In ending, I hope you decide to debate these issues, point by point, and not hide behind NZMA/WMA liturgy, so those of us who live our lives by reasoned humanist principles, and for whom this issue is of great importance, don’t end up having to argue in the upcoming debate around Maryan Street’s Bill, with yet another priesthood, immutable, trying to force on us articles of faith. This debate belongs to all of us; not the medical profession. If your anti-euthanasia views hold against my points, then argue them, and in your own words.
This post is the second in a series on euthanasia, setting out the principles that will be involved in the debate over Labour MP Maryan Street’s private member euthanasia bill, when she tables it again sometime after the election.
Below is the reply from Dr. Mark Peterson, Chair of the New Zealand Medical Association (NZMA), to an email from myself which can be read here - this post will make more sense if you were to read that first, though the below can be read standalone. Due to the disappointing sparsity of Dr. Peterson’s response I have a further series of questions for him, as well as the restatement of my original points that were not addressed, (most of them.) Below is printed first the doctor’s reply, after that I have posted my further email, particularly questioning the basis of ethics employed in the NZMA statement against euthanasia.
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Email from Dr Peterson:
Dear Mr Hubbard
Your comments and questions regarding my statements on euthanasia have been passed on to me.
When making statements attributable to me in my position as Chair of NZMA my personal opinion is irrelevant – I am stating the position of the NZMA.
I draw your attention to the NZMA position statement on euthanasia which is available on our website: http://nzma.org.nz/policies/advocacy/position-statements/euthanasia.
NZMA is a member of the World Medical Association and our position on euthanasia is consistent with, and based on, the WMA policy on euthanasia. http://www.wma.net/en/30publications/10policies/e13/index.html. We are not out of step with the rest of the world.
Yours faithfully
Dr Mark Peterson | Chairman
New Zealand Medical Association (NZMA) |
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My Further Reply to Dr. Peterson:
Dear Dr. Peterson
Thank you for your reply; needless to say, I find the NZMA and WMA’s position inhumane and – for reasons I shall give in the following - outdated, so given the Association, and yourself, get to frame this debate, I despair. The NZMA's policy against euthanasia is the briefest of documents given the importance of the topic, quote:
Thank you for your reply; needless to say, I find the NZMA and WMA’s position inhumane and – for reasons I shall give in the following - outdated, so given the Association, and yourself, get to frame this debate, I despair. The NZMA's policy against euthanasia is the briefest of documents given the importance of the topic, quote:
The NZMA is opposed to both the concept and practice of euthanasia and doctor assisted suicide.
Euthanasia, that is the act of deliberately ending the life of a patient, even at the patient's request or at the request of close relatives, is unethical.
Doctor-assisted suicide, like euthanasia, is unethical.
Then some few lines concerning it is okay, however, to give pain relief even if in doses that result in an earlier death for the patient, which is an ethical mess I will cover in my final paragraphs, but for now note in the substantive denial above, no explication of the basis for saying euthanasia is unethical; the public is simply to take it as an article of faith apparently. The World Medical Association Declaration is worse; this is the entire declaration:
Euthanasia, that is the act of deliberately ending the life of a patient, even at the patient's own request or at the request of close relatives, is unethical. This does not prevent the physician from respecting the desire of a patient to allow the natural process of death to follow its course in the terminal phase of sickness.
That’s it: again no reasoning whatsoever on the basis of ‘unethical’. And that basis is crucial, for example, the ethics of euthanasia for me, within my philosophy, is simple: I don’t believe in an afterlife, or an arbitrary God who 'owns me', I own my life and thus believe once a certain set of circumstances occur, and my life is reduced to a certain state, which I will know – my wife and I have living wills – then my life ceases to have a value and becomes a painful chore. It is not unethical to end such a life, if that is what I choose. That system of belief in the West which says such a life has value, however, because it contends we don’t own our lives, God does, is Judeo-Christian, a belief system increasingly irrelevant for a large portion of an atheist population, although I suspect the ethical basis of the NZMA position on euthanasia, following the WMA, making their positions little more than an historical artefact circa the twenty first century. The thing is we don’t know because the NZMA and WMA declarations are such deficient documents.
