Danielle van Dalen

By Danielle van Dalen - 28/04/2020

Danielle van Dalen

By Danielle van Dalen -

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FAQ #11 | How do we currently care for people at the end of their life?

The legalisation of euthanasia and assisted suicide is often framed as the only compassionate response to people with terminal illnesses or degenerative diseases. However, this is not the reality. Current end of life care in New Zealand includes palliative care (for example Hospice New Zealand), and controlled withdrawal or patient-led withholding of life-sustaining treatments, and advance care planning.

  • Palliative care aims to “affirm life and regard dying as a normal process,” while providing care that “intend[s] neither to hasten nor postpone death.” This involves good symptom management, supporting patients and whānau by integrating psychological and spiritual care, and improving the quality of life.[1] It can be accessed at any time of a life-threatening illness, including when death is years away or when a curative treatment is underway. New Zealand has been recognised as providing the third best palliative care services in the world.[2]
  • Withholding or withdrawing life-sustaining treatments are relatively new concepts which arose because advanced medical treatments are able to prolong life almost indefinitely, for example when an artificial ventilator keeps someone breathing while they are unconscious.
    Withholding life-sustaining treatment is deciding not to start an intervention that is thought to be more harmful than beneficial, even though this means the patient may die in the near future. Withdrawing life-sustaining treatment, on the other hand, is when a current medical intervention is stopped because it is deemed to be more harmful than beneficial, knowing that it might lead to death.[3] Both of these practices are ethically and legally practiced in New Zealand.
  • Do Not Resuscitate orders, or DNRs, are when someone decides before their heart or breathing stops that when they naturally die, they don’t want any medical interventions to bring them back to life. Any New Zealander may create a DNR.
  • Advanced care plans and directives are the result of a discussion on future health care between patients, families or carers, and health care professionals. It can be a written or verbal directive and holds legal authority when the patient is deemed mentally incompetent.[4] It can also include the appointment of the Enduring Power of Attorney who would make decisions on behalf of the patient, when he or she loses competence.[5] Every adult New Zealander should have an advanced care plan.

Each of these treatments provide a compassionate response to people at the end of life with terminal illnesses or degenerative illnesses. Moreover, unlike euthanasia and assisted suicide legislation, these options are better able to provide vulnerable people from abuse by providing care that finds value in every person and every day of life, as well as recognising that medical intervention is not always the answer.[6]

RETURN TO END OF LIFE | REFERENDUM SHORT CUTS PAGE

GO TO NEXT FAQ #12 – Have jurisdictions that said no to assisted dying legislation responded with alternative approaches to caring well for people at the end of life?

 

Authorised by J. Abernethy, 49 Cape Horn Road, Hillsborough, Auckland 1041


ENDNOTES:

[1] R MacLeod, J Vella-Brincat, S Macleod, The Palliative Care Handbook: guidelines for clinical management and symptom control, 8th ed, (Wellington: Hospice New Zealand, 2016), 7.
[2] “2015 Quality of Death Index,” (The Economist, 6 October, 2015) https://eiuperspectives.economist.com/sites/default/files/2015%20EIU%20Quality%20of%20Death%20Index%20Oct%2029%20FINAL.pdf, accessed 24/4/20.
[3] C Connolly, O Miskolci, D Phelan, DJ Buggy, “End of life in the ICU: moving from ‘withdrawal of care’ to a palliative care, patient-centred approach”, (British Journal of Anaesthesia, 2016), 117 (2): 143-5.
[4] New Zealand Medical Association, Advance Directive: Information and Sample Forms, Wellington: Ministry of Health, 2011, 1-3.
[5] New Zealand Medical Association, Advance Directive: Information and Sample Forms, Wellington: Ministry of Health, 2011, 1-3.
[6] G Gillett, “A Report on Euthanasia for the NZMA,” (2017) p.16, https://www.nzdoctor.co.nz/sites/default/files/2017-11/NZMA-euthanasia-Gillett-report.pdf, accessed 20/4/20.

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Danielle van Dalen

By Danielle van Dalen -

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