Hospice doctors and nurses must be allowed a choice on End of Life Choice. The palliative care specialty is not some form of commune where everyone must conform strictly to the leader’s beliefs, writes Dr Miles Williams.

The coming into force of the End of Life Choice Act has been a uniquely New Zealand experience. Politicians of all persuasions have toured the country to hear and read submissions from thousands of their fellow countrymen and women.

The Bill was vigorously debated in parliament and voting was by conscience vote rather than along party lines. As a result Members of Parliament voted that the bill become an Act.

However, it was an Act with a difference; it could only come into force if the majority of New Zealanders voted for it in a binding referendum, an additional step stipulated by one of the government coalition members, a party incidentally that has now gone west.

Many would say that a referendum is the worst possible manner in which to decide the fate of any bill, particularly one of this nature, because it allows the uninformed or the grossly misinformed to determine the outcome: in this case whether New Zealanders should gain the right to make an intensely personal decision at the end of their lives.

Senior members of the medical profession have let the New Zealand public down by putting their heads in the sand and remaining tight-lipped on this issue.

Nonetheless, despite a well-funded anti-euthanasia campaign that included the publication of misleading and distorted versions of the Act, and statements that were downright false, the referendum passed because of the indisputable wish of the people.

Work can now focus on establishing the mechanisms by which the benefits of this legislation can be made available to all New Zealanders: both to the small number who will actually require assisted dying, and to all other New Zealanders who will benefit from the type of engagement that can occur under this legislation.

This includes the subtly different but important sorts of conversations that will now be possible between patients, their families, and their doctors.


What is a doctor’s professional obligation: to place the wellbeing and rights of patients at the centre of their professional practice, or to preserve life? Click here to comment.


Senior members of the medical profession have let the New Zealand public down by putting their heads in the sand and remaining tight-lipped on this issue. This is despite the obvious fact that the End Of Life Choice movement has been a global one initiated by ordinary people facing personal tragedy for many years, and it has been clear for some time that the people of New Zealand have wanted to join this movement.

Why is it then, that apart from a small group of doctors, the medical profession did not publicly support their patients on this issue, particularly when they were in a position to reassure the public by referring to the abundant literature describing successful overseas experience?

The answer is complex, probably reflecting a number of issues including the conservative nature of the profession, deeply ingrained outdated medical traditions, uncertainty, lack of knowledge, and ultimately, personal convictions opposing the policy. Many were frightened to explore the topic with their patients lest they themselves become labeled or stigmatised, or engender fear.

We live in a secular society and the palliative care specialty is not some form of commune where everyone must conform strictly to the leader’s beliefs.

The New Zealand Medical Association  has not helped in this regard. The Association’s board members have shown themselves to be a reactionary group, prepared to use disingenuity and dishonesty to maintain the status quo rather than explore new approaches.

Members of the organisation have behaved as if the title of “doctor” entitles them to pass judgment without consultation, without research, without attending international conferences and without listening to those with different perspectives.

These are all things that registered medical practitioners must do if they wish to fulfil their ongoing medical, educational, and professional requirements for the purpose of making sound and informed decisions on issues that will affect their patients.

The hospice/palliative care specialty must review its position. Assisted dying has been successfully integrated with palliative care in many countries including Australia, and there is no reason why this cannot be achieved in New Zealand.

We live in a secular society and the palliative care specialty is not some form of commune where everyone must conform strictly to the leader’s beliefs.

It is unreasonable and unacceptable for any organisation to impose its doctrinal beliefs on all its members. There are those who work in hospice/palliative Care who support the Act but are unable to participate. They should be permitted to voice their opinion.

This legislation will be truly liberating for the majority of New Zealanders even though only a very small number will actually need its benefits. The conversations that can occur when patients as well as their doctors can be truly honest with one another and discuss their deepest fears, will be importantly different than from before.

Difficult conversations such as “should I have a heart transplant?”, “should I consider potentially disabling or personality-changing brain surgery?”, or “should I have palliative chemotherapy?” will be more complete and offer a clearer perspective when they can also include “should I consider the possibility of euthanasia or assisted dying?”

You only ask such questions when your back is truly against the wall, and you know it.

I am pleased, relieved and proud that New Zealand has joined this movement and I know that the legislation will bed down safely and securely in this country.

Cardiologist and general physician

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