Euthanasia, the PM and the current situation

The Prime Minister has been reported commenting on euthanasia and that’s started more discussion, including on Kiwiblog:

PM on Euthanasia – this relates to a Stuff report.

There’s been an excellent comment in the thread at Kiwiblog that I think sums up the current situation very well.

  1. annie  Says:
    August 23rd, 2012 at 2:51 pm Euthanasia: the PM is, quite simply, lying. Presumably he’s the victim of some of the medical misinformation that seems routinely to come his way.Euthanasia in the sense of a permitted, planned death, doesn’t take place in our hospitals, or if it does it is rare and usually involves the rather vile method of witholding fluids from an unconscous patient who will never recover. But who, if the evidence is to be believed, can still experience thirst.

    You may, if you are fortunate enough to have a humane hospital physician who puts your welfare above that of his/her own immortal soul, be given enough opiates to render you pain-free, even at the risk of causing a respiratory arrest. On the other hand, and more usually in busy hospitals, you may just be left to get on with it. However, if you start looking comfortable, forget any further dose increases.

    The hospices encourage the view that they are little oases of calm and comfort, and indeed to a significant extent they are. But not all people have a good response to opiates – for many they don’t do a hell of a lot. You can give 10mg of morphine to a person with severe acute appendicitis and render them comfortable; to another person of the same weight and gender the same dose will just take a tiny edge off. For instance. Cancer pain is no different.

    More importantly, the hospices don’t see, supervise or admit all patients, and in many cases don’t do it well. Te Omanga in Lower Hutt is an excellent hospice; but if you live in other cities you can’t be assured that you will even be seen – some hospices seem to be pretty quick to work to rule if they get full, and to hell with the leftovers.

    This sort of bland ignorance on the PM’s part is not only disappointing, it’s positively harmful to the facts of the debate. We need both decent palliative care and the option for voluntary euthanasia. At the moment we have neither.

There’s an excellent hospice in Dunedin, I don’t know how you can do it better, but I have seen firsthand how that doesn’t necessarily avoid an uncomfortable, anguished and ignominious death.

And I agree – there is some decent palliative care, it needs to be more widely and easily available.

Euthanasia – links and news

YourNZ

Euthanasia’s number 1 question – can we do better?

Euthanasia discussion – comments
Here are some of the comments from Euthanasia and Assisted Suicide — A Discussion We Need To Have held in Dunedin on Thursday. Euthanasia debate podcasts.

Voluntary Euthanasia in New Zealand
Voluntary Euthanasia in New Zealand: An Analysis of Compassion, Autonomy, and Secularism in the Public Sphere
By: Thomas M. I. Noakes-Duncan

Personal end of life experience
It has been suggested in the recent public debate in Dunedin that all that needs to happen is for more widespread top palliative care to be available to anyone that wants it.

Euthanasia interest and support growing
It seems that the euthanasia debate (and support) is building up steam.

Choices about euthanasia
I had a close encounter with the pros and cons of euthanasia recently as I watched my mother die. She had expert care and assistance in her home and at the hospice. The hospice uses care plans that emphasise comfort for the patient within current laws.

In the news

Time to talk about dying

(Sean Davison in a letter to the ODT) One of the main reasons to publish was to open the public’s eyes to the issues surrounding the deaths of our loved ones and encourage debate on a change in the law. Society is now embracing issues that have previously been uncomfortable to deal with such as sexuality, homosexuality, contraception, Aids, abortion and drug abuse.

Legal euthanasia kills justice for all

John Kleinsman Stuff OPINION: As the spokesperson of a Catholic bioethics centre, there are some who discount my message because of my religious affiliation, rather than on the basis of its merits. It’s a classic case of “playing the man instead of the ball”. As two commentators noted in response to comments I recently made about the dangers of legalising euthanasia: “I am sick of the religious trying to force their narrow views on society.

While I think Christians have as much right to express their views as any other New Zealander, I am, in all honesty, not interested in imposing my religious views on anyone. Actually, with respect to euthanasia, my own personal view is irrelevant.

This is not free choice – but a lack of choice. Legalising euthanasia will end up being an illusory choice for far greater numbers of persons than the few who will ever choose to exercise a legal right to be killed.

It is the role of the law in a democratic society to ensure the interests of the majority are not prejudiced by choices granted to a few.

Man admits assisting wife in suicide

An Auckland man has admitted assisting the suicide of his wife, who suffered from multiple sclerosis.

