Euthanasia and the value and meaning of life

Philip Matthews: Euthanasia debate reveals deep divisions about the value and meaning of life

In December, the End of Life Choice Bill passed its first reading in Parliament with 76 out of 120 MPs voting to send it up to the Justice Select Committee on the slow process to becoming law.

Despite the deep nature of questions it raises about the meaning and quality of life, the Parliamentary debate was unusually polite and respectful. There was, as former MP and pro-euthanasia campaigner Maryan​ Street notes, a pleasant absence of grandstanding, time wasting or personal abuse.

The details may change but the bill presently would allow for a New Zealand citizen or resident over 18, who is suffering from a terminal illness that is expected to end their life within 6 months or has a grievous and untreatable medical condition, to opt for an assisted death. There are safeguards of informed consent and assessment by two doctors.

The pro-euthanasia camps argue that civilised countries like ours at this point in history should allow for death without suffering, a painless option. You hear a lot about the dignity of the dying.

“In a modern and compassionate society, the law should allow for a decent death,” said Chris Bishop, one of the 21 National MPs to vote for the bill.

The strongest opposition in Parliament came from Simon O’Connor​ who said that “fundamentally, I do not believe doctors should be killing their patients”. O’Connor was one of the 35 National MPs who voted against.

Nine Labour MPs voted against, including Pasifika MPs Jenny Salesa​ and Poto Williams, Māori MP Rino Tirikatene and Pākehā MPs Phil Twyford and Damien O’Connor.

All NZ First MPs voted for it at this stage, but want to see a referendum on euthanasia. All of the Green MPs backed it.

David Seymour’s bill was drawn from the members’ Bill ballot.

“It is not pleasant to talk about painful death,” said Act MP David Seymour, whose bill continued the unfinished business of Street’s earlier attempt to make assisted dying legal.

In this corner there is compassion and dignity, while opposition to euthanasia is often imagined as medieval and unenlightened, a product of redundant religious faith. But actually, Street says, arguments are more complex and nuanced.

It is a complex issue. I am generally in favour of legalising assisted dying/euthanasia and certainly want to be able to make choices for myself about the way I die if I get the chance, but have some concerns about how legislation will both give personal choice but also protect against abuse or misuse.

There is no monolithic block for or against. Her years as the unofficial godmother of the euthanasia movement in New Zealand – she is now president of the End of Life Choice Society – have shown her that there are some Catholics for, as well as many against. There are Māori for and against, Pasifika for and against, Asians for and against.

The polling Street cites was conducted by Horizon in May 2017 and found that 75 per cent of New Zealanders support or strongly support the right to die, with support at its highest among Pākehā and other Europeans and lowest among Asians and Indians.

It is, Street knows, a deeply individual matter. Faith or politics may play a part, or politics or, more likely, life experience.

I have experienced the end of life and deaths of both my parents over years (father, emphysema) and months (mother, cancer). I believe my father was effectively assisted to die but I was shut out of the process (by the hospital he was in, possibly to protect themselves), this was a very difficult time. My mother died in a hospice, under the best possible care but still fraught – they reacted to her pain with just enough pain killers, until the next time she suffered.

This is where Raymond Mok comes in. What does it mean to say that those with serious medical conditions can legally opt out of life with the help of the able-bodied? Does it imply that their lives are less precious, less valuable?

It smacks of discrimination to him. We want to be progressive in our thinking but legalising assisted suicide for only the ill or disabled is not moving forward.

“I think it’s not the Government’s role to say who is eligible to live or die,” Mok says. “If it is the choice of the individual, then it shouldn’t be limited to people with severe illness or disability.”

This does present a genuine dilemma that gets to the heart of our ethics. In our rush to offer a compassionate death to those who are suffering, we might also be suggesting that they are somehow worth less than others. As Mok says, the important thing is that a consenting adult is making an informed and conscious decision to die, regardless of illness or disability.

Street steps carefully into this ethical minefield and says that “when it comes to people with disabilities, this needs to be treated with the utmost respect, because their lives are typically a struggle, society views them differently already, and they feel that because they are already vulnerable, they will be more vulnerable”.

