Assisted dying and end of life

Our view on issues around assisted dying and end of life

(May 2017)

Mary Potter Hospice offers free specialist palliative care to people with a life limiting or terminal illness from Wellington city to Kapiti. The values of Mary Potter Hospice, which shape the way we deliver our service, include respect, compassion, dignity, hospitality and stewardship.

Assisted dying in any form is against the ethos of Mary Potter Hospice. We would oppose any change in the legislation to legalise the practice of assisted dying.

Our Views:

  1. Palliative care should be easily available to all who need it, and the Government should ensure that public funding is made available to increase access to hospice and palliative care services.
  2. Only when all New Zealanders have ready access to expert end-of-life care, can a balanced debate about assisted dying begin.
  3. A balanced debate on assisted dying requires a wider discussion on death and dying. We hold the view that a broad based discussion is also needed on palliative care. Palliative care manages the physical, social, psychological, spiritual and emotional needs of people approaching the end of their life and helps them die well with dignity.
  4. We are concerned that prescribing medication for the relief of pain and the management of symptoms near the end of life appears to be confused for many people with causing the end of life.
  5. We recognise that there is a range of views among New Zealanders and we respect the right of people to take an individual position.
  6. As a member of Hospice New Zealand and with professional membership of Palliative Care Nurses NZ (PCNNZ) and Australian and New Zealand Society of Palliative Medicine (ANZSPM) we acknowledge and support their respective positions on assisted dying and physician-assisted suicide.
  7. We oppose any change in the legalisation to legalise the practice of assisted dying (2).


Appendix 1: Terms and Definitions

There is a great deal of confusion about the terms used to describe decision making at the end of a person’s life. Terms are often used inter-changeably, when in fact they mean quite different things.

In 2015 the Ministry of Health published a glossary with these terms.

Palliative care

Palliative care improves the quality of life of patients and families who face life threatening illness, by providing pain and symptom relief, spiritual and psychosocial support from diagnosis to the end of life and bereavement.

Palliative care:

  • provides relief from pain and other distressing symptoms
  • affirms life and regards dying as a normal process
  • intends neither to hasten or postpone death
  • integrates the psychological and spiritual aspects of patient care
  • offers a support system to help patients live as actively as possible until death
  • offers a support system to help the family cope during the patients illness and in their own bereavement
  • uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated
  • will enhance quality of life, and may also positively influence the course of illness
  • is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

Assisted dying

The term ‘assisted dying’ is often used to describe circumstances in which a person is either helped to end their own life or where there is a deliberate act to end a person’s life (2).

Medically assisted dying or death

‘Medically assisted dying’ is the generic term that involves medical participation in the euthanasia or death of person through administering or providing drugs or equipment that will cause the death of person. The term includes (as a sub-set definition) physician assisted suicide (see definition below).

Assisted suicide

Assisted suicide is where a person intentionally, knowingly and directly provides 3 the means of death to another person. In the context of the euthanasia debate this assistance is provided at the request of the person, with the intention of relieving intractable suffering. If a person dies as a result of this self-administered act, then it is considered an ‘assisted suicide’.  Assisted suicide is illegal in NZ (3).

Physician-assisted suicide

Physician-assisted suicide is when a doctor intentionally helps a person to commit suicide by providing drugs and/or equipment for self-administration, at that person’s voluntary (and competent) request. The doctor does not directly cause the death. The person must be able to act to either administer the drug or perform the action which will cause the death themselves. Physician-assisted suicide is illegal in NZ (3).

End of life

There is a continuum of time that can be considered ‘end of life’ just as there is a time continuum where someone can be considered to be ‘dying’. Someone may be said to have reached the end of life or dying when they are living with a condition they are likely to die from – in weeks, months or years– and are receiving care to cope with the symptoms of this condition.

Glossary: The end of life period is triggered by a transition in the place of care, levels of care and/or goals of care. The major transition to the end of life period is in changing the focus on the person from curative and restorative care, which aims to extend the quantity of life, to palliative care which aims to improve the quality of life.

Palliative care considers a prognosis of up to 12 months or a year as appropriate for admission to the Hospice service.

In the Hospice service, ‘Last Days of Life care’ refers to the care provided in the last days of life and into the bereavement.   It focuses on preparing for an imminent death, and managing the end of the condition. It is the period of time when death is imminent and may be measured in hours or days (4).

Do Not Attempt Resuscitation (DNAR)

This refers to a process where a patient, following discussion with a doctor on the potential effects of the resuscitation process (particularly cardio-pulmonary resuscitation/CPR) decides that they do not want this procedure. Typically in hospital, a form is signed by the doctor and/or the patient, and held in the patient files.

Resuscitation also refers to a range of interventions which involves activity to stimulate a recovery, such as intravenous fluids or antibiotics, or assisted breathing etc.   Mary Potter Hospice uses a consent form process to discuss whether such interventions are appropriate and desirable for the patient.  It is possible that a patient may still want to have one procedure (eg intravenous antibiotics) but not another (eg CPR). Our responsibility is to have that discussion so that the patient understands the consequences and can make an ‘informed decision’.  We fill out an Ambulance Plan, which is kept in the patient’s home so it is accessible to ambulance staff, which outlines for ambulance staff what treatments are, and are not, agreed to be appropriate by the patient and the health professionals involved in their care.

Allowing natural death

Allowing Natural Death (AND) is the terminology Mary Potter Hospice uses instead of DNAR. The AND concepts are applied to a range of medical interventions on a case by case basis, following an in-depth discussion with the dying individual and their family, and in accordance with the individual’s values and wishes. It means that the Hospice focus is on ensuring comfort measures and ensuring that appropriate levels of pain relief are provided to allow a natural death with dignity and compassion.

Starship Hospital use the term ‘Te Wā Aroha’: a time of love or time of compassion. The Māori name for the Starship Children’s Hospital end of life care plan (Kidshealth 2014).

References

  1. Euthanasia and physician-assisted suicide: a view from an EAPC Ethics Task Force. Materstvedt, L.J., Clark, D, Ellershaw, J et alia. 97-101, s.l. : Palliative Medicine, 2003, Vol. 17.
  2. Hospice New Zealand. Statement on hospice care and assisted dying. www.hospice.org.nz. [Online] March 2012. http://www.hospice.org.nz/cms_show_download.php?id=418.
  3. Care for the dying; not euthanasia. ASMS Association of Salaried Medical Specialists [Online] 23 August 2012. [Cited: 30 November 2012.]
  4. New Zealand Palliative Care Glossary. Wellington: Ministry of Health. December 2015
  5. Gold Standards Framework. [Online] 2012. [Cited: 30 November 2012.] http://www.goldstandardsframework.org.uk/.