[00:00:26] Speaker A: Welcome back to the New Zealand Voice for Life Pulse podcast, where we discuss all things abortion and youth euthanasia. What if the biggest driver behind euthanasia isn't pain, but rather loneliness? What if what we call choice is shaped less by autonomy and more by fear, pressure and unmet needs? In this episode, we hear from a doctor with years of experience in end of life care. He's someone who has sat in the room for some of life's most difficult and deeply human moments. He offers a perspective that's rarely heard in public debate, a perspective that challenges assumptions behind assisted dying and raises deeper questions about what people really need at the end of their life.
[00:01:02] Speaker B: I've had hundreds of conversations over my career now with people who are dying, and the thing that strikes me is not that they're not actually worried about pain. Actually, we're reasonably good at that, I'd like to think. But they're worried about loneliness and they're worried about abandonment and they're worried about being dependent and needing someone else to help them with their toileting and because they feel that's undignified.
Actually, I look after young people who are paralyzed and have been for years and need help with their toilet in and they've got lots of value and they think they've got loads of value. So I think there's often fear of where you might end up and loss of control. And so those things are things that I think are the key drivers for a sister dying in. The data would support that. The Canadian data says about a third of people go for euthanated because of loneliness.
It's awful that we as a society would choose to care for someone who is lonely by ending their life.
How on earth did we end up there? That's just not the sort of world I want to live in.
And I don't want to say it's not hard. Actually, it's hard, but I was looking after a young person, was perfectly physically well over the weekend, who felt like her life wasn't worth living and she needed here because she was suicidal.
Do I say to her, well, maybe you're right. Here, have an injection?
No. She is of incredible value and so I want to give hope, not a lethal injection.
[00:03:09] Speaker C: When did you have your first experience with what that looked like in a hospital setting?
[00:03:14] Speaker B: For a long time, people have raised the issue, but this is before legalisation. It would come up in conversation. People would say, I wish I could die, I wish you give me an injection, I'm over this. That wasn't an option then. And so I understand a little bit of what brings people to that position where they ask for that before. It's just common when you're dealing with elderly people or with sick people or people who have a terminal illness, they're thinking about dying. It's part of. It's part of life and very present, very real for people in that situation.
Before legalization, you could then always have a conversation about to explore that. What is dying like for you? What are you sick of? What could be different?
What are you worried about?
What are you frightened of?
What makes your life not worth living from your perspective?
And you could have those conversations knowing that you were seeking answers, that because euthanasia wasn't an option, actually, this is the roof by which we've got to solve it. And so often you were able to help people to a different place, a place of greater acceptance of dying or fixing particular problems or addressing conflict within families or estrangement with them is a very, very common comment from people who are frail, so elderly or dying as I don't want to be a burden. It's the sense that they can't impose on others, they can't ask of others. It's not fair that the salt of the earth sort who have always done things for others but don't want to be in a place where they feel a burden.
That breaks my heart as someone who cares, because these people are treasures. They have lived a good life. They have helped so many other people.
And you just want to say to them, you are not a burden. You are now going to enable other people to do what you have done yourself.
You're going to enable other people to be their best selves and help you in a stage of life that will come to all of us.
And so you always had those conversations. It was okay. In fact, it was what you had to do to help.
And nowadays it's okay. I'm a conscientious objective, but I'm required by legislation to give you here, this phone number. You can ring it up and they'll do it for you. But when poisoning your patient is legal and what they're asking for, it just takes all the attention off those other things, which can be really helpful, really.
I'm going to say profound.
I don't want to trivialize the suffering that people experience at the end of their life.
Both the start and the end of life can be quite messy.
So I'm not trying to trivialise that. It is often difficult and sometimes not that often there is pain that is
[00:06:46] Speaker C: difficult to Control the fears that we faced going into introducing this legislation, particularly from those in healthcare. Things like not being able to truly care, not being able to push back on the idea of wanting to end your life.
You were mentioning the contrast between before, you could push back strongly as a doctor and help solve problems. But now there's a major question mark and hesitation and you feel that legally you almost immediately have to refer.
Is there a line? How do you navigate it?
[00:07:23] Speaker B: There's a legal framework which if someone asks people don't generally come in and say, sister died day after tomorrow. Here's the time, here's the place. It arises in conversation. And I can, I feel okay to have a full conversation with a patient, with someone who I'm doing the journey with, amongst which I will say, look, I am not someone who supports euthanasia. I don't think in the grand scheme of things it's going to help.
