By The Defender.
With the number of Kiwis needing palliative care expected to increase by 51% by 2038 according to a Ministry of Health report from 2016, and services barely keeping up, New Zealanders will be put at risk.
This, in the context of the already complicated era of legalised euthanasia, only deepens the divide and false 'choice' it presents.
Human rights lawyer and #DefendNZ ambassador, Richard McLeod, called it “a ‘Claytons’ choice” – a choice that exists in name only and isn't genuine.
He says that if we look at our ageing society – people living in vulnerable situations, who are most likely older, may be living alone, and who are likely lonely – the ‘choice’ of assisted suicide or euthanasia may well be their only option.
“1 and 5 elderly people live in extreme loneliness – people who are victims of elder abuse, people who have been rejected by their family or their whanau, and people who have been failed by the state.”
Disability advocate, Kylee Black, says, “choice is a relative term”.
“A lot of people agree with euthanasia ‘in principle’ without understanding what that means. People say that you have a choice… but choice is made in context! Not everyone has the same level of choice.”
Black warns “we need to make sure that we have the right supports around people first, before we’re having a conversation about euthanasia.”
But parliamentarians and the public alike did not heed McLeod nor Black’s advice prior to legalising the End of Life Choice Act.
Lack of finances, pressure on family members, and the constant worry about accessing the necessary resources already do not make for an even playing field.
Let alone, how easy it would be for someone in these situations to feel as though they don’t have a real choice. Instead, they may feel obligated to make things easier for others by opting for euthanasia.
And then we consider the inconvenient reality of the premise of this article.
Projections show a 51% increase in palliative care capacity is needed by 2038 – or more Kiwis will suffer and may only be offered the supposed ‘choice’ of assisted suicide or euthanasia.
Which begs the question. Why is half of the palliative care in New Zealand currently funded by op shops and bake sales, and why have successive governments in New Zealand not increased funding to this critical health service, rather relying on volunteers and donations from individuals?
New Zealand’s 32 hospices look after around 20,000 patients per year or about one in three Kiwis who die each year. The cost of delivering the services in 2021 was around $176 million. Of that, only $88 million came from government funding.
Meanwhile, euthanasia services, including flying specialists around the country, are fully-funded. That, after years of palliative care service's lobbying for increased funding, and this being met with increases hardly matching inflation.
Otago University palliative care specialist, Dr Sinead Donnelly, has previously worked in countries where funding for hospices covers 90–95% of costs. She says “New Zealand hospice services are 30 years behind the times, and it's not acceptable.”
Dr Catherine D’Souza, Aotearoa chairwoman of the Australian and New Zealand Society of Palliative Medicine, contrasts the supposed choice. “It just doesn’t feel right. Whatever your view on assisted dying, I don’t think anybody would support that system, where you’ve got a free choice to die, or an expensive service to live.”
Another question we can ask is why are junior and student doctors are only receiving a tiny bit of training on palliative care – something #DefendNZ ambassador, Professor Rod MacLeod, calls, “woeful”.
“I think it's fair to say that in New Zealand the students are only getting a few days out of their five or six-year programme with direct exposure to palliative medicine specialists, and quite frankly that's woeful.”
Author of 2020’s election-year-best-seller, The Final Choice: End of Life Suffering - Is Assisted Dying the Answer?, Caralise Trayes, asked why we support birth with antenatal classes and support groups, whereas when facing death, we are expected to do it alone – with little or no understanding about the process of death and dying.
“Why do we not find a way to educate people about death to the same degree? Science can be incredibly helpful to dispel fears and debunk myths around the process of death.”
All in all, the conclusion we are to draw from this is that the government budget simply doesn’t value the benefits of caring for a good death for all its citizens. And that as a society and individuals of compassion and care, it falls on us to step up and create support networks, increase funding for hospices, and advocate better care for those at the end of life.
Yes, we must continue to lobby governments – this one and the next – for equitable access to palliative care, but if our track record is anything to go by, it’ll be up to us to create the systems and supports society, and our terminally ill, will increasingly and desperately need.
Lives will depend on it.