Euthanasia bill passes, awaitng public referendum

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#2353631 15-Nov-2019 07:44

JaseNZ:
Which would be a shame if they back tracked it is after all democratic vote , My vote would be a definite yes and I would like to think it would be honoured if that was the majority consensus.

Opinion polls consistently give close to 70% support for this in general. It would have to be a bad bill to lack that support at the referendum.

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#2353717 15-Nov-2019 09:00

Fred99:

JaseNZ:

Is this a binding referendum regardless of who gets into power ??

I think that the strict answer to that has to be no. Parliament makes laws, convention says that they should respect the binding nature of a referendum even if they opposed it, but it doesn't stop them from either not enacting it, or reversing any legislation on a whim (ie: even if recreational marijuana use was legalised, it could be made illegal again). So even if a party says they'll honour the referendum they can change their mind - but that could probably be political suicide.

I think in Aus, there's mention of "referenda" as binding in their formal constitution. The easy way around that is to have a Claytons' referendum - by calling it a plebiscite - thus effectively a non-binding "poll". Thus the "plebiscite" they had a couple of years ago on marriage laws, non binding, a government full of religious extremists and assorted nutters, but they honoured the result anyway.

I think the principle is Parliament is absolutely sovereign. So theoretically, if the referendum passes there is nothing to stop a future government from passing a euthanasia repeal act that reverses it. The law is not entrenched in any way so it will only require a stright 50%+1 majority in the house to change it. Obviously with an estimated 70% public support for it it will be unlikely for a party to go strongly against it.

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#2682376 29-Mar-2021 10:43

I see from this that the anti-euthanasia forces are fighting a rear-guard action against the bill. They insist that many euthanasia candidates would change their minds if only they were presented with better palliative care options. I have my doubts about this. For one thing, they are only talking about physical pain management. My understanding is that current treatments cannot manage pain in all cases. Pain is a subjective matter. How can any doctor really know what a patient is experiencing?

Apart from that, why the obsession with a ‘natural’ death? Pain is not only physical. Even if you can remove someone’s pain without turning the person into a vegetable, what then? Do they spend months lying in bed unable to move staring at a wall with only their thoughts for company as they wait and wait and wait for the end? That hardly seems like an improvement.

I can’t prove it, but anecdotal evidence that emerged during the euthanasia debate strongly indicates that most of those so vigorously opposing euthanasia are practicing catholics. Of course anyone is entitled to believe anything they like, but that does not entitle them to impose their beliefs on others, especially others who are suffering. This is a personal issue for me as I am close to someone in this situation.

Okay, let’s assume for the sake of argument that someone in the last stage of a terminal illness can be kept free of physical pain. Now what? Most people in the last stage of a terminal illness are incapable of physical activity. They are usually confined to bed. Are YouTube videos supposed to give them quality of life in their final days? Are they going to think thoughts they have never thought before? How many times can they say goodbye to their loved ones? Probably they will pass the time by just sleeping more.

If someone decides they have had enough, I fail to see what point is served by making them cling on. Of course this must be their own choice, but if they choose a peaceful exit, what value is added by denying them that? What great revelations will they experience in another few weeks of waking and sleeping, waking and sleeping? The alternative to euthanasia is not suddenly springing back to vigorous life. It is just a slower trip to the abyss. If someone wants to put it off as long as possible, let them. If someone doesn’t, also let them. Keep the moralistic value judgements up your cassock where they belong and allow dying people the basic respect of being able to die without having to put up with unceasing preaching in their ear to the bitter end.

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#2682556 29-Mar-2021 14:53

Rikkitic: I see from this that the anti-euthanasia forces are fighting a rear-guard action against the bill. They insist that many euthanasia candidates would change their minds if only they were presented with better palliative care options. I have my doubts about this. For one thing, they are only talking about physical pain management. My understanding is that current treatments cannot manage pain in all cases. Pain is a subjective matter. How can any doctor really know what a patient is experiencing?

I don't see this as an anti article. The article quotes respected experts in palliative care. It could well be a good point:

Article: Patients wanting euthanasia must be over 18, have a terminal illness likely to end their life within six months, be experiencing unbearable suffering and have the capacity to make an informed decision about it.

At face value this does not specify that access to high quality palliative care is required. Perhaps that is an omission.

