Position Statement on Euthanasia and Physician Assisted Suicide

We believe that every individual should have the right to die with dignity with the availability of compassionate medical and nursing care that takes account of physical, mental and spiritual needs, so that the end of life is as peaceful as possible for the individual and his or her family. We also uphold the patient's autonomy to refuse or discontinue treatment at any time.

There is increasing debate about end of life issues. We acknowledge that this arises from many factors including personal fear of being in a situation of intolerable suffering and the desire to stay in personal control of the process of dying.

As doctors we have a duty of care to our patients which is built on the trust and confidence of our relationship with our patients, a relationship which has often developed over many years. To this end we believe that high quality palliative care should be available and adequately resourced throughout the country. We strongly believe there is no place for euthanasia or physician-assisted suicide (PAS).

For centuries the medical profession has upheld the principles of The Hippocratic Oath including “I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone. I will give no deadly medicine to any one if asked, nor suggest any such counsel”. This is still implicit in the training of medical students today in New Zealand and many other countries.

We join the New Zealand Medical Association, the World Medical Association and many other medical societies across the world in strongly opposing Euthanasia and PAS, and instead advocating for the promotion and resourcing of good palliative care.

Terms

  • Euthanasia is commonly defined as “the act of deliberately ending the life of a patient for the purpose of ending intolerable pain or suffering” despite the original Greek meaning “good death”.
  • PAS is defined as occurring “where the assistance of a medical practitioner is intentionally directed at enabling an individual to end his or her own life” and usually this involves the provision of a prescription[i].
CMF NZ highlights the following concerns regarding the legalisation of Euthanasia and PAS.

General concerns (These should concern everyone, not just people with Christian beliefs.)

  • It will compromise the role of the medical profession and is likely to reduce trust in health professionals and healthcare systems as a whole. It is likely to have a detrimental affect on the doctor-patient relationship. (We are trained, and patients expect us, to care not kill)
  • Legalising euthanasia and PAS, especially for those with “an irreversible physical or mental medical condition that, in the person’s view, renders his or her life unbearable”[i] sends a message that “suicide is okay”. It is also at odds with the concerns of public officials such as the Chief Coroner about the frequency of suicide in New Zealand in all age groups. Suicidal thoughts are usually associated with depression or other mental conditions most of which are amenable to treatment. Depression often goes undiagnosed in the elderly and those with terminal illness. When depression is properly treated, many people with terminal illness change their minds about wanting to die[ii]. Caring for those with suicidal ideas or actions costs more in time and effort but is the ethical thing to do, rather than assisting them to end their lives.
  • Legislation for Euthanasia and PAS across the world defines the reason for instigating it as being the suffering of a terminal illness expected to cause the person’s death within a certain time. Predicting the timing of death is notoriously inaccurate and even the certainty of a terminal diagnosis may not always be assured[iii],[iv].
  • There is evidence that legalising PAS puts pressure on vulnerable people including the disabled and elderly who consider themselves a financial and emotional burden to their family and society[v]. Elder abuse is known to be a serious problem already and legalising euthanasia and PAS would create a real risk of coercion, whether imagined or real, on the patient to request early death. The right to die, becomes the duty to die[vi].
  • A significant number of people who feel that they would like to undertake PAS or euthanasia when young and fit change their mind when terminally ill. Requests for it in terminal illness usually result from unresolved physical, emotional or spiritual distress and when given appropriate palliative care individuals no longer seek this option[vii].
  • There is no guarantee of death with dignity by PAS or euthanasia and it is reported that 7% of episodes of PAS are accompanied by complications of the medication such as seizures and 15% experience delayed completion[viii], and there is evidence of unresolved distress in families[ix]. Complications are also poorly reported[x]. A Dutch study found that in 18% of cases doctors intervened by giving a lethal injection because of problems or complications[xi].
  • Proponents of Euthanasia and PAS often cite the promotion of individual autonomy but there is the risk that it would come at a cost to other people’s autonomy and injustice to, for example, distressed family members, the doctors involved and to the community as a whole. As George et al commented “The autonomy argument is thin... the final decision for PAS or therapeutic killing rests with the doctor”[xii].
  • As euthanasia and PAS are legalised a country embarks upon a “slippery slope” in which legalised killing is seen to be an acceptable solution for more and more situations. This has become clearly evident in the Netherlands where in 2011 the Royal Dutch Medical Association (KNMG) released guidelines regarding acceptable criteria for euthanasia. They included psychosocial factors such as “loss of function, loneliness and loss of autonomy” and “confinement to bed, fatigue, exhaustion and loss of fitness”[xiii]. Euthanasia has also been extended to disabled children[xiv],[xv].
  • Once legalised, therapeutic killing becomes a legitimate consideration in resource management, and indeed a Dutch survey has shown that 15% of doctors were concerned about economic pressures[xvi]. There has been pressure from government to offer PAS instead of expensive medication as a way to save resources in Oregon[xvii].
  • Legal processes are not being followed in all cases; Lord Walton who chaired the UK Government Health Select Committee on Medical ethics summarised their debate on Euthanasia by saying “- we concluded that it was impossible to conclude that all acts of euthanasia would be truly voluntary; laws are regularly circumvented by some health professionals.”[xviii]. Research is now showing that legislation cannot protect the elderly and disabled and especially those not competent to make a request for euthanasia. Increasing numbers are being euthanized without their explicit request[xix],[xx],[xxi] and increasing cases are not even being reported[xxii].
  • Capital punishment in NZ was abandoned because the possibility of one innocent life being taken was too much. Surely it is a retrograde step to legalise euthanasia and PAS when there is evidence that increasing numbers of innocent people are dying, i.e. being killed without their consent.

