Next year when we go to the polls to vote in the next government we will be also be asked about euthanasia.
The Science Media Centre has asked some professionals working in nursing, psychology, law, and palliative care to answer some questions about the finer points of the Euthanasia Bill. In this post, I have included four of the many questions that they asked as well as the answers including one that asks about the Hippocratic Oath, which tells medical professionals to do no harm.
Question: How does the Hippocratic Oath fit in here, as it explicitly prevents the administration of lethal drugs?
Answer:
“This is a difficult point and a bone of contention for many in the healthcare profession. Drugs that are potentially lethal are given every day, just in doses that do not cause death. There is a very fine line between relieving suffering and giving too much medication. But the Hippocratic Oath is also based on beneficence and non-maleficence and so this is where doctors (and nurses) can decide if what they are giving is in the best interests of the patient.
“It would be easy to argue, however, that by not allowing assisted dying, harm is caused to some individuals. A position of balance is needed, and this may be where some practitioners feel able to support this Bill.”
Dr Rhona Winnington, Lecturer, Nursing, AUT (North Shore campus)
Question: How should terminal illness be defined, and how can we be sure we’re getting it right?
Answer:
“Determining terminal illness with less than 6 months to live will certainly be an educated ‘guess’ by expert clinicians and we can expect that clinicians will get it wrong about 25% of the time. However, it is important to remember that ultimately the decision to complete assisted death will be with the person who is requesting it. We know that in the US states where assisted death is legal, less than 1% of all deaths are assisted, and that of those that do request assisted death, almost one third will not utilise the prescriptions they have obtained to hasten their death and will experience death without clinician assistance.”
Dr Michal Boyd, Associate Professor & Nurse Practitioner, School of Nursing, University of Auckland
Question: What cultural considerations should the public have when we’re thinking about these potential law changes and who they will affect the most?
“Most affected will be those who care deeply about their loved ones and life after death, and the stigma it will generate throughout the lives of those affected. We keep the memories of our loved ones alive and they journey with us in so many different ways e.g. we remember them in our prayers, we acknowledge them as we approach the marae and in the marae, we talk about them to the grandchildren, and in stories we tell through social media or film, etc.
“Consideration should also be given to the differing expectations of family members as well as religious and cultural needs, and how this law change may not only impact life but also the human conscience and spirit (soul). For Christians, this is also an important time of prayer and worship with the church family.
“Consideration should also be given to the competency and ability of the person to know when and how to communicate, and to whom, when a person has reached end of life stage – is it the health practitioner whose role we see primarily is to preserve and protect human life? Do they know for sure when a person will die? within six months?
“When my father was diagnosed with stomach cancer, the doctor could not and would not tell us when he would die because he simply did not know.
“Placing a loved one in a rest home or hospice was an emotional and a very tough decision for caregivers and their families to make, and usually only undertaken when support needs were extremely high. The priority for patients and their families was to be cared for in the comfort of their own home, surrounded by their family and friends.
“As part of my research, a family carer told me how happy she is in the knowledge (sense of empowerment it gives her) that she’s done her duty to her parents right to the very end – caring for her mum until she died, and then later caring for dad until he died.”
Dr Ofa Dewes, Pacific health researcher, Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland
Question: How will conscientious objection work for health professionals?
Answer:
“There will be significant problems within the health care system if and when some doctors and nurses exhibit a willingness to commit an act of euthanasia when others are strongly opposed to such an act.
“I believe that several doctors and nurses will not only opt out of the entire process, but that they will actively resist it. In doing so, they will no doubt experience those instances of interpersonal disharmony and acrimony that may well occur after their refusal to participate. For newly qualified doctors and nurses, the pressure to conform will be even higher, because they will feel pressured to not ‘rock the boat.’ I therefore have great concerns in both instances, i.e. whether they refuse to participate, or whether they agree to participate. In the latter case, I really do wonder just how a decision to participate in the delivery of lethal doses of medication, remaining at the bedside until the act of dying has been concluded, and then carrying on with their other work will affect them both psychologically and morally in the medium to long term.
“I realise that all of this could all be a highly difficult situation for those doctors and nurses who are both opposed to and accepting of euthanasia. This ‘conscientious objection’ situation will of course be permitted under the proposed legislation, but it will come at a considerable price. For instance, there are known cases of both personal and interpersonal conflicts between nurses in countries such as the Netherlands who are prepared to perform an act of euthanasia, and those who are not. Nurses frequently suggest that euthanasia presents them with highly complex ethical quandaries, i.e. they feel that their involvement introduces significant personal conflict, moral uncertainty, guilt, frustration, fear, and secrecy, let alone the anxiety provoking challenges to long-established social and religious values or rules.
“For those doctors and nurses who do decide to take part in such an act, I have no doubt that some if not many of them may be haunted by the words of an ex-member of the Netherlands’ five euthanasia oversight committees, Professor Theo Boer: ‘We shouldn’t pretend that killing a human being whose natural life is not ended is normal. That is certainly not the view of Dutch doctors – they continue to stress that it is emotionally very burdensome to do euthanasia.’”
Dr Martin Woods, School of Nursing, Midwifery and Health Practice, Victoria University of Wellington