Euthanasia Debate III: Fact File: Pain Remediation Alone Is Not The ‘Answer’; Polling of British Medical Association has a Lesson for NZ Medical Association.

In the upcoming euthanasia debate that will be held in New Zealand post-election around Labour MP Maryan Streets die with dignity bill, I hope MSM reporters are going to make the New Zealand Medical Association (NZMA) answer the questions I have posed them in my last email: it is not right they will get to (overly) influence the debate, when they refuse to justify their position against a reasoned argument: there is no basis argued by them for stating euthanasia and assisted suicide are ‘unethical’ in what constitutes a policy statement on euthanasia which is first deficient, then negligent in stating that despite euthanasia being – for whatever their reason, it is not explained – ‘unethical’, it is yet ethical to give pain medication in doses that may ‘shorten life’. That remains an ethical mess that could see medical professionals put needlessly in fear of their careers, or freedom, given the current actions of the Chief Coroner MacLean to change the death certification process, so such doctors who are over-medicating can be found out, and presumably convicted; a course of action taken by Judge MacLean which NZMA has plainly not anticipated. Furthermore, the evidence grows that worldwide, as within their own association, there exists no consensus against euthanasia amongst medical professionals.

The majority of this blog is my mind working my life out, I’m not interested in simply copying and pasting the dailies with a one line opinion attached, however, on this post – and throughout on this topic - I will be deliberately derivative simply to show the wealth of educated, knowledgeable and wise support for euthanasia that exists, and also the facts surrounding the science of medicine that still leaves many of us inevitably dying in pain. The below is a summary of two articles that appeared in The Guardian over the last week, namely:

Call to Let Doctors Help Terminally Ill Patients Die; and,

This Plea to Legalise Assisted Dying Must Not Be Ignored.

The UK is debating its own dying with dignity legislation, known as Lord Falconer’s assisted dying bill, which comes up for its second reading on July 18, meaning there are many facts coming out of their national discussion, relevant to the coming debate here, and I’m glad to say, all of which backs up virtually the totality of my points made previously in correspondence with Dr Mark Peterson, Chairman of the New Zealand Medical Association (NZMA). To begin with, the position of the British Medical Association, like our own Association, following the World Medical Association, is against euthanasia, however, the British Association has polled it’s members, and 61% of them believe it appropriate their Association remain neutral in that country’s debate, because as I stated to Dr Peterson, the issue of euthanasia is not about the medical profession, it’s about us; our lives and deaths; our choice as patients.

… many supposedly representative medical bodies have a stance of opposition to assisted dying. This is despite the view of the majority of doctors (some 61% in a recent poll) that organisations such as the British Medical Association should remain neutral, as this is a matter for society, not the medical profession, to decide.

Furthermore in response to Dr Peterson’s scaremongering to our press a fortnight ago that if euthanasia were brought in ‘where would it stop’, the mentally incapacitated, the elderly and infirm, et al, overseas experience in those many jurisdictions where euthanasia and assisted suicide are legal show this simply isn’t the case; regarding, by way of example, the state of Oregon:

The 17-year experience of the Death with Dignity Act in Oregon has shown that a law similar to the one proposed by Falconer (though the latter has more safeguards) can be administered safely. The worries expressed by opponents that it might have adverse consequences for medical care and society have not been realised. The Oregon Hospice Association initially opposed assisted dying. It withdrew its opposition after eight years of the law, finding that there was "no evidence that assisted dying undermined Oregon's end-of-life care or harmed the interests of vulnerable people".

The British campaign has benefited over recent months, by one of Britain’s most senior medical professional’s publicly supporting Lord Falconer’s bill: Professor John Ashton:

Doctors should be able to help terminally ill patients end their lives days or weeks before they die, one of the leaders of Britain's medical profession has urged.

Terminally ill patients should be provided with the professional equivalent of midwives to help ease the pain and suffering and if necessary shorten the end of their lives, said Prof John Ashton, president of the Faculty of Public Health.

He demanded a change in the law so that doctors caring for people who are dying can end their suffering by giving a lethal dose of drugs to those who want it without the risk of prosecution.

He is the most senior doctor yet to publicly back patients' right to die.

Regarding assisted dying, Prof Ashton states:

"All over the country people are spending their last days and weeks in major discomfort because their medical carers are not willing to accept that it's the end of the line and to give them the necessary sedation to just speed things up a bit."

Just as midwives help babies come into the world, some terminally ill patients in pain may seek the help of a health professional to end their life. "We have midwives; we need an equivalent of a midwife at the end of life," he said.

He also urged the NHS to stop "keeping people going at any price" when they are near death by doing everything possible to prolong their lives, such as using drips and trying other forms of treatment, which he described as "a big problem".

And striking at the heart of our Dr Peterson’s claims to a medical consensus against euthanasia, I note this quotation:

Prof Raymond Tallis, the chairman of Healthcare Professionals for Assisted Dying, a 1,000-strong group of doctors and nurses, backed Ashton. "It's totally appropriate that they should have the assistance of physicians if they have intolerable symptoms. It's very much the humane response to human suffering," said Tallis, an ex-professor of geriatric medicine at Manchester University.

Ashton had previously said that he "absolutely" supported doctor-assisted suicide. "As a humanist I believe each person as a citizen has an exclusive right to the final freedom – the choice of when and how to exit life," he told the BMJ.

