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Who speaks for doctors on euthanasia?

 Where do doctors stand on euthanasia? It's hard to know because no one's asked them. Photo / Getty ImagesThe NZMA is possibly the most influential single voice opposed to assisted dying but it represents as few as 20 per cent of registered doctors — whose opinions it hasn’t surveyed.

Opposition by doctors is one of the most powerful forces in ensuring that parliamentary bills for assisted dying fail to become law. Doctors are regularly ranked among the most trusted members of society and will undoubtedly be involved in implementing any law change. If they say assisted dying is unethical or wrong, the public takes notice.

Conversely, when doctors endorse assisted dying, they have a profound effect on public opinion, as neurosurgeon Brian Owler has shown in Victoria. In October, Professor Owler, a former president of the Australian Medical Association, urged Victorian politicians to pass voluntary assisted dying laws, saying “life is not defined by a heartbeat”.

“Life is more,” he said. “It is the experience of this world, of those around us; it’s the love and comfort of our families.

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“Some might say that suffering is part of life, and I agree it is. But respecting life does not mean that suffering is something that must be endured by an individual, particularly against their wishes.” 

Owler’s influence — both through his public advocacy and his chairing of the Victorian parliamentary taskforce investigating assisted dying — has been credited with playing a vital role in legalising assisted dying in Victoria, the first Australian state to do so.

Similarly, when Dr Stephen Child, then chair of the New Zealand Medical Association, made a written submission to the Health select committee in February 2016 (and an oral submission in September), his words carried great weight.

He told the committee, “While we acknowledge that there is a range of opinions within the medical community, it is the NZMA’s view that euthanasia and doctor-assisted suicide are contrary to the ethics of the profession.”

His submission added that even if euthanasia or doctor-assisted suicide were legalised or decriminalised, they would remain unethical.

Media coverage claimed that “doctors” were opposed to assisted dying.

How many doctors are actually represented by the NZMA?

But does the NZMA’s stance warrant such attention? Does it speak for a majority of doctors on such a topic? Its website certainly gives that impression, proclaiming: “The New Zealand Medical Association (NZMA) is the country’s foremost pan-professional medical organisation in New Zealand representing the collective interests of all doctors.” 

Dr Child began his written submission to the select committee: “The NZMA is New Zealand’s largest medical organisation, with more than 5500 members from all areas of medicine. The NZMA’s mission is to provide leadership of the medical profession…”

The lobby group for doctors is confident and loud in asserting its pre-eminence. But when I asked the NZMA if it could tell me what proportion of registered doctors in New Zealand belong to it, and whether it polled its members on assisted dying, its media officer told me she was “reluctant” to give out that information without knowing “what sort of use the information might be put to”.

In a follow-up query, she gave a firm “no” to answering either of my questions. Instead, she suggested I speak to Dr Kate Baddock, who has taken over from Dr Child as chair, to offer “context”.

In fact, Baddock was happy to acknowledge that the association hadn’t polled members on the topic but said the NZMA “was looking at how we might seek membership opinion on this very important but very controversial, very emotional and very complex issue”.

I asked how, in that case, could she know what members think about assisted dying. She avoided answering that question directly, but said, “At this point in time, we have a position statement [opposing assisted dying] and we will not be changing that until we have such a survey in hand.”

Baddock said the NZMA was determined to devise questions that avoided the “inherent bias” in such surveys. She couldn’t give an “actual timeframe” for setting one up. “It might be three weeks, it might be three months, it might be six months,” she said.

In short, the NZMA hasn’t polled its members on assisted dying, but intends to, at some time in the future.

However, even after repeated questioning, Baddock steadfastly refused to reveal the number of doctors her organisation represents, She would only say that the NZMA has “a member in probably most, if not all, general practices in New Zealand”, and that “over 50 per cent of all GPs belong, and a lesser percentage of other specialties, although I am not actually aware of the exact proportion”.

When I asked, “So you are absolutely not going to tell me how many doctors you represent?”, Baddock said “no”.

She said the numbers were less important than the “proportion of doctors” nationwide who belonged to the NZMA, but wouldn’t tell me that either, because it is “difficult to determine in the New Zealand setting”.

