to be placed in a person's medical file that specifies they would want euthanasia if their circumstances became unchangeable and intolerable. This would be similar to the advance directive notice "do not revive", which any person can request. By law, medical staff must obey this.

Brennan says patients who had not made this advanced decision would have to "tolerate the circumstances they had found themselves in" - no matter how much pain they were suffering.

He says as the law stands, people are forced to "take action ahead of time". "They know that if they leave it too late they may not be physically able to do it, and if their family assists they would be prosecuted," he says.

"We want the law to allow assisted suicide, so that other people can be involved without having to commit a crime."

Pollock also prefers this option. "My personal opinion is that New Zealand should be in line with Dutch law," he says. "I think this is a better option than Switzerland where the doctor can't give the injection but can give the patient the medicine. Either way, the family can be with the person who is dying."

"I believe it is a human right to have control over your own life," says Brennan. "Dying is a part of living and I want that same freedom over the way I depart this life. I don't want someone else dictating how I end my days."