“All forms of life on this earth have their periods of birth, infancy, youth, maturity, and finally decay.”
Jim Clayton, Napier
One of my grandfathers said he “wanted to die with his boots on.” And he did, while fixing his ‘63 Chrysler, at the ripe old age of 89.
My other grandfather survived Ypes and the Somme, and he would recite, “old soldiers never die, they simply fade away.” True to his tune, he wore out and died in his sleep. He too was 89.
But many of us are not so fortunate, and our deaths can be preceded by a prolonged period of disability, often with pain and suffering.
That’s what is happening to my dad right now. He’s not in pain, and how much anguish he is suffering is hard to tell. Certainly he did not expect to require full-time nursing in his old age. But he’s in the best possible care with other old people whose bodies and /or minds have worn out.
At first, the atmosphere of the rest home was disturbingly institutional, and seeing so many old folks all together was daunting. But soon I saw the level of care administered, and how that care is dispensed with respect and courtesy. Now my heart is warmed when I see a group of our most vulnerable citizens, grooving as best they can to a three-piece band, or playing indoor bowls with all the determination they can muster.
On a recent visit I passed a door and recognised the name of a man I haven’t seen for 30 years. Later, a friend told me he had cancer, and would move to Cranford, ‘when the time comes.’
Most likely he will be hooked up to a diamorphine syringe-driver and soon lose consciousness. It is currently against the law to administer a fatal dose, and death can take some time when the cause is dehydration.
If Maryan Street’s End-of-Life Choice bill was law, the man I haven’t seen for 30 years, could gather his family and friends, say goodbye, and end his life with them by his side.
In the proposed law change, eligibility for medical assistance to die is strict. You must be of sound mind, and have an illness that two doctors think will kill you within a year.
We will not be able to end our lives simply because we are old.
End-of-Life Choice is an appropriate name for Maryan Street’s bill because it frames the issue as a human right. It is saying, under certain circumstances, we can ask for assistance in ending our lives.
If drawn from the ballot this will be the third ‘assisted suicide’ bill to come before Parliament. And like those of Michael Laws (1993) and Bill Brown (1995), Maryan Street’s bill is a heart-felt attempt to help others circumvent the suffering they witnessed with dying loved ones.
End-of-Life Choice is a recognition that end-of-life can be so miserable we’d rather die prematurely.
Some believe we treat our pets with more dignity in death than we do ourselves.
After being diagnosed with terminal cancer, Dr John Pollock made an impassioned plea when he wrote: “Over the years our vet has put down several of our ailing, elderly pets, the latest a week ago. A contented, serene animal, surrounded by the people who have loved it for years, passed from life to death in a peaceful, painless minute. I have metastatic melanoma – how I wish that service was available to me. The law insists we must provide only ameliorative help while patients may reach the most appallingly wretched states, sometimes akin to those who died of starvation in Nazi concentration camps. Ironically if we allowed a cat or a dog or a horse to reach such a condition we would be breaking the law and risking a prison sentence …”
However many of Dr Pollock’s peers do not agree with him.
The Medical Association of New Zealand is “opposed to both the concept and practice of euthanasia and doctor assisted suicide.” Rather it “encourages the concept of death with dignity and comfort, and strongly supports the right of patients to decline treatment, or to request pain relief, and supports the right of access to appropriate palliative care.”
Key triggers controversy
And that stance was clearly demon-strated by palliative care professionals when John Key responded to End-of-Life Choice by telling Newstalk ZB: “I think there’s a lot of euthanasia that effectively happens in our hospitals.”
Australian and New Zealand Society of Palliative Medicine chairwoman Sinead Donnelly replied by saying: “We never practise euthanasia; euthanasia is the deliberate ending of life, and is illegal and unethical.”
And from Sandy Macleod, medical advisor to Hospice New Zealand:
“It appears the Prime Minister has confused the ceasing of curative treatments with ending a person’s life. In situations like this people are in fact dying from an advanced disease, not from the withdrawal of treatment.”
He said: “Palliative care provides comprehensive management of physical, psychological, spiritual and existential needs of a person facing a life limiting illness. As sickness progresses towards death, the focus of care is on minimising suffering. To minimise suffering it is not necessary to kill the sufferer.”