When I pointed out that there are around 14,000 registered doctors in New Zealand, so we could easily work it out as a percentage of that — she replied, “Possibly, but I have no intention of doing that.”

I told her that the information was essential for the public to work out how much weight it should give to the NZMA’s opposition to assisted dying, especially as its website purports to represent most doctors. She agreed that it did purport to do that, but still wouldn’t tell me.

NZMA numbers revealed in radio interview

As it happens, I discovered by chance that the number of doctors in the NZMA had been revealed in an RNZ interview in April 2017. Elizabeth Berryman, a sixth-year medical student and NZMA board member, was standing for the position of chair and said one of her motivations was the huge drop-off in association members. “A majority of doctors” were members at one time, she said, but now, out of a national total of 14,000 registered doctors, the organisation “represents only about 20 per cent” of them. She said that although the NZMA has 5500 members, “44 per cent of them are undergraduate medical students”. 

If Berryman’s figures are correct, the NZMA covers roughly 3000 registered doctors.

And the figures must be correct because, in the same interview, the outgoing chairman of the NZMA, Dr Child, said they were.

In fact, he couldn’t have been more definite. When the RNZ host asked: “What’s the membership numbers looking like?”, Dr Child replied: “The memberships are sitting exactly as Liz has outlined to you. Which is higher than most of the voluntary medical organisations around the world, like the Australian Medical Association, the American Medical Association…”

This is an extraordinary admission on two counts. The first is that the NZMA represents such a small percentage of doctors in New Zealand and, second, that most other medical associations have even lower membership rates than the NZMA. (It has been estimated that the American Medical Association has only 18 per cent coverage of doctors. 

It is significant because the NZMA cites strong opposition to assisted dying by other medical associations worldwide — and principally the World Medical Association — as a way of bolstering its own stance. Nobody would easily guess from statements made by the NZMA that their stance is based on very flimsy ground, both here and internationally.

Doctors, like the public, have divergent views on euthanasia

Naturally, many doctors are not best pleased that the NZMA, with its few thousand doctors, assumes the mantle of leadership of all 14,000 — or that it makes statements on assisted dying as if it represents most of the profession.

In November 2016, Hawkes Bay cardiologist Miles Williams, who supports assisted dying, told the select committee hearing: “It was misleading of the chairman of the NZMA in his submission to this committee to imply that the association’s policy against euthanasia represents the views of most doctors. New Zealand doctors have divergent opinions on euthanasia (as does society in general) but no formal polling of medical practitioners has been undertaken by the association.” 

Other doctors simply can’t understand how the NZMA has arrived at its position.

In 2010, Auckland GP John Pollock, who was dying of metastatic melanoma, wrote an open letter to New Zealand Doctor, republished in the NZ Herald. “The New Zealand Medical Association is against euthanasia. To me this is unfathomable. I have discussed it with many, many of my colleagues over the years and have found that the vast majority are for it. Indeed, I have met many who, at great risk to themselves, have succumbed to a patient’s begging for a merciful release.” 

Mostly, the media uncritically repeats the line that most doctors are against assisted dying. In March, the NZ Herald published an editorial on the “unenviable task” that Parliament’s health select committee faced in assessing the merits of assisted dying. It noted, “The weight of public opinion appears to support a right to die with deliberate medical assistance though the weight of medical opinion remains decidedly against it.” 

Given the absence of authoritative surveys of doctors’ opinions on euthanasia, neither the Herald nor anyone else in the media can have any way of knowing where the weight of medical opinion lies.

Of course, it’s very easy for journalists to echo the NZMA line, not least because other doctors’ organisations — the Association of Salaried Medical Specialists and the Royal New Zealand College of General Practitioners (with its 4800 GPs) — currently don’t have a position on the topic and neither made a submission to the health select committee.

The euthanasia debate will roar back into life early next year when David Seymour’s End of Life Choice Bill comes before Parliament. It will be a much more honest discussion if the media acknowledges that what the majority of the medical profession thinks of euthanasia or assisted dying is, as yet, unknown — and that it is quite possible more are for than against.