Assisted death

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.

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4 thoughts on “Assisted death

  1. An excellent argument. I have seen the pain, both physical and emotional, at the end of life when pain is all that is left. You are right, we would not inflict that on a dog, yet we do it to ourselves and to our loved ones. I lost my partner to cancer, thankfully before it became an unbearable burden… but we had discussed and agreed what would happen then. I almost lost my son when he was stabbed through the brain and left for dead. I know that medical miracles can happen… but not to those terminally ill and in increasing agony. I am no believer in suicide, but I do believe in choice. Many of those who are nearing the end of a long and painful journey would not have survived to reach that level of pain without the intervention of modern medicine in the first place. We prolong life simply because we can… it is not, I believe, something we always should do.

    • I feel for your loss, Sue. I also lost my wife recently to metastatic cancer, and we also had conversations about the end. It was a period that I can never forget, and I felt terrible throughout it because for once there was nothing I could do to stop the inevitable. Fortunately, she died before the worst occurred, so any choice was not required, but I could not help but think about what might have been inflicted on her.

      • It is a terrible, helpless feeling, when you watch someone you love in such pain and know you can do nothing, isn’t it. And you know you will do anything… regardless of the laws of your land. When my partner died, gently one morning, my first emotion was relief… I was simply glad he had gone before it reached a place of too much pain and loss of self for him. But no, we do not forget.
        I am so sorry that you and your wife had to go through this together.

  2. Thank you for your sympathy. For what it is worth, Claire told me more than once she merely wanted to get it over with, so I know she would not feel bad about it. As it happened, she died somewhat earlier than anyone expected, but yes, as you say, the time she was bed-ridden was terrible for both of us, in Claire’s case because she felt badly about leaving me, which is what she was – always thinking of others and not of herself.

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