She believes that two things underpin both the assisted dying bill and disability charters, and they are maximum autonomy and dignity. Just as disability rights activists want to enshrine those qualities, so too does the pro-euthanasia camp.

But yes, it is a highly tricky area that must be approached with as much sensitivity and empathy as we can muster. As for the palliative care backers, Street says that she too is a great supporter of it but “I only wish that in New Zealand it were universally accessible and it were universally of a high standard. Neither of those things is true.”

Hospices are as good as we could have under current law, but only a small number of people die in hospices.

The slippery slope argument is harder to combat, though. What happens if we keep normalising the right to die or keep expanding the parameters? How far does liberalism take us? Australian ethicist Xavier Symons made this point recently when euthanasia was debated and made legal in the state of Victoria. In the Netherlands, Symons noted, euthanasia deaths have trebled since 2002, and are now more than 4 per cent of all deaths, with increasing requests from people who are not terminally ill but simply “tired of life”.

Is it a slippery slope, or generally an increasing number of people choosing what they want?

There is something very sad about this trend: boredom, illness and loneliness in the most prosperous societies in history, where some would rather be dead and no longer a burden.

Whatever the reasoning and reason, it should be an individual’s choice, providing there are adequate safeguards.

Would we accept this in New Zealand? Street agrees it is not palatable and she has been adamant about safeguards that would restrict assisted dying to those old enough to vote and the need for citizenship or residency to stop New Zealand from becoming a site of death tourism, as has been seen in Switzerland.

The Swiss situation has only arisen because of a lack of legal choices in people’s own country.

Most of us already can make choices about committing suicide, but options are far from ideal.

One of the biggest fears is becoming incapable of taking our own lives but wanting to opt out of life.

One contradiction is the use of modern medicine to prolong life far beyond natural processes, but legally forbidding using medicine to easy one to their death a bit sooner than may otherwise occur.

It will be an interesting debate, with passion on both sides of the argument. I hope this debate can be conducted with dignity.

Matthews wraps one person’s illness, experience and views around his article, seeming to use that as a proxy for his own views, but there are many circumstances in which people live and die.

WHERE TO GET HELP:

* Lifeline (open 24/7) – 0800 543 354

* Depression Helpline (open 24/7) – 0800 111 757

* Gambling Helpline – 0800 654 655

* Healthline (open 24/7) – 0800 611 116

* Samaritans (open 24/7) – 0800 726 666

* Suicide Crisis Helpline (open 24/7) – 0508 828 865 (0508 TAUTOKO).

27 Comments

  1. Kitty Catkin

     /  January 7, 2018

    Passive euthanasia-withholding treatment like antibiotics-has gone on for ? Nobody would have given antibiotics to a man we knew who had early onset dementia; this intelligent, dignified man no longer knew anyone and had to be admitted to a dementia ward where he was the youngest, I suspect. He had all the indignities of the condition, of course, until pneumonia put an end to it.

    • Gezza

       /  January 7, 2018

      About 3 months before dad died the rest home rang trying to get hold of ma as we couldn’t – she was out somewhere shopping & her mobile was turned off.

      So I went up there. They needed approval to put him on a sleeping medication as he was wandering the corridors at night with no idea where he was or what he was doing. There was an increased risk of heart attack or stroke with both the meds the doc could prescribe.

      Anyway, while I was talking to the doc & their RN, I asked about the likely progression of his dementia & they said that his dementia alone would kill him if nothing else, like pneumonia, did. At the end point of his dementia he would lose the ability to chew and swallow, they said, and the end is usually not long after that happens.

      He did later get pneumonia, and they did treat it with antibiotics, & it cleared it, but he did, 1 month later, mentally get rapidly worse, started having trouble chewing & swallowing, & he died within 10 days of the onset of that trouble.

