The modernisation seeks to fill a twenty-six-year gap and reflect some of the modern challenges.

Dr John Kleinsman, director of the NZ Catholic bishops' Nathaniel Centre for Bioethics, is delighted with the bishops' update.

Kleinsman describes the new document as a "succinct overview of eight key moral areas, including a new section on information technology and artificial intelligence."

Among the modern challenges the bishops consider

• Information technology and artificial intelligence
• Justice and correction systems
• War and peace
• Poverty
• Discrimination and abuse
• End-of-life issues
• Beginning of life issues
• Integrity of Creation

Kleinsman says that people generally know what the Chucrh teaches but are unsure of why.

Te Kahu o te Ora - A Consistent Ethic of Life summarises key points which can give people greater insights into Catholic thinking, comments Kleinsman.

"It is a great source for open and informed discussions", says Kleinsman who, as well as being a theologian, is a married man, father and grandfather.

The original Te Kahu o te Ora was inspired by Cardinal Joseph Bernardin's A Consistent Ethic of Life.

Bernardin's work grew from his observation that we must act consistently because all human life is sacred.

It was Bernadin's view that it was inconsistent to protect life in some situations but not in others.

In the years following Roe v. Wade, Bernardin argued that human life is always valuable and must be respected consistently from conception to natural death.

Being pro-life is not only about abortion or euthanasia.

Being pro-life must encompass war, poverty, access to health care, education and anything that threatens human life or human wellbeing, he argued.

Stephen Lowe, the Bishop of Auckland, the Apostolic Administrator of Hamilton and President of the NZ Catholic Bishops Conference, describes the update as "Opportune".

Lowe says human life and emerging challenges are interconnected.

"The essence of Te Kahu o te Ora is the interconnectedness of all life, from the womb to the Earth," he said.

Lowe says Pope Benedict put it well some years ago:

"There are so many kinds of desert. There is the desert of poverty, the desert of hunger and thirst, the desert of abandonment, of loneliness, of destroyed love. There is the desert of God's darkness, the emptiness of souls no longer aware of their dignity or the goal of human life. The external deserts in the world are growing, because the internal deserts have become so vast."

"While traditional human life issues continue to need our attention, we are now facing many new problems, all interlinked.

"The key message of Te Kahu o te Ora is that everything is connected, whether it is life in the womb or the life of the Earth," Lowe repeated.

Sources

• Supplied
• Catholic Sun

Plainly the upcoming End of Life Choice referendum concerns me, others like me, and all those involved in my care.

I've just put the phone down after my phone consultation. My results are excellent.

No new disease showing up in my body and the tumour much the same as it was on the last scan.

I'm back ‘under observation' (meaning a doctor check-in every six weeks and CT scan every three months).

It's an upward-swing of the pendulum, another reprieve - delivered with care, grace, attentiveness, in the best possible way.

This was my post-chemotherapy review and I was nervous, though I'm mostly beyond this now.

It's two years since the cancer - an aggressive soft-tissue sarcoma - spread to the bone in my hip and I was told there was no cure: my treatment from now on would be palliative.

This was a shock.

I'd already been through the treatment mill - radiotherapy every day for close on six weeks.

And here I was almost over the five-year mark, sitting in a golf cart being ferried to the A&E department of my local hospital.

Two years on, and inconceivable as it seems to me, I'm facing the end of my life.

Something personal

We're coming up to a referendum on this very topic.

I'd like to add something personal to the conversation.

Personally, I've noticed the reticence most people have around the subject of unexpected or early death, as if it's either too delicate to speak about or not worthy of attention.

It seems to me we have a natural barrier to facing the end of life.

It poses us with an immense challenge, a distinct loss of control.

Action being easier than inaction, my first instinct was to fight. I was frightened, I was angry, I was incredulous. How could this be happening to me?

My next instinct was to draw a deep breath, pull myself up tall, and face things square on.

A few years ago, my young daughter took me along to hear Joy Cowley speak.

Her message was startling: ‘Face your fears in life!'

Her talk had a powerful impact on me: I'm indebted to her.

My initial prognosis was 12 months.

It wasn't long before my oncologist was ‘keeping me alive till Christmas'.

Since then my family and I have lived through two Christmases.

Clearly, in my case at least, there's deep uncertainty here. The defining clause in the Act relies on this. I'll be able to ask for an assisted death. Continue reading

These are the word of American physician and palliative care advocate Dr Ira Byock in response to the crisis we find ourselves in across the globe.

Without doubt, Covid-19 has made us contemplate our own deaths in a way we haven't had to for several generations.

While we have so far been spared the volume of deaths witnessed overseas, through the media we have learned a lot about what people are going through.

We have also heard the stories of 20 New Zealanders (at the time of writing) who have sadly died.

Among these are tragic accounts of people of all ages who have deteriorated very quickly and died, even when they have received the best and most appropriate medical care available.

