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I write in reply to David Richmonds critical letter (NZMJ 3 July)1 about my previous paper (NZMJ Feb 2015)2 reporting General Practitioner (GP) Attitudes to Physician Assisted Dying (PAD).Regarding whether the GPs knew what was being asked, each GP was provided with the Explanatory Note which was part of the Maryan Street End-of-Life Choice Bill, and which defined very clearly what assistance to die meant: ie, it involved either giving the patient a drug to take themselves, or drug directly administered by the doctor with the intention of ending their life.3Euphemistic languageRichmonds comments about using the term PAD instead of killing are typical of his letters elsewhere. I make no apology for that. Murder is not the same as PAD. Murder is violent, unwanted, does not respect the victims autonomy and is regarded universally as morally abhorrent. PAD is ethically totally different in that it is requested by a mentally competent patient; is compassionate in that it relieves unbearable suffering; respects the patients autonomy; and allows the patient to say farewell to their friends and relatives while still conscious. It may be regarded as an extension of medical treatment. Richmond is intellectually dishonest when he repeatedly states that both of these acts are the same and tries to classify them under the word killing. Similarly, there is a big difference between irrational suicide and PAD, where the patient is given a drug to take themselves.4 This has been argued extensively and now well accepted in the Psychological literature. But opponents of PAD want to pretend that there is no difference.Words are important in the PAD debate and the opponents of PAD are guilty of trying to frighten people by continual use of emotive words such as killing and suicide and seem to get very annoyed when other words are used which more accurately describe what is happening.We look forward to the day when New Zealands overbroad and disproportionate homicide and suicide legislation is amended to allow for these differences, and which any sensible person can understand.Safeguards from abuseThis issue is an important one, but Richmonds often stated view is that safeguards are always inadequate, and this is proved by information from Belgium. This is simply incorrect. The information he presents about assisted suicides in Belgium is out-of-date, as showed by two later papers from the same authors he quoted, following further detailed analysis of 2007 Belgium reports.5 To quote: Most of the cases we studied did not fit the label of non-voluntary life-ending for at least one of the following reasons: the drugs were administered with a focus on symptom control; a hastened death was highly unlikely; or the act was taken in accordance with the patients previous wishes . That doesnt say that there are not some cases of hastening of death without explicit request. In Belgium, in 2013, these amounted to 1.7% of the survey sample (6,188 patients),6 not 33% as stated by Richmond. The figures also represent a significant decrease from those before legalisation occurred, so it can hardly be argued that it is a result of legalisation of PAD. Hastening of death without explicit consent also happens in New Zealand of course and occurs in approximately 4-5% of patients treated in end-of-life situations by New Zealand GPs.7 This is done by compassionate doctors, although the practice is strictly illegal and not reported. Belgium has been an admirable example of a country where what actually happens is reported and should be respected for that.It would be to the advantage of New Zealanders if David Richmond would stop scaremongering and trying to frighten politicians, medical practitioners and the public with poorly evidenced statements.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Jack Havill, Retired Intensive Care Physician, Hamilton, New Zealand

Acknowledgements

Correspondence

Jack Havill, Retired Intensive Care Physician, Hamilton, New Zealand

Correspondence Email

jhavill@wave.co.nz

Competing Interests

- - Richmond D. Re: Physician-assisted dying- a survey of Waikato general practitioners. NZMJ July 3 2015;128(1417): 57-58 Havill J. Physician-assisted dying - a survey of Waikato general practitioners. Jack Havill. NZMJ. Feb 20 2015;128(1409):70-71 Explanatory Note. End of Life Choice Bill. www.ves.org.nz Brief of Amicus New Mexico Psychological Association in support of Plaintiffs. Morris vs Branderberg. Sept 2014. Internet. Chambaere K, Bernheim JL, Downar J, Deliens L. Characteristics of Belgian life-ending acts without explicit patient request: a large-scale death certificate survey revisited. Canadian Medical Association Journal Open: E262-E267. Published online Dec 2, 2014 Chambaere K, Stichele RV, Mortier F, Cohen J, Deliens L. Recent Trends in Euthanasia and other End-of-Life Practices in Belgium. N Eng J Med March 19, 2015; 372:12 Mitchell K, Owens G. End of life decision-making in New Zealand general practitioners: a national survey. NZ Med J 2004; v117 no 1196 (published on line 18th June 2004)- -

