New research on euthanasia practices in New Zealand has just been released. It focuses on the thoughts and experiences of doctors and nurses, and is the first of its kind since euthanasia and physician-assisted suicide (PAS) became legal in New Zealand.
The research is entitled Early experiences of the End of Life Choice Act 2019 amongst assisted dying practitioners in Aotearoa New Zealand and led by Dr Aida Dehkhoda, a Research Fellow in Psychological Medicine at the University of Auckland.
The findings provide valuable insights and warnings into euthanasia/PAS practice; however, much of the research appears written from a position that accepts the ethics of assisted suicide and euthanasia, as well as expecting there should be an expansion of the practice.
Initial Observations
The research focused on the medical and health professionals involved in euthanasia/PAS – so doctors and nurse practitioners. A total of 22 people were involved, all doctors, except one nurse practitioner.
Almost 70 per cent of these doctors were general practitioners (GPs), which immediately raises concerns around medical competency. While GPs are skilled, they are not necessarily versed in palliative care, gerontology, or familiar with the pharmaceuticals used to end life (it is unlikely they will have ever used the powerful sedatives and other anaesthetics required to end a person’s life). Those in the research said as much themselves, noting they were not as familiar with the medications and were surprised by some of the patients’ reactions to the lethal drugs.
Distressingly, one medical practitioner talked of surprise when a patient did not die quickly and instead gagged, choked, and struggled to breathe after orally ingesting lethal drugs. As we have discussed on the Family Matters podcast with an expert anaesthetist – Dr Sharon Quick – those trained in such drugs know they can burn the throat and cause great distress.
Of the doctors and nurse practitioner involved, half were men and half were women. Seventy-three per cent were of European ethnicity, 23 per cent Asian, and the rest (only four per cent!) did not say. Experience as a medical or health professional was varied, with almost 10 per cent of those participating in euthanasia/PAS having less than 10 years medical experience. The majority of those involved had between 10 and 30 years experience.
One comment from those surveyed that we thought was rather telling, was how few doctors and nurses want to be involved in the practice of euthanasia. So few in fact, that the researchers deliberately choose to use gender-neutral pronouns to reduce any chance of an individual doctor or nurse being identified.
This lack of personnel was further highlighted by the doctors/nurses themselves, noting that so few of their colleagues want to be involved that having a second medical/health person to witness the death is extremely difficult.
It should be noted that the wish for witnesses was also to ensure the doctor/nurse ending the person’s life could not be accused of having done anything untoward.
Motivations of patients and doctors
The research found that, unsurprisingly, the main reason people seek euthanasia/PAS is fear of losing control of their lives. While clearly underlying health issues, it was people’s fear of future suffering and death that drove the requests. This was further emphasized by the doctors who noted that the ‘unbearable suffering’ criteria is totally subjective.
For the doctors and nurse practitioner interviewed, their motivation to be part of euthanasia/PAS was usually due to having witnessed the suffering of a relative or patient. Researchers also noted that many practitioners were motivated by their own fear of suffering and death, alongside a strong philosophical commitment to autonomy.
Ironically, these practitioners talked about the importance of autonomy yet also expressed opposition to other doctors/nurses who conscientiously object to the practice of euthanasia.
Other Observations from The Research
Those surveyed felt the euthanasia process was rather difficult, bureaucratic, and too strict. They struggled with the six months to death prognosis. Worrying, all this points to a desire to expand euthanasia. Equally worrying were practitioners questioning the need to obtain consent from the patient on the actual day of euthanasia/PAS.
Some of those surveyed talked of the anxiety about their work and not being open with their peers or friends about their involvement. It is implied that this is a fault of society not being accepting, rather than the response of a moral conscience!
As expected, the more a doctor/nurse involves themselves in euthanasia/PAS, the less concerned they are with the ethical questions around the practice. Many report having a growing sense of satisfaction with their work. This is of no surprise though, for a cognitive dissonance must be either ignored or explained away.
Finally, the overall tone of the research is one of support for euthanasia/PAS. It also echoes the ‘wish list’ of those wanting to expand euthanasia. For example, it accuses hospices of ‘conscientious absolutism’ for not wishing to be any part of ending their patient’s lives.
As the quote below also illustrates, the research is effectively arguing for normalising euthanasia/PAS and changing medicine from being an ethical profession to one that is simply transactional”.
Discussing the unspeakable, the act of dying or providing an assisted death that has not yet become a societal norm, and the absence of cultural and societal understanding around it, continues to influence the experiences of patients, families, and practitioners with AD. Understanding these perspectives and experiences is crucial for ongoing discussions and potential revisions to ensure a more balanced and patient-centred approach to providing AD practices.
This article was originally published by Family First New Zealand.