      • Kitty Catkin

         /  January 7, 2018

        It’s would you rather be eaten by a lion or a tiger, but totally unfunny.
        .
        Another friend who was a doctor so knew better than most the horrors of dementia-and his father had it-was open about hoping that he would die before he went like that. Alas, his wish wasn’t granted. I would not be sorry to hear that he had died, except selfishly because I like him so much-one couldn’t be. Again, an intelligent and dignified man who would have hated to see what he has become.

        As I have said before, I basically had to say to the hospital to stop the treatment as it was running on the spot, a decision I wouldn’t wish on anyone. My husband died soon after he went to Hospice. I cannot praise them enough.

  2. oldlaker

     /  January 7, 2018

    The argument by a few advocates for the disabled that assisted dying will degrade the value of disabled people’s lives is bizarre. It’s also worth noting that disabled people (including the one featured in the article) won’t be able to access assisted dying unless they are in an advanced state of decline (which most aren’t). And in jurisdictions like Oregon, most people who receive fatal medication don’t take it until they are nearly dead anyway and it mostly only shaves a few days off terminally ill patients’ lives. Around a third of those prescribed the drugs don’t take them but want them for reassurance that they can if conditions become unbearable. The disabled argument is a weird sideshow but I think we will see a lot more of it because opponents realise their former standby (palliative care is always effective) has been thoroughly debunked.

    • Kitty Catkin

       /  January 7, 2018

      I photocopied and kept a magazine article about Oregon, and felt that if one has to have it, theirs was about the best one.

      Perhaps a difference could be made between assisted dying and euthanasia in their terminology. I must say that ‘euthanasia’ makes me think of the person not doing it themselves and possibly not consenting, whereas ‘assisted dying’ is totally voluntary,

      • Kitty Catkin

         /  January 7, 2018

        They are already that, (google) but many people call them both euthanasia.

        It’s ironic that the quote ‘Thou shalt not kill, but needst not strive/Officiously to keep alive.’ is usually taken to mean doing someone a kindness; not prolonging their suffering. In fact it is a cynical quote from Clough’s ‘The Latest Decalogue’ , a cynical reworking of the 10 Commandments and, in the context, obviously means not going to great lengths to keep someone going against your own interests. The other lines include ‘Thou shalt have one god only, who/Would go to the expense of two ?’ and ‘Do not adultery commit/Advantage rarely comes of it.’ ‘Thou shalt not steal, a paltry feat/It’s much more lucrative to cheat.’

        Clough died in 1861.

        • Kitty Catkin

           /  January 7, 2018

          Be at the expense. I always get that wrong.

  3. PartisanZ

     /  January 7, 2018

    ” … increasing requests from people who are not terminally ill but simply “tired of life”.” denotes symptoms of other problems in modern Western society, variously known as depression, chronic fatigue etc, manifestations of ‘cultural insanity’ or ‘mutiny of the soul’ …

    https://charleseisenstein.net/essays/mutiny/

    The misleading thing about that “tired of life” sentence is that it’s used as an argument against End-of-Life-Choice when in reality those people WILL NEVER BE GIVEN EoLC because they are not or until they become terminally ill.

    This is about as facetious an argument as anyone could conceivably use! But use it ‘they’ will, and a lot more besides … Who are ‘they’ …?

    4 Nov 2017 was the 20 year anniversary of Death-with-Dignity in Oregon –

    “The wildly controversial Death With Dignity Act allowed terminally ill patients with less than six months to live to ingest a lethal dose of drugs.

    The bill sparked death threats, legal battles and a massive freak-out in the Roman Catholic Church, which spent millions of dollars campaigning against it.

    In the past two decades, the law has rocked the medical profession, served as a political pawn and comforted the hopelessly sick. At least 1,127 people have used the law to die in Oregon”

    With a population roughly equivalent to Aotearoa NZ, 4.1 million in 2017, 57 people taking advantage of Death-with-Dignity per year does not seem very many. In other words, its perfectly possible that End-of-Life-Choice will cover no more people than those who would have suicided anyway due to terminal illness? [We do not know how many of our 600+ suicides per year are terminally-ill people, but I suspect 57 would be a conservative estimate]

    Yet the possibilities of Death-with-Dignity and the probabilities of ‘ordinary’ suicide barely warrant comparison …

    The organized Churches’ principal source of power is their monopoly on death and the afterlife. The desire for immortality is, for much of the world’s population, greater even than the desire for wealth and power … ?