Before I end this round up, I want to press home a point that exists indirectly in all of the above, that being palliative care leaves many, still, dying in barbaric suffering:

Ashton's call for "midwives for the end of life" is a response to a serious problem in the way the medical profession approaches the care of dying people. In part, as Ashton points out, this is driven by the false expectation that there is a medical answer to every problem and an unwillingness to recognise when medical interventions are futile, or worse, compounding the patient's suffering.

The development of palliative care, in which Britain has led the way, is partly a corrective to this unthinking attitude. It begins with the acknowledgement that there is a time to move away from aggressive treatments and the illusion of cure to a focus on symptom control. But we need to recognise that while this serves the needs of the majority of patients, many still suffer terribly.

A recent survey has found that even in hospices (which offer the best possible care) 2% of people – at least 6,000 adults - have no relief during the last three months of life. We can anticipate that this proportion rises for the final days and hours.

No civilised society can ignore this level of suffering. On grounds of compassion alone, the Falconer bill must command our support. If it is passed into law it would be possible for terminally ill, mentally competent adults with a settled wish to die to be given a life-ending prescription by a doctor.

For people such as me, we look on this debate in confusion at how, by the twenty first century, any individual or body could deny a compassionate euthanasia. But we don’t have to look far for the cause. As I explained in my email to the NZMA, that Association hides behind their deficient policy which merely channels a darkness from our past in the form of those who are the vanguard of that belief the lot of humanity is suffering ordained by some ridiculous, arbitrary and monstrous God: Christians. Back to the situation in Britain:

Andrea Williams, the chief executive of the Christian lobby group Christian Concern, led criticism of Ashton. "To say that it's care for a doctor to kill is … a complete denial of their Hippocratic oath," she said. "A doctor is there to care for the patient, not to kill the patient. Midwives joyfully bring life into the world. It's not a doctor's place to play God at the end of life."

Here’s an idea Andrea: grow up. Thankfully, unlike Islam, we in the West had our Enlightenment to blunt the sword of an infantile obsession with Christian myth making; please don’t hold our lives, and the nature of our deaths, our choices, to your medieval faith and superstition. Your cruel God does not own my life, I do. And Prof John Ashton is very clear about what those who would deny us sovereignty over our own bodies are dooming some portion of us to:

Those who oppose the bill must recognise that in doing so they are riding roughshod over a fundamental principle of medicine and medical ethics – respect for patient choice. And they should also remember the alternatives to medically assisted dying: botched suicide attempts, death by voluntary starvation and dehydration, pilgrimages to Switzerland and help from one-off amateurs who have the threat of prosecution hanging over them.

And I note already, sadly, Prime Minister John Key is on record this weekend he won’t be voting for Maryan Street’s bill because it goes ‘too far’ - and before you get to it, go to hell, John, with the watered down 'political' version you're no doubt worming your way toward. We are so badly served in New Zealand, where our choice seems to be between a left wing that will destroy us economically, while tethering our individual lives tighter and tighter to the Big State, or right wing conservatives who still hold the Big State front and centre of our lives in issues such as euthanasia (abortion, et al).  There is no choice for freedom loving capitalists who are social liberals, so be warned right wing: you’ve had my vote up until this election simply because of economics, however, this election, I may yet make a protest party vote to Labour, for the only reason of giving Maryan moral support. Now if you read my blog you’ll understand what a sacrifice that would be, but from that, right wing parties, you better start figuring this out, because the issue of getting such civilised law through that for once defends my rights, and my sovereignty over my own damned body, is that important to me I will party vote Labour, this once.

For those of you who support euthanasia, Maryan is going to require all the help and pressure she can muster to prick the consciences of the too many old fogey authoritarian social conservatives in our Fortress of Legislation: email them, lobby them, and then email Dr Peterson, care of the New Zealand Medical Association, that perhaps he might want to put pen to paper and responsibly answer my last letter to him: you can read that letter here. Because if we can get the NZMA to at least stand on the side-line, there may be the inkling of a chance. Not otherwise though.

Footnote:

 

Whaleoil is running the partisan line that John Key is the hero in the piece who is prepared to discuss this issue prior to the election. Unfortunately Key’s statement came from a mere discussion, and his stance will be counter-productive. My thoughts on it are as I have posted to Whale’s post:

 

Unfortunately Key will only support a watered down version of Maryan's upcoming bill, thus he will be voting down that bill. His comments were only from a general discussion, there is no talk of him changing the current rules, so by not voting for that bill, we will be even further away from civilised assisted dying legislation. That's a disaster, especially in light of the chief coroner's current efforts to change death certification process so those doctors currently mercifully over-prescribing pain medication in such circumstances can be found and convicted.

 

Key's better approach would be to work with Maryan to ensure we get legislation in the statute books (and he should tell Judge MacLean to pull his head in.)

 

Update 1:

Well my offer to give a party vote to Labour hasn't lasted long. On David Cunliffe's mooting of changing the burden of proof in rape cases on a Labour win, that is, that every person charged with rape no longer must be proven guilty, but must instead prove they had consent, I would be voting for a basic individual right - euthanasia - at the expense of the very foundation of a free Western society, for once you take away innocent until proven guilty, there's no free West left anymore.

Note the burden of proof already is reversed in tax cases to run the tax surveillance state, so there is no free West, but extending that to criminal jurisdictions such as rape is *the* end. Mind you I had foretold in this earlier post how identity politics and Marxist feminism would lead to this.


Related Posts:
 

Euthanasia Debate I: Email to Dr. Mark Peterson - New Zealand Medical Association.
 

Euthanasia Debate II: Reply from Chair NZMA; My Response - Sorry State of Medical Ethics.