Concerns that arise from our Christian viewpoint.

  • All modern justice systems, following the lead of the Ten Commandments, (specifically the sixth which states "You shall not murder”, Exodus 20 v 13), prohibit the intentional taking of another person's life. This is in conflict with the intent of euthanasia, i.e. to intentionally kill another human being.
  • We believe all human life is a gift of God that is precious and should be valued. We are committed to following Christ's example to care and have compassion for all, especially the vulnerable, as we are all created in the image of God. In human society we are all dependent on each other, therefore the community has a responsibility to care for its members irrespective of their circumstances.

In summary

Euthanasia and PAS are both unethical and unnecessary - we do not have to kill the patient to kill the symptoms or to allow them to die with dignity. So, instead of euthanasia we advocate for the availability of compassionate care for all people with terminal illness, ensuring that their physical, emotional, and spiritual needs are met in ways that are appropriate for each individual, and that families are adequately supported in providing care for their terminally ill family member.


[i]Australian Medical Association as quoted in 'A response to Euthanasia in Australia' Christian Medical Dental Fellowship of Australia In, 2011, P1

[ii]Maryann Street proposed End of Life Choice Bill, Part 2, Clause 6 (1) (b) (ii), 2013

[iii]Chochinov HM et al Desire for death in the Terminally Ill Am J Psychiatry 1995; 152 1185-1191

[iv]Poulson J, Benbow EW, Hasleton PS. Discrepancy between clinical and autopsy diagnosis and the value of post mortem histology. Histopathology 2005, 47: 551 – 559

[v]Christakis NA, Lamont EB. Extent and determinants of error in physicians’ prognoses in terminally ill patients. New Eng. J Med. 2000 172: 310 – 313.

[vi]Fifth Annual Report on Oregon’s Death with Dignity Act 6th March 2003 as cited in CMF file no 22 Euthanasia by Prof Tim Maughan, Christian Medical Fellowship London 2003

[vii]George, R.J.D., Finlay G, Jeffrey D. Legalised euthanasia will violate the rights of vulnerable patients. BMJ. 2005 September 24; 331 (7518): 684-685

[viii]Breitbart W, Rosenfeld B, Pessin H, Kaim M, Funesti-Esch J, Galietta M, Nelson CJ, Brescia R Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA. 2000 Dec 13; 284(22):2907-11.