But be that as it may, returning to your reply, the single question you partially answered was one of three, only, and the most minor of my queries, thus I would appreciate answers to those questions which I will repeat again below, and expand on by linking specifically to the matter of rights, as explanation for why euthanasia and assisted suicide are indeed ethical - although first, a quick clean up, reiterating two relevant points unanswered even in the part you did respond to:
1. Has the NZMA polled its members on the issue of whether individual members see euthanasia and assisted suicide services as unethical? What were the results of that polling? This is important given the Association’s policy statement gives no guidance on the nature of ethics, or why euthanasia is unethical.
2. If the NZMA has not polled its members, then why not? Social mores are always changing; the ethical debate here will be evolving over time. Indeed, there are few fields outside medicine where ethics can afford to be less rigid, less debated, yet the simplistic WMA and NZMA statements on euthanasia are basically unchanged.
3. The above two points are further relevant in light of your final 'defence', quote, 'We [NZMA] are not out of step with the rest of the world' ... whereas to the extent you are saying there is a consensus against euthanasia, you are wrong. There is not the world consensus you imply, and hence there are differing interpretations of the Hippocratic Oath. And I’m at pains to point out none of this changes the principle of the individual right involved - I'll deal with that next because you, the NZMA and WMA, avoid it: but first to the matter at hand, how do you explain legal euthanasia in Belgium, Netherlands and Luxembourg, and legal assisted suicide in Switzerland, Germany, Colombia, Japan, plus the US states of Washington, Oregon, Vermont, New Mexico and Montana? These represent large populations, large professional bodies, and indicate there is no 'world consensus' that you would have me believe from your email. To sum up, is the NZMA merely slavishly following what it sees (erroneously) as some type inane consensus that ignores completely the humanity of every individual health services user, their uniqueness, and the sovereignty they hold over their own bodies, without continually working this issue through with its members? What is the evidence that you have consensus even within your own Association, given many doctors are unofficially, illegally, aiding voluntary euthanasia, per the original article of my first email, and my previous quotation of Professor Mike Ardagh, who has a PhD in bioethics, that "active voluntary euthanasia was at times the right thing to do", indicating there is plainly no more consensus amongst Association members, than there is world-wide.
1. Has the NZMA polled its members on the issue of whether individual members see euthanasia and assisted suicide services as unethical? What were the results of that polling? This is important given the Association’s policy statement gives no guidance on the nature of ethics, or why euthanasia is unethical.
2. If the NZMA has not polled its members, then why not? Social mores are always changing; the ethical debate here will be evolving over time. Indeed, there are few fields outside medicine where ethics can afford to be less rigid, less debated, yet the simplistic WMA and NZMA statements on euthanasia are basically unchanged.
3. The above two points are further relevant in light of your final 'defence', quote, 'We [NZMA] are not out of step with the rest of the world' ... whereas to the extent you are saying there is a consensus against euthanasia, you are wrong. There is not the world consensus you imply, and hence there are differing interpretations of the Hippocratic Oath. And I’m at pains to point out none of this changes the principle of the individual right involved - I'll deal with that next because you, the NZMA and WMA, avoid it: but first to the matter at hand, how do you explain legal euthanasia in Belgium, Netherlands and Luxembourg, and legal assisted suicide in Switzerland, Germany, Colombia, Japan, plus the US states of Washington, Oregon, Vermont, New Mexico and Montana? These represent large populations, large professional bodies, and indicate there is no 'world consensus' that you would have me believe from your email. To sum up, is the NZMA merely slavishly following what it sees (erroneously) as some type inane consensus that ignores completely the humanity of every individual health services user, their uniqueness, and the sovereignty they hold over their own bodies, without continually working this issue through with its members? What is the evidence that you have consensus even within your own Association, given many doctors are unofficially, illegally, aiding voluntary euthanasia, per the original article of my first email, and my previous quotation of Professor Mike Ardagh, who has a PhD in bioethics, that "active voluntary euthanasia was at times the right thing to do", indicating there is plainly no more consensus amongst Association members, than there is world-wide.
Incidentally, interesting the only person in this discussion with a degree in medical ethics believes euthanasia is ethical.
