Health Minister Shane Reti (himself opposed to assisted dying) and the coalition partners are drawing up the review's terms of reference.

While Act Party leader David Seymour, who instigated the Assisted Dying laws, would like changes made to the eligibility criteria, he accepts nothing's likely to change any time soon.

The review itself won't change the law, he says.

That's because the review outcome is simply a report to Parliament. It will probably make some recommendations, but there was no requirement for the government to pick up the changes or Parliament to debate it.

It's more likely an MP will take the recommendations and put them into a member's bill which will need to be pulled from the ballot to be considered, Seymour explains.

Timeframe change needed

At present, assisted dying is available only to terminally ill adults with fewer than six months to live.

Seymour wants the "cruel" six month timeframe to be scrapped.

Auckland's Totara Hospice - the only one in the country offering assisted dying on its premises - would "at best like to see that timeframe removed, or extended to twelve months".

"The Act says suffering is defined by the patient so we don't see the need for a time requirement to be put on suffering" chief executive Tina McCafferty says.

The 'gag clause'

Seymour and McCafferty want the rules preventing doctors from discussing assisted dying to change. At the moment, patients must raise the question with their doctor.

McCafferty says that restriction is "at odds with the actual responsibilities of healthcare professionals ... to inform patients of all choices they can have in their care".

"Not everyone is articulate when it comes to health literacy, and I want to see that potential bias or inequity mitigated" she says.

Hospice NZ chief executive Wayne Naylor agrees. He also wants the clause clarified and provisions for family bereavement and grief support considered.

Law review does not equal law change

Seymour says the government is not obliged to take any action on the review recommendations nor is Parliament required to debate them. The review in itself won't change the law.

Furthermore, the coalition government had to "speak with one voice".

"I know there are people in the Cabinet who would say it would actually conflict with their conscience to have to support this legislation" he says.

Whatever changes are recommended, there are a couple of restrictions Seymour does not want altered.

One is that end-of-life choices are restricted to mentally competent people.

The other is that these people must be adults.

"For me, children have always been out, [and] people who have lost the capacity to decide for themselves are out" he says.

Source

• RNZ

He's concerned about ACT Party leader David Seymour's desire to widen the End of Life Choice Act criteria. Seymour argues the change is necessary, as many who want assisted suicide are "missing out".

Seymour says this is mainly because those people don't have a terminal illness likely to end their lives within six months.

The six-month terminal prognosis requirement prevents those with chronic conditions or disabilities from being eligible.

Betty argues broadening the eligibility criteria would not improve equitable choice for those facing end-of-life decisions.

It should not progress in light of the current palliative care climate in New Zealand, he cautions.

Nor should it happen without careful analysis.

Despite its supreme importance to New Zealand's health system, palliative care is not well catered for, says Betty.

"There's no strategic plan as to what is going to happen with palliative care, there's fragmented services, lack of funding… the list goes on. It's not a situation we can allow as a first-world, caring society."

The contrast and imbalance of palliative care vs assisted suicide and euthanasia is sizeable and cause for concern, he says.

"We have one part of the system fully-funded and overseen in an apparently coherent way by the Ministry of Health (assisted suicide and euthanasia), and the other sector that doesn't even have a strategic plan in place, that is inequitably funded, and has no coherent overview of how to develop the service.

"Why don't we have the exact focus on palliative care, so anyone making the biggest decision of life can make an equitable, informed choice?"

It's remiss of the Government, politicians and the Ministry of Health, he says.

Betty says New Zealand's 5,500 GPs, specialist GPs, trainees and rural hospital doctors often provide palliative care to their patients free of charge.

That's because there is no funding available for end-of-life care - a serious failing of the system, he says.

"Palliative care is so dependent on local funding, which is traditionally done by DHBs, but there's a total lack of funding, resourcing and a national approach."

This, coupled with a growing workload and an increasing complexity in clinical patient needs, adds pressure to palliative care practices.

"The question becomes - why don't we have that exact same focus on palliative care," Betty says.

The Assisted Dying Service Data and Report from 7 November 2021 to 30 September 2022 says only about 80 percent of those choosing assisted suicide or euthanasia have access to palliative care.

Betty cautions against this analysis.

"It doesn't show perceptions of what is going on or the quality of care they are receiving," he says.

The data's effectiveness should be questioned when the Act is reviewed, he adds.

"Everyone is affected by death and dying. That is part of health. Good dying and having equitable choice is a fundamental part of the healthcare system we set up. It has to be given space and focus at this point."

Source

• Scoop
• NZ Herald
• 1News

A year after coming into force, the End of Life Choice Act is working well and opponents of the law change had "melted away," Seymour says.

