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Time to look at end-of-life ethics in New Zealand – comments

Press Release – Science Media Centre

Today’s sentencing of a scientist in a high profile assisted suicide case has re-ignited debate on the ethical and legal issues surrounding euthanasia, and assisted suicide.Time to look at end-of-life ethics in New Zealand – updated comments
24 November 2011
Today’s sentencing of a scientist in a high profile assisted suicide case has re-ignited debate on the ethical and legal issues surrounding euthanasia, and assisted suicide.

Sean Davison — now a forensic scientist in South Africa — was sentenced in Dunedin to 5 months home detention for “counselling and procuring” the suicide of his terminally-ill mother Patricia Davison.

Further background on the case, details of New Zealand’s high aged suicide rate and the findings of an expert euthanasia panel in Canada were included in an earlier SMC alert and can be found on our website.

Please find below updated commentary, collected by the SMC, from New Zealand experts on end-of-life ethics, in the wake of the Davison sentencing and the Canadian report recommending legalisation of euthanasia.

Feel free to use these quotes in your reporting. Please contact the SMC if you would like to contact these experts.
Prof Mark Henaghan, Dean at School of Law, University of Otago (abridged, read in full here):

“The one area where we don’t have anything — such as in the Sean Davison case — is the area of voluntary euthanasia, or assisted suicide”

“There’s not a perfect answer. If you leave things as they are, you end up with the problem Mrs Davison faced, and that seems a little tough. The changing demographics of the NZ population — with an increase in the proportion of elderly — means that these issues should be discussed. Though I felt very sorry for Sean Davison, I think the court case has brought the issue to a head”.

“Its the one area where there is still a criminal offence and I think that’s the area we need to focus on. It’s a question of whether we see that as sufficiently different to switching off life support or whether we move quickly to a much more liberal position based on autonomy, an individual’s choice. To say that so long as an individual makes a choice, a doctor should act on it: that’s quite a big leap. I don’t think society would be ready to make that leap quickly.

“We do need to debate it — that’s something we haven’t done enough of. A mature society like ours should be able to debate these things in the cold light of day — it’s slightly less emotionally-charged than the abortion debate, but has similar implications”.

Professor Donald Evans, Bioethics Centre, Otago University (abridged, read in full here):

“There is a great deal of difference between cases of withdrawing treatment and allowing a person to die on the one hand and deliberately administering substances or using other means to deliberately commission the death of a patient.

“More difficult are the cases where a clinician administers an agent which somewhat hastens the death of the patient but which is not administered for this purpose. Here the traditional doctrine of ‘double effect’ is invoked. It is not perfect but it is the best account of such cases possible. The contrast here is between, on the one hand, delivering a drug like diamorphine to relieve the otherwise intractable pain of a terminally ill patient. The drug has the side effect of depressing respiration and, in some cases, hastening death. The doctrine distinguishes between, on the one hand, administering a drug as a pain killer with the unintended but known possibility of hastening death , and, on the other hand administering a patient killer such as Potassium Chloride to produce cardiac arrest and thus kill the pain by killing the patient. Thus though suffering is the trigger for such extreme treatments their proper application does not count as deliberate commissioning of death even the price of pain relief is a possible foreshortening of life.

“Doctors in my experience do not want the law to impose such a right on them. They are trained to save life and to relieve suffering. Of course they know well how to end the life of a patient but this activity they do not regard as part of their professional calling. Indeed they are rightly concerned that bestowing such a right on them would be to oblige them to take a poisoned chalice (to use an unfortunate metaphor). They fear that the doctor/patient relationship would be fundamentally altered where the doctor might be seen as an agent of death. The elderly, the severely disabled, the seriously ill might be concerned that in times of scarce resources they might well be considered as usefully dispensable by the medical profession.

“There will always be a small number of practitioners who, with pressure groups, support such changes in the law. Where such changes have occurred, as in the Netherlands, the provision of good hospice care and the research into pain relief has been put on the backburner.

“Whilst one has great sympathy for individuals who have been placed in the invidious position of being on the receiving end of passionate requests from loved ones to assist them to die a change in the law to permit such actions would produce many more extremely worrying cases of disregard for the dignity of human beings.”

Previous comments collected by the Science Media Centre

Professor Glynn Owens, Department of Psychology, Auckland University:

“There are difficulties in any legislation being able to cover all groups – with the best will in the world there will be people for whom euthanasia might be a desirable option but who fall outside the guidelines. In every country where research has been conducted (including NZ, where it is illegal, and the Netherlands, where it is legal) cases occur which fall outside the law.

“The (Canadian report) lacks a reference to the person being (terminally) ill, which raises many interesting questions. Most countries where there has been some form of legislation have specifed as a requirement that the person concerned be suffering from a life-threatening illness; the Netherlands is a notable exception here, and indeed there has been at least one case of euthanasia being provided for a person with no significant physical health problems. The question becomes one of whether “unbearable and irremediable suffering” is sufficient justification.

“I am unimpressed by ‘slippery slope’ arguments which are usually ill-formulated and defined, and which typically do not indicate the supposed underlying mechanisms. It is no coincidence that philosophers refer to “The Slippery Slope Fallacy” and indeed one writer has tellingly noted that “once you start accepting slippery slope arguments you’re on a very slippery slope” .

“I think it’s extremely important that these issues be discussed in context, and that we recognise that what is appropriate in some countries may not be appropriate in others. For example in some countries it is never going to be possible to provide high-quality end-of-life care for all citizens (this is one reason why the Northern Territory of Australia, with some very isolated small centres of population, was keen to permit the legalising of Physician-Assisted Suicide). There is no doubt that the decision to end one’s life can be rational (our military history books are full of the stories of war heroes who are assumed to have made such decisions).

“Personally speaking, I would welcome the establishment of a similar working party in New Zealand to consider the issues in depth. Although I do not personally like the idea of euthanasia, I am certainly willing to consider the topic dispassionately”.

Associate Professor Rod MacLeod, Department of General Practice and Primary Health Care, Auckland University, on the Royal Society of Canada Report (abridged):

“In my view this (Canadian) document does not provide a balanced view at all. The information and comment about the effect and value of palliative care is minimised. Indeed some of the terminology used is confused in its thinking. Terminal sedation, in the glossary, has an ambiguous meaning and is not what I and the majority of my colleagues would understand as terminal sedation. Therefore comment about some aspects of this paper are guarded. Related to these comments therefore I must assume that the ‘expert’ advice given about palliative care may have been misleading or of a poor standard.

“The commentary in favour of euthanasia and physician assisted suicide (PAS) based on a philosophical argument of respecting autonomy is flawed in my view. This is an entirely western view of ethics and for example, it is my understanding that autonomy (individual autonomy) is not the over-riding ethical principle in the Pacific people for example. Whilst one may argue for autonomy in this instance there are many other examples where autonomy is not the over-riding ethical principle – we are not ‘entitled’ to various sorts of health care intervention just because we want them.

“In New Zealand, we do have a developing programme for the completion of advanced care plans – this will enable NZers to have those conversations about end of life care that may not be happening now.

“The impact of legalising euthanasia and PAS would be enormous on institutions and on individuals. How can this be accommodated within public hospitals for example? What effect will it have on the doctor patient relationship? This is built on trust, respect and compassion which may well be damaged if the patient thinks that the doctor may possibly be the one to end their life.

“If we are to have an on-going debate in New Zealand (and we almost certainly will) I sincerely hope that we will have a better informed one than is suggested by the contents of this document”.


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