Often, in this kind of situation, health care professionals talk about ‘planning for the worst and hoping for the best'.

This might involve challenging but honest conversations about what is important to you, what you value most and what treatments can and can't be offered. Dr Peter Saul, an intensive care specialist from Australia, calls this "speaking the truth with kindness".

However, for some families, these conversations will have been made more difficult by not knowing what their family member would have wanted in this situation.

Indeed, our research shows that many of us don't think - or talk - about our end of life preferences until it is too late.

There has never been a more critical time than now, in the midst of a pandemic, to think about who you would want to speak up for you should you become sick and are dying.

• Will those whanau closest to you know what you value most?
• Do they know what is most important to you?
• Will they know what kind of treatments and care you would or wouldn't want if you become critically unwell?
• What would a ‘good' death mean for you?

And we would argue that you shouldn't wait until you are really sick or at the end of life to have these conversations.

You can talk to friends, families and whanau about what you value, who is important to you and what is most important to you now. Continue reading

In response, MPs may be tempted to think they can fix the Bill—narrowing the scope, tightening the wording, maybe limiting it to terminal illness and ditching the current provision for grievous and irremediable medical conditions.

But in reality, even the safest version of this Bill would be dangerous.

This is a hard thing to say and to hear, when there are many stories of suffering and pain that each of us will hope we never have to go through.

Both sides of the debate are motivated by compassion and concern for the vulnerable. No-one is coming at this with the intent to harm, but good intentions are not enough.

Researching the international law and experience in places like Oregon, Washington State, Canada, Belgium, and the Netherlands, we find four main issues with even a restricted version of the Bill.

Too broad a criteria

First, the eligibility criteria would be broad.

Even if limited to people with a terminal illness likely to end their life within six months, doctors acknowledge that prognosis is more art than science.

Oregon has a provision like this, but their official reports show that in 2017, somewhere between 1 and 14 people who were prescribed lethal drugs went on to live longer than their six-month prognosis.

Other jurisdictions failure

Second, other jurisdictions have failed to craft effective safeguards.

For example, the Bill states that a person must express a desire for euthanasia or assisted suicide free from pressure.

However, pressure is very difficult to detect and requires a long-term relationship between doctor and patient.

In Oregon last year, the median doctor-patient relationship before an assisted suicide prescription was just 10 weeks.

Dividing society unequally

Increasing numbers of people in Washington and Oregon have named being a burden on family and friends as one of the reasons they opted for assisted suicide.

In Washington last year, this was 56 percent of the people who received a lethal prescription.

Although the numbers vary each year, the trend is rising steadily.

Patients may name other reasons too, like loss of autonomy, but for a Bill that is based on an ideal of free choice, the rising burden statistics should be a serious concern.

Third, whatever the safeguards, legalising euthanasia and assisted suicide would divide society into two unequal groups.

We'd be telling some people to hang on to life, because their suicide would be a tragedy.

We'd be telling others that their suicide is an understandable, rational act, that under the circumstances we agree their lives are not worth living. This underlying logic has no natural limits.

Small start points expand with time

This leads to the fourth issue.

The practise of euthanasia and assisted suicide tend to expand over time.

There's no reason to think we'd be immune.

For example, in 2014, Belgium made children of any age eligible to seek euthanasia, albeit with stricter criteria.

We cannot always control what happens after something like this has been legalised.

Passing this law would be a momentous turning point, one that would fundamentally change the make-up of our society.

We have never before said that it is acceptable to kill people because they are sick or dying or disabled, or that we'll accept them killing themselves.

Risks too great

Passing this law would be a momentous turning point, one that would fundamentally change the make-up of our society.

Parliaments around the world consistently reject bills like this one, because they recognise that the risks are simply too great.

Even the most tightly restricted version of this Bill would see people slip through the cracks—people who are misdiagnosed, who feel like a burden, who aren't caught by the safeguards.

Their deaths would be wrongful deaths—wrong according to the Bill's own criteria.

As UK Professor Onora O'Neil outlines, if we lived in a perfect world, maybe a Bill like this could be considered.

Doctors infallible

In this world, doctors would be infallible and their decisions and predictions would always be right.

Patients would be completely rational, never making decisions out of fear, pressure, or unstable emotions.

Families would be loving, compassionate and unselfish, with never a thought for their inheritance. But in the real world we live in, legalising euthanasia or assisted suicide should be a non-starter.

It's just too risky.

• This column represents the evidence and arguments delivered by Alex Penk (pictured) and Danielle van Dalen in Maxim Institute's Oral Submission to the Justice Select Committee as they considered the End of Life Choice Bill.
• First published at the Maxim Institute. Republished with permission.
• This column was also published in Fairfax newspapers on Wednesday 20 June 2018 and on stuff.co.nz
• Image: Maxim Institute

Heather Davidson, 54, has been sentenced to life imprisonment after she smothered cancer victim David Paterson, 82, with a pillow, only hours away from his natural death.

