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The limits of our care

While reading last week’s NZ Herald series “Cancer – The cost of a life,” I wondered what the introduction of euthanasia and assisted suicide could mean for the New Zealand portrayed.

The Herald series highlighted the fact that among the 20,000 people who will receive a cancer diagnosis this year and the 9,000 who will die of cancer, many will struggle to gain access to drugs and treatments that could prolong their lives or even potentially cure their cancers.

Resources within healthcare are finite, even as the need they must meet seems to grow infinitely. There is a calculus behind the decisions that Pharmac makes regarding what drugs and treatments to fund: what evidence is there of a drug’s effectiveness; how many people will be helped by a treatment; what types of outcomes can be expected from a drug or treatment’s application?

In other words, Pharmac, and the Ministry of Health and healthcare more broadly, have to make a lot of value judgments. How valuable is a person’s life? What does a good life look like? How do you weight the dire needs of a few against the substantial needs of the many?

The Herald series seems to indicate that, currently, these value judgments are not being made well when it comes to cancer patients. Inequalities of care and resultant mortality are evident in certain parts of the country and amongst certain populations, such as Maori and Pacific Island women. And there are promising new drugs and treatments that Pharmac doesn’t cover, putting them out of reach of all but the wealthy or those who are increasingly turning to crowd-funding sites. Melanoma patient and mother Leisa Renwick is quoted as observing, “It seems to me that in this country, rich people are able to get treatment and poor people aren’t. They are sent home with lots of pain-killing drugs. They are sent home to die. I think that’s really wrong.”

So what could the introduction of euthanasia and assisted suicide to this New Zealand look like? In a healthcare system that has limited resources, that has to make value judgments about how much a person’s life is worth, and that exhibits increasing inequalities in access to life-prolonging and life-saving drugs?

In the US state of Oregon, which legalised assisted suicide in the late 1990s, cancer patients on government-funded healthcare plans have been sent letters telling them that their prescribed cancer treatments won’t be funded, but that the state will pay for either their assisted suicide or hospice care. Cancer drugs, as the Herald reported, can cost hundreds of thousands of dollars, and costs can run for years; assisted suicide can cost just a couple hundred dollars, and usually only requires one dose.

New Zealand clearly already has a problem with caring as well as it should for those with cancer. The Herald series should give pause to all those who have compassion for the terminally ill, and force us to look again at the solutions we wish to offer them.

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