As long as there are thoughtful, concerned doctors working in the medical profession in New Zealand, legalising assisted dying never will be anything other than a Plan B for determined individuals seeking to take some control at the end of their lives, writes Lecretia Seales’ former husband, Matt Vickers
Comment: I enjoyed reading Doctor Carmen Chan’s thoughtful piece on assisted dying, and it raised some excellent questions. Is there an inequality problem with assisted dying? Would people with fewer resources and limited access to quality healthcare choose assisted dying as an option? Chan laid out a convincing case. If you didn’t have the best healthcare available, wouldn’t it stand to reason that you might choose assisted dying, particularly if you were vulnerable, impoverished, or unable to travel?
It is a reasonable question, but I didn’t have to look very far to find the answer. I currently reside in the United States. There are fewer countries in the world with a more inequitable health system than the USA.
If you don’t have health insurance in the United States, you are shut out of the healthcare system, or can become bankrupt as a result of it. I’m not exaggerating. The leading cause of personal bankruptcy in the USA, by a large margin, is unpaid medical bills. If you can pay for it, you can get some of the best medical care in the world. For others, if you get seriously sick, you are confronted with significant medical and financial problems.
Several states in the USA have assisted dying laws. Oregon was the first in the world to legislate for it. It is now available in seven other states and the District of Columbia.
If Chan’s logic were to hold up, then in a country like the United States, with such a vast disparity of access, you would expect to find vulnerable groups reflected in the demographics of those who pursued assisted dying as an option, seeking this in the face of a lack of other choices.
But when you look at the data over the last 20 years in Oregon, what you find is the opposite. Forty-six percent of the applicants are married, 73 percent are college-educated, 98 percent have health care insurance, and 90 percent are in hospice care. Ninety-six percent of patients chose to tell their families. The vast majority have cancer or serious neurological illnesses.
In short, the sort of people who access assisted dying, even in a profoundly inequitable country like the United States, are people like Michael Cullen, or Lecretia Seales, or Bobbie Carroll. It is not the marginalised, impoverished, vulnerable people for whom Chan expresses concern. That is a fact.
New Zealand is very different from the United States, but there is no reason to expect that assisted dying would work any differently in New Zealand. On the contrary, in a kind and compassionate country like New Zealand, it is likely to work better.
The example of Chan illustrates this. Our medical community is full of hard-working, dedicated, thoughtful and compassionate doctors like her who would never offer assisted dying as a default option, but who would fall back on training to help and heal their patients first and foremost.
Patients who are vulnerable, uncertain or inauthentic who request assisted dying are exceedingly unlikely to have those requests granted. Those requests take extraordinary strength of will to voice.
You would have to stand up to an authoritative medical figure, like a Carmen Chan, or an Amanda Landers, or a Sinead Donnelly, or a Mary English. You would have to confront all of their treatments and assurances and offers of help and “it’ll be okay”s and to look them in the eye and say, “No thank you, I want to do things my way.” And you would have to keep saying that, convincingly and unwaveringly, in the face of hard questions and genuine concern, until you were all the way through the process.
It is only people like Michael Cullen, Lecretia Seales, Bobbie Carroll, and the others who have come forward, who would ever have the personal conviction and inner strength to be able to do that. Would a person under coercion have any hope of convincing Dr English of their sincerity? Of course not. They’d be afraid even to try.
When I asked Dr Silvan Luley, of Switzerland’s Dignitas, what patients requesting their help are like, he said: “Very autonomous, self-determined people. In fact, that’s what most people write in their requests. ‘Look, I’m now 80, I’ve survived the war, I survived the depression times after the war, I’ve worked all my life and I’ve done what a man needs to do and I’ve brought up my family and so on. It’s my life, it’s my choice […] I’m going to decide until the very last moment, and it’s my decision to end my suffering when I want.’”
GP Rob Jonquiere, of the Netherlands, told me: “It is still, for most doctors, the most difficult request they can get, the patient asking the doctor for his help. Every doctor will immediately get in a kind of fighting stance and say ‘Let’s see what we can do to make things more bearable’.”
“If you come to me [and ask for assisted dying] I’ll say, let’s talk about it. Come back tomorrow and we’ll sit down and have a serious talk. In a harsh way, you have to convince me that you are really suffering and I’m going to try and convince you that you’re not hopelessly suffering.”
Even in regimes where the criteria are broader than in New Zealand, patients need to set themselves against a system designed to help and heal in all possible ways before they can end their suffering early.
New Zealand’s law, when implemented, will have precisely the same dynamics. As Dr Peter Reagan of Oregon says, “It doesn’t need to be easy, it just needs to be possible.” And New Zealand’s legislation, as implemented by our medical community, will make assisted dying anything but easy.
Chan also argues that we should better fund palliative care, so that assisted dying is not needed. Firstly, assisted dying is required no matter how well funded palliative care might be, because palliative care isn’t perfect. Both sides agreed on this fact in Seales v Attorney-General. The quality of palliative care in Canada, the Netherlands and parts of the USA is excellent, but there is still a place for assisted dying.
Secondly, there is no perfect state for palliative care that will ever be achievable. Waiting for utopia is no answer for those patients, like Michael Cullen or Bobbie Carroll, who are suffering now.
Finally, it is quite possible to support assisted dying and palliative care concurrently. I certainly do. At my late wife Lecretia’s funeral, we gladly collected donations for the Mary Potter Hospice in Wellington, and I took great comfort in being able to offer that sum to them for all the great work that they do.
I am grateful for the extraordinary work Dr Chan does as a health professional and a member of our New Zealand medical community. I am grateful for her contribution to the debate.
But she should not see legalising assisted dying as a threat – and nor should anyone else. As long as there are thoughtful, concerned doctors like her working in the profession, it never will be anything other than a Plan B for determined and committed individuals seeking to take some control at the end of their lives.
That is just one more reason, among many, why New Zealanders can feel very comfortable voting Yes for the End of Life Choice Act in October.