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01 April, 2019
Mike Hosking (M): Now there’s a series of public debates starting tonight to discuss moves to legalise euthanasia. The Justice Select Committee will report back to Parliament on the End of Life legislation next week; Second Reading of that legislation likely to go ahead in the next month. Now, figures released yesterday show that more than 90% of the Kiwis who made a submission on the euthanasia bill want the proposal law scrapped.
Now Canadian palliative care expert Dr Leonie Herx is against assisted dying and is in the country and is with us. Good morning!
M: How heated did the debate get in Canada?
Dr Leonie Herx (L): Oh goodness, it was very heated. Um, for many years actually leading up to the legalisation in June 2016. So we’ve now had legalised euthanasia in Canada for two and half, almost three years, so.
M: Right, and in what form do you have it?”
L: Yeah, so we have something called ‘medical assistance in dying’, which is really a euphemism for euthanasia and assisted suicide. Most cases, actually 99% of cases, are euthanasia where people die through a lethal overdose of drugs. Whereas assisted suicide is a physician prescribes the medicine and you ingest it yourself.
M: Whether you agree with it or not in Canada, has it worked or is it working relatively smoothly, or are there endless lawyers involved and the scrap goes on?
L: Yeah, so that’s the part I was really hoping to have a chance to help New Zealanders understand, because I think there’s been a very rosy picture painted about how it’s unfolded in Canada and the reality is far from that. Unfortunately it’s been rife with problems of every kind of thing that you can imagine, from vulnerable people and changing eligibility criteria and the increased numbers. We’re in a very different place now two and half years into it than any of us ever expected.
M: In what way though?
L: Yeah, so in terms of eligibility, you know, you think that this is for someone with a, a, like a life-limiting condition who is at their end of life and they have uncontrolled symptoms. And our statistics have been consistent with international statistics that it’s actually not people that have poorly controlled physical symptoms. It’s people who have fear of loss of control; they are worried about dying, and they’re worried about being a burden to others. Um, and so, but, what’s happening is it’s become a human right in Canada now and it’s essential medical service. So, there’s been an expansion of criteria into areas that none of us ever imagined. Um so, including the government’s looking at bringing in euthanasia for mental health as a primary diagnosis. Um and for mature minors, and what I mean by that is, (Mike: Wow) children who are felt to be capable of making their own health care decisions, which is often like 12, 13, 14…
L: There’s no minimum age. It’s up the physician to determine whether they understand…
M: Is that a direct reflection, do you think, of the broad-based debate and once you bring it in and cross the line that is where it will go anywhere, or is it a direct reflection of a liberal government?
L: Yeah. No, I think it’s a reflection of the issue itself that once you let the genie out of the bottle you can’t really put it back in. And it’s been this relentless push in Canada to expand the criteria. Including some of our Superior Court justices have now said that it’s unethical to say that you have to have a life-limiting condition. And so now there’s been approval of patients who have chronic disease. So the Justice has actually said that ‘foreseeable death’, which is the same thing as having a terminal condition proposed in the New Zealand bill, is no longer a need to be part of the eligibility criteria. We had a…
M: So what’s ‘chronic’?
L: Yeah, so for example, we had a woman who through this court process had osteoarthritis, which is not a life-limiting condition. It’s a chronic illness where you live with pain and you can have your pain managed. So, she received euthanasia. There was also a woman who had Parkinson’s Disease, whose doctor first denied her access to euthanasia because she felt her prognosis was at least five years. And through this same court process that woman became euthanised.
M: What it doesn’t change though… So, so, so, you go down that particular track, but, what it doesn’t change, no matter who you are or what your condition is, it’s your - this is the argument - it’s your right and your life, and if I happen to have Parkinson’s or whatever and I decide that’s for me, then who are you to tell me it’s not?
L: That’s right. Well, I think the issue is that people don’t understand that you’re talking about 100% of people who die and in Canada we’re up to 1.5% of people who die are choosing to die through euthanasia. You really need to make sure that you are protecting all those other people from not having a wrongful death and not being killed if they don’t want to. We’re already seeing cases in Canada that are unaccounted for. For example, the data out of Quebec: Over two year and three month period there was 1664 people who died through euthanasia and 142 deaths, almost 10% of those deaths, are not accounted for. Meaning there’s a discrepancy between what physicians reported and what institutions reported. So we know nothing about those cases.
