Dr Conrad Engelbrecht is a doctor in anaesthesia and pain medicine for Waikato DHB and co-head of the Braemar Pain Clinic in Hamilton.
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04 April, 2019
By Dr Conrad EngelbrechtAnaesthetist and Pain Medicine Specialist
OPINION: In debate around the End of Life Choice Bill, there is a lot of talk about pain and suffering. Is it possible to stop all pain and suffering? Can pain and suffering make a life no longer valuable, and make death a better option than life? What should a doctor's role be when a patient is experiencing intense pain and suffering?
As an anaesthetist and pain physician working at a pain clinic, it's my job to help people who are in pain. On a day-to-day basis, I see patients who are suffering, and my job is provide them with an avenue to alleviate their suffering.
I can tell you that pain and suffering are complex experiences. Of course pain can be physical, but it can also be emotional, existential, spiritual or psychological. It can be caused by medical and physical conditions, as well as by emotions and issues held deeply inside a person. Pain often affects people on multiple levels. It affects their moods, their ability to function, their physical activity, how they sleep, their mental well-being, and their social interactions and engagements.
When people experience pain over long periods of time, and when that pain is relentless, people can suffer from low moods and even develop depression and anxiety. They lose things that are important to them: jobs, hobbies, the ability to work, and a sense of self-worth. I have met many patients with chronic or intense pain who feel like they are no longer valuable to their families, their community, or to society – that they're more of a burden than a blessing.
But these people do still have value, and it is our job, at the pain clinic, not only to help them with their pain, but also to demonstrate to them that they still hold value as people.
If I am going to help a patient who comes to the pain clinic, I need them to trust me. I need them to expose some of the deepest worries and issues within themselves, so that I may help them to heal and to experience less pain.
Not long ago I rang a patient whom I was going to anesthetise.The very first question he asked me after I introduced myself was where did I stand on the End of Life Choice Bill. I was really sideswiped by the question because, at that time, I didn't really know much about the Bill or why it would be relevant to my work. But the patient wanted to have a conversation with me about it because he thought it was really important. He sees the Bill as a risk to New Zealand, and he wanted to know where I stood on it because he wanted to know if he could trust me as his doctor.
After that conversation with my patient, I started to look into and think about the End of Life Choice Bill from my perspective at the pain clinic.
It was clear from the conversation I had had already with one patient that the End of Life Choice Bill, should it pass, could destroy the trust that some of my patients have in me. Should I have the power to end their life, some patients could feel like they couldn't tell me when they are having a tough time or disclose to me the depth and reasons for their pain and suffering because they'd be afraid that I would think they should just let me end their life. I need to hold out hope and healing to my patients at all times, to never waver in my belief that they have value.
Guiding people down a pathway from pain to improved quality of life is intensive work and requires a lot of investment from myself, the whole team at the pain clinic and, of course, the patient. At the pain clinic, we're already underfunded. Should the End of Life Choice Bill pass, would there come a time when the Ministry of Health could decide that more funding isn't needed, or even cut our current funding, because there was an easier way to stop a person's pain – by ending their life?
Could patients ever feel like recovery and improvement, though possible, were too hard, and opt for an assisted suicide? And what if some of our patients weren't getting the necessary support that they needed – from us, from the State, or from their caregivers? Could they see assisted suicide as their only viable option?
As someone who works with people in pain every day, I can't support the End of Life Choice Bill. It takes a vulnerable population, one that experiences depression and anxiety and already worries that their lives hold no value to society, and offers them suicide as a solution to their pain and suffering. It would destroy the trust that some of my patients have in me, as their pain doctor, to be a safe space where they can discuss the causes of their suffering.
Rather than talking about ending the lives of those who experience pain and suffering, I would like to see our politicians talking about policies and funding that provide patients with the support that they need to be able to navigate what can be a difficult path from pain to improved quality of life. I wouldn't want any one of my patients to choose to have a doctor end their life because they don't have a good alternative option or the support necessary to make it on the path back to well-being.
Dr Conrad Engelbrecht is a doctor in anaesthesia and pain medicine for Waikato DHB and co-head of the Braemar Pain Clinic in Hamilton. Conrad’s concerns about the End of Life Choice Bill arose out of conversations he had with several of his patients, including Kylee Black, after hearing from them that should the Bill pass, they would become suspicious of the motivations of their doctors, and they would feel pressure to end their lives. He speaks out to #DefendNZ Vulnerable and appears in a documentary from #DefendNZ released Thursday 28 March (below).
Watch Kylee’s documentary in widescreen and read her complete story here.