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I write in reply to David Richmonds critical letter (NZMJ 3 July)1 about my previous paper (NZMJ Feb 2015)2 reporting General Practitioner (GP) Attitudes to Physician Assisted Dying (PAD).Regarding whether the GPs knew what was being asked, each GP was provided with the Explanatory Note which was part of the Maryan Street End-of-Life Choice Bill, and which defined very clearly what assistance to die meant: ie, it involved either giving the patient a drug to take themselves, or drug directly administered by the doctor with the intention of ending their life.3Euphemistic languageRichmonds comments about using the term PAD instead of killing are typical of his letters elsewhere. I make no apology for that. Murder is not the same as PAD. Murder is violent, unwanted, does not respect the victims autonomy and is regarded universally as morally abhorrent. PAD is ethically totally different in that it is requested by a mentally competent patient; is compassionate in that it relieves unbearable suffering; respects the patients autonomy; and allows the patient to say farewell to their friends and relatives while still conscious. It may be regarded as an extension of medical treatment. Richmond is intellectually dishonest when he repeatedly states that both of these acts are the same and tries to classify them under the word killing. Similarly, there is a big difference between irrational suicide and PAD, where the patient is given a drug to take themselves.4 This has been argued extensively and now well accepted in the Psychological literature. But opponents of PAD want to pretend that there is no difference.Words are important in the PAD debate and the opponents of PAD are guilty of trying to frighten people by continual use of emotive words such as killing and suicide and seem to get very annoyed when other words are used which more accurately describe what is happening.We look forward to the day when New Zealands overbroad and disproportionate homicide and suicide legislation is amended to allow for these differences, and which any sensible person can understand.Safeguards from abuseThis issue is an important one, but Richmonds often stated view is that safeguards are always inadequate, and this is proved by information from Belgium. This is simply incorrect. The information he presents about assisted suicides in Belgium is out-of-date, as showed by two later papers from the same authors he quoted, following further detailed analysis of 2007 Belgium reports.5 To quote: Most of the cases we studied did not fit the label of non-voluntary life-ending for at least one of the following reasons: the drugs were administered with a focus on symptom control; a hastened death was highly unlikely; or the act was taken in accordance with the patients previous wishes . That doesnt say that there are not some cases of hastening of death without explicit request. In Belgium, in 2013, these amounted to 1.7% of the survey sample (6,188 patients),6 not 33% as stated by Richmond. The figures also represent a significant decrease from those before legalisation occurred, so it can hardly be argued that it is a result of legalisation of PAD. Hastening of death without explicit consent also happens in New Zealand of course and occurs in approximately 4-5% of patients treated in end-of-life situations by New Zealand GPs.7 This is done by compassionate doctors, although the practice is strictly illegal and not reported. Belgium has been an admirable example of a country where what actually happens is reported and should be respected for that.It would be to the advantage of New Zealanders if David Richmond would stop scaremongering and trying to frighten politicians, medical practitioners and the public with poorly evidenced statements.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Jack Havill, Retired Intensive Care Physician, Hamilton, New Zealand

Acknowledgements

Correspondence

Jack Havill, Retired Intensive Care Physician, Hamilton, New Zealand

Correspondence Email

jhavill@wave.co.nz

Competing Interests

- - Richmond D. Re: Physician-assisted dying- a survey of Waikato general practitioners. NZMJ July 3 2015;128(1417): 57-58 Havill J. Physician-assisted dying - a survey of Waikato general practitioners. Jack Havill. NZMJ. Feb 20 2015;128(1409):70-71 Explanatory Note. End of Life Choice Bill. www.ves.org.nz Brief of Amicus New Mexico Psychological Association in support of Plaintiffs. Morris vs Branderberg. Sept 2014. Internet. Chambaere K, Bernheim JL, Downar J, Deliens L. Characteristics of Belgian life-ending acts without explicit patient request: a large-scale death certificate survey revisited. Canadian Medical Association Journal Open: E262-E267. Published online Dec 2, 2014 Chambaere K, Stichele RV, Mortier F, Cohen J, Deliens L. Recent Trends in Euthanasia and other End-of-Life Practices in Belgium. N Eng J Med March 19, 2015; 372:12 Mitchell K, Owens G. End of life decision-making in New Zealand general practitioners: a national survey. NZ Med J 2004; v117 no 1196 (published on line 18th June 2004)- -

