Dr Tanisha Jowsey asks: what does it mean to have a ‘good death’ and, if the end of life bill passes, who will be willing to help? 

May you live to be a hundred — and decide the rest for yourself. ~ Irish Proverb

The end of life referendum concerns an issue that deeply polarises people. Regardless of which way you plan to vote, it’s worth considering two things: what a good death looks like and who would we be asking to assist if the bill is passed?

Most of us are hoping for a ‘good death’ at the end of a long life filled with wonder, love and satisfaction. In the humanities, for literally thousands of years people have contemplated what a good death looks like. While there are plenty of options to consider, minimal suffering usually features. I don’t want to suffer. People who have famously fought to legally have control over their death – Michael Cullen, Lecretia Seales, Bobbie Carroll and others – didn’t want to suffer. Chances are neither do you.

When Kiwi Matt Vickers wrote of his views on the upcoming referendum concerning assisted dying he was responding to Carmen Chan’s contributions to the debate. And he did so from a privileged space as the husband of Lecretia Seales – an incredible lawyer from Tauranga who endured brain cancer while she fought to reform law in New Zealand so that people suffering with terminal illness could choose to end their lives. Lecretia died in 2015 and we can well imagine that for Vickers the pain of that journey may still be present. Yet, in his piece on Newsroom last week, Vickers offers a clear and balanced message of pro-choice options that makes clear the journey to choosing assisted dying will not be easy for anyone.

Vickers does not go into the emotion-heavy trauma of the options he and his wife faced. But I want to be really clear about how grizzly the situation is for the people for whom the proposed law change can make a significant positive difference. A palliative doctor friend told me some time ago of a patient who had terminal illness and was dying. My friend had informed her compassionately that she could try to eat but would almost certainly choke to death, and therefore the only agency she had was to choose death by starvation or by choking. My friend was so sad by the patient’s situation. This is an unusual, rare and grim situation that we would never wish on anyone. But for people in such circumstances – if more than 50 percent of people in New Zealand vote yes – they will have the option to limit their suffering.

Who will assist?

In May 2019, the End of Life Choice Society of NZ invited a doctor from Canada – Dr Stefanie Green – to the University of Auckland to discuss what has been happening in Canada since the law changed in 2016 to allow assisted dying in qualified circumstances. The room was filled with a hundred clinicians and public health researchers. Green’s message was clear: doctors don’t do this because there is money to be made or because it helps them to rest easy. They do it despite it being really hard because they care so deeply for human rights and they want to help people who are determined to exert some control over their end of life suffering.

Many of my friends and colleagues are doctors and nurse practitioners. These same professionals may be called upon if the ‘End of Life Choice Act’ comes into effect. Most of them will refuse to practice assisted dying when it becomes legal. If New Zealand is anything like Canada or the Netherlands or some States in the USA, then a small handful of our doctors will say yes. And New Zealand will need strong policy, legal, and public support to ensure their wellbeing in the days ahead. The fact that David Seymour’s End of Life Bill was passed last year suggests that a lot of the policy and legal work has been done to guide and protect our healthcare professionals.

The public work is happening right now, in the build up to October 17 and the general election, when we will be voting as a country on this issue. The issue is in the news, people are debating, and different ethical and moral concerns are being raised. And this open discussion and personal deliberation is all important, critical in fact to the public making informed and well-considered choices.

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