Physician Assisted Suicide - Palliative Care

Michael McCabe
Issue 1, August 2000

The recent visit to New Zealand of euthanasia advocate, Dr Philip Nitschke, the submission for ballot of a Death with Dignity Bill by MP Peter Brown, and the announcement of a further $3.5m [in addition to the $13.5m currently spent] for palliative care, by Health Minister Annette King, highlights an on-going debate in New Zealand about the care of the dying.

In announcing the additional funding for palliative care Annette King spoke of the need to ensure that people who are dying and their family/whanau have access to all the essential services, and that these services are provided in a co-ordinated and culturally appropriate manner. The New Zealand Palliative Care Strategy Discussion Document, launched at the same time, is designed to set in place a systematic and informed approach to the future provision and funding of palliative care services.

Advocacy for physician-assisted suicide needs to be set in the context of a much wider debate about how we as a society should care for the dying. We will all die, so how should we care for the terminally ill? Similarly, how should we respond to those who say, It is my right to choose how and when I die, or to others who say, It is the role of medicine to alleviate all pain and distress, and especially for the dying. How should we respond as a community to the needs of the dying? Should New Zealand introduce legislation to allow for the hastening of death for the terminally ill, similar to that in the State of Oregon in the United States of America or similar to that in the Netherlands?

The call to legalise physician-assisted suicide presents society with profound questions:

Is dying such an overwhelming experience that the only possible way out of this impasse is to allow assisted suicide?
Is physician-assisted suicide morally right, or morally wrong?
Is physician-assisted suicide consistent with medicine's role in relieving suffering?
Do we define a person's worth in terms of productivity?

While death is a natural part of life we do not handle this reality well. In this debate, it is easy to lose sight of who the terminally ill are people like us who once pursued careers, dreamed dreams, and raised families. As we go about our daily lives, theirs are coming to the end.

While not underestimating the complexities of caring for the dying, what the terminally ill and their loved ones often need is the type of support offered by the hospice movement adequate pain relief, symptom control, holistic care, and compassionate presence that enables the dying person to find meaning in their life's journey.

It is very natural for us to fear the unknown and to have fears about our dying. Rather than asking others to assist us in hastening our death, it is more helpful to become aware of what control we already have. Many fear dying because they are simply unaware of what options already exist for the terminally ill:

If pain is present, it can be controlled.
If treatments are having no effect, they can be withdrawn.
If symptoms are distressing, they can be addressed.

Advocates for physician-assisted suicide emphasise choice and empowerment as compelling reasons to legalise euthanasia. This argument founders when one considers the emotional wreckage resulting from the appalling teenage suicide rate in New Zealand. To allow assisted-suicide for the terminally ill is a dangerous precedent for society to set, especially when there is such an urgent need to continue to improve the care of the dying. To focus resources and effort on making better use of the insights of palliative care would not only enhance care of the terminally ill by reducing the gap between science and the bedside, it would also make assisted-suicide unnecessary.

Rev Michael McCabe, PhD
Director
The Nathaniel Centre