[ix]Johanna H, Groenewoul et al. Clinical Problems with euthanasia and physician assisted suicide in the Netherlands”, New England J Med, (Feb 24, 2000) pp 553-555

[x]Wagner,B. MullerJ., Maerker A., Death by request in Switzerland: Posttraumatic stress disorder and complicated grief after witnessing assisted suicide European Psychiatry 2012 27:542-546

[xi]Nuland S. “Physician-Assisted Suicide and Euthanasia in Practice”, New Eng J Med. 2000 February 24, pp583 – 584

[xii]Johanna H, Groenewoul et al. Clinical Problems with euthanasia and physician assisted suicide in the Netherlands”, New England J Med, (Feb 24, 2000) pp 553-555

[xiii]George, R.J.D., Finlay G, Jeffrey D. Legalised euthanasia will violate the rights of vulnerable patients. BMJ. 2005 September 24; 331 (7518): 684-685

[xiv]Peter Baklinski, LifeSiteNews.com Oct 24 2011, referring to a June 2011 position paper of the Royal Dutch Medical Association, titled “The Role of the Physician in the Voluntary Termination of Life”

[xv]Doctor freed in 'justified' mercy killing, Chicago Tribune, April 27, 1995

[xvi]Leenan JI, Ciecielski-Carlucci C Force majeure (legal necessity). Justification for active termination of life in the case of severely handicapped newborns after forgoing treatment. Camb Q Health Ethics 1993;2: 271-4

[xvii]Onwuteaka-Philipsen BD, van der Heide A, Koper D, Keij-Deerenberg I, Rietjens JA, Rarup ML, et al. Euthanasia and other end-of-life decisions in the Netherlands in 1990, 1995, and 2001. Lancet 2003:362: 395-9

[xviii]Oregon offers Doctor-assisted suicide instead of Medical Care Dan Springer Jul 28 2008 Foxnews.com http://www.foxnews.com/story/0,2933,392962,00.html

[xix]Select Committee on Medical Ethics Report. London: HMSO, 1994. (House of Lords paper 21-I)

[xx]Chambaere K, Bilsen J, Cohen J et al. Physician assisted deaths under the law in Belgium. A population based survey. C.M.A.J. 2010, 182: 895 – 901. (Shows that 32% of euthanasia deaths are without request.)

[xxi]Bilsen J et al. Medical End-of-life practices under the euthanasia law in Belgium, New England J Med (2009):1119 – 1121

[xxii]Chambaere K et al. Physician-assisted deaths under the euthanasia law in Belgium: a population based survey. Canadian Med Assn J (2010), 895

[xxiii]Smets, Tinne, et al. Reporting of euthanasia in medical practice in Flanders Belgium: cross sectional analysis or reported and unreported cases. BMJ (2010) 5178

Finding out more

If you interested in learning about this important issue, here is where you might start.

Care Alliance

Care AllianceThe Care Alliance Trust is a broad coalition assembled to oppose euthanasia and assisted suicide. The Alliance was formally established in 2012 to oppose the Bill, and includes organisations from across the health, medical, youth, disability, elderly, youth and faith sectors. They are a united voice against the proposed Bill and the serious public safety issues it raises for vulnerable New Zealanders and their families.

Euthanasia-Free NZ

Euthanasis-Free NZEuthanasia-Free NZ is a network of individuals from diverse professional, social and philosophical backgrounds. It is founded on the belief that legalisation of euthanasia and assisted suicide poses a great threat to the wellbeing of our society.

Christian Medical & Dental Fellowship of Australia

Our Australian counterparts, have taken an active role in the euthanasia debate across the Tasman. An outline of their views can be found in the CMDFA Position Statement on Euthanasia.

Christian Medical Fellowship - United Kingdom

CMF United KingdomOur UK counterparts have a long history of speaking out on ethical issues. They have many resources regarding ethics, including around the end of life. A good place to start is their publication, CMF Files: Euthanasia.