    • Kitty Catkin

       /  January 7, 2018

      Facetious ? It doesn’t seem funny to me.

      The expression ‘weltschmertz’ or world-weariness is a very old one, and so is the condition.

      Why do people say ‘suicided’ and not ‘committed suicide’ when suicide is a noun ? Nobody would say ‘ X was homicided’.

      • Kitty Catkin

         /  January 7, 2018

        Weltschmerz was coined in the 18th century.I guessed that it was a turn of the c.18-c.19, given the trends of the time.

        Ennui-which is difficult to translate but has a similar shade of meaning-is also an old expression.

        These feelings are not new. I don’t think that any doctor should be asked to help someone to commit suicide when they can do it themselves quite easily.

        • PartisanZ

           /  January 7, 2018

          Ohh … thanks so much for all that ‘correction’ Miss Kitty … I meant “fallacious” of course ….

          I think and indeed very strongly feel and believe that every doctor should be asked for help by all of their patients who are suffering from ennui or weltschmertz or world-weariness or whatever the fuck you want to call it … because then the doctor will know the true extent of the illness … the dis-ease … and doctors in general might perhaps be prompted to do something about it other than prescribe symptom-masking pharmaceutical drugs …

          What I was saying and will repeat again and seemingly need to repeat endlessly is that doctors WILL NEVER BE ALLOWED to prescribe death-medication for these conditions because the conditions ARE NOT CLASSIFIED AS TERMINAL ILLNESSES …

          Its the terminally-ill people WHO DO COMMIT SUICIDE I am concerned about …

          • Kitty Catkin

             /  January 7, 2018

            Asked for help, yes, but not help to kill the patient. In fact, doctors don’t just dish out pills; there are dedicated mental health organisations to which people are referred,

            I have heard that in Holland people can be given overdoses for things like-in one case-not getting on with the children so being lonely. But this may be wrong. I hope so.

            • PartisanZ

               /  January 7, 2018

              You’re just not connecting are you? Asking for help to kill oneself in a clinical, confidential situation where it is ABSOLUTELY IMPOSSIBLE for the doctor to help you suicide is a ‘healthy’ thing for the patient to do.

              It’s an appropriate if extreme cry for help … which the doctor can then deal with in a variety of ways including, as you say, referral to mental health services …

              Mental health services, as I understand it, also rely heavily on medicating symptoms rather than treating causes …

            • NOEL

               /  January 7, 2018

              Why should doctors have to carry the burden of assisted suicide?
              They shouldn’t. So taking them out of the equation how do you draft Euthanasia without them?

            • Gezza

               /  January 7, 2018

              Mental health services, as I understand it, also rely heavily on medicating symptoms rather than treating causes …

              Absolutely they do! Get referred to a psychiatrist & the first thing most seem to do is pump pills into the patient. Most of these meds have positively frightening side effects.

              In many, there’s an increased risk of suicidal ideation on starting it, & no immediate help if that happens – just an 0800 helpline, which patients feeling suicidal may not actually want to call.

              I had a situation once when an American psychiatrist was making quick home visits, going onto the internet on his smartphone, scribbling out scripts & demanding I try something new every week – usually 2 or more items, before I’d even completed the “loading dose” of last week’s drugs.

              Man, I was frightened – they were all potential suicide ideation pills. When I quibbled, he angrily said “Look, I know what I’m doing, these will help you – don’t you trust me?” I was too scared to say “no I fucken don’t mate” – in case he hit the roof. Christ, trust him? The reason he was visiting was because I was suicidal at the time.

              Thank god I came right in the end, more by good luck than good management.