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#2682558 29-Mar-2021 14:55

Rikkitic: I can’t prove it, but anecdotal evidence that emerged during the euthanasia debate strongly indicates that most of those so vigorously opposing euthanasia are practicing catholics.

This could be seen as implying that the professionals quoted are practicing Catholics and additionally are not making any medical point at all. I see no evidence for that either way. Even if they were practicing Catholics I'd be inclined to assess the quality of the evidence they are providing rather than religion. To me this article appears to raise valid ethical concerns around end of life care. It does not appear to be anti.

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#2682563 29-Mar-2021 15:23

To take all your points, the article in itself is not anti but the arguments it cites are, especially if you read between the lines. The entire piece, from beginning to end, is about doubts and expected problems with euthanasia. Nowhere is there a single positive comment to be found:

'Palliative care specialists fear health practitioners with as little as six hours online training could end up providing euthanasia for patients who would have wanted to live if they had proper care and pain relief.' That is the lead sentence.

'Palliative care specialists say that might mean euthanasia is unavailable in some areas and a small band of itinerant doctors with no connection to their patients may do the bulk of the cases.'

'He said that meant that under the euthanasia regime people who would have changed their minds could be put to death.'

And so on and so on. The entire article is a thinly disguised anti-euthanasia hit job. I used to be a journalist and I have seen plenty of these. I know how it works.

I vividly remember the debate between David Seymour and Dr Sinead Donnelly. I am not a fan of Seymour but he was brilliant in this and he did an excellent job of triggering Donnelly's catholic prejudices, causing her to completely melt down and start ranting. I have also been personally involved in a letters to the editor debate with another couple. As with Donnelly, they tried at first to keep their catholic beliefs in the background but their true motives emerged as the discussion continued. From these and other examples I have seen, the strongest opponents of euthanasia do appear to be catholic, and they do try to keep the fact quiet until they are cornered. Most if not all palliative care specialists seem to be strongly anti-euthanasia and at least some are certainly catholic. There almost seems to be an element of turf protection to this. If palliative care specialists start from a standpoint of prolonging life as far as possible regardless of any other consideration, they can hardly be seen as objective professionals.

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#2684279 30-Mar-2021 19:40

Rikkitic: To take all your points, the article in itself is not anti but the arguments it cites are, especially if you read between the lines. The entire piece, from beginning to end, is about doubts and expected problems with euthanasia. Nowhere is there a single positive comment to be found:

I think that's fair in a sense. Public support at the referendum was overwhelming, the law has passed, it will happen, and from this point it's all about details of implementation and interpretation. The implementation will affect real lives and it's worth considering the points made.

Googling randomly I see at least one of the professionals potentially has a private association with a Catholic institution, so you might or might not be right about that part. The article does not indicate if the two medical professionals quoted are fully against the legislation and the whole concept in it's entirely. Regardless, I think the general point made around access to palliative care and understanding of palliative care is worth considering regardless of who made it or why.

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#2684397 30-Mar-2021 22:31

My argument has always been that people should have a genuine choice. I am neither for nor against euthanasia as such. Those who reject it for themselves should never be pressured to change their minds. It is a valid choice that must be respected. The converse is also true, and that is where I have problems with those who propagate against it. Just because someone believes it is wrong, does give them some special right to impose their belief on others.

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#2685191 1-Apr-2021 08:38

Rikkitc: Just because someone believes it is wrong, does give them some special right to impose their belief on others.

I agree, but that is the not the question here. The referendum passed with overwhelming support. There are very serious ethical questions being raised around implementation and these should be considered in implementation:

RadioNZ: University of Otago bioethics researcher and palliative care physician Dr Janine Winters presented an international literature review to the Ministry of Health in February.

It included a 2000 study from the Netherlands where in 21 of 114 cases, the patient did not die as soon as expected or woke up and the physician had to give a lethal injection.[...]

But Dr Winters said there were other legal and ethical issues such as whether the patient would again have to give consent - something she believed the New Zealand law had not contemplated.

This is a perfectly valid ethical concern. In the same article the NZ Nurses Union state concerns that their members have not been provided with any best practice or ethical guidance at this time about how to interact with patients on this topic. This is important because nurses are a point of contact and discussion with patients. Same again.

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#2685241 1-Apr-2021 10:52

gzt:

I agree, but that is the not the question here. The referendum passed with overwhelming support. There are very serious ethical questions being raised around implementation and these should be considered in implementation:

RadioNZ: University of Otago bioethics researcher and palliative care physician Dr Janine Winters presented an international literature review to the Ministry of Health in February.

