What’s up, doc? Oh, a sharp difference of opinion on legislation to help the terminally ill

Deep divisions in the medical community have become apparent as David Seymour’s End of Life Choice Bill is about to return to Parliament – on Wednesday next week – for what promises to be a tortuous clause-by-clause third reading debate.

A group of doctors who support the Bill – which would allow the terminally ill to get  medical assistance to end their suffering – this week accused the New Zealand Medical Association of ignoring international evidence on the issue in favour of “conservative cultural and personal beliefs”.

In a letter to NZMA chair Dr Kate Baddock, the group accused the six-member NZMA board, which opposed the Bill in submissions to the justice select committee, of ignoring international “disciplined, rational, evidence-based scientific medicine” on the issue.

“As such you and the board could be accused of being no more advanced than the ‘anti-vaxers’ or the ‘anti-1080 lobby’, whose beliefs cannot be impinged upon by science, fact or rational thinking,” the letter said.

It was signed by Dr Miles Williams, cardiologist, of Hastings, and 18 other practising and retired doctors.

They said the 133-year-old NZMA has

“ … been on the wrong side of history in the past, for example in taking conservative, paternalistic and moralistic approaches on issues such as contraception and abortion”.

The letter specifically responded to an interview Baddock gave to TV1’s Breakfast programme on May 22, the day a full-page open letter headed Doctors want no part in assisted suicide was published in newspapers.  The letter claimed to have been signed by 1200 doctors, but this was “updated” on July 16 to 1181.

The open letter was organised by the Care Alliance, a group of Christian, hospice and palliative care organisations set up in 2012 to oppose voluntary euthanasia. The first signature was that of Sinead Donnelly, an Irish-trained doctor who has publicly campaigned against the Bill alongside Catholic doctor Mary English and her husband (and former PM) Bill.

The NZMA is coy about how many of the 17,000 registered medical practitioners on the NZ Medical Council’s books belong to it.  But a board member, Elizabeth Berryman, told Radio NZ in April 2017 it represented only about 20 per cent of doctors registered at the time.

The RNZ report further said 44 per cent of association members are medical students.

In his letter, Dr Williams said that in claiming that no end-of-life choice legislation could be safe, the NZMA is

“ … asserting the superior intellect, insight, analytical powers and judgement of the six members of a small parochial New Zealand board whose collective knowledge and experience of this subject is likely to be limited to discussions around the boardroom table” over that of the judiciaries of countries and states in Europe, the Americas, Canada and Australia, representing more than 150 million people.”

The letter has been forwarded to all MPs. In it, Dr Williams says:

“It is important that the New Zealand public is made aware that there is absolutely no contemporary evidence to support any aspect of your opposition to giving the people of this country the right to End of Life Choice.

“It has been successfully implemented in many countries, none of whom have reversed their legislation. It is not unethical, there is no evidence in the literature of coercion, increased suicide rates, distrust of doctors, exploitation of the vulnerable, or of wrongful deaths.

“In all of these countries and states the practice is subject to government-controlled audit. Your dismissal of polls, not only in this country, but of those undertaken in many nations around the world, showing that the majority of people in these countries understand and support EOLC, represents blatant and unapologetic paternalism.”

The NZMA claims to be the country’s only pan-professional medical organisation representing the collective interests of all doctors and a strong advocate on medico-political issues.

But Dr Williams said many medical and nursing organisations around the world had taken a neutral or supportive stance towards end-of-life choice, including the Royal College of Physicians, the Royal Australasian College of Physicians, the Royal NZ College of GPs and the Royal Australian College of GPs, the American Academy of Family Physicians, the UK Royal College of Nursing and the New Zealand Nurses’ Organisation.

He contended that in the interview on the Breakfast programme on May 22,   “the quality and accuracy” of the statements Dr Baddock made “fell well short of the standards aspired to by the NZMA”.

One of the signatories is Dr Jack Havill, a retired intensive care medicine specialist and former President of the End-of-Life Choice Society of New Zealand.  He acknowledges that a number of the doctors who signed are retired and says:

It is a difficult issue and many practising doctors in favour will not express their views publicly because it is currently illegal.

“They do not want to be classed with the approximately four per cent of doctors who break the law to help patients die in their final illness, according to two Auckland University studies.

A 2015 report published in New Zealand Doctor showed that in an anonymous survey 11.8 per cent of GPs admitted hastening the death of a suffering patient.

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