Is palliative care adequate?
The argument seems to be that palliative care in New Zealand is adequate for coping with those dying from incurable disease.
One of Hawke’s Bay’s most experienced palliative care doctors disagrees.
Libby Smales was Medical Director of Cranford Hospice for 15 years.
“I don’t agree with those doctors who say we have everything we need right now, because it’s so obvious we don’t,” says Dr Smales. “If we did why did Sean Davison get five months home detention for helping his mother die, and Evans Mott have to go through the hell of leaving his wife to die alone?”
Dr Smales is referring to two high profile police prosecutions, for while it is not illegal to commit suicide – the law was changed in 1961 – it is illegal to assist in suicide.
Sean Davison, a micro-biologist lecturing at the University of Cape Town, returned to New Zealand to spend time with his mother, Pat, a medical professional with an honours degree in physics from London University. She was dying of cancer that had spread to her lungs, liver, and brain.
After a few weeks of stability, Pat Davison’s health rapidly deteriorated, and she began what she termed her ‘Bobby Sands’ diet, after the IRA member, who in 1981 starved himself to death in Maze Prison, Belfast.
Thirty-one days into her water-only regime, Sean Davison wrote that his mother was “falling to bits”. Her tongue seemed to be completely decayed and her bedsores made him wince. His mother pleaded with him to help her end her life. And he did, saying later: “I did the compassionate thing by helping my mother to her death. I believe any humane person would have done the same thing. I ask myself how in a civilised society we can allow this to happen.’’
On the strength of his ‘confession’ Sean Davison was charged with ‘procuring and inciting’ suicide. He pleaded guilty and was sentenced to five months home detention.
Rosie Mott suffered an aggressive form of multiple sclerosis, a degenerative condition for which there is no cure.
“It’s incurable, untreatable and degenerative. It does everything but bloody kill you, it’s hideous. Rosie waited four years to see if there was some way to turn it around. But she was not prepared to lose control. That wasn’t a life she wanted,” said her husband Evans.
Evans Mott agreed to help research suicide methods and assemble a kit with which Rosie could kill herself. So not to implicate him, she made a video stating her intentions. “I’m making this movie so that nobody is under the illusion that I’ve been coerced into what I’ve done,” she said.
On the morning Rosie was ready to end her life, she asked her husband to leave her alone in their Auckland home. He returned several hours later to find her dead.
Making legal judgments
Evans Mott was charged, but in her judgement Justice Courtney said: “I think the consequences of a conviction would be out of all proportion to the gravity of the offending … You acted out of love and your motivation was to support your wife in the decision she made.” And she discharged Mr Motts without conviction.
Before jumping to the conclusion the courts are taking a more lenient attitude towards assisted suicide it’s important to consider the last paragraph of Justice Courtney’s judgement. “I emphasise,” she said, “that this decision represents the very particular circumstances of your case, which are at the lower end of the spectrum from any other case decided in this area.”
How End-of-Life Choice is legally framed is a most important aspect of the bill.
“I remember years ago in England,” says Libby Smales, “when I was doing medicine and my brother was doing law, I was absolutely horrified at how death and dying was managed, and we had the same discussion then, as we’re having now. He said then, ‘we’re too thick to draft the legislation; we’re not capable, not willing to address the issue legally.’ That’s why I admire Maryan Street for giving it a go.”
Jurisdictions that have ‘given it a go’ seem to have successfully overcome the legal barriers, and it’s interesting to note that in Oregon (population 3.5 million), whose law End-of-Life Choice most emulates, of the 935 prescriptions written for lethal medication since the law was passed in 1997, 596 patients have died from taking the medication.
That 37% did not take the medication indicates some patients make the choice as a reassurance, giving themselves an option, which makes their suffering more bearable.
As Libby Smales points out, “I recall a comment from a motor neurons sufferer who died last year. She said, ‘I can’t enjoy the now because I’m so terrified about the then. If only I knew that when I can’t bear this any more, I could end my life, I would be able to have so much more enjoyment of life in the now.’”
Suffering in the death stage of our lives is not only about pain. Fear, anxiety, dread, and apprehension all come into play, and how comforting it would be to know that at any time, we could pass on, with our loved ones by our side.