Rosemary Mott died at her home in Paritai Dr, Orakei, on December 28 last year. Her husband was accused of aiding and abetting her suicide by allegedly helping her to research euthanasia and acquiring equipment and material for her.

Sunday Star Times: Strong public support for euthanasia
The Sunday Star-Times reader poll of more than 1000 people also found almost three-quarters of people would help a terminally-ill loved one commit suicide.

Euthanasia, assisted suicide or assisted death is being discussed a lot. Maryan Street is going to put a End of Life Choice Bill into the Members Bill ballot to try and get another vote on it. This is a collection of relevant links and information.

Discussions

Kiwiblog: The euthanasia debate

If the debate is about how do we make euthanasia safe, rather than does a person have a right to end their own life, then that is a step forward. We should firstly recognise that we already have unregulated passive euthanasia in New Zealand, where people are allowed to die, even though they could be kept alive. I think there is far greater risk in the status quo, than in legislating the circumstances under which someone’s wishes to die can be implemented with assistance.

The Standard: Euthanasia Bill
Maryan Street’s “End of Life Choice Bill” has triggered another round of debate. A recent poll shows public support for legalising voluntary euthanasia at an all time high. It’s a question of “when” not “if”.

Kiwiblog: Support for Euthanasia?
I think the current law is quite cruel when people like Sean Davison are made into criminals for doing what his mother begged him to do.”

Links

Maggie Barry, hospices and euthanasia

Panelists on Backbenches last night were asked their view on Maryan Street’s proposed euthanasia legisaltion.

National MP Maggie Barry said she hadn’t seen what would be in the bill yet but she would definitely oppose it, She cited her experience:
National Party profile: Her extensive community work includes being Patron of Hospice NZ
Mary Potter Hospice: MAGGIE BARRY BECOMES HOSPICE’S AMBASSADOR

She said that hospices and good palliative care meant that euthanasia wasn’t necessary. She also claimed that pain was not experienced by a patient if cared for.

I think she’s wrong. I’ve seen close up very good palliative care in a hospice situation. One problem was that pain relief was often reactive. And it didn’t prevent severe discomfort, nor did it avoid the loss of dignity my mother dreaded.

As good as they are there’s things a hospice can’t deal with adequately.

Personal ‘end of life’ experience

I’ve had recent first had experience with end of life issues when I was closely associated with the illness and death of my mother. She had the best possible palliative care through the Otago Hospice.

It has been suggested in the recent public debate in Dunedin that all that needs to happen is for more widespread top palliative care to be available to anyone that wants it.

And also here:

End-of-life issues authority, Otago University bioethics centre Professor Grant Gillett, said the issue was not clear.

The terminally-ill were often unsure about the situation, and wanted to know their options but not go through with any.

“It’s a feeling of being socially isolated, a fear they are going to lose control and that the illness is going to take over, that is behind a request.”

He said instead of giving in to the desire for euthanasia, it might be better to create a more caring approach to treatment.

To an extent this is the right approach. But from my experience it’s not the whole answer.

I couldn’t fault the palliative care my mother received – as far as they were able to provide comfort under the current laws. They seemed to be scrupulous in following the law.

But it was deficient in several key areas:

  • It was always reactive to pain. When my mother was obviously in pain they would administer more pain relief – but this was already reactive, after they noticed she had already experienced pain, sometimes quite severe.
  • The most unsettling and upsetting aspect of my mother’s death was what ended up to be extreme discomfort due to increasing accumulation of liquid in her lungs.
  • My mother ended up in a situation that she had expressly stated she wanted to avoid – she would have been horrified to see here state in the last time of her life.

Pain relief (sometimes reactive) and attentive care did not provide my mother with what she wanted.

The only way of being more caring would have been to have helped her out of her suffering sooner, provided it was clear that’s what she wanted ( from my conversations with her I think it would have been).

This leads of course to the much promoted idea of a person’s right to choose for themselves.

 

 

Choices about euthanasia

I had a close encounter with the pros and cons of euthanasia recently as I watched my mother die.

She had expert care and assistance in her home and at the hospice. The hospice uses care plans that emphasise comfort for the patient within current laws.

March
Emergency admission to hospital with reflux and difficulty eating. Tests done, suspected possible hernia. Discharged.
Continued having eating and reflux problems.

April
Further outpatient tests.

