Sea of Faith — Dunedin

Allan Kellehear’s A Social History of Dying (2007)

Kellehear distinguishes three periods in which humans had or have a distinct understanding of dying.

The Economist – NZ 3rd best place in the world to die

What are we talking about?

•Euthanasia (E)
•Physician-assisted suicide (PAS)
•Withholding or withdrawing treatment – not E/PAS
•Fine, but important lines – between medicating for suffering compared to medication to kill.

Why are we talking about it?

Demographics, mortality trends, costs
•We’re getting older and more multicultural.
•The long dying: move from communicable to chronic diseases dominating death
•Inequalities challenge
•Secular developments

End of Life Choice Bill

The purpose of this Bill is to provide individuals with a choice to
end their lives and to receive medical assistance to die under certain circumstances.
Those circumstances are:
• that the person making the request must be mentally competent, as attested by 2 medical practitioners:
• that the person suffers from a terminal illness which is likely to cause death within 12 months, or from an irreversible physical or mental condition that, in the person’s view, renders his or her life unbearable:

Disadvantage dying?

Health and Social Problems are Worse in More Unequal Countries

http://www.closertogether.org.nz/inequality-in-nz/

Secular development

Spirituality and Religion
•Disentwining thesis: growth of contemporary spiritualities
•“I’m spiritual, not religious”
•Secular – choice (see Charles Taylor)

‘Unbearable suffering’

•Experience of undignified and (unnecessarily) painful deaths (e.g. early HIV/Aids deaths)
•What is a good death?
•Who has the power?
•Peaceful death desired
•Spiritual / existential issues – why most people want to kill themselves (Prof Rod MacLead)

THE NEW ZEALAND MEDICAL JOURNAL

Journal of the New Zealand Medical Association

A D (Sandy) Macleod

__________________________________________________________

Medical Practitioners do not have the knowledge and expertise to participate competently and reliably in selecting those fit to be offered euthanasia and assisted suicide. Issues relating to the clinical assessment of such requests by the terminally ill, diagnostic errors, prognosis, competency, and mental health status are, as yet, not adequately scientifically resolved.

_________________________________________________________

Our position on euthanasia and PAS is based on our spirituality.

Spirituality means different things to different people. It may include (a search for):

–one’s ultimate beliefs and values;
–a sense of meaning and purpose in life;
–a sense of connectedness;
–identity and awareness;
–and for some people, religion.

It may be understood at an individual or population level.

Oxford textbook of Spirituality in Healthcare Edited by Mark Cobb, Christian M Puchalsky, Bruce Rumbold

HANDBOOK OF RELIGION AND HEALTH. Second Edition HAROLD G. KOENIG, DANA E. KING, VERNA BENNER CARSON.

“There are not many people that have got it all together when they die” (hospice nurse)

I think it’s important, but especially important in the situation I’m in.

It would be very difficult if I didn’t have any sense of spirituality.
Fran, 62, education, Ca

•Dependent on life before cancer
•Identity challenged
•Challenges and opportunities
Common spiritual needs included
•religious needs (small number),
•existential needs (meaning & purpose),
•peace of mind (relationships, financial, hope, humour, identity, congruency)
•blocks to peace of mind (spiritual pain, anger, fear, guilt, regret, worry, uncertainty, grief and despair).
•Family needs least met
“A significant part of the work of the dying is dealing with spiritual issues.” – (Hospice chaplain)

1. Spirituality broadly understood
2. Evidence growing
3. High spiritual needs at end-of-life / time for spiritual growth
4. Spiritual care currently patchy
5. Context/zeitgeist: spiritual needs growing
6. Further NZ research / policy / practice needed

•What do the wisdom traditions add to this discussion?
–Meaning of life and death?
–What’s a good death?

•Netherlands – legal in 2001
•Belgium 2002
•Luxembourg 2009
•US States: Oregon, Washington
•1995 Australia – Northern Territories

•Multi-country/multi-year study (1996-2007)
–E/PAS – highest 2.0% of all deaths (on death certificates)
–Intensified alleviation of symptoms – 19-33%

Source: Cohen, J. & Deliens, L (2012) A Public Health Perspective on End of Life Care. Oxford Uni Press. Chap. 4

•Ethical
•Practical
•Historical
•Religious
•EoL healthcare professionals and other HCPs
Source: <a href=”http://www.bbc.co.uk/ethics/euthanasia/”>http://www.bbc.co.uk/ethics/euthanasia/</a>
<a href=”http://euthanasia.procon.org/view.resource.php?resourceID=000126″>http://euthanasia.procon.org/view.resource.php?resourceID=000126</a>

Pro-euthanasia arguments

•Rights
•Practical issues
•Philosophical
•Death itself

Source: <a href=”www.bbc.co.uk/ethics/euthanasia”>/www.bbc.co.uk/ethics/euthanasia/</a>

•Pro – civilized society – shouldn’t die in pain and indignity – should be able to manage it legally
•Anti – religious opposition; if legal will be abused
•Societal attitudes – mostly pro, but when examined in research less assertive

•Legal issues – should individuals be convicted for helping their loved ones die?
–How will we know if there was coercion, agendas?

Questions to consider

• What is the relationship between good EoL care and desire for a hastened death?
–Complicated – has been argued that good hospice/palliative care attends to pain (physical/spiritual)
–Belgium study challenges this…

• The burden issue
– to family, cost (health $ EoL last year 80%/40% last month (US Luce & Rubenfeld 2002)