Alarm bells

The latest Ministry of Health reports on euthanasia raise many questions. I address four of the most critical, including that the numbers being presented, don't add up.

In a month or so, we will see over one thousand New Zealanders having ended their lives by euthanasia.   This is based on the Ministry of Health’s latest reports on euthanasia/assisted suicide state that since the law came into effect (November 2021) till June this year, 867 people have died already.

My opposition to euthanasia is well known but I think many people will still find this number very high for a ‘service’ that has been running for just under three years.  I recall when I chaired the Health Select Committee inquiry into euthanasia that proponents for change spoke of numbers being in the tens.  I knew then, as we know now, that once you open the door to euthanasia you begin in the hundreds and it only expands from there.  Already in New Zealand we are seeing more and more people taking the euthanasia route as well as politicians looking to expand the criteria so the numbers will inevitably get larger.  We only need to look to Canada to see how far, crazy, and disturbing this goes.  In one instance a man went into a hospital feeling suicidal and seeking help, and was then euthanised; in others, military veterans were offered euthanasia as a cheaper option than installing the likes of wheelchair ramps; or the case with Candice Lewis, a 25 year young woman with cerebral palsy and spina bifida who was told by ED doctors it would be selfish to not take assisted suicide.

Stepping aside from the ethical debates around euthanasia, it is fair to say that from reading the reports, there are significant problems with the law as it stand - yet little attention is being paid to this.  Even if you are someone who conceptually agrees with euthanasia/assisted suicide, the issues below should be of concern and ringing some alarm bells.

Again, no matter what you think about euthanasia (in favour, or oppose) – the law ultimately gives enormous power to the State to end some citizens’ lives.  It is a frequent misunderstanding that the individual is making the choice alone.  We all have choices around life and death, but euthanasia provides a legal pathway for others to be involved in someone’s death.  This is a unique power both in terms of the action (someone needs to terminate your life) and also legal protection (the doctor/nurse cannot be charged with murder as they would in other circumstances).  Due to this, enormous care must be taken to ensure the legal processes prescribed are followed, and that compliance and accuracy are monitored.

There are at least four red flags in recent reporting and operational dynamics that need to be highlighted and should be of serious concern to New Zealanders:

THE NUMBERS DON’T ADD UP

Through the good work and diligence of a friend, he has highlighted that the official numbers around euthanasia, being put out by the Ministry of Health, do not add up - that one set of reports contradicts the others.

When we take the latest quarterly report (end of June) and look back over the previous twelve months, there is a reported total of 347 deaths by euthanasia/assisted suicide.  However, when you read the annual report from the Register that covers the same time period, she says there were 344 deaths.

The same discrepancies exist when you compare the number of applications for assisted suicide/euthanasia.  The quarterly reports say 847, while the annual report say 834.

At one level the difference in numbers may not look like much. There was only a difference of three deaths and thirteen requests.  If this was three dollars missing from a five million dollar bank account, most would barely notice and just ‘account’ it away.  It’d probably not be a big deal.  But we are not talking about bank accounts here or money.  We are talking about human lives; and lives that are specifically and deliberately being ended.  I would hope that, no matter ones view on the ethical nature of euthanasia, we would all agree that this a serious issue that needs addressing.

If the Ministry of Health cannot accurately record the number of euthanasia deaths – something we would presume is relatively simple and straightforward – then confidence in the operations of the wider system is challenged.   Questions are being put to the Ministry about this, and they will need to be very clear as to why they got the numbers wrong.  As I have said many times when it comes to euthanasia, one erroneous death is one death too many.

EVERYONE’S FINE …

The reports also note that only one in every one hundred people are being referred for a psychological assessment when requesting euthanasia or assisted dying.  This is extraordinarily low, indicating that doctors are either missing the signs or ignoring them.

Every day we see headlines about significant and widespread mental health issues in New Zealand and yet we are somehow to believe that only 1% of all those seeking euthanasia have psychological issues worthy of further consideration.  From the reports, can we infer that doctors involved in euthanasia believe that 99 of every 100 people they see are emotionally stable, carefree, rational, and calmly contemplating the end of their lives.

Those involved in end of life care will tell you that depression, anxiety, worry, and upset are all normal for those dying or having received a terminal diagnosis.  They will also tell you that family members also feel these emotions and tensions.  This is normal and natural.  I have spent enough time in hospices and hospitals, and with those suffering and dying, to know it’s a highly emotional time for all involved.

So, for euthanasia doctors to assess 99% of patients as being perfectly fine and not requiring any further psychological assessment is just not believable.  As I noted at the start, either they are choosing to ignore the evidence in front of them or they do not have the necessary skills to make the assessment.   

A COMMITTEE THAT STRUGGLES

Up until very recently, the three person body known as the  End of Life Review Committee, has never been fully constituted.  This committee is meant to comprise of a medical professional (doctor), a health professional (e.g. a nurse), and an ethicist. Since euthanasia became legal the review committee has struggled to have either an ethicist or a doctor on the panel.

Some may say that this is not a big deal.  I say it is.  This committee exists to make sure that euthanasia is operating within agreed legal and medical frameworks, and is why the three roles are quite specific and necessary.  Proponents of the law always make a big deal about the supposed robust processes and systems in place.  If they cannot even find three people to fill the oversight committee, how can we have confidence that the systems are working appropriately.

It also must be asked, why the government has struggled to find people for these three roles?  The answer of course is simple - so few doctors, nurses, and ethicists want anything to do with euthanasia, let alone be on a panel to review the deaths that have occurred.

WHERE’S THE MONEY??

One other worrying aspect in the reports was that one in four people seeking euthanasia were not accessing palliative care.  Positively, three in four are!  However, we should be asking questions as to why one in four are not.  Palliative care is an essential part of end of life care – be this full medical care or simply having a professional to talk with as you journey through to the end.

I suspect this situation indicates the inability of some New Zealanders to access palliative care.  So to that end, the issue is not so much about euthanasia as equity of access - although of course, if you cannot access palliative care, then euthanasia may look like a good option.  

We have some amazing hospices and services, but they are not available throughout New Zealand.  It is a bit of that ‘postcode’ lottery that politicians talk about.  We also have limitations on what General Practitioners can prescribe in terms of ‘end of life care’ drugs.  Finally, we also know there is a lack of government funding for palliative care.  There is a reason hospices in particular run so many fundraisers and have second hand stores and the like.  They need to raise lots of money to provide their essential services.

The sad irony is that the government fully funds euthanasia but refuses to fully – or even better – fund palliative care.  Euthanasia ends life prematurely.  Palliative care gives life to the very end.   I know which one I would preference funding for.