May
Diagnosed with oesophageal cancer.
Treatment options explained. Booked for radiation therapy to try to relieve symptoms.
Continued difficulty eating – can’t eat many things, can only eat liquids or near liquids. Some food, for example meat, cannot be eaten at all.

July
Three week course of radiation begins.
Admitted to hospital after first treatment.
Several days later discharged to family home, radiation continues.

August
Eating continues to be difficult, no real improvement.
Saw specialist, advised relief may take another month.

September
Liquid diet only.
Saw specialist who advised they had done what they could, referred to Hospice for in home palliative care.

Week 1
Bad back pain for several days, admitted to hospital with kidney infection.
Tests confirmed cancer now in liver.
Eating increasingly difficult.

Week 2
Back in home but has difficulty managing.
Talks about considering self euthanasia. Says she just wants to go quickly.
Has fall on footpath in town.
Needs walking frame.
By the end of the week it’s obvious she needs more care.

Week 3
1. Assessed by hospice doctor, booked into hospice for assessment
2. Arrived at hospice and advised she would be there about a week.
3. Advised that she wouldn’t be leaving the hospice.
4. Drinking is increasingly difficult. She says she just wants to go quickly.
5. Has final interview for hospice memoirs.
6. Had a fall overnight trying to go to toilet. Enjoyed watching rugby on TV. Last “meal”.
7. Significantly worse.

Week 4
1. Continues to deteriorate. Family advised she is now on final care plan, death could be within a day or two but could take much longer.
2. Looks terrible, barely recognisable. Barely awake all day. Overnight her body goes just about completely cold. Death rattle begins.
3. Bounces back in the morning. Awake and seems to enjoy family visits in the afternoon. Goes cold again overnight.
4. She looks nothing like my mother. Slight recovery, then has internal bleed.
5. Cold. Slightly warm. Cold. Hasn’t eaten since Saturday, all she has had is moisture swabs in mouth. Death rattle gets worse despite drugs.
6. Vigil continues. Turned regularly with distress. In the evening death rattle isn’t be relieved. Nurses turn her with a lot of discomfort.
7. Very distressing. Nurses leave room to get drugs.

At about twenty minutes after midnight my mother opened her eyes and looked at me, she looked desperate, pleading, terrified, I’m not sure what, just terrible.

Then thankfully she died.

After the nurses had finished my mother looked like herself again, relaxed.

My mother was lucky she died relatively quickly. Her last few months were mostly not nice for her, increasingly less so. During that time she never enjoyed a meal.

My mother had talked a number of times about wanting to go quickly when her time was up. She mentioned several times about euthanasing herself. The hospice always made it clear they had to comply with the law and within that they did a fantastic job.

But…

What the best possible palliative care did for my mother over her last few days was supply her with regular drugs, support relatives who were on death watch, and turn her regularly.

The regular turns were necessary, but they were awful. They were about the only times my mother became semi awake, because it was so disruptive and uncomfortable for her.

It was a turn that actually triggered her death. It’s ironic that they are allowed to turn a patient and know it can commonly precipitate death, but they can’t up her drugs to do the same thing.

Euthanasia is a very tricky subject. If it was legal when should it be allowed?

In retrospect I think (and I think my mother would probably think similarly) that it would have been sensible and far better for her if she had been helped to die sooner. While her last Wednesday was “useful” for saying goodbye to quite a few visitors if she could have seen how she looked she would have been horrified.

Looking back I think that her last Monday evening when it became obvious she was in a state of dying a decision could have been made to ease her pain and discomfort and help her die.  She got no benefit from being nursed through an extended death.

The last week was very hard on extended family who put their lives on hold and gathered round to watch a strange old body suffering. But the decision isn’t about them.

I’m certain if my mother had seen herself in any of her last week alive she would have been horrified – it was the sort of situation she’d made it clear she wanted to avoid if at all possible.

I know there are many variables when people are dying and it’s impossible to be certain of timeframes and discomfort levels.

But to me it seems senseless, and it could easily be seen as cruel, to extend someone’s life when there is virtually nothing to be gained from it.

If I can have a say in the course of my death I would like to be able to state that I want to be able to die comfortably, if necessary with assistance, and I don’t care if there’s a slight chance that I could have eked out another day or two of consciousness.

Care has to be taken in deciding when to go – if you are lucky to get the choice – but denying any legal opportunity to choose a more comfortable way of dying a little bit sooner is not very caring. It’s selfish of those insisting on every last minute of life extension.