More than 40 people attended CMFnz’s most recent webinar, which provided some wonderful insights into “Faith, Medicine and Choices at the End of Life”. We were joined by three guest speakers, Dr Amanda Landers (palliative care specialist), Dr David Tripp (general physician and intensivist) and Dr Wendy Pattemore (palliative care specialist). The session was chaired by Dr Steve Withington and addressed three key areas: general issues around end of life care, COVID-19 and the issues it raises around end of life care, and the End of Life Choice Act referendum.
General issues around end of life care
Dr Landers and Dr Pattemore began by describing palliative care and its role in caring for people at the end of life. They explained that palliative care is able to meet people “where they are” by providing time to listen and pause. Dr Landers emphasized that although death has been medicalized in society and may be seen as a “failure” in some parts of medicine, it is seen as “normal” and not a failure in palliative care.
When it comes to making choices about end of life care, the key is identifying the goal of treatment or care for the patient and in some situations, the family. This requires effective communication in which the physician does not impose their own desires or wishes on the patient, but takes time to listen and hear what is important for the patient and what they really want. It also means acknowledging the suffering of those observing, especially as this may be expressed as fear of their loved one suffering. If the family are making decisions on behalf of the patient (for example, if the patient does not have competency to make decisions) then it may help to ask “What would your Mum [or Dad] want?” rather than “what do you want?” Dr Tripp went on to say that it is important to pause and consider what is driving the “treatment treadmill” and how each investigation or treatment strategy will change management.
So what does it mean to be a faithful Christian doctor in the end of life conversation?
Personally, it may be having certainty about God’s love providing sustenance through every season of life. And practically, it may mean taking a spiritual history (for example, “what is it that brings you joy?” “What brings you meaning?” “What are your sources of hope?” “Do you have a faith or belief system?”) and/or acknowledging the value of suffering and the importance of the conclusion of life with your patient. As Dr Pattemore explained, “some people say [death] is the ‘end of life’ but I see it as a ‘conclusion of life’. And sometimes you have to get to the end of the book to get the juicy pieces”.
COVID-19 and issues around end of life care
Dr Tripp acknowledged that COVID-19 has exposed a tremendous amount of fear and anxiety. He reminded us that if New Zealand were the United Kingdom then approximately 4000 people would have died from COVID-19. He went on to highlight the dichotomy of caring for those who were dying without the presence of their loved ones during the lockdown, and the irony of sacrificing the economy for our people only to have the End of Life Choice Act on our doorstep. He emphasised the value of caring for our patients (as epitomized by staff who moved in to support residents at a dementia rest home care facility in Dunedin) compared to the lonely portrayal of euthanasia.
End of Life Choice referendum
Our guest speakers expressed concern about the public’s general lack of knowledge and understanding of the upcoming End of Life Choice Act Referendum. They acknowledged the following issues:
- Many New Zealanders do not realise there are two referendums and if they do then they think of the Cannabis legalisation and control referendum.
- There is an understanding that euthanasia will change the dying process so that the patient no longer suffers. However, physical suffering can already usually be well managed during the dying process and euthanasia will not alleviate suffering entirely.
- There is a presumption that Members of Parliament have done their due diligence and that the Act is sound.
Our guest speakers went onto address the concerns they had about the way the Act has been written and its safeguards. They highlighted the following issues:
- The rapidity at which euthanasia can be administered and the lack of time to work through any issues (that is, a patient may request euthanasia on Friday and be dead on Monday).
- The lack of clarity about how conscientious objection will be managed and how clinicians will be expected to fulfil their professional expectations. At this stage the patient may contact their medical practitioner of choice (that is, someone who may not be known to them) and this practitioner is obliged to set the legislation in motion.
- The patient does not have to tell anyone else about their request.
- The potential for coercion (which may occur as a “medical nudge”, a “nudge” from the patient’s family and/or the patient’s feeling of being a burden) and how medical practitioners will identify and call out coercion, especially if it has the potential to compromise the patient/family/doctor relationship.
- Patient capacity, in particular, a patient’s ability to request euthanasia if their capacity fluctuates.
- The amount of paperwork involved in requesting and performing euthanasia.
- The effect euthanasia may have on the patient-doctor relationship in future as a doctors’ role changes from healing and saving lives to include killing.
Despite concerns about the End of Life Choice Act and referendum we can continue to trust God and hope. As Angela Huor, an attendee at the CMFnz webinar, commented:
"Suffering and death has a completely different meaning in the light of the cross and an eternal perspective. The idea of bringing restoration into something perceived to be so broken/hopeless (that is, the dying process) is so countercultural and nonsensical that ... it's perhaps where light shines the brightest."