And I acknowledge your right to access that.
I won't stand in the way, but I won't help. Oh, I won't participate. I will help you, but I can't help you with that particular part of your care. And I'm required to give you a phone number. Here it is. Do you mind if we go back and talk about some of those things that were really on your mind now? For me, I've been in the trenches a long time.
I feel comfortable doing that. I've been in lots of gnarly situations.
I've been in many end of life situations with families where there is civil war or where there is just really complex stuff going on.
So in a sense there are settings where I feel not comfortable, but skilled.
My concern is really for younger doctors, particularly those who feel very uncomfortable about euthanasia. Is that sort of the script they are given by the system is, okay, let me help you with that request. And they're just going to feel torn. They're going to know on the inside this is not right. There are so many other things we could be exploring here. I hope they will try and do that. But the system marches on and I think it will.
And as it becomes more common, people will just know that's an option and will come to you with having made up their mind without actually having explored their options.
And so I really feel concerned for younger doctors. Can I give you a couple of examples of situations?
People's autonomy is actually taken away. This is not something that is giving people a choice. It's something that's taken away choices I vividly recall. In fact, it's happened. A lot of times I've seen someone in a hospital session who has come to hospital with vague symptoms or concerns, often from a gp.
You put them through the scanner and you find that they're unfortunately riddled with cancer.
And that's a big bolt out of the blue.
They've had some pain, they haven't been feeling well, they're a bit nauseous, and there's some sort of cancers that just sort of show up like that.
And so you sit down with them and you walk them through the process of saying, this is what we find. This is what we found. We've got some more work to do to tell you exactly what sort of cancer is. But I'll be honest with you now and say that I would be most surprised if this was a cancer that could be cured.
And therefore, we're talking about the last chapter of your life. And that's like. That's hitting someone with a baseball bat.
That's a really confronting conversation to have.
And it's something that doctors get a reasonable amount of training in.
And some do it okay, and some. It's not their forte. But what I would do with someone sitting in hospital is saying, look, this is an awful situation, but I'd be quite sure that the last thing you want to do with whatever time you have left is sit in a hospital waiting room or in a hospital bed.
I presume you'd be more comfortable at home, that you'd want to be with family, not with strangers in white coats or whatever.
We will get you there, and we'll start this process of caring for you at home.
And do you introduce the idea of palliative care?
And so there are many times that I've seen people on that. You talk them through what palliative care looks like. This is good pain relief. This is helping you navigate the plans that you'll need to make. How do you care for your family? How do we care for your family? That's all part of good palliative care. So we've made these referrals.
How about you go home?
And that can kick in.
And then a month later, they turn up in ED in constant pain because their number hasn't come up yet.
And so often I know I'm sending people home to a system that is completely overwhelmed.
And despite my best endeavors, despite me pleading with different parts of the system, it's not going to work. And so I send someone home to a month.
And I recall cases like this where someone has had no support, no contact, has lived with the pain has kept thinking, I wonder if they'll get in touch with me today because I've got now got a really long list of questions during that time.
You know, people can plunge into grief with or fear without any support and then they come back in crisis a month later.
Now I need to see the pod with a phone number that they can ring to end it all.
And I think, oh, that sucks. The problem is that in New Zealand, our palliative care services that are awesome, but they're funded by cake stores and op shops and as our baby boomers age and die, they are just really under the pump and there are saints out there. I think some of our palliative care doctors and nurses are, you know, heavens, I want them on my case, but there aren't enough of them and we're not fixing that.
And so I'm having to pretend that there's this good care available, sending people home to that just hoping, but knowing that they now have a phone number that someone will show up at their home and the clock is ticking. It's the only service that comes to your home and within days you can be over this.
I think like, no, that's not a choice, that's a bulldozer.
And I fear that we're pushing people into that option.
I'm worried that it's actually reducing people's choices, but it's letting us off the hook in terms of funding and providing good palliative care and that individuals we're giving an out to and it's when the system should be doing a whole lot better.
This needs to change. How do we fix this? What's a step towards fixing this?
Well, it's more than fun palliative care, it's about thinking about workforce.
You know, we have each year more people dying as we have more baby boomers arriving at that end of life.
We're going to need more nurses, we're going to need more doctors, we're going to need more support services in the community.
We're going to need some people in the policy world to monitor that. We're going to need some public accountability around how much of that service is providing. But at the moment we're busy disestablishing all those roles because we've run out of money there as well.
