In New Zealand, unlike some other places, assisted death has some probability of the assistant being charged with homicide, and recently the question of assisted dying was raised by a legal case initiated by a lawyer Lecretia Seales, who was dying as a consequence of an inoperable and untreatable brain tumour. Her case was, she wanted to be permitted to have a doctor assist her death when the pain became intolerable without the doctor being liable for being charged with homicide, and her case was based on the Bill of Rights. In the end, Justice Collins refused her case, based, correctly in my opinion, on the fact that the Courts are there to implement the law, and not to change it. Justice Collins argued that it is the role of the politicians to change the law. As it happens, the politicians have had this issue raised many times, but they invariably ignore it. Lecretia happened to be known by relations of mine by marriage, and I have written letters to papers on this issue, and this post summarizes the arguments I believe are relevant.
To be clear here, the arguments I am putting forward apply only to the case of people with terminal illness that cannot be cured, there is pain that cannot be avoided, and no improvement is reasonably in sight.
First, why do the politicians duck the issue? In my opinion, because they fear losing votes from the minority that hold life sacred and are prepared to vote on that single issue alone. That is the curse of our form of government, which is in fact, if not in name, a Republic. A republic form of government is where the people elect their representatives; a democracy is where the people vote on the issues. More on politicians and governance in later posts. However, one comment here: the government is prepared to spend $26 million on a referendum on whether we should have a new flag. Why cannot a question be included where polls suggest 70% of the population would approve of a change? Is not letting the people vote an example of the democracy we claim to have?
The case for assisted death is simple: why should people have to put up with insufferable pain? The counter argument that there is palliative care does not apply because if that works, there is no pain. A recent survey of doctors carrying out palliative care showed that in a few per cent of the patients there was clear and intense pain, no matter what, and for some of the others, pain was avoided only by putting the person into such a sedated state that they were unaware of their surroundings. Exactly what is the point of that? What is the real difference between death and being totally unaware of your surroundings, from the point of view of the patient. The problem arises when the palliative care no longer works, and the evidence is incontrovertible that this happens for the unfortunate few. Exactly how many examples of “insufferable pain” there are is unclear because only the clearly worst cases will be acknowledged. That is because it requires a confession that palliative care has failed, and doctors are usually unwilling to admit they have failed. I believe the solution is simple: it is the person suffering the pain that determines whether it is sufferable, and not someone else, who really has no standing in the specific death.
There seems to be an argument, Let nature take its course. Well, we do not do that in general. The people that make this argument presumably die young with the pain of rotten teeth, but I suspect, hypocrites that they are, they go to the dentist. Similarly, I expect they will have surgery when an appendix flares, and take various pharmaceuticals to alleviate various troubles. We interfere with nature frequently to make our lives better, so why not improve them by stopping things that make lives worse?
There are a number of other arguments against assisted death, such as people will rush to it. As far as I know, there is no evidence of that, and in any case, it should be available only to people for whom there is no reasonable possibility of a cure. There is the argument that relatives will push for it. Again, there is no evidence, but again the assistance should only be available for people who are lucid enough to ask for it, or to set down the conditions in a living will. One of the more callous arguments that turned up in the Seales case was that if granted, more people with insufferable pain would request it. Why should a person bear insufferable pain? We do not allow our pets to. There are also examples of patients who do what they can to kill themselves rather than suffer, and, perforce, make a rather more unpleasant ending of it. There is one other point. If the patient knows he can pull the plug anytime, he can stop worrying about future pain and better enjoy what time he has left. Is that not desirable?
To me, there are two questions. Why should the views of others, of religious, “moral” or whatever origin, be imposed on those who are suffering? Why should not the purpose of medicine be to maximize the quality of life, including the quality of the end of life? We all die; why not make it avoid long and unnecessary torture? What do you think?
As a final comment, Lecretia died within 24 hours of hearing of the failure of her case. I am writing this to give her final case perhaps a little more meaning.