And so to that crucial clarification regarding the central principle here: this debate is about an indivisible individual right - the ownership of one's body: just because there may be a 'consensus' here, either in your mind, or in the form of a 'tyranny of a professional majority', if that right of an individual to live and die as they wish, so long as they do no harm, is ever breached by the supposed consensus, then the consensus is always wrong. Whatever a world body says, if it overrides my right to die in the manner I wish, with whom I wish present, that world body will always, in every individual applicable case, be wrong, and hiding behind such a consensus is lazy and/or irresponsible. This proposition is unarguable, (plus the more years I put behind me the more I have come to understand that truth in numbers and consensus is a very dangerous assumption, especially in this case where the NZMA and WMA ethical assumptions are never stated or explained so members are in no position to critically evaluate the Association’s position.)
To my further two unanswered questions I would like to repeat and expand on.
And so to that crucial clarification regarding the central principle here: this debate is about an indivisible individual right - the ownership of one's body: just because there may be a 'consensus' here, either in your mind, or in the form of a 'tyranny of a professional majority', if that right of an individual to live and die as they wish, so long as they do no harm, is ever breached by the supposed consensus, then the consensus is always wrong. Whatever a world body says, if it overrides my right to die in the manner I wish, with whom I wish present, that world body will always, in every individual applicable case, be wrong, and hiding behind such a consensus is lazy and/or irresponsible. This proposition is unarguable, (plus the more years I put behind me the more I have come to understand that truth in numbers and consensus is a very dangerous assumption, especially in this case where the NZMA and WMA ethical assumptions are never stated or explained so members are in no position to critically evaluate the Association’s position.)
To my further two unanswered questions I would like to repeat and expand on.
Firstly, euthanasia and assisted suicide remaining illegal, dooms every individual in New Zealand who would wish for voluntary euthanasia, to dying in circumstances they would not wish, some scenarios of which will be horrific. Yet for those (many) of us who believe in the right to die with dignity, for those many historically who have killed themselves, often in chilling and tragic circumstances, in the acknowledgement of this right, and for those who will continue to do so regardless of the law and what 'you' think, we euthanasia advocates have no desire to force such practice on those who don't want this, neither amongst the dying, nor the medical profession; that is, it is obviously voluntary, and on all parties involved. Doctors won’t have to provide euthanasia services, only those who (thankfully) will wish to – and I believe some certainly will. So lack of a law such as the one Maryan Street proposes forces a portion of the population into dying in possibly dire circumstances against their wishes; while the presence of such humane law is on the basis only of complete voluntarism, meaning there is no harm to anyone, vis a vis, everyone gets to live, and die, as they wish. Given this, what gives the NZMA, and the law-makers, the moral right to forcibly abnegate voluntary transactions and interactions between consenting adults, pursuing if not their happiness, certainly their dignity and quality of life?
Secondly, my initial question for yourself, and because you personally will be, whether you like it or not, fronting the coming debate, and this issue revolves entirely around individual responsibility, the human right involved attaching to the individual, this is relevant: do you subscribe to any form of religious belief, and religious practice, that influences your interpretation of the Hippocratic Oath, and thus your anti-euthanasia views? Noting your rather sensationalist ‘throw away’ quotation in the article which set this correspondence off that you ‘wondered where euthanasia would end up, killing the mentally ill, et al’ puts you squarely, personally, in the anti-euthanasia camp. Given the importance of your position in this debate as the mainstream media's first 'go-to', I think it important religious affiliation is put on record, and not just for you, but all parties involved in the debate. (Are statistics available on the religious make up, or not, of NZMA members?)
And a final line of questioning, with troubling implications, that arises from Chief Coroner, Judge MacLean's, recent workshops mooting changing the way deaths are certified in a manner that those (compassionate) doctors who have and do effectively provide, albeit illegally, voluntary euthanasia in specific family cases, can be discovered and convicted. Both in your capacity as Chairman of NZMA, and personally as a human being, how are you going to feel about your members being hauled through the legal system and losing their careers, perhaps their freedom, for the only crime of caring? Quite apart from the undesirable situation this will give rise to, when doctors protecting themselves have to stop their 'past humane practice', meaning every individual at the last stages of their life, if unlucky enough to be trapped in the medical system, will have no hope of mercy. And even with the current unsatisfactory situation I have had friends and acquaintances die of cancer over recent times, the last over April gone, and know from this that pain and severe discomfort is not wholly solved by morphine or any existing pain relieving regime; some of those friends had long periods of pain, for no purpose - their lives were over - and that's before we get to relevant individual preferences regarding dignity and how they would have chosen for their lives to end. (Pity also the idiot consensus against cannabis based pain killers; for one of my friends it proved the best ‘medication’.)