            • phantom snowflake

               /  January 7, 2018

              Gezza, one of the (many) things a psychiatrist won’t tell you is that there are many people who get no benefit from taking antidepressants. It’s kind of a dirty secret that eventually those considered to have “treatment-resistant depression” will be pressured to have ECT (Electroshock). In New Zealand, currently many are shocked against their will. Not sure if this is of interest to you but I commented about this elsewhere recently:

              https://thestandard.org.nz/open-mike-23-12-2017/#comment-1429689

            • PartisanZ

               /  January 7, 2018

              @NOEL – “Why should doctors have to carry the burden of assisted suicide?”

              The key word is “voluntary” maybe? The experience of Oregon seems to indicate doctors can opt in or out?

              Clearly some do opt in.

            • Gezza

               /  January 7, 2018

              It’s an appropriate if extreme cry for help … which the doctor can then deal with in a variety of ways including, as you say, referral to mental health services …

              I think it’s still a pretty stock-standard initial first response from GP’s to put someone presenting with anxiety/depression (the two are usually twinned), & the usually-associated sleeping disorders, on anti-depressants & highly addictive sleeping pills.

              Although there are a variety of genetically-linked depressive conditions, like bipolar disorder – which do require long term medication, these are classic symptoms of unrelieved stress, from whatever cause, including simple burnout from overwork.

              Few people really need sleeping pills.

              But a good GP will follow up an initial prescription of anti-depressants & if they haven’t solved the problem, will refer the patient to a clinical psychologist – if they get access for the patient to one a under a free treatment programme.

              A good clinical psychologist is worth their weight in gold, imo. My impression is we’re woefully short of them.

            • Gezza

               /  January 7, 2018

              @ snowy. Yes, I was surprised to learn they still use ECT. They tried it on my bipolar 2 tuakana a few years back but had to stop before the course was completed because of some medical problems it was causing. He was probably about 59 and overweight. I forget what the exact medical issue was, have the feeling it was affecting his heart rythym.

            • phantom snowflake

               /  January 7, 2018

              G; would like to say more but sleeping pills kicking in so may soon be incoherent. (I have a strong interest in many issues related to mental health)

            • Gezza

               /  January 7, 2018

              snowy, ok, but I’d be interested to hear more from you.
              In my 20’s I had a dutch flatmate who I liked & thought was just a bit quirky.

              He went on to develop full-blown schizophrenia & used to hear the saints talking to him (that would’ve been around 1976).

              They put him through ECT at Porirua mental hospital. It messed him up. I got a shock at the state of him when I visited a few times. In the end his family sent him to The Netherlands where the mental health & social services were much better than NZ’s.

              He still visits every few years.

      • Gezza

         /  January 7, 2018

        Nobody would say ‘ X was homicided’

        I’d put money on it that police persons in the US do. They are the masters of making verbs of nouns.

    • PartisanZ

       /  January 7, 2018
      • Kitty Catkin

         /  January 7, 2018

        It must be wrong-I read somewhere that a high % of deaths in Holland were euthanasia-25%, I think-but this is obviously false. Of course, the woman who didn’t get on with her family could have asked, so that may be true.

  4. Alan Wilkinson

     /  January 7, 2018

    There are plenty of ways to end your life for those physically capable. AFAICS the law change is needed by and should be directed at those who become physically incapable of acting for themselves.

  5. Safeguards and guidelines are bound to fail. Government safeguards will not stop people suffering from depression from seeking PAS. Doctors will be placed in the terrible position of making judgement calls. Who can die and who will live? How close should a terminal cancer patient be to death before the lethal dose is administered?

    If all depends on autonomy – to decide for one’s self the time to die, what is the point of safeguards? People will find a way around them.

    What if people are asking for PAS out of a sense of duty, because they feel they are a burden? What if they are being pressured into the decision? What if they are demented or unconscious or mentally handicapped? Safeguards and guidelines will not protect them.

    We ought to err on the side of caution. Let’s concentrate on eliminating the suffering, not eliminating the sufferer. This is true compassion.

  1. Euthanasia and the value and meaning of life — Your NZ – NZ Conservative Coalition