At the time of Martin’s remand, in March of last year, a Colmar Brunton poll showed that 73% of respondents favoured changes proposed in NZ First MP Peter Brown’s Death With Dignity bill, which would have gone to referendum. Instead, the bill was prevented from going to Select Committee by a vote of 60-59 in Parliament. As the University Chancellor Rosemary Barrington said in her role as chair of the debate, this meant that, “as a society, we were not able to be entering into the kind of discussion and debate that occurs through the Select Committee process.” Debate is, or should be, at the heart of social change, or lack thereof, so it is little wonder that Barrington was proud to host the first of a series of such debates at universities around New Zealand.
Martin was to be joined by Dr. Philip Nitschke (aka Dr. Death, of EXIT Australia). However, illness prevented him from attending. The opposition’s disappointment was palpable; likewise mine, as I’d hoped for an interview. Kevin Moar, leader of the opposition (made up of Vic debaters – merely there to play devil’s advocate, rather than as anti-euthanasia campaigners. And there are a number of issues that do devil the cause): “I’m particularly sorry [Dr. Nitschke isn’t here] because a lot of my speech was going to be about baiting him into defending some of his wild, outrageous public statements. Statements like suicide pills should be available on supermarket shelves.” Me too. Instead, Martin was joined by Paul Stannard, a long-time campaigner, and Dr. Judith Aitken of the Capital Coast Health Board, taking a more ambivalent view of the issue.
Martin was, obviously, prevented from talking about her own case at the debate as it was sub judice; however, one would still be forgiven for expecting a fairly heavy dose of emotive rhetoric. Instead, she was measured, eloquent and undoubtedly committed to her cause. The argument for voluntary euthanasia is strongly grounded in compassion – which can lend it an almost philosophical bent, as so much of the discussion revolves around the idea of right and control over one’s own body, a paradoxical situation where one has to grapple with some tricky intangibles like autonomy and choice applied to the very earthy business of dying. This is, perhaps, why it’s something people aren’t comfortable talking about – not because it’s about death, but because these are hard ideas to get one’s head around.
Martin brings these ideas together in her discussion of the progression of terminal illness: “Choice has a lot to do with hope. Hope reigns manifest in the presence of choice, but hope changes in the course of a terminal illness. Hope begins with the manifestation of symptoms: ‘Gosh, I hope it’s not something bad.’ Then the appointment with the doctor: ‘Gosh, I hope he can find out what it is.’ And then the result of the diagnosis: ‘Gosh, I hope we can get some treatment for this.’ As progress develops: ‘I hope the treatment will work.’ And as the illness develops further: ‘I hope the treatment will give me more time.’ And then as the illness develops still further: ‘I hope that I will die gently and peacefully, surrounded by the people that I love.’”
The unfortunate case is that, for people who love the patient, they’re rarely at the same emotional point: they’re still hoping to have the patient alive for longer, even when they are ready, perhaps, to face their own death. And for someone who’s well, no matter how close a relationship you have with the patient, no one can really understand that kind of intractable pain. Hospice studies find that the pain experienced towards the end of a terminal illness can be dealt with effectively in 90-95% of cases. A good success rate, Martin argues, “until you consider that, in New Zealand, on average 7,500 people die from cancer each year, so that tells us that 750 people each year would experience pain that could not be controlled, unless it is doctors under the doctrine of double effect, that is, giving so much painkiller that the person is rendered into a state of terminal sedation and stays in that state until they finally pass away. And that in itself is the nature of death for a lot of people. And adds to the cause of extensive trauma to the people who love them and endure that alongside with them.”
“Double effect” is the status quo in New Zealand, as Stannard asserted, “[legislative change] would legalise what they already do, but don’t talk about. I was talking to a very prominent medical professional … and he was telling me about the same sorts of things. I won’t tell you who he is, of course, but the doctors all know that they do help people to die in the end.” In other words, “for a little part of their lives, they would get away from having to play God.” The advantages of legalised voluntary euthanasia to the medical profession are rather more controversial than the benefits to the individual patient that Martin outlined. The fiscal realities of almost any healthcare system will come to the fore: it is, sadly, cheaper to euthanize a patient than immerse them in palliative (that is, pain relief and hospice) care. Stannard and family referred to his late wife as “the six-million dollar woman” as she was in the grip of the terminal stages of cancer last year. The resources saved by avoiding what could be seen as “unnecessary” palliative care “could be reallocated to those who do have hope for some quality of life.” The limited choice given to terminal patients now is the level of pain relief they have. It’s an inhumane trade-off: do you retain clarity and consciousness, but deal with excruciating pain, or slip into a semi-comatose, but pain-free existence?