Prosecutor Jonathan Sharp said Mr Paterson had "previously firmly expressed his opposition to any intervention in the dying process and at the care home he had never asked anyone to help him end his life".

"As a devout Christian he had strong ethical objections to euthanasia.

"He directed a DNR (do not resuscitate) instruction on his medical records be removed.

"He said it would be God's decision and only God's when it was his time to meet his maker."

Before ending Mr Paterson's life, Davidson called a cancer support line and told the handler she was planning to kill Mr Paterson because she could not bear to see him suffer.

Davidson said her friend could not eat or drink, was "skin and bone" and was in a "dreadful state".

She told the operator: "I just think it would be better if I just put a pillow over his head."

She went on to ask: "Would I be a murderer if I did that?" and was undeterred by the response: "Yes in the eyes of the law you would."

Davidson could be heard on the recording protesting: "If he was a dog he would have been put down months ago."

The call was referred immediately to the police, but could not be traced as it was made on her mobile phone.

The recovering alcoholic then took a pillow and pushed it down on Mr Paterson's face, even though he struggled against her, injuring himself in his fight to breathe.

Davidson and Mr Paterson both attended the same Church of England parish.

Davidson's counsel said if she knew Mr Paterson was so close to death, she would never have killed him.

She shows remorse and is ashamed, her counsel said.

Sources

• The Telegraph
• The Guardian
• Image: WRPI

The report on the Liverpool Care Pathway echoed concerns raised by Catholic physicians and by Bishop Philip Egan of Portsmouth, who said doctors were being asked "to make a definitive judgment that a patient is about to die and that feeding and hydration can be summarily withdrawn".

The LCP is also used in New Zealand hospitals with Ministry of Health funding.

"This is not civilised. It is a national disgrace," said the Minister for Care and Support, Norman Lamb, after learning of "too many examples of poor practice and poor quality care, with families and carers not being properly involved and supported".

He said the LCP would be phased out and replaced by individual care plans for the dying.

The report — titled More Care, Less Pathway — said the protocol's "tick-box" approach to end-of-life care allowed medical professionals to base clinical judgments not on patient needs but on whether criteria set out by the framework had been met.

"It would seem that when the LCP is operated by well-trained, well-resourced and sensitive clinical teams, it works well," the report said.

However, reports of "uncaring, rushed, and ignorant" treatment abounded and "many families suspected that deaths had been hastened by the premature, or over-prescription of strong pain-killing drugs or sedatives and reported that these had sometimes been administered without discussion or consultation".

"There was a feeling that the drugs were being used as a ‘chemical cosh' which diminished the patient's desire or ability to accept food or drink."

The report emphasised that medical professionals would be guilty of professional misconduct if they refused a patient food and fluid, and demanded better policing and funding of end-of-life care.

Numerous examples were cited of patients dying of thirst. The review team also heard stories of nurses shouting at families who intervened to give their relatives a drink.

Some patients took up to 16 days to die after they were wrongly diagnosed as dying and placed on the pathway.

Sources:

National Catholic Reporter

Independent Catholic News

Daily Mail

More Care, Less Pathway

Image: The Guardian

The inquiry will focus on the Liverpool Care Pathway, designed to ease the suffering of patients in their last hours or days of life.

The pathway often involves sedation and the withdrawal of life-prolonging drugs, nutrition and hydration.

Critics say people are being put on it without their relatives being informed, and that the pathway is being used to hasten the deaths of patients who are not imminently dying.

When Norman Lamb, Britain's Care and Support Minister, announced the review, he said consider whether payments to hospitals for meeting targets on their use of the pathway might have led to "bad decisions or practice".

The Daily Telegraph has revealed that six out of 10 National Health Service hospital trusts had received payments totalling $NZ23 million or more for attaining these goals. In some hospitals more than half of all dying patients were put on the pathway

Department of Health officials have insisted that the payments are to ensure that patients are "treated with dignity" as they die — and many doctors argue that the widespread adoption of the Liverpool Care Pathway has led to improved care for the dying.

"It is clear that everyone wants their loved ones' final hours of life to be as pain-free and dignified as possible, and the Liverpool Care Pathway is an important part of achieving this aim," Mr Lamb said.

"However as we have seen, there have been too many cases where patients were put on the pathway without a proper explanation or their families being involved. This is simply unacceptable."

The Catholic Communications Network said Archbishop Peter Smith of Southwark, chairman of the English and Welsh bishops' Department for Christian Responsibility and Citizenship, welcomed the review.

It said Archbishop Smith had passed on "specific concerns raised with him by some clinicians" and had called for such an inquiry in a letter to the government in September.

Sources:

Catholic News Service

The Telegraph

Image: The Spectator