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General Practitioner explains why he supports End of Life Choice

ARTICLE POSTED: 16 February 2018 - Dr David Robins. Retired General Practitioner


I am a retired Medical Practitioner with a career of over 45 years in family medicine, anaesthetics, obstetrics, emergency medicine and remote-area practice. While my voice is only one of many, I hope that it will be understood that this article is based on a lifetime’s experience of dealing with sickness and death, rather than on any abstract concept of philosophy, religious dogma or ethics.

Very often, the fortitude of my patients at the end of their lives has been a source of admiration and inspiration to me, though sadly on some occasions a painful, lingering, ugly death has been a salutary and fearful moment. Like very many of my colleagues, I have on occasions administered medications, to relieve pain or distress, that I know will hasten a patient’s demise, but I appreciate that this is difficult in institutions outside the privacy of family practice. On very rare occasions I have been asked, by patients or their relatives, to intervene to assist in a more painless and dignified death, and have been saddened that current law does not permit this. I certainly would have considered complying with patients’ requests had the law permitted it. I suspect that such requests will become more common than was the case in the past, as more frail dependent or elderly people, and some survivors of modern medical practices, are more likely to die slowly and miserably.

I would like to pay tribute to my medical, nursing and counselling colleagues who work in palliative and terminal care, and this article is in no way intended to denigrate their efforts. Indeed, I believe that more resources in this area would reduce the number of seriously ill people taking their own lives, or requesting assisted deaths should legislation allow this. And yet…. there are rare occasions when the best efforts of palliation just cannot bring adequate relief from suffering, particularly at life’s end, but also in some cases of chronic or progressive illness. Surveys show that most people, particularly as they age, have less fear of death itself than concerns about the manner of dying, particularly fear of pain and distress, loss of bodily functions, and loss of control, especially if the process is prolonged. In these circumstances the end can be, to misquote Thomas Hobbes, not ‘nasty brutish and short” but rather ‘nasty brutish and long” In most cases these fears are unfounded. Palliative care, if needed, is usually effective in symptom relief, and conscious control is often preserved until the end. Many deaths are unremarkable, some are inspiring or even heroic, but a few are emotionally and/or physically distressing in spite of palliation, putting both the dying person and their family and friends through immense and sometimes long-term emotional trauma. It is in these cases that help could and should be available to expedite death in those who, in their right minds, request such action.

In my view, possibly the most important reason for legislation to permit assisted dying is to allow all of us, particularly as we get older, to anticipate our ends with less trepidation, knowing that clear choices for intervention (or non-intervention if we so choose) will be available at the end, even though few of us will ever need such assistance. Therefore legislation in these matters has the ability to affect, for the better, every inhabitant of this country, by allaying the fears that I have mentioned. Any legislation will clearly have to include extensive checks to prevent coercion of the vulnerable, and to ensure that informed consent by the patient is given for any assisted death, and under these circumstances I cannot accept the ‘slippery slope’ arguments of those opposed to legislation which is not, I believe, borne out by overseas experience. It is also a huge insult, both to those family members and friends of the terminally ill who have their loved ones’ interests at heart, and also to the medical and legal professions who would be involved in ensuring consent and lack of coercion - I believe that we can trust doctors involved to meet these criteria, and any deviation from these restraints would obviously be a criminal offence, and would have grave consequences in a doctor’s ability to continue in practice. Furthermore it shows disrespect to our elected representatives in their ability to pass the required legislation with appropriate safeguards. I have faith in the ability of the New Zealand Parliament to undertake this task, and hope that the Select Committee will recommend that it does so.

For those who, faced with the circumstances which would justify an assisted death, choose to submit to God’s or Nature’s Will, I have great respect and some admiration, but I strongly resent and disrespect their effort to deny me and others the right to self-determination at the end of our lives, on the basis of their own perceptions of morality, ethics or philosophy, just as I would not dream of trying to influence their own decisions.

The number of submissions, both for and against assisted dying, should not influence the Select Committee’s recommendations on the End of Life Choice Bill to Parliament. Rather the Committee should be guided by the quality of submissions and also, I believe, by reputable surveys that show a considerable majority of New Zealanders of all ages, political affiliations, gender and ethnicity support legislation to enable assisted deaths in limited circumstances. Such surveys can of course be subject to statistical bias (as can submissions to the Select Committee) so the ultimate survey would be a referendum, which could be carried out at the next election. Please do not fail to consult and respect the will of the people – there will be difficult decisions for you to make, but you were not elected merely to make the easy calls

In summary, I borrow from the language of the American Declaration of Independence, and state that I hold this truth to be self-evident, that those close to death and suffering from unrelievable pain or distress have an inalienable right, and that is to seek medical help in choosing the timing and nature of their deaths. Should right-to die legislation be assisted by the recommendations of the Select Committee, and in the unlikely event of me requiring assistance to leave this world, there will be several things for me to do; firstly to give my love to family and friends; secondly, to thank my medical colleagues for their assistance; thirdly to thank the Select Committee for its efforts.

Dr David Robins. Retired General Practitioner

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