He's concerned about ACT Party leader David Seymour's desire to widen the End of Life Choice Act criteria. Seymour argues the change is necessary, as many who want assisted suicide are "missing out".

Seymour says this is mainly because those people don't have a terminal illness likely to end their lives within six months.

The six-month terminal prognosis requirement prevents those with chronic conditions or disabilities from being eligible.

Betty argues broadening the eligibility criteria would not improve equitable choice for those facing end-of-life decisions.

It should not progress in light of the current palliative care climate in New Zealand, he cautions.

Nor should it happen without careful analysis.

Despite its supreme importance to New Zealand's health system, palliative care is not well catered for, says Betty.

"There's no strategic plan as to what is going to happen with palliative care, there's fragmented services, lack of funding… the list goes on. It's not a situation we can allow as a first-world, caring society."

The contrast and imbalance of palliative care vs assisted suicide and euthanasia is sizeable and cause for concern, he says.

"We have one part of the system fully-funded and overseen in an apparently coherent way by the Ministry of Health (assisted suicide and euthanasia), and the other sector that doesn't even have a strategic plan in place, that is inequitably funded, and has no coherent overview of how to develop the service.

"Why don't we have the exact focus on palliative care, so anyone making the biggest decision of life can make an equitable, informed choice?"

It's remiss of the Government, politicians and the Ministry of Health, he says.

Betty says New Zealand's 5,500 GPs, specialist GPs, trainees and rural hospital doctors often provide palliative care to their patients free of charge.

That's because there is no funding available for end-of-life care - a serious failing of the system, he says.

"Palliative care is so dependent on local funding, which is traditionally done by DHBs, but there's a total lack of funding, resourcing and a national approach."

This, coupled with a growing workload and an increasing complexity in clinical patient needs, adds pressure to palliative care practices.

"The question becomes - why don't we have that exact same focus on palliative care," Betty says.

The Assisted Dying Service Data and Report from 7 November 2021 to 30 September 2022 says only about 80 percent of those choosing assisted suicide or euthanasia have access to palliative care.

Betty cautions against this analysis.

"It doesn't show perceptions of what is going on or the quality of care they are receiving," he says.

The data's effectiveness should be questioned when the Act is reviewed, he adds.

"Everyone is affected by death and dying. That is part of health. Good dying and having equitable choice is a fundamental part of the healthcare system we set up. It has to be given space and focus at this point."

Source

• Scoop
• NZ Herald
• 1News

The court and society have thrust assisted-death squarely into the laps of physicians and we are now left grappling with what this will look like.

My perspective as a palliative care physician on living and dying has been shaped by the thousands of patients and families I have had the privilege of walking alongside as they face suffering in the context of a life-threatening illness.

It is from this vantage point that I can say with resounding confidence that physician-assisted death is not palliative care and should have no home within a palliative care service.

And I am not alone in this perspective.

In a recent poll by the Canadian Society of Palliative Care Physicians, 74 per cent of members felt that euthanasia and physician-assisted suicide should not be provided by palliative care services or palliative care physicians.

The World Health Organization's definition of palliative care states:

"Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual."

Palliative care also "… affirms life and regards dying as a normal process; and intends neither to hasten or postpone death."

By definition, palliative care does not hasten death, and while dying is a normal life process, killing is not. Let's not kid ourselves or cloak reality with soft words — physician-assisted death is killing.

Dying is hard work for everyone involved: the patient, family and care providers.

It is innately an existential matter and asks us what life is all about.

Dying is a normal process and final growth stage of life.

Like birth, it is an important developmental stage in the lives of humans, but unlike birth, one that we seldom talk about as a society.

Those of us privileged to work with and journey alongside the dying and their families will tell you that dying can be transformative — relationships can be healed and past hurts reconciled.

Requests for hastened death are predominately related to existential suffering and do not correlate with physical symptoms such as pain. These existential concerns are typically due to loss of control, loss of hope, loss of meaning in one's life, or a sense of burden to others.

Thanks to the great work of Canadian palliative care physicians such as Balfour Mount and Harvey Chochinov, we have developed holistic dignity-conserving palliative care interventions that aim to restore purpose, meaning and hope in the face of loss that accompanies a life-threatening illness.

These therapies help a person focus on living while dying.

The foundations of our work in palliative care are trust and relationship.

Trust between patient and physician, family and care providers and between members of the health-care team. Is trust really engendered when we reach out with one hand inviting patients to engage in the hard and intense work of addressing their suffering, while in the other hand, we hold the needle to end their lives?

Suffering is not limited only to the individual.

Individuals are inevitably part of a community - family, friends and care providers, to name a few.

Individual choices affect us all. Continue reading

• Leonie Herx is the Head of the Division of Palliative Medicine and Associate Professor in the Department of Medicine, Queen's University. She holds the W. Ford Connell Chair in Palliative Medicine.