So it's a system wide thing and it's something that we need to say how good it can be. There are lots of voices saying, oh, euthanasia is the way to go because we've now got a bureaucracy that's set up to do that. So that's their message. Voices in the public space have said that for a long time. There's a well organized network around that.
I'd just like to say I have seen so many people die well, who have arrived at their end of their life with all the.
The worry and fear that comes with that, and had deeply meaningful times with family who have had superb care, whose hands I have held as they've taken their last breath.
And that's a life well lived.
[00:16:29] Speaker C: There's some real power in there and there's some real truth to it. And it's not just one liners and catchphrases. This is actually what we really, really need. This is the foundations of what needs to happen. It's not going to be an easy thing, and death isn't easy. The process has been easy. No one likes it, but it can be done.
[00:16:51] Speaker B: Well, I talk to older people and older people are very accepting of this.
You know, you get to the point where you know your turn's coming and particularly as you age and all your friends die, you just, you know it's happening.
And so I think for older people, dying is quite normal. I think for younger people, and particularly people who are dying young. So younger people who have a terminal illness that is not common at their age, but then it's this, this fear thing is much greater. And I don't think fear is well addressed by a lethal injection.
And just don't, don't think that's gonna help.
[00:17:39] Speaker C: What do you think the value of a good death is? I think you've briefly touched on it. You've seen some of those tremendous moments.
I love what you shared. It was an incredible insight, it's quite profound really, of these people, these salt of the earth people that have given out and served for their lifetime, understanding not only that it's their moment to receive, but they're actually in those moments they are calling up the next generation to step into the very thing that they did that's just so powerful. When the dying process is cut short, what is lost?
[00:18:17] Speaker B: I think we lose so much. I think we lose for the person the privilege of being cared for. I don't, I don't want to patronize people, but I had an elderly relative die recently who for a long time had been fully dependent.
And I just take my hat off to the saints who cared for her. She was comfortable, she was just.
But there was this whole community of people who were, who are able to be their best selves by using their gifts. Their passion, their love to care for this person at the end of their life. Just as there are people who do that at the start of life. There are teachers who do that in the classroom, there are cops, cops who do that in the rough neighborhood who are making the world a better place. What do we lose? I think we often lose real time as families.
And I've had many conversations with families at the end of one of their family members lives where I've been able to, you know, help them notice the elephant in the room, maybe name the elephant in the room, sometimes usher the elephant out of the room.
Now usually those sorts of things have long histories and sometimes that's just the way it is.
But I've been with someone who was dying, whose last words were now able to be I love you.
And lead the tide.
Now maybe you can construct that in a setting of euthanasia, but if someone's opting for an assisted death because that's all too hard, or because they've long ago lost hope, or because someone's never returned their call, so I'm just not going to try anymore.
You give away the opportunity for that to happen.
And I have seen it happen so often.
And I've also seen people screaming over a dying body. You know, we're human.
Rap happens.
So again, I don't want to trivialize that it is difficult, but I just.
Euthanasia takes away so much potential, takes away so much of the reality of life, or takes away the really important stuff, life as well as in death.
I could tell you a story of a case which to me emphasizes the dilemma.
I was looking after a frail woman who was living at home with her daughter.
She was elderly, her daughter was midlife.
Daughter was probably not going to do life by herself.
You know, she had possibly mild intellectual disability. I wondered. Her mum said she'd never done well academically and had a minimum wage job and still lived with mum.
The issue was that she had significant chronic health conditions. She was struggling at home and it was abundantly clear to me that living independently was increasingly challenging. She needed 247 care. She had going into a rest home, which she was fiercely resisting because she had a house with me to sell the house and could not then leave it to her daughter.
So at that point her daughter becomes homeless.
There were other family members that were up and running. You know, they hadn't been at large, they had their own houses. But she was particularly concerned for her daughter who was never going to be able to own her own home and would probably struggle to afford or manage her own living situation any other way.
And so her mum was talking about euthanasia.
I think she would have qualified, you know, it wasn't a stretch to think that she only had six months left to run and her only motivation was, this is how I can provide for my daughter, whom I love dearly.
And that's the reality. She would have complied. She said. She would have said, the thought of my daughter not having anywhere to live brings me unbearable suffering.
And I'm clearly at the end of my life. She's just ticked all the boxes.
I also wanted to foster conversations with her family and with her daughter. And there was. There was lots of, you know, I don't want to go in a rest home. It's a very common conversation with him, with people. I'm, you know, carry me out the box. Don't you dare take me to a rest home.