"The figures overwhelmingly show a law that is working. People can and do get through the process to become eligible for assisted dying, some change their mind, some are assessed as not eligible. That is what we'd expect if the law was working."

In the year since the law was passed, 214 patients have been euthanased.

In all, 596 people have applied, and 294 have been deemed eligible and 120 people were turned down because they were not eligible.

Seymour says a third of the ineligible patients were declined because they didn't meet the criteria of having a terminal illness likely to end their lives within six months.

He says he suspects "some if not many have an illness that is terminal but without a certain timeframe."

Seymour says he agreed to the six-month timeframe to gain the Green Party's support to pass the bill.

"I fear that compromise is leading to people ... missing out on having choice and control, even though their long suffering is just as real as those with a more immediate terminal condition."

His original bill would have allowed non-terminal patients with "grievous and irremediable conditions" to get access to voluntary euthanasia.

The amended law, which was voted on in a public referendum, made it explicit that applicants could not get access to assisted dying on the basis of disability or mental illness alone.

Seymour says he will argue for the euthanasia law criteria to be broadened when the law comes up for review in 2024.

He is also concerned that one in six applicants had died of underlying conditions before they were able to get an assisted death.

"It's excluding people with long-term conditions, and that means a lot of suffering that may not be necessary," he says.

Better palliative care

While Seymour wants the law relaxed, health experts are calling for wider support for palliative care services.

Royal College of GPs says it's too early for any new legislation changes.

The College is calling for ongoing observation for the next 12 months.

The Royal College of GPs medical director, Dr Bryan Betty says he'd like more funding for palliative care services sector-wide.

"There is underfunding for hospice, there is underfunding for specialist palliative care services, and there's under-funding of palliative care to general practices which support patients who are dying."

Since December 2021, numbers seeking end-of-life treatment have risen from around 15 per month to around 20 in September 2022.

Source

• NZ Herald
• One News

The Assisted Dying Service which came into force last November has just released its first annual report for the period from November to March.

By the end of June, 400 people had applied for an assisted death, 143 had died and 68 were deemed ineligible.

John Kleinsman, a bioethicist at The Nathaniel Centre, is particularly concerned that the Ministry of Health has six full-time positions dedicated to assisted dying - and there is no dedicated team for palliative care.

"There is an action plan for palliative care developed after a review in 2017 but many health practitioners working in the palliative care sector are not seeing any action," he says.

"Proponents of the End of Life Choice Act promoted its introduction as being all about choice, but it's a 'Clayton's choice' (no choice) if palliative care, which we know is effective, is not accessible."

Kleinsman says that end-of-life "choice" is heavily weighted in favour of assisted dying, because of the increasing demands on New Zealand's underfunded palliative care sector.

"Demand is projected to rise 50 per cent in the next 10-to-12 years and access is uneven depending on where you live," he says.

"It has been well documented that palliative care is grossly underfunded in Aotearoa.

"The idea that assisted dying will become a solution to a lack of quality end-of-life care is extremely distressing and frankly unethical and undermines the notion of it being a choice."

The Assisted Dying Service's report also notes many want the threshold for accessing euthanasia lowered - they complain the End of Life Choice Act is too restrictive.

"The legislation is not as enabling as some people were hoping for with the criteria making an assisted death more restrictive than overseas jurisdictions," the report says.

Kleinsman says this is precisely the pattern that has unfolded in other countries and something that many warned about.

He says he hopes the Ministry will collect a broader range of data on assisted dying, including people's reasons for choosing the service.

At present, statistics are collected on applications, numbers accepted for assisted dying and those who don't qualify or died before being able to make use of the Service.

Additional statistics could help safeguard against wrongful deaths by helping to identify whether people felt a "duty to die" because they were a burden on family or caregivers, he says.

The Assisted Dying Service's first annual report says patients and family members say they are happy with the Service, the support from doctors and the "peaceful" and "dignified" deaths of their loved ones.

Sources

• NZ Herald
• Supplied - Nathaniel Centre

So, it was a huge disappointment when we learned that, despite billions of dollars being allocated to health, Budget 2022 offered no extra support for the 32 hospice services that offer palliative care to nearly 20,000 patients and their whanau every year.

The lack of government recognition given to this vital service - one that we all expect for our loved ones in their time of need - means that hospices must continue to rely on revenue from their op shops and fundraising events in order to continue to provide free palliative care in their communities.

All hospice services are completely free of charge to everyone who needs them.

Yet of course, this essential and valued service is not really free.

Hospice services cost a lot to provide.

Last year, it cost close to $176 million. While the Government provided $88m, hospices had to raise over $87m to bridge the gap.