Secondly, my initial question for yourself, and because you personally will be, whether you like it or not, fronting the coming debate, and this issue revolves entirely around individual responsibility, the human right involved attaching to the individual, this is relevant: do you subscribe to any form of religious belief, and religious practice, that influences your interpretation of the Hippocratic Oath, and thus your anti-euthanasia views? Noting your rather sensationalist ‘throw away’ quotation in the article which set this correspondence off that you ‘wondered where euthanasia would end up, killing the mentally ill, et al’ puts you squarely, personally, in the anti-euthanasia camp. Given the importance of your position in this debate as the mainstream media's first 'go-to', I think it important religious affiliation is put on record, and not just for you, but all parties involved in the debate. (Are statistics available on the religious make up, or not, of NZMA members?)
And a final line of questioning, with troubling implications, that arises from Chief Coroner, Judge MacLean's, recent workshops mooting changing the way deaths are certified in a manner that those (compassionate) doctors who have and do effectively provide, albeit illegally, voluntary euthanasia in specific family cases, can be discovered and convicted. Both in your capacity as Chairman of NZMA, and personally as a human being, how are you going to feel about your members being hauled through the legal system and losing their careers, perhaps their freedom, for the only crime of caring? Quite apart from the undesirable situation this will give rise to, when doctors protecting themselves have to stop their 'past humane practice', meaning every individual at the last stages of their life, if unlucky enough to be trapped in the medical system, will have no hope of mercy. And even with the current unsatisfactory situation I have had friends and acquaintances die of cancer over recent times, the last over April gone, and know from this that pain and severe discomfort is not wholly solved by morphine or any existing pain relieving regime; some of those friends had long periods of pain, for no purpose - their lives were over - and that's before we get to relevant individual preferences regarding dignity and how they would have chosen for their lives to end. (Pity also the idiot consensus against cannabis based pain killers; for one of my friends it proved the best ‘medication’.)
Worse, as I intimated at the start of this email, regarding the Chief Coroner's current actions, I would also point out the new death certification process he is looking for seeks to criminalise one of NZMA's chief policies provided as a sop for not allowing euthanasia, namely:
In supporting patients' right to request pain relief, the NZMA accepts that the proper provision of such relief, even when it may hasten the death of the patient, is not unethical.
Bit of doublespeak there, I reckon, trying to have it both ways, plus an ethical mess as it’s that rift of woolly minded nonsense anti-euthanasia advocates often give me - wink, wink, nudge, nudge, in applicable cases in the hospitals euthanasia does happen, doctors mercifully hurry some along, we just don’t know about it, so we don’t need to formalise and legalise actual euthanasia. Seriously, the NZMA needs to take a long hard look at its (anti)euthanasia policy statement: it’s negligent. Unfortunately, I believe you'll now find Judge MacLean is looking to prosecute doctors in just such circumstances of over-medication, meaning pain remediation plans will inevitably become more conservative: and thus the Association's 'out' – duplicitous as it is - for not allowing 'honest, above-board' euthanasia may soon be gone: the alternative to euthanasia may be thoroughly inadequate pain management regimes, and a higher incidence of painful, extended deaths. Will this change the NZMA's policy against euthanasia proper? Has the Association discussed with the Chief Coroner the likely cruel results of his current actions, and how they would appear to be in conflict with your policy document?
In ending, I hope you decide to debate these issues, point by point, and not hide behind NZMA/WMA liturgy, so those of us who live our lives by reason, don’t end up having to argue in the upcoming debate around Maryan Street’s Bill, with yet another priesthood trying to force on us articles of faith – the basis of your policy statement - and like all priesthoods, too moribund to change in line with changing social mores as we leave behind the darkness of an infantile religious mysticism, and embrace a knowledgeable and compassionate humanism. This debate belongs to all of us; not the medical profession. If your anti-euthanasia views hold against my above points, then argue them, and in your own words; albeit to do so you'll have to go back the step before the NZMA statement on (anti)euthanasia, and explain the reasoning behind its use of 'unethical' - that is, why is it?
Please note that I write a blog, and all this correspondence is now in the public domain. I look forward to your further reply.
Yours faithfully
Mark Hubbard
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