The quandary is this: a significant number of people are suffering, and it’s nobody’s fault; Not the patient’s, not the medial profession’s, not family members’, not the government’s (leaving aside smoking and the like). In fact, no one is found to be at fault until the sufferer is put out of their misery, when people like Lesley Martin face criminal charges. Little wonder that 73% of New Zealanders were in favour of legislative change.
But as people and organisations in favour of voluntary euthanasia tug the heart strings of society by dealing with the realities of terminal illness, those against deal instead with reality full stop: the experience in the Netherlands and Oregon; the sometimes worrisome claims made by proponents like Dr. Nitschke. Legislation is the thin end of the wedge, they argue – what are your safeguards and how will you ensure that they work? In last week’s debate, Moar argued, “safeguards don’t work. We only have to look at, in New Zealand, the Contraception, Sterilisation and Abortion Act to see that’s true. And whatever your opinion of abortion is… all the safeguards that were supposed to make that a limited activity haven’t been proven to be true. And we look at euthanasia examples from where it’s been made legal overseas, in Holland, where more than half the people euthanized now are done so without any specific consent whatsoever.”
The Netherlands experience is frightening. A 1991 study by the Dutch government (10 years before the law actually took effect) found that 1040 people were killed involuntarily, a third of those euthanized. 14% of those people were fully conscious and competent of making decisions. 72% had never undertaken any wish to be euthanized or end their life or die. In 8% of cases, their doctors still believed there was treatment available, and in a 2001 study, 13% of Dutch physicians admitted euthanizing people without any report, despite the law taking effect that year. Moar explained that: “In a 1993 survey done by the Dutch equivalent of Grey Power, about the Dutch healthcare system, there were no questions about euthanasia whatsoever, yet 10% of members volunteered that they feared medical treatment because they feared being euthanized.”
What, then, is the alternative? In a perfect world, resources for palliative care would be unlimited. But when you’re stuck between not wanting to condone a system that has proved problematic to a far-from-acceptable degree, and simply not having the resources to ramp up palliative care to help those liminal patients who are not, or cannot be helped, do you accept the status quo of “double effect”? Many opponents of voluntary euthanasia would say yes. As Nicola Willis, speaking for the opposition, explained, “what we have, for those who are in a really terrible situation, on the cusp, is the principle of double effect. And this is what we’ve had talked about in terms of the fact that doctors kill people anyway. Now let’s be very clear about the difference here. What doctors do when they apply the principle of double effect, is that they apply morphine, not intending to kill, but knowing that that may be a side effect, but a necessary side effect, of relieving pain – which is the doctor’s number one goal. And we say that’s okay. What we won’t condone is doctors who intentionally kill patients because the job of relieving their pain has become too difficult. We say that’s an unacceptable cop out, and as a society, we can’t sanction that kind of a cop out, because then it leads to a situation like the Netherlands, where 6000 people have died, without wanting to die because their doctors knew better than they did.”
It’s not just the Netherlands’ experience that serves to reinforce the fear of heading down a slippery slope; it’s also the attitudes of some of the front-line campaigners. Stannard, responding to Moar’s comments about wishing to bait Dr. Nitschke, said: “I don’t always believe in everything he does either, but I might add that to get change, we need to have people right out there, pushing the boundaries, and I think Dr Nitschke does that.” Pushing the boundaries is one thing, but many of Dr. Nitschke’s and EXIT Australia’s goals are troublesome. Comments attributed to him in his workshops are occasionally explained away as misdirection by the media (bad media!), but here is a direct quote from his website (http://www.exitaustralia.net/exit/projects/peacepill.htm): “Just one example is those who suffer Alzheimer’s disease. They become biographically dead long before they become biologically dead. Nevertheless, they do not suffer unbearably within the accepted meaning of the term. Rather it is their spouses and children who suffer terribly if not unbearably. The ‘Peaceful Pill’ does offer a solution of sorts [for] Alzheimer’s sufferers.” This clearly moves far beyond the realms of those suffering intractable pain at the end of terminal illness, likewise his suicide devices, which remove almost all ability to regulate any kind of system. In that case, is pushing the boundaries hindering the cause rather than helping?
Lesley Martin faces her charges in the High Court today. The decision will have profound repercussions on this debate in New Zealand; let’s hope the issue doesn’t die with unfinished business.