In today's climate of high inflation and Covid, $87m is a near-impossible amount to be expected to raise from selling second-hand jumpers and running charity events.

When people and businesses are struggling, and the hospice retail stores lose out on their revenue because of economic conditions and lockdowns, it becomes starkly clear that our hospices are in a desperately precarious financial situation.

Many people miss out on specialist palliative care from hospices due to factors largely beyond their control: their diagnosis, their ethnicity, their age, and where they live.

Hospices need better funding so that they can reach out to rural and remote areas, and develop services that meet the needs of Maori and other ethnic groups, and those with dementia and other chronic health conditions.

Government funding through district health boards (DHBs) is highly variable, with some hospices only funded to around 45% of their operating costs, and others nearly 70% funded.

Many communities are not in a position to provide the additional millions required to keep services free, never mind expanding hospice care and extending it to those missing out because of where they live or their diagnosis.

This is a classic case of post-code lottery that the Government says it wants to remove with its health reforms. Continue reading

• Wayne Naylor is Hospice New Zealand's acting chief executive.

Fewer than 50 percent of patients wanting palliative care can access it.

These findings contradict the Government's stated plans to its improve its palliative care provision.

Evidence is mounting that assisted suicide is actively damaging the already inadequate palliative care system.

Some patients are choosing to die rather than to continue to live without adequate palliative care.

The Catholic Church has long supported palliative care for patients living with a life-threatening illness.

It calls euthanasia or medically assisted suicide an "intrinsically evil" act.

What palliative care experts say:

Three palliative care experts say since Medical Assistance in Dying (MAiD) legislation was passed in June 2016, palliative care provisions and services have reduced.

"It's like a cancer growing within the palliative care programmes", Dr. Neil Hilliard says.

"(MAiD) is starting to take over to a certain degree. But still only five percent of people are choosing MAiD; 95 percent would prefer to live well until they die naturally."

His comments support recent testimony from two of Canada's leading palliative care physicians to a Special Joint Committee of Parliament.

The Committee is reviewing the country's assisted suicide legislation.

Dr. Leonie Herx told the Committee that only 30 to 50 percent of Canadians who need palliative care have access to it.

"Currently, Canadians have a right to medical assistance in dying, but not to medical assistance in living.

"Having accessible, high quality palliative care needs to be a universal health care right in Canada."

Only a "very few," or about 15 percent, have access to specialist palliative care, she said.

The physical, emotional and spiritual suffering can lead patients to feel depressed and hopeless, and a burden to others. There are many factors driving requests for MAiD.

"Earlier palliative care can alleviate suffering before it becomes irremediable."

She said "significant deleterious effects" MAiD has had on palliative care include diminished resources and increasing distress experienced by palliative care clinicians."

She is especially concerned that:

Places where euthanasia is incorporated into palliative care has led to palliative nurses leaving their jobs because they felt unable to provide such care.

Hospice palliative care nurses are expected to provide assisted suicide.

Palliative care clinicians are suffering increasing moral distress from forced participation in MAiD; if they don't participate, hospices and palliative care units lose funding.

There is a critical shortage of specialist and generalist palliative care physicians.

Time is spent on administrative issues related to MAiD instead of providing palliative care.

There is decreased access to specialised palliative care when beds are taken by patients to have MAiD administered.

About patient fear - some won't access palliative care because of their association with assisted suicide. Some fear palliative care will hasten their death or they might be euthanised without their consent.

Another specialist told the committee assisted suicide needs to be "distinct and separate" from palliative care to ensure that the latter does not suffer.

"MAiD assessors and providers are in a conflict of interest if providing palliative care at the same time."

Source

• America Magazine

Where to get help:

Need to Talk? Free call or text 1737 any time to speak to a trained counsellor, for any reason.

Lifeline: 0800 543 354 or text HELP to 4357

Suicide Crisis Helpline: 0508 828 865 / 0508 TAUTOKO (24/7). This is a service for people who may be thinking about suicide, or those who are concerned about family or friends.

Depression Helpline: 0800 111 757 (24/7) or text 4202

Samaritans: 0800 726 666 (24/7)

Youthline: 0800 376 633 (24/7) or free text 234 (8am-12am), or email talk@youthline.co.nz

What's Up: online chat (3pm-10pm) or 0800 WHATSUP / 0800 9428 787 helpline (12pm-10pm weekdays, 3pm-11pm weekends)

Kidsline (ages 5-18): 0800 543 754 (24/7)

Rural Support Trust Helpline: 0800 787 254

Healthline: 0800 611 116

Rainbow Youth: (09) 376 4155

If it is an emergency and you feel like you or someone else is at risk, call 111.

