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OPINION: The End of Life Choice Act (2019) relies too heavily on doctors. I am a physician with 18 years of experience, most of them in general practice, and I am deeply concerned about the risk that the Election Act at the end of life (2019) will expose New Zealanders, if this law becomes law .
The law will allow any physician with a current medical license to offer physician-assisted suicide as a service. The Act does not describe any additional standards that these physicians must meet, or minimum years of experience or particular training that they must follow. This Law is fundamentally based on the trust that doctors are competent and moral to act as a witness, judge, jury and executioner within the limits of the Law.
There is very little independent oversight, independent witnesses, or significant liability within the Act to hold the enacting physician to account or to keep them under control.
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Not all New Zealand physicians are safe enough to practice under the Choice at End of Life Act, writes Dr. Caroline Ansley.
Article 37 of the law also clearly states that there will be immunity from criminal liability (i.e. no risk of conviction) for any doctor who makes a mistake in delivering the requirements of the law.
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What this means in practice is that if a doctor makes a mistake and a patient dies unjustly, there are no consequences for the doctor under the 1961 Crimes Act.
Doctors are like the rest of the population: there are as many individuals who are harassed, stressed, struggling with serious life problems that distract them, and people prone to making mistakes in my profession as anywhere else in the population. We are not immune to unethical, immoral actions, or laziness and incompetence, and we are certainly not immune to the systemic bias that permeates the culture that teaches us all that some lives are more valuable than others.
Often times, patients do not feel heard by their doctor. The large number of complaints to the Commissioner of Health and Disability each year from aggrieved patients towards their doctors would attest to the fact that people feel let down by their doctors on the left, right and center.
The high level of skill required to negotiate the complex and highly charged landscape surrounding death is not available to all physicians. I look at my seasoned colleagues who work in palliative care and know that they have skills in this area that I, and many of my other medical colleagues, simply do not have.
Conversations about death and dying are difficult and not all doctors have the same ability to receive them. When there is an avenue of conversation within this broad expanse of difficult to speak (the choice), which is concrete, defined, actionable, and ‘requested’, we are sure that every physician who is in this conversation with his or her patient will discuss all available options?
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Dr. Caroline Ansley is a primary care physician in Christchurch and has worked in a wide range of practices with patients from a variety of socioeconomic, ethnic and age groups.
For some reason in this debate the general population is putting us on pedestals. And frankly, I’m scared of that. In 23 years in medicine (if I include my medical school years) I have worked with the majority of ethical, principled, thorough, competent and truly excellent physicians. But I have also worked with a small number of doctors who have been very unpleasant people, or who have harassed others, or who have practiced medicine in a way that concerned their colleagues. I have worked with physicians who lack good interpersonal skills or who do not recognize that they are making poor decisions. I have worked with doctors so overworked that patients feel rushed, overlooked and ignored. And I have worked with a doctor who was removed from the medical record, deemed unfit to practice, due to years of inappropriate sexual contact with some of her patients, which was harmful, plain and simple.
Being a patient in New Zealand is not yet a safe, consistent or fair enough experience, and not all physicians live up to the trust we place in them. Because the consequences are irreversible, we must expect a very high standard for practice under the Act and, unfortunately, while all physicians will be able to do so, not all New Zealand physicians are safe enough to practice under the Act of choice of the end of life (2019).
The law simply does not contain adequate safeguards to protect New Zealanders from the small group of doctors whose practice is below average. Don’t give doctors this power because we are not all up to the task. This law is not safe. Vote no.
Dr. Caroline Ansley MBChB, FRNZCGP is a GP.
