Bioethics Forum Essay
Why New Zealand Should Permit Aid in Dying
Having read with interest Josephine Johnston’s essay on the aid-in-dying case before a court in New Zealand, I’d like to elaborate on some salient points. I have been actively involved with Oregon’s Death with Dignity Act for 14 years, and there are three misconceptions that warrant clarification and education.
First of all, the New Zealand case pivots around the interpretation of “aiding or abetting suicide.” Lecretia Seales has a terminal illness and is appealing to the High Court at Wellington to differentiate aiding or abetting suicide from aid in dying. If the Crimes Act, Section 179, would be interpreted to separate the concepts of suicide and aid-in-dying, her doctor could be protected from prosecution should she assist Seales by prescribing a medication to enable her to end her life peacefully.
With death being imminent, Seales would like to be empowered with the personal freedom to define how and when dying will occur. Seales is fighting for autonomy to have the liberty to end protracted suffering for herself and all New Zealanders. It is an aberration of the concept of aid-in-dying to compare it to suicide. Having guided innumerable terminally ill people through aid-in-dying, I have experience regarding how these differ.
For people who avail themselves of aid-in-dying, death due to their illness is inevitable. When a person qualifies for aid-in-dying under Oregon’s Death with Dignity law, two physicians must agree that this person’s life will end within six months. Death is not a choice. These people have suffered through excruciating pain, failed treatment, and humiliation up to this point. Consequently, they have given thorough consideration to how much and how long they can continue with the unrelenting burden of physical and existential agony. They hold thoughtful and emotional deliberations with their loved ones; and they finally arrive at a measured decision that they would like to end their suffering by planning a tranquil ending at a time and setting of their choice.
In contrast, suicide is often an impulsive and violent reaction to a problem which could have a solution. Unlike with aid in dying, with suicide, death is chosen.Further, it can leave the family and friends in shock–angry and wondering how they might have been able to prevent the loss of the person they loved. Bereavement might be sadly overcome with memories of the horrific death itself, plus the ensuing guilt, instead of commemorating the loved one who was so tragically lost.
With aid in dying, in my experience, people are at home surrounded by their loved ones with perhaps the background of their favorite music. Memories are shared, affirmations and hugs are exchanged, there is laughter, and there are tears. But most importantly, the patients had the right to express when enough suffering was enough, and they were supported with genuine understanding and comfort during the final tranquil moments of their lives. It is truly an honor to be entrusted in these end-of-life journeys.
In the New Zealand case, another argument against Lecretia Seales is that she has the option of palliative care to relieve her pain. While palliative care can be very effective for physical pain and symptom control, it is not always successful. There are many instances in which the terminally ill person has built tolerance to the opioids, thereby greatly reducing the efficacy of the medication. Subsequently, as increased dosages of opioids are administered in order to overcome the endurance, the person is sedated. Many people complain about too much deep sleep, confusion, and forgetfulness, as well as physical side effects such as nausea, vomiting, and constipation. They are assert that they are not themselves. Therefore, some people find sedation as a means to pain control objectionable.
Finally, it is very important to note that the most prevalent reasons that terminally ill people choose to pursue aid in dying are not physical pain, but rather existential pain.Specifically, the three most frequently cited explanations are loss of control, loss of dignity, and the inability to pursue life’s pleasures.Palliative care cannot solve these existential problems.
Given the reality of suicide vs. aid in dying, the possibility that opioids cannot address some people’s unrelenting pain, and existential suffering being the primary reason that terminally ill people choose aid in dying, isn’t Lecretia Seales’s appeal to end her life legally and peacefully on her own terms a most humane request for herself and the people of New Zealand?
Sue Dessayer Porter, MBA, MS, is a volunteer who works with Oregon’s Death with Dignity Law and speaks on the subject.
Posted by Susan Gilbert at 06/01/2015 02:45:20 PM |