Experts say we already have a "postcode lottery" determining who dies in pain.

The scale of the problem contrasts with the provisions of the newly available End of Life Choice legislation.

The new legislation offers a fully-funded system to enable terminally ill people who meet exacting criteria to end their lives.

But, if a terminally ill person wants palliative care and to end their lives naturally and in comparative comfort, funding is chancy.

Much of it comes from the likes of selling strawberries and second hand clothes.

"Looking to the future is a nerve-wracking experience, as we see costs increasing but no sign of a commitment from Government to help us with the additional costs," Mary Potter Hospice chief executive Brent Alderton​ says.

"It is ironic that the new end-of-life-choice service is fully funded and our hospice care funded less than 50 per cent."

The hospice makes up the rest itself - from second-hand shops, bequests, donations, events and reserves.

This year's Strawberry Festival fundraiser, however, was cancelled due to Covid-19. The Hospice already had a $100,000-plus deficit from last financial year.

Danielle van Dalen​ of the Maxim Institute says the need for palliative care in New Zealand is expected to increase by 50 percent in the next 20 years and double in the next 50 years.

The pandemic's disruptions to fundraising have resulted in some palliative care services having to dip into savings for the first time, she said.

"If funding doesn't go up, along with other things, more people will have bad deaths."

Sue Sutherland, who is the general manager of marketing at Nurse Maude, says the Government provides about 70 percent of hospice service funds. Like the Wellington hospice, they have to fundraise the rest.

If the forecast increase for hospice palliative care becomes a reality, there would need to be a rise in Government funding "so everyone who needs palliative care can continue to receive it," Sutherland says.

Health Minister Andrew Little says the Ministry of Health is already looking into improving the "equity and quality of palliative care...".

Talks with those working in palliative care show there are already areas needing improvement, he says.

The Government funding for palliative is currently set at $490.7 million over four years.

It gave an additional $20m for four years in 2019 and a $7.3m boost in 2020 due to Covid-19.

College of General Practitioners medical director Bryan Betty (pictured) said the Government should have fully funded palliative care when it brought out the End of Life Choice Act.

He says the current underfunded palliative care system created an "uneven playing field".

Funding to provide good quality, consistent palliative care is needed throughout New Zealand, he says.

Source

• Stuff
• Image: Freemasons NZ

"The choice is distorted towards aid in dying and away from palliative care."

Gray - an associate professor with Otago University's Department of Primary Healthcare & General Practice says the new Act's funding mechanism focuses on the wrong things.

"Should funding euthanasia be a health priority for New Zealand's public health system especially when compared with palliative care?" he asks.

Gray says the funding mechanism for the new legislation provides "…funding for health practitioners to deliver assisted dying services is to support equity of access to assisted dying services for eligible persons."

The ‘health practitioners' in this case are medical doctors and nurse practitioners (as against registered nurses).

Research suggests assisted dying in this country will be predominantly taken up by a small number of mostly educated white people, Gray says.

There is no additional legal patient revenue stream available other than the resource provided under the Act.

Privately employed doctors and nurse practitioners can claim a gazetted government fee, but can't charge patients a co-payment. District health board-employed doctors and nurse practitioners can provide assisted dying services in this capacity but they can't claim this fee.

Gray also observes the funding objective means assisted dying is different from the vast majority of other services general practice and hospital specialist private practice provide. Unlike most of those services, assisted dying is fully funded by the Government.

In his view, the differences highlight two issues.

Firstly - why is ‘End of Life Choice' fully funded when most other services, particularly palliative care, are not?

Secondly, funding is critical for the Act's implementation. If the funding does not cover the cost of providing the services, very few can be expected to provide them.

To fully fund euthanasia while and not providing fully funded palliative care makes a mockery of the "End of Life Choice" Act's title, says Gray.

He says the ‘choice' between fully funded assisted dying and severely underfunded palliative care is "horribly distorted".

Responding to calls to increase euthanasia funding would be even worse in the absence of addressing the underfunding of palliative care, he says.

He observes there was nothing in the Assisted Dying referendum, or discussion beforehand, that addressed whether it should be fully funded.

This is likely to significantly limit the already limited numbers of general practitioners willing to provide aid in dying, he says.

If he's right in this, public hospitals will face demand for assisted dying when their services are already very stretched, Gray says.

He thinks the answer is for assisted dying to be partially-funded under the existing government capitation payments to general practice, with a patient co-payment to reflect the cost of providing the service.