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

I write in reply to David Richmonds critical letter (NZMJ 3 July)1 about my previous paper (NZMJ Feb 2015)2 reporting General Practitioner (GP) Attitudes to Physician Assisted Dying (PAD).Regarding whether the GPs knew what was being asked, each GP was provided with the Explanatory Note which was part of the Maryan Street End-of-Life Choice Bill, and which defined very clearly what assistance to die meant: ie, it involved either giving the patient a drug to take themselves, or drug directly administered by the doctor with the intention of ending their life.3Euphemistic languageRichmonds comments about using the term PAD instead of killing are typical of his letters elsewhere. I make no apology for that. Murder is not the same as PAD. Murder is violent, unwanted, does not respect the victims autonomy and is regarded universally as morally abhorrent. PAD is ethically totally different in that it is requested by a mentally competent patient; is compassionate in that it relieves unbearable suffering; respects the patients autonomy; and allows the patient to say farewell to their friends and relatives while still conscious. It may be regarded as an extension of medical treatment. Richmond is intellectually dishonest when he repeatedly states that both of these acts are the same and tries to classify them under the word killing. Similarly, there is a big difference between irrational suicide and PAD, where the patient is given a drug to take themselves.4 This has been argued extensively and now well accepted in the Psychological literature. But opponents of PAD want to pretend that there is no difference.Words are important in the PAD debate and the opponents of PAD are guilty of trying to frighten people by continual use of emotive words such as killing and suicide and seem to get very annoyed when other words are used which more accurately describe what is happening.We look forward to the day when New Zealands overbroad and disproportionate homicide and suicide legislation is amended to allow for these differences, and which any sensible person can understand.Safeguards from abuseThis issue is an important one, but Richmonds often stated view is that safeguards are always inadequate, and this is proved by information from Belgium. This is simply incorrect. The information he presents about assisted suicides in Belgium is out-of-date, as showed by two later papers from the same authors he quoted, following further detailed analysis of 2007 Belgium reports.5 To quote: Most of the cases we studied did not fit the label of non-voluntary life-ending for at least one of the following reasons: the drugs were administered with a focus on symptom control; a hastened death was highly unlikely; or the act was taken in accordance with the patients previous wishes . That doesnt say that there are not some cases of hastening of death without explicit request. In Belgium, in 2013, these amounted to 1.7% of the survey sample (6,188 patients),6 not 33% as stated by Richmond. The figures also represent a significant decrease from those before legalisation occurred, so it can hardly be argued that it is a result of legalisation of PAD. Hastening of death without explicit consent also happens in New Zealand of course and occurs in approximately 4-5% of patients treated in end-of-life situations by New Zealand GPs.7 This is done by compassionate doctors, although the practice is strictly illegal and not reported. Belgium has been an admirable example of a country where what actually happens is reported and should be respected for that.It would be to the advantage of New Zealanders if David Richmond would stop scaremongering and trying to frighten politicians, medical practitioners and the public with poorly evidenced statements.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Jack Havill, Retired Intensive Care Physician, Hamilton, New Zealand

Acknowledgements

Correspondence

Jack Havill, Retired Intensive Care Physician, Hamilton, New Zealand

Correspondence Email

jhavill@wave.co.nz

Competing Interests

- - Richmond D. Re: Physician-assisted dying- a survey of Waikato general practitioners. NZMJ July 3 2015;128(1417): 57-58 Havill J. Physician-assisted dying - a survey of Waikato general practitioners. Jack Havill. NZMJ. Feb 20 2015;128(1409):70-71 Explanatory Note. End of Life Choice Bill. www.ves.org.nz Brief of Amicus New Mexico Psychological Association in support of Plaintiffs. Morris vs Branderberg. Sept 2014. Internet. Chambaere K, Bernheim JL, Downar J, Deliens L. Characteristics of Belgian life-ending acts without explicit patient request: a large-scale death certificate survey revisited. Canadian Medical Association Journal Open: E262-E267. Published online Dec 2, 2014 Chambaere K, Stichele RV, Mortier F, Cohen J, Deliens L. Recent Trends in Euthanasia and other End-of-Life Practices in Belgium. N Eng J Med March 19, 2015; 372:12 Mitchell K, Owens G. End of life decision-making in New Zealand general practitioners: a national survey. NZ Med J 2004; v117 no 1196 (published on line 18th June 2004)- -

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