It included a 2000 study from the Netherlands where in 21 of 114 cases, the patient did not die as soon as expected or woke up and the physician had to give a lethal injection.[...]

But Dr Winters said there were other legal and ethical issues such as whether the patient would again have to give consent - something she believed the New Zealand law had not contemplated.

This is a perfectly valid ethical concern. In the same article the NZ Nurses Union state concerns that their members have not been provided with any best practice or ethical guidance at this time about how to interact with patients on this topic. This is important because nurses are a point of contact and discussion with patients. Same again.

I went through this with a strongly opinionated couple via the letters column of my local newspaper. They also cited studies done in The Netherlands. So I dug deeper and discovered that their sources were catholic publications citing other publications and the couple were also catholic. Unlike the couple, I speak Dutch so I went to the original sources and could see how the facts were 'adjusted' to support a particular viewpoint. I demonstrated this in my final letter, to which there was no further reply.

The Dutch study you refer to is probably this one. It was published in the New England Journal of Medicine so is in English, if you want to read it. The study actually looks at two different groups of people. In the Netherlands assisted suicide as well as euthanasia is legal. The two categories involve different requirements and procedures. The group of 114 were not euthanasia cases, but assisted suicide. The authors point out that the problems described mainly occur with assisted suicide, not with euthanasia. This is from the paper: "In general, problems were more frequently reported in cases of assisted suicide than in cases of euthanasia. The responsible physician decided to administer the lethal medication in 21 of 114 cases in which the original intention had been only to provide assistance with suicide. In most of these cases, the patient did not die as soon as expected or awoke from coma, and the physician felt compelled to administer a lethal injection because of the anticipated failure of the assisted suicide. In some cases, the physician administered a lethal injection because the patient had difficulty swallowing the oral medication, vomited after swallowing it, or became unconscious before swallowing all of it."

Without getting into arguments over the moral aspects, this example illustrates the importance of looking for multiple sources to establish context. Otherwise simply quoting one source without context can create a false impression, whether intended or not.

I do not know if Dr Janine Winters has a hidden agenda. I haven't researched her private life. But the reason I keep bringing up the catholic faith is because I keep discovering that many vociferous objectors to euthanasia turn out to be practising catholics, though they don't advertise the fact, and the clear instruction of the church is to oppose legislation like this with all possible means. That makes me question the objectivity of such professionals. If they follow their faith in this, they have to oppose euthanasia regardless of any evidence. I would not trust such a person to look after my own medical interests.

Dr Winters is a hospice and palliative medicine physician and both she and the Hospice New Zealand organisation have officially come out strongly in opposition to euthanasia. You can read her statement here in the Otago Daily Times. I don't question her professionalism but how objective can any review of hers be in a situation like this?

I fully agree that the ethical questions raised by euthanasia are legitimate and must be adequately dealt with before this law comes into force. I also agree that medical people who will have to deal with this must be given proper practical and legal advice. I do not have any problem with any of that, but as I originally stated, I harbour a suspicion that religion-motivated objectors to euthanasia are trying to use these perfectly valid arguments as a kind of rear-guard action to undermine application of the law and that needs to be called out.

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#2685305 1-Apr-2021 12:56

I was aware of the Otago Daily Times article. That one was prior to the referendum.

Rikkitic: The Dutch study you refer to is probably this one. It was published in the New England Journal of Medicine so is in English, if you want to read it. The study actually looks at two different groups of people. In the Netherlands assisted suicide as well as euthanasia is legal. The two categories involve different requirements and procedures. The group of 114 were not euthanasia cases, but assisted suicide.

Well, that's a revelation. Thanks for that. That makes the article I quoted extremely misleading in that aspect.

There is a separate quoted figure in the journal article for euthanasia - a term which I object to because I think it's more like end-of-life-choices-in-extremis in the NZ context and legislation - and it looks like that figure may take some untangling before it's clear. I'll return to read the journal further at some point.

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#2685314 1-Apr-2021 13:11

I'm not saying that all anti-euthanasia campaigners are massaging the facts to serve their prejudices. I don't know. I just have a strong hunch that at least some of the hospice brigade are not being completely straight. Selective quoting that plays up one side of a debate and minimises the other does not serve the pursuit of truth. Probably there are some mistakes that shouldn't have happened but that doesn't mean nobody should be entitled to end their suffering when they choose.