Source

• Scoop
• Image:University of Otago
  

Because of its views, the Delta Hospice Society (a member-run organisation) is likely to lose $1.5 million in funding from the Fraser Health Authority, a public health care authority in British Columbia. It is also facing losing its permission to operate as a hospice in February 2021.

Both euthanasia and assisted suicide were legalized federally in Canada four years ago.

Since April last year, at least 6,749 Canadians died as a result of euthanasia or assisted suicide.

The Supreme Court of British Columbia ruled in June that the hospice had acted wrongly in its attempts to define its Christian identity and to exclude euthanasia because it had not been indiscriminately approving new applications for membership during 2020.

The Society has appealed the decision.

The hospice has been challenged by three of its members, including former director Sharon Farrish.

The legalization of euthanasia in Canada led to governance problems for the Delta Hospice Society, says Madam Justice Shelley Fitzpatrick, who wrote the June decision.

Farrish became executive director of the Delta Hospice Society in June 2019, when the society had about 160 members.

At that time, Fitzpatrick noted, "there was an increasing view that [Medical Assistance in Dying - MAiD] should be offered by the Society."

Membership in the hospice society swelled last year from about 400 at the beginning of October to 620 by the end of November.

"The clear inference is that the MAiD issue caused substantial interest in the community, and motivated people to get involved in the Society so that they could express their views at the [Annual General Meeting] as members of the Society," Fitzpatrick said.

At a general meeting in November 2019 a new board was elected that opposed provision of euthanasia at the hospice's facilities. Farrish was terminated as executive director.

The British Colombia hospice maintained physician-assisted suicide was "incompatible" with hospice palliative care, and that being pressured to provide it was incompatible with its mission.

Angelina Ireland, president of the board of the hospice society, says the Hospice has "worked really hard to have the people to trust us that when they come to hospice they will not be killed. We will take care of them, they will take care of their families.

"And now basically the government has said that any hospice that does not provide euthanasia, it's not allowed to exist."

Since then, the board of Delta Hospice Society has worked to preserve its character as an organization that allows for natural death.

Ireland is proposing the Society "return to our roots and fully affirm our Christian identity." She is urging the acceptance of a new constitution and bylaws.

The proposed new constitution would call the Society "a Christian community" meant "to provide compassionate care and support for persons in the last stages of living, so that they may live as fully and comfortably as possible, until their natural death."

Source

• CNA
• Image: The Times

Cancer Society medical director Dr Chris Jackson began the meeting.

He said the lockdown has kept people with cancer and immune-suppressive issues safe.

However, there have been problems, around people getting treatments, being away from their families while undergoing treatment etc. Continue reading

"Deathbed Etiquette" highlights the importance of good accompaniment of dying people.

The guide, is produced by The Art of Dying Well, a project supported by the university.

The university says its new guide draws on the experiences of hospital chaplains, palliative care consultants, nurses, friends and relatives and includes a raft of practical tips.

Jo Elverson, a consultant in palliative medicine at St Oswald's Hospice, Newcastle says she found those closest to the dying person are best placed to help them to die peacefully.

She encourages families at the bedside to follow their instincts.

"Sometimes, they need confidence, permission if you like, to do what they believe is the right thing."

Another palliative care consultant said she hoped the guide communicated "that dying is not a clinical event. It is a normal event in someone's life".

The launch of the guide coincides with a Onepoll survey commissioned by the Art of Dying Well and St Mary's University which asked 2,000 people across the UK whether they were prepared to be at the bedside of a loved one as they were dying.

The Poll highlighted that women outnumbered men in their responses to the two most extreme positions.

Almost twice as many women as men said they were totally prepared to die and women than men also considered themselves to be totally unprepared!

The Poll also confirmed older respondants felt better prepared to sit by the bedside of a dying person.

Almost a quarter of people aged over 55 (23 per cent) said they were totally prepared, while only 12 per cent for those aged 18 to 34 felt this way.

This finding is in line with the experience of our experts who have found that the ability to cope with death and dying increases with age.

Sources

• The Tablet
• Image: Theran Times

The court and society have thrust assisted-death squarely into the laps of physicians and we are now left grappling with what this will look like.

My perspective as a palliative care physician on living and dying has been shaped by the thousands of patients and families I have had the privilege of walking alongside as they face suffering in the context of a life-threatening illness.

It is from this vantage point that I can say with resounding confidence that physician-assisted death is not palliative care and should have no home within a palliative care service.

And I am not alone in this perspective.

In a recent poll by the Canadian Society of Palliative Care Physicians, 74 per cent of members felt that euthanasia and physician-assisted suicide should not be provided by palliative care services or palliative care physicians.

The World Health Organization's definition of palliative care states:

"Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual."