Outside the rest home I meet a friend who has visited the man painfully dying of cancer. She tells me he “wants to be set free”. Sadly, he has more suffering in store before his wish is granted, because, let’s face it, sometimes we treat our pets more humanely than we do our fellow humans.
Inside the home, the old folks are being entertained with music and games, and I reflect how important it is to distinguish between these vulnerable, worn-out bodies and minds, with the man suffering a painful death from aggressive and incurable disease.
Where assisted suicide is legal
With minor differences in protocol the three Benelux countries have legalised assisted suicide under the following conditions:
- The patient’s suffering is unbearable with no prospect of improvement.
- The patient’s request must be voluntary and persist over time.
- The patient must be fully aware of their condition, prospects and options.
- There must be consultation with at least one other independent doctor who needs to confirm the conditions mentioned above.
- The death must be carried out in a medically appropriate fashion by the doctor or patient.
Assisted suicide has been legal in Switzerland since the 1940s. As such it is “a crime if and only if the motive is selfish”. What is important in Switzerland is motive, not intent. All assisted suicides in Switzerland are videotaped. Once a death is reported to the police, the police, an officer from the coroner’s department and a doctor all attend the death. At this time family and friends are interviewed. If a selfish motive cannot be established, there is no crime. By all reports these deaths are open-and-shut cases.
Interestingly, Swiss law also states that the “permissibility of altruistic assisted suicide cannot be overridden by a duty to save life”. This safeguards those assisting in the suicide, as long as the motivation is altruistic.
Washington State (2006)
With minor variations, two US states allow for assisted suicide when:
- There is a diagnosis of terminal illness that will kill the patient within six months.
- The patient requests, in writing, from his or her doctor, a prescription for a lethal dose of medication for the purpose of ending their life.
- The request must be confirmed by two witnesses, at least one of whom is not related to the patient, and is not entitled to any portion of the patient’s estate.
- After the request is made, another doctor must examine the patient’s medical records and confirm the diagnosis.
- The patient must be determined to be of sound mind.
- If the request is authorized, the patient must wait at least 15 days and make a second oral request before the prescription may be written.
Unlike Oregon and Washington State, Montana has not codified assisted suicide. The change came as a result of a court case, when a group of doctors, on behalf of Robert Baxter, a 76-year-old truck driver who was dying of leukaemia, asked the court to establish a constitutional right “to receive aid in dying”. The state argued that “the Constitution confers no right to aid in ending one’s life”, but Judge Dorothy McCarter, of Montana’s First Judicial District Court, ruled in favour of the plaintiffs, stating that the “constitutional rights of individual privacy and human dignity, taken together, encompass the right of a competent terminally-ill patient to die with dignity”, thus protecting doctors from prosecution.
NZ prosecutions for assisting suicide
Sentenced to two years supervision after pleading guilty to a charge of manslaughter over the death of his ill wife.
Dr Chris Simpson
Convicted of manslaughter after his terminally ill mother was found dead. He was sentenced to three years imprisonment.
Sentenced to 18-month jail term with the option of home detention for the death of his ill wife. He ultimately served nine months in prison.
Convicted of attempted murder after saying in her book, To Die Like a Dog, she twice tried to assist her mother to die in 1999. She served nine months of a 15-month sentence and subsequently failed in two appeals to have her conviction overturned.
Found guilty of the attempted murder of his elderly, terminally ill mother. He was sentenced to six months community detention and 150 hours community work.
Charged in relation to a suicide pact with his wife. Both were suffering terminal diseases. He was found dead in his home before he could be bought to trial.
Found not guilty of aiding and abetting the suicide of his wife. He researched suicide methods on her behalf, but was not with her when she tried to take her life.
Sentenced to five months home detention for aiding the death of his terminally ill mother. Police prosecuted on the strength of his admission in his book, Before We Say Goodbye.
Discharged without conviction for assisting his wife’s suicide. Rosie Mott suffered an aggressive form of multiple sclerosis, a degenerative condition for which there is no cure. Her husband agreed to help research suicide methods and assemble a kit with which she could kill herself. So not to implicate him, she made a video stating her intentions, and she asked her husband to leave her alone in their Auckland home. He returned several hours later to find her dead.