Assisted dying is a complex subject that raises challenging ethical questions for hospice care. Hospice New Zealand recognises that across society there is a range of different views, and respects the right of everyone to take an individual position. It is our view that the question of whether there should be a change in the law is one for society to consider and for the parliament to decide.
The term 'assisted dying' is often used to describe circumstances in which a person is either helped to end their own life (physician-assisted suicide) or where there is a deliberate act to end a person's life (euthanasia)
Hospice New Zealand does not support a change in the law to legalise assisted dying in any form. Nor do we consider that a change in the law would be in the best interests of the people we care for.
It is important to stress that hospices' always work strictly within the law, which currently means it is a criminal action to help someone commit suicide and may result in prosecution.
We believe Government should be investing in palliative care, increasing access to care and support not legalising euthanasia. Only when all New Zealanders have ready access to expert end-of-life care can a balanced debate begin. We support that all New Zealanders have the right to choose where they die.
All people with a life limiting condition should be made aware of options for hospice and palliative care, and should be offered an individual assessment of their needs to ensure that appropriate palliative care is being provided. This should be an integral part of advanced care planning.
We believe that palliative care should be routinely available to all who need it, and Government should ensure that public funding is made available to increase the availability of palliative care, whether provided by the hospital, at home (by the primary health care team), in residential aged care facilities or in hospices.
Greater education and training is needed to dispel the myths surrounding pain and symptom relief, and encourage all those prescribing medication for symptoms near the end of life to consult with hospice specialist clinicians and other palliative care experts where necessary.
The ethos of hospice and palliative care, as defined by the World Health Organisation, is that it ‘intends neither to hasten nor postpone death’. This philosophy is a cornerstone of hospice care in New Zealand.
Our aim is to see the very best care for everyone facing the end of life. This means that:
Hospice and palliative care must be provided according to the principles of equity, irrespective of age, race, gender, sexual preference, ethnicity, faith, social status, national origin and the ability to pay for services. Palliative care must be available to all populations including vulnerable groups such as prisoners, sex workers and drug users.
Hospice and palliative care goes beyond managing the physical needs of people approaching the end of their lives. It places equal weight on their social, psychological, spiritual and emotional needs. It helps people to die with dignity.
Good palliative care is founded on a trusting relationship between patient, family and the health care provider, which is undermined by euthanasia.
As a result, good palliative care can greatly improve most people’s experience of living with and dying from a life limiting condition. Many people using hospice services, whether it is the patient, family or friend find that they have a further positive phase of life which they never expected to have – perhaps coming to terms with their situation and experiencing a greater quality of life than they had imagined possible during their final weeks or months.
There are many unanswered questions which require clarification before there could be any change in the law.
Hospice New Zealand believes that more research is needed to inform the public debate and future policy by government in particular:
If there was to be a future change in the law, consideration would have to be given to:
Compassionate communities value and care for the most vulnerable people - the elderly, those living with disabilities or mental health issues - to ensure they do not feel like emotional, financial or care burdens.
In recent years, there have been significant improvements in health care decision making, which give people greater control over decisions about their treatment and care.
It has also been identified that there is a lack of open discussion between health and social care staff and those approaching the end of life and those who care for them; this is one of the key barriers to the delivery of good end of life care. The New Zealand Palliative Care Strategy (2001) sets an expectation of all palliative care providers; that they must provide information to the public around expectations of a palliative care service.
There is an emphasis in the palliative care sector on ensuring that services provided to people approaching the end of their lives are, as far as possible, responsive to their needs and preferences. This is evident through the introduction of advanced care plans where people are given the opportunity to consider what care they wish to receive, based on the best available information about what may lie ahead of them and what services are available.