Those losses of independence are very challenging. But it was just clear that, you know, her big concern was for her daughter and for that reason she would choose to die.
And I just think that's incredibly sad. That's not the sort of world I want to live in where a parent chooses to end their life so that their children are provided for.
Like, what does that say about us, that that's not where we want to, you know, and that's the reality as it happened. In the time following, she actually died suddenly, unexpectedly, which often happens towards the end of life. So we.
I think we both had a smile on her face at that point.
You know, she had.
She died well. She was well cared for. Her family. We had kept conversations with her family that her, you know, she was in the last chapter of her life and I didn't know when the end would be.
She would be thrilled that her daughter was now provided for.
So in a sense, we never. We never got to the crunch.
We didn't have to get there for her. It was just quite sensible, quite logical.
Here's a difficult situation. I love my daughter dearly. I'm going to die anyway. Let's do it in a way that she gets to keep house.
And I just thought, oh, yeah. I just think the autonomy argument thinks about that or considers that it pretends that the decisions are just about me. It's about me and when I choose to die and.
But no, it's.
There's always a context. There always other people in the room.
There's always family, there's always expectations. There's always, or very often a sense of people not wanting to be a burden.
Always A sense of people worrying or fearful or needing to resolutely be in control.
Yes, indeed, need and think it's not. Where is the choice of all? This idea of free choice is like, no, that's not the world I work in.
The other thing was the drift and criteria, which is a concern of mine. And it was always, it was something we always said. Once you have said it is okay for the state to sanction killing someone whose life is deemed to not have value, then it must, the criteria must extend over time. Now we've certainly seen that elsewhere in the world. But also it makes sense. Once it's okay to kill one person, the person who said seven months before the expected death compared to the person who's five months of the expected, it's okay for one, it's, you can't say it's not okay for the other. And so there will always be pressure to stretch the line of fact. It's being unfair not to.
And as certainly the Netherlands, Belgium take psychological psychiatric diagnosis, Canada oscillates around that.
And I see people with mental health diagnoses whose lives in my view would be far more difficult than anyone with cancer. But if you are chronically suicidal and every day is just gray or black, will give you a follow up appointment in three months time who suffers more?
It's not me. Not for me to judge, but guess what I think. And so if you're accepting that it's okay for the person to take the life of a person with cancer, it's almost cruel, it's almost devaluing the suffering of the person who suffers in other ways to say, no, you're not eligible. So it's just got to change over time.
And everyone said no, of course not.
Guess what's happening?
And I see that as that's going to land us in an awful place, particularly with young people. I work with young people.
I also care for young people who are in very significant distress and that evidences it in terms of overdose, in terms of eating disorders, in terms of crippling anxiety, in terms of quite horrendous chronic pain for those people. I actually see hope because I've cared for people and I've seen the recovery that is very often possible.
It's usually in fact always a long and difficult journey.
But I've seen those people over time get up and get on with lives, have relationships, have families, do stuff, but in a way that they could never anticipate at the time.
And so to have an option of euthanasia when things are Dark and have been dark for a while.
I don't want to be a doctor in that world. Life sometimes is really hard.
And I care for people who have significant chronic addiction, which is poorly understood, poorly resourced, who spend their lives beating themselves up or something over which they have no control.
And I could well imagine people in that setting saying, actually, there is no hope.
My life is not worth living.
Thanks for an easy way out.
[00:30:30] Speaker C: How far do you think New Zealand is off of that picture?
[00:30:35] Speaker B: I think it would be a very simple bureaucratic tweak.
I don't think many people understand what we're talking about. If we would extend the criteria. I mean, we're just changing some criteria, aren't we? If it's okay for them, maybe we should consider who else it's appropriate for. I certainly don't think politicians are over it.
I think they have very simple caricatures of life in the trenches and the health sector. And that was very evident in the debate over the bill and even the naivety of the bill about you have a doctor and you have a patient and they make a decision. I think, no, that's not how it works.
There are families, there are important connections there. There are teams of health professionals who have different pieces of the puzzle, hold different bits of the care, see things differently. But the sort of very naive caricature of we have a doctrine patient and they'll go away and do a deal.
I just don't think people get it. And once you have that move, then there's just. I don't like the word coercion because actually, I don't think people providing assisted dying want to coerce anyone. They're in it to do good as they see it, but it just becomes a very easy option that lets everyone else off the hook, lets the system off the hook, let our stretched budgets off the hook, lets the families off the hook means you can organize your death so that people can plan ahead
[00:32:13] Speaker C: and book cheat flights that cheat in life overall.