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#2695159 20-Apr-2021 09:09

RNZ seems to be doing a series of very negative one-sided hit pieces on the legislation. This is the latest. It doesn't even pretend to be objective in any way, but is designed to make people as fearful as possible about the integrity of the process.

Countries like Switzerland and The Netherlands have been doing this for years and have plenty of experience to draw on. Also American states like Oregon. Even in this country, veterinarians routinely put down animals large and small. It is not rocket science.

I am a former journalist and I'm good at reading between the lines. This smells to me like an orchestrated campaign designed to serve a particular agenda. I expect better from RNZ.

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#2695480 20-Apr-2021 22:33

Rikkitic: RNZ seems to be doing a series of very negative one-sided hit pieces on the legislation. This is the latest. It doesn't even pretend to be objective in any way, but is designed to make people as fearful as possible about the integrity of the process.

Once again I don't see this the same way. As a supporter of end-of-life-choice I see these issues as valid ethical questions that must be addressed in NZ context.

I did find the comparison between American lethal injection and NZ end-of-life choice entirely hyperbolic and speculative and I really wonder where that one came from.

After your earlier asseement I do think that journalists have a responsibility to understand and elucidate any non-secular motivation on the part of interviewees.

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#2695933 21-Apr-2021 11:04

As I think I have made clear, I fully agree that valid ethical questions about this should be addressed in the New Zealand context. I don't have any issue with that at all.

But this is not what the RNZ articles are doing. Just start with the headline on this latest one: 'Distressing death warning for "unregulated" euthanasia drugs'. That is not a neutral heading. It is calculated to be alarmist. It is also misleading, as you yourself have pointed out, since it intentionally conflates amateurish experiments with execution drugs in the USA with entirely different drugs and procedures that might be used for euthanasia. It goes out of its way to paint a scenario of failed and possibly painful (physically or mentally) death attempts that is in no way substantiated by the information in the article. It is designed to scare, not inform. It is a hit piece serving a specific agenda. And just in case readers have not already got the intended message, the very first sentence of the article is this: ‘Patients requesting euthanasia will be given unapproved, unregulated and "off label" medicines, sparking warnings of prolonged and distressing deaths.’ That is hardly a neutral, objective statement.

‘Hundreds of pages of documentation, much of it heavily redacted, has been released under the Official Information Act to RNZ as part of an investigation into how prepared New Zealand is to introduce assisted dying.’

This sentence from the article almost seems to suggest that someone is trying to hide something. Uh oh, nefarious things going on. What the article doesn’t mention here, though it does come up later in a different context, is that it is illegal to specify methods and substances used to bring about voluntary death. No wonder the documentation is ‘heavily redacted’.

After that comes Dr Bryan Betty and a largely gratuitous excursion along improvised intravenous execution drugs in the USA, with a sudden unheralded leap from intravenous to oral, then back to American executions.
The article keeps bouncing between oral administration and injections, using the issues of one to cast doubt on the other. These are two distinct and separate procedures that have nothing to do with each other. Where euthanasia exists, the standard method of administration is almost always by injection. This does not cause vomiting and the other issues associated with oral administration. Focusing on that is intentionally misleading. It is also worth mentioning again that assisted suicide is not the same thing as euthanasia, and oral administration almost always means assisted suicide, as it involves a wilful act of the person concerned.

Once the propaganda is stripped away, the main points of the article are that drugs for oral administration may not have undergone Medsafe approval, while those used intravenously will not have been approved for this specific purpose. This does not mean they won’t work, or will necessarily have bad side effects. It is noteworthy that the article quotes different experts opposed to euthanasia in any form, but not a single one who actually supports it. All talk about the possible problems. None discuss the likelihood of those problems not occurring at all. Yet New Zealand has the benefit of the considerable knowledge and experience acquired overseas. It is not like we have no idea how to approach this. Once again, we have been doing it with animals of all kinds for many years. There is no reason to think it can’t also be done with humans. By all means let us investigate any potential issues thoroughly, but let’s do it honestly and without preconceptions.

While careful reading of the article does provide more nuanced information, most people are not careful readers and will react to the deceptive and emotive bits. It is a hit job serving an agenda and not the kind of analysis RNZ should be doing.

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