Why pro-euthanasia doctors largely stay silent

by Graham Adams / 30 January, 2018
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 Is subtle pressure preventing doctors from speaking out in favour of euthanasia? Photo / Getty ImagesThose who support assisted dying have strong incentives to not say so publicly.

The influence of doctors on the debate about assisted dying is powerful. For many people, being told that doctors are against law reform is all they need to know about the topic. If doctors say they want nothing to do with assisted dying, that becomes a compelling reason to justify their own opposition.

And some doctors are very happy to state their opposition publicly. A list of around 350 of those opposed — organised by Wellington palliative care specialist Sinead Donnelly under the auspices of the Care Alliance — is being circulated online. Of course, the names of a few hundred from a total of more than 14,000 registered doctors in New Zealand is relatively inconsequential but few people will realise what a small proportion of doctors it represents. And, unfortunately, the list has not been matched by one of those in favour, even though many are.

Opponents of assisted dying are very keen to have people believe that most, if not all, doctors don’t want a law change. Semi-retired paediatrician Russell Franklin, who staged a lone protest in December at a press conference held on Parliament’s steps to launch David Seymour’s campaign for his End of Life Choice Bill, was reported to have said that no doctor supported it

It was ironic therefore to see the same report featured a photo of Dr Franklin arguing with Dr Jack Havill, a retired intensive care specialist and former president of the End-of-life Choice Society, which gave the lie to Franklin’s wild assertion.

The New Zealand Medical Association also wants to give the impression that doctors don’t approve of assisted dying even though the lobby group — which touts itself as “representing the collective interests of all doctors” — has only around 3000 members. And since it doesn’t poll them, it can have no real idea of how many are in favour or against. Nevertheless, it is staunchly opposed

In contrast, the Royal New Zealand College of General Practitioners, recognising the diversity of opinion among its 4800 members, hasn’t adopted a position on assisted dying. In a newsletter in December it said: “It would be impossible for the college to develop a position that fairly and accurately represented all members’ views.”

There are few surveys of doctors’ opinions, but a study published in the New Zealand Medical Journal in June 2017 showed that 37 per cent of doctors (and 67 per cent of nurses) “strongly” or “mostly” agreed that assisted dying should be legalised, “assuming provision of appropriate guidelines and protocols”. 

Dr Lance O’Sullivan, who supports assisted dying, told RNZ recently that he thinks doctors are “afraid” in the current environment and more than 37 per cent would be in favour once there was “greater rigour around a programme of euthanasia”. 

Dr Havill has been a long-time advocate of assisted dying. Asked by Noted why he thought doctors in favour often don’t speak up, he recounted his own experience as a practising doctor and the subtle pressure to stay quiet. “When I was in intensive care practice, I did not want to be known as the ‘euthanasia doctor’ because this could be misconstrued, especially by those with opposing views. Thus I became very circumspect.

“My colleagues knew about my views, but because it was illegal it was probably not wise to spread it about amongst relatives and so on. So I stuck carefully to the law but told others of my views in the profession and advocated changing the law. 

“Some thought I was perhaps a ‘funny’ doctor because of this and professional groups were reluctant on the whole to engage with me.

“When I spoke to the Northland College of GPs and outlined what voluntary assisted dying was all about, they had a straw vote and virtually everybody put their hands up saying that they would like it available for themselves. But only about one-third thought they would like to actually do it for a patient.”

He also nominates “a more prosaic reason” — ignorance among doctors. “I guarantee that less than 10 per cent have read the End of Life Choice Bill. Doctors are busy people and unless they have a particular interest they often speak from the seat of their pants and, of course, many do not have much experience of dying patients because that is not their particular field.”

This view of widespread medical ignorance is corroborated by the NZ Medical Journal study cited above, which found that less than 10 per cent of doctors and only 4 per cent of nurses rated themselves as “well informed” on the legal safeguards for patients and doctors in jurisdictions where assisted dying is already legal.

Havill believes there “is some professional capture by palliative care doctors too”.

“They had to fight to get palliative care and hospices established against their colleagues who thought they were not needed. But now they tell others to back off – ‘We are the experts in dying and provide excellent care to all patients who are dying.’ This puts other doctors off because they recognise their expertise.”

In other words, some medical opposition could be seen in part as a turf war.

Matt Vickers has been a leading voice in the campaign to legalise assisted dying ever since his wife, Lecretia Seales, took a case to the High Court in 2015. He thinks that some of the reluctance for doctors to speak out may be due to the doctrine of “double effect” in which intention is everything. Basically, doctors are allowed to administer pain relief even if it shortens a patient’s life as long as their intention is to alleviate pain.

The result is a grey legal area in medical practice, which Vickers wrote about in NZ Doctor:

“Currently the protections for doctors are less than ideal, and potentially put doctors at great risk. We know from various New Zealand studies that some end-of-life practices that doctors engage in flirt very close to the boundaries of the law.

“The Crimes Act specifically protects doctors performing surgery from prosecutions for assault, or unsuccessful and lethal surgical procedures from prosecutions for manslaughter. But bump up the pain relief above certain levels for a suffering patient and you are in a very grey area.

“Your legal protection, under the doctrine of the double-effect, is your intent. Right now, it’s conceivable that all it would take is a grieving family member to question that intent and make a complaint to the police before you found yourself criminally investigated.”

In short, a doctor may see being outspoken in favour of assisted dying as something that could be used against him or her in the event of a criminal charge concerning their handling of a death, which is an extremely powerful reason to keep quiet.

And although doctors have many good reasons to avoid speaking out in support, it seems highly improbable that a profession that largely endorses abortion could be overwhelmingly opposed to assisted dying.

Dr John Pollock, an Auckland GP who died of metastatic cancer in 2010, pointed this out in an open letter to NZ Doctor that was also published in the NZ Herald:

“Is it really likely that the profession that sanctions the termination of the lives of thousands of healthy unborn babies each year would criminalise the shortening of the lives of suffering, dying patients who ask for that last merciful service?” 

Pollock said he had discussed assisted dying with “many, many” of his colleagues over the years and found that “the vast majority are for it”. It would be good if many of them made submissions to the Justice select committee debating the provisions of David Seymour’s End of Life Choice Bill and not leave the field to those opposed.

 Where to make a submission

Submissions on the End of Life Choice Bill can be sent to the Justice select committee, by email, letter, or online. Submissions close on February 20, 2018.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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