Palliative care also "… affirms life and regards dying as a normal process; and intends neither to hasten or postpone death."

By definition, palliative care does not hasten death, and while dying is a normal life process, killing is not. Let's not kid ourselves or cloak reality with soft words — physician-assisted death is killing.

Dying is hard work for everyone involved: the patient, family and care providers.

It is innately an existential matter and asks us what life is all about.

Dying is a normal process and final growth stage of life.

Like birth, it is an important developmental stage in the lives of humans, but unlike birth, one that we seldom talk about as a society.

Those of us privileged to work with and journey alongside the dying and their families will tell you that dying can be transformative — relationships can be healed and past hurts reconciled.

Requests for hastened death are predominately related to existential suffering and do not correlate with physical symptoms such as pain. These existential concerns are typically due to loss of control, loss of hope, loss of meaning in one's life, or a sense of burden to others.

Thanks to the great work of Canadian palliative care physicians such as Balfour Mount and Harvey Chochinov, we have developed holistic dignity-conserving palliative care interventions that aim to restore purpose, meaning and hope in the face of loss that accompanies a life-threatening illness.

These therapies help a person focus on living while dying.

The foundations of our work in palliative care are trust and relationship.

Trust between patient and physician, family and care providers and between members of the health-care team. Is trust really engendered when we reach out with one hand inviting patients to engage in the hard and intense work of addressing their suffering, while in the other hand, we hold the needle to end their lives?

Suffering is not limited only to the individual.

Individuals are inevitably part of a community - family, friends and care providers, to name a few.

Individual choices affect us all. Continue reading

• Leonie Herx is the Head of the Division of Palliative Medicine and Associate Professor in the Department of Medicine, Queen's University. She holds the W. Ford Connell Chair in Palliative Medicine.

Bishop Philip Egan's pastoral message followed a report which concluded 650 people died at a hospital within his diocese between 1989 and 2000 after they were given large doses of painkillers without medical justification.

Egan said he was "shocked and saddened" by the report and described the deaths as "a terrible tragedy."

Seriously ill patients are still facing the same threats within Britain's National Health Service, Egan says.

The likelihood of them being over-sedated and dehydrated mean people are safer being cared for at home than in hospital, he says.

While he says Britain's National Health Service "is a huge blessing," Egan says it's important to be "vigilant to the policies, values, priorities and procedures that operate within it."

"As next of kin, gently insist on being involved in decisions. It might be appropriate to ask staff for a second opinion or a re-evaluation of treatment."

He has also called for a review of geriatric and end-of-life care "in relation to fundamental moral principles."

In this respect, he noted it is "not morally permissible until the very last to withdraw feeding and hydration."

So far, no medical professionals have been prosecuted following the investigation into the deaths of the 650 people.

Jeremy Hunt, who is the secretary of state for health, has indicated that police will study new evidence produced by the investigating panel.

Source

• Crux
• Catholic Herald
• Catholic Register
• Image: Twitter.com

He is seeking to influence the Justice Select Committee to reject submissions and in so doing undermining the democratic process.

Seymour's baseless allegations are deeply offensive and insulting to the thousands of New Zealanders who have sent submissions on behalf of their children, families and wider community expressing their great concerns this ill-advised bill represents.

What Seymour is in fact saying is that the parliamentary process of receiving submissions is of no significance or value.

Seymour is saying that public opinion polls, conducted by asking, frankly, what can be described as ‘leading' or at least ill-informed questions are of superior value.

This is nonsense.

David Seymour should if he wishes to retain any credibility refrain from commenting on the submissions.

Seymour

• has not seen the 28,800 submissions,
• is not qualified to comment on the quality of the submissions, and
• should allow the Justice Committee to get on with its business of considering the submissions.

David Seymour's dismisses organisations opposed to doctors killing patients or assisting suicides, calling them the anti-assisted dying lobby.

David Seymour is aware that this "lobby" fully supports lawful and ethical assisted dying as set out by the New Zealand Medical Association in its submission to the Justice Select Committee.

Ethical assisted dying is

• death with dignity and comfort,
• the right of patients to decline treatment,
• the right to request pain relief even it it may hasten the death of a patient, and
• the right of access to appropriate palliative care.

The "lobby", though, totally opposes assisted dying entailing the deliberate ending of a patients life or assisting their suicide masquerading as medical care.

David Seymour claims that opinion polls consistently reveal that the majority of New Zealanders support "medically assisted death."

Opinion polls deliver results favouring poll sponsors

The polls are misleading.

We believe that many of those polled simply want to ensure that pain relief and the withdrawal of burdensome treatment does not become illegal.