M: Do you not know anything about those cases because that might be administrative, or are you suggesting there’s something dark and sinister going on there?
L: I, I mean I think there could be, but ‘we don’t know’ is the truth.
M: So in other words, when an old lady turns up with Parkinson’s, or whatever, they… who knows what happens to them.
L: Yeah, we’re not sure. But I did want to say one thing about the mature minors. We got to the point… So the government actually mandated a task force to look at expanding the criteria to include mental health as a primary diagnosis and mature minors. And the biggest kids’ hospital in the country, the Toronto Hospital for Sick Children, has already published their guidelines for how euthanasia for these children will be accomplished. Including in the guideline is that parents, if the child says they don’t want their parents to know…
M: So, no way, seriously?
L: … After the child has become euthanised the parents will be informed that their child is dead. And these are, like I said, 12, 13-year-olds.
M: Is, that’s not, that’s not, that’s only a guideline for a hospital. That will get shot down. There’s no way in the world that they’d let that ride as a rule.
L: “Well it’s expected that that’s coming next in the change in the legislation.
Mike: Well, what’s the age of a minor in Canada then?
L: Well, so, there is, it’s.. That’s the problem. It’s not defined. So, adult is 18, but a mature minor can be anyone who is felt to be capable of understanding what the decision means. It could be a 13-year-old.
M: Even in law for example?
L: Right, right. M: So in law, so parental responsibility. So, is the parental responsibility different in euthanasia than it is in the other parts of the law in Canada potentially?
L: For a mature minor it applies for any healthcare decision, which in this case would be choosing to die, choosing to be killed.
M: Geez, what a whacky old country you’ve got going there.
L: Yeah, I think... Well…
M: And I know where you come from and so you’re a conservative and I get that. But if you held a poll or asked a whole bunch of people, would most people see it as unusual or are Canadians embracing this and think it’s good times?
L: So I think what’s been very difficult is that it has been kind of normalised as part of medical culture. And that we forget that what it means is if a society legalises euthanasia you’re really saying that a portion of the society’s lives are not worth living. And what’s the impact on that and our responsibility for caring for one another as a human family. And my position is actually as a palliative care physician, not a conserva... It’s not a political, or it’s not a religious thing.
M: I was going to ask. Because, traditionally the debate here has been held: It’s two groups, you’ve either made up what side of the... You know what I mean? There’s no winning over anymore. We’re just on one camp or another. Is that changed at all in Canada, do you think? Or, you were on that camp and you’re still in that camp and that is what it is?
L: Yeah. No, for me it’s about the philosophy of care and palliative care. Shortening people’s lives and ending their lives is not part of providing palliative care. So that’s been a very difficult battle in Canada because people want to lump in euthanasia as part of end of life care. So it’s actually reduced access to palliative care resources in Canada because the funding is kind of lumped together, so...
M: Sure. But as you sit there as a medical professional and you’re dealing with a person who is going to die and isn’t happy and they do want to go out with euthanasia. Who are you to tell them not to?
L: So again, I think you have to think about the whole population and are you… How many deaths from a wrongful death perspective is too many, right? So. it’s one thing to say this, you know, 1.5% of the population may choose this. And those are the people who are probably going to choose to die with or without palliative care, right. Like, palliative care can take care of most types of suffering, I’m not, you know, trying to, under the disillusion that we can control all types of suffering. But that’s just part of being a human being and how we take care of one another. But those people are going to want to die no matter what. But we need to also think about the, the suffering that is displaced onto the other people around them and if you think about all the people that are involved in providing euthanasia, from pharmacist to floor cleaners, to nurses, the witnesses for consent, there’s dozens and dozens of people that the suffering gets passed onto.
M: Great talk. And have a good stay in the country and good luck. Good luck with the debates.
L: Thank you very much.
M: It’s nice to meet you. Leonie Herx is with us.