[00:32:16] Speaker B: Yeah, yeah. I think actually we've just lost a whole lot.
The system is moving very quickly to rein in the ability for doctors to stand apart, to say, of course you have the right to do this. I will not stand in the way, but I will stand out of the room. I cannot be involved.
But that is seen as paternalistic, as me not doing what the patient wants. And it should only be about the patient.
Which is just ridiculous because so many times doctors say no to patients. Someone comes to me, and while wanting a drug of addiction, I say no. I Don't think this is in your best interests. I'm not going to do it. Here's something else we can think about. Here's something else we can talk about. So you actually want a doctor who's prepared to stand there as. And bring their perspective, what they think is in the patient's best interest, together, and you work on that together.
To say that I am not allowed to have that room. That is actually, I think, very dangerous for our health system. Do you want a doctor who must.
Must do what the bureaucracy tells them to do?
No, you want a doctor who's gonna. Who's prepared to go into bat for you, who's allowed to have a different view from what head office says you must do.
And this idea that we should shut down the.
A thoughtful doctor, a doctor who's trained, who's conscientious, who's concerned, who's there.
[00:34:08] Speaker C: Sometimes people think freedom of conscience is actually more about the doctor's personal beliefs on moral issues. And while that is an element of it, what you're describing goes kind of beyond that.
[00:34:23] Speaker B: We want all doctors to be moral.
Do you want to have an amoral doctor?
Do you want to have a doctor who has no concern about what is right and wrong?
How's that going to work? But this idea that we can tell the doctor, you're not allowed to have ideas about right or wrong in this situation, this idea that you can tell doctors to park the judgment about what is right or wrong, that's not what good medicine's about. Good medicine requires doctors to be exercising conscience every time someone walks into the room about their sore throat. Do you want me to be concerned about what is good and what is bad, what is right and what is wrong? Or do you just want me to be a robot?
The issue also is that if doctors are having to shut up and do what they're told, that's a very damaging place for doctors. That's exhausting. I've been there. Where you're looking at a system that is not going well, where you're looking at patients who would benefit from drugs to which we don't have access.
That hurts the patient, but it hurts us too. And you can only take so much of that before your good people are starting to say, I just can't do this.
I can't sit in this room and feel so compromised across so many different things.
And so restricting ability to opt out of assisted dying processes would be a really big nail in this. Often it's already called. It's a nails. It I would be concerned about what that would do to many doctors who are punching well above the weight, who are doing really good work for their patients, providing really good holistic care with all the pressure that brings.
Here's another kick in the guts for them.
[00:36:28] Speaker C: What would you say to other doctors and healthcare workers and professionals in this setting that would encourage them to do what they should be doing?
[00:36:37] Speaker B: You're not alone, that you're encouraged to think you're alone. You're a system set up to make you an outlier. You're conscientious and cheap. You're in a court. You're in a corner by yourself, swarming against the tide. But actually you're not alone.
There are many people like this, many people who are concerned and you just need to put your head above the parapets just a little bit and start to find those people and connect and share to talk to, go to organizations who would support you to read up on their material. There's a lot out there that will give you some reassurance that you're not mad, that you're not stuck in the dark ages. But no, you are on solid ground and you are not alone.
Many of the people who are concerned about this are just and the treacherous head down going at 120 kilometers an hour on everything else already giving 120%.
And so it's hard to find more space to think about the issue, to connect over the issue, to prepare yourself for what you will do when you're in the hot seat, when you're in the room and someone asks, you're on solid ground and connect and prepare and speak up.
Find ways that are safe for you. It's not something doctors like to do at all. We are not people who rock the boat.
But this is not rocking the boat. This is caring for your patient. This is about caring for other patients. This is about caring for people who will feel expected to consider and even progress with assistant dying.
You're giving them freedom as you exercise your own freedom.
[00:38:41] Speaker A: The Pulse podcast is brought to you by Voice for Life New Zealand. If you enjoyed this show and you think that having a strong pro life voice in the public square is essential, then please support this podcast and all of the other important pro life work that Voice for Life is engaged
[email protected] nz donate that's voiceforlife.org nz donate link in the show notes thanks again for tuning in. We'll catch you next time on the Pulse.
[00:39:20] Speaker B: Sam.