The polls have often been commissioned by organisations that support euthanasia and appeal to people's fears about "insufferable pain."

The result is therefore not accurate.

David Seymour says he hopes that submissions will have suggestions that will enable the Committee to improve the bill.

The truth is that nothing can fix this bill.

Nothing the Committee can do can make doctors killing patients or assisting in their suicide which is intrinsically evil ever acceptable, ever.

• Ken Orr is spokesperson for Right to Life NZ
• Image: ODT

The Fraser Health Board's decision to impose the provision on their facilities has been widely criticised.

A number of people have rejected the decision.

They include Vancouver's Archbishop J. Michael Miller, the director of Fraser Health Board's palliative care programme, many health care workers, volunteers, community leaders and concerned citizens.

"The government needs to immediately halt any efforts to force access to assisted suicide in facilities where caregivers - whether family, friends, or health-care workers or volunteers - selflessly attend to the sick and suffering," Miller says.

He thinks trying to coerce caregivers into supporting assisted suicide is "a serious error".

As communities "we must also ask ourselves where and why we are failing to provide for and accompany those who are dealing with lengthy illnesses or approaching death … we need to reach out to the suffering in our midst."

Miller says the Church must provide more support for the dying.

He notes "all of us, not only those who are caregivers, are called to act on Jesus's teaching," of carrying each other's burdens.

Furthermore, he said the provision points to an overarching concern, that the sick and lonely are "burdensome" to society.

In most cases adequate pain management can be offered to patients, he said.

"But what about the lonely, the abandoned, and those who see themselves as a burden to others or society?" he asked.

"How do we address their needs and assure them that their life has meaning?"

Miller is grateful for those who tend to people near the end of their lives.

"These men and women are an example for all of us … as we seek ever better ways to accompany the suffering, not to wash our hands of them with a lethal injection."

Dr. Neil Hilliard, who is the medical director of Fraser Health's palliative care programme, also spoke out against against the physician assisted suicide provision.

He pointed out it "is not in accordance with palliative care as defined by the World Health Organization, which "affirms life and regards dying as a normal process" and "intends neither to hasten or postpone death".

Hilliard has resigned as a Fraser Health director, but says he will continue to work with patients who "choose life in the face of death."

Source

• Catholic News Agency
• Crux Now
• Image: Fotolia

Dr Sinead Donnelly said she was affronted by the fact that "a politician would imply he understood the finer details of medicine and medical treatment better than me or my colleagues."

Donnelly said it was unfortunate even to repeat what Seymour said "but I do so to explain my justified outrage.

"For too long we have retained our professional discipline and shown restraint by not reacting publicly to such loose and ill-informed pronouncements."

She said doctors do not intentionally end the lives of patients by giving too much morphine.

"We train under strict supervision according to national and international standards of excellence in the discipline and science of use of morphine and other drugs for symptom control."

On Thursday 30th November in an interview with Hillary Barry on TVNZ, Seymour had claimed doctors were already providing patients with lethal injections and were assisting in their suicide. His words were, "It's happening anyway."

Donnelly said politicians do great harm to the perception of medical practice, and instil unnecessary fear and anxiety in the minds of the public by promulgating, on national television, incorrect, misleading and unsubstantiated statements.

"If Mr Seymour knows he is incorrect, then he is misleading the people. If he does not know that he is incorrect, then he is quite simply showing his abject lack of knowledge on this topic," she said.

Dr Sinead Donnelly trained as a specialist in general and palliative medicine in Ireland, Scotland and the USA. She has worked in Wellington since 2008.

Source

• New Zealand Herald
• Scoop
• TVNZ
• Image: Stuff

"But given the bi-cultural context of this country, we need to know what Maori want at end of life and how services can be better directed to meet their needs."

Working bi-culturally is the focus for Gott and her team on the Te Arai Palliative Care and End of Life Research Group at the School of Nursing, of which she is director.

As part of their research, digital stories were created by whanau about Maori caring for their kaumatua at the end of life.

When the digital stories were launched in 2015, one of the research team, Dr Moeke Maxwell, said they were to be used in the University's School of Nursing as a teaching resource.

The Digital Story telling began as a small part of the research programme, but it has had a huge impact.

"They are being heard within their wider communities, by health professionals and policy makers, which is an important first step to ensuring they receive better support," Gott said.

"We have also found completing a story helps individuals make sense of what is, inevitably, a very difficult time in their life."

"It has been beyond our expectations.

"The stories are being used across New Zealand, both within Maori communities and for teaching, and are being picked up internationally."

Gott says an example is the teams in Australia that are looking at replicating the idea in Aborigine communities.

