Feb 28 2013


Published by under Uncategorized

Euthanasia, Physician-assisted Suicide, and Spirituality

Dr Richard Egan
Dept of Preventive & Social Medicine
Dunedin School of Medicine
University of Otago


28 Feb, 2013


•Introduction – and the lens through which I see?
•What are we talking about?
•Why are we talking about it?
•Positions – anti & pro

Who am I?

How one understands, studies and explains spirituality may be considered as much related to the individual researcher’s beliefs and worldview, as to his or her discipline, methods or subjects.
(Schneiders, 1989, p.694)


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


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)

Journal of the New Zealand Medical Association
 Euthanasia and physician-assisted death
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.
Why spirituality and euthanasia?
Our position on euthanasia and PAS is based on our spirituality.

Spirituality Studies

•Spirituality in New Zealand education
•Spirituality in New Zealand hospice care
•Psycho-social-spiritual supportive care in cancer
•Spirituality in ODHB oncology ward
•Spirituality in medical education
•Spirituality in aged care
•Spirituality and dementia study
•Spiritual care professional development project
•Spiritual care in cancer care across 16 countries
•Spiritual care, baseline study, Africa

What is spirituality?

Map of the terrain.

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.
Egan, R., MacLeod, R., Jaye, C., McGee, R., Baxter, J., & Herbison, P. (2011). What is spirituality? Evidence from a New Zealand hospice study. Mortality, 16(4), 307-324.
Oxford textbook of Spirituality in Healthcare Edited by Mark Cobb, Christian M Puchalsky, Bruce Rumbold

Spiritual Needs?

“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

Spiritual Needs

•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)

Spirituality is relevant in healthcare.

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

Questions to consider

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

Other countries

•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

Anti- euthanasia arguments

•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

•Practical issues
•Death itself
Source: <a href=”www.bbc.co.uk/ethics/euthanasia”>/www.bbc.co.uk/ethics/euthanasia/</a>

Summing up

•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

Questions to consider

•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)

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