The study was led by Dr Lisa Williams and co-researchers, Dr Tess Moeke-Maxwell (Ngai Tai) and Dr Stella Black (Tuhoe) along with Gott.

Watch a Digital Story

Source

• The University of Auckland
• Newsroom
• Screenshot: YouTube

As well as feeling proud that these young women were choosing to fill their free time with such worthy pursuits, the sight of the "hospice" logo brought back some very vivid memories for me.

Some years ago now, my gentle loving mother-in-law was told she had motor neurone disease. This has to be one of the cruellest diseases in the world.

Gradual loss of all motor ability, including movement, speech and eventually swallowing and breathing, yet retention of mental and cognitive faculties - I suspect it is a deeply frightening journey to be going through, and I fervently hope scientists around the world are making progress towards an eventual cure.

Until then, I had no idea that patients with illnesses like this could even access the hospice service, let alone be offered such a wide range of support - I had always assumed that the hospice only catered for people with cancer, at the very end of their life.

Over the years that followed, as my mother-in-law's health declined, the local hospice played a hugely important role in her care.

They offered a regular place of respite - very aptly named, as it does indeed provide relief for not only the patient but their caregivers too.

During these respite stays, the skilled hospice team could reassess her needs, adjust medications, and offer the kind of holistic care that is difficult for families to provide at home.

Arts and craft sessions, massages for tired limbs and achy muscles, and sympathetic counselling when required are just some of the benefits we saw during her visits there.

The fact that families, and especially grandchildren, were welcome there made it a place surprisingly full of life and vitality, and often laughter amidst the grief. Continue reading

• Dr Cathy Stephenson is a GP and forensic medical examiner.

Alternative therapy comes up most days but the vast majority of my conversations as an oncologist are about prolonging life.

They are about doing the utmost to extract the last drops from a finite life, if not for their own sake then for the sake of a child's graduation, a grandchild's birth, a friend's wedding.

The miracle my patients yearn for is not deliverance from their terrible disease but a little more time to cherish life, with all its shortcomings. They say that the drudgery of life beats the anonymity of death.

Yet as I walked out of a parliamentary committee hearing on end of life choices, a woman confronted me and nearly spat at me with silent rage.

"How dare doctors tell me I am not allowed to die?" she said.

Although this had not been the essence of my submission, her anger was palpable as she held out photos of her emaciated sister.

"I'm sorry," I replied.

"Sorry isn't good enough!" she scoffed.

I saw that she viewed the medical profession as the last bastion against the dignified death her sister was owed.

The encounter was still on my mind when I met a favourite patient. He was gaunt and frail, living from one morphine dose to the next. A proud farmer who used to tame intemperate bulls, he couldn't lift a glass of water now.

"I'll die when I die," he shrugged, "but I don't want my doctor to kill me."

This man held a strong opinion that no doctor should perform the dual role of sustaining and extinguishing life.

These two accounts illustrate the real dilemma faced by many in the medical profession when it comes to doctor-assisted euthanasia.

Our lived experience rarely matches the febrile and polarising debate occurring in the community. Continue reading

• Dr. Ranjana Srivastava is an Australian oncologist, a Fulbright scholar and an award-winning author. Her latest book is After Cancer: A Guide to Living Well.

SPIEGEL: Doctor Gawande, are you beginning to feel your age?

Gawande: Without question. I had to switch bifocals this year. I was always near-sighted and now I'm also far-sighted.

My 19-year old daughter has started beating me at word games because I just don't process like I used to. While playing tennis, I never had to stretch nor worry about injuries. That's over as well. Overall, it's the kind of little aches and pains that make you think: Yes, I'm getting older.

SPIEGEL: In your book "Being Mortal," you describe vividly what happens when we age: Our heart muscle's performance begins to deteriorate at 30, before the age of 40 our brain power starts to decline. At the age of 60, on average, we'll have lost one third of our teeth. Does your own decline scare you?

Gawande: It's an experience that definitely bothers me. The mental image I have of myself is still the person who was 30 years of age rather than the person turning 50 this year.

SPIEGEL: Four years ago, your father passed away at the age of 76. Did the experience of his death magnify your concerns?

Gawande: Surprisingly, no. It actually helped me. Up until the end, my father had things he loved and cared for. We should consider ourselves lucky to become older than the generation before us.

Many of us will become dependent, that's inevitable, but that doesn't mean one can't have a good life. For my book, I talked with a 94-year-old man. Every joint he had was aching. He had to support himself with one of those walkers that had tennis balls on each of the legs. Sometimes, he seemed confused. Yet, he had things he loved about life and that was true of my father as well. Continue reading

Sources

• Spiegel Online
• Image: AnswerCare