Final Farewell

Euthanasia is a word that provokes many strong emotions. A word that has a tree of definitions that branch out and differ from one leaf to the next. Each leaf represents a case that conflicts between what each individual believes. On the surface, it may seem like selfish murder, but beneath the media interpretation is a family struggling to go through with a decision they feel is best for their loved one. Each case is independent of all others. No two ‘leaves’ can be compared, and no one can judge the decisions made by others unless they were a part of that decision.

The New Zealand government is yet to pull the End of Life Choice Bill from the ballot box. However, there is a high chance that one day it will, and although statistics say New Zealanders are supportive of voluntary euthanasia, the debate will rock the country and divide it in two. It is already sparking concern and the phrase ‘euthanasia on demand’ is forming a negative connotation for the bill (NZDoctor.co.nz, 2012). Until then, the palliative care services continue to improve and develop with the education provided to doctors and nurses on caring for patients holistically.  

"You matter because you are you. You matter to the last

moment of your life, and we will do all we can, not only

to help you die peacefully, but also to live until you die."

~ Dame Cicely Saunders - founder of the modern hospice movement (Ministry of Health, 2013).

The fact that child euthanasia does exist was a shocking realisation. The killing of their child is not decision parents make lightly. However, letting a child suffer minutes or even days, because of the way they are being killed, is questionable and unfair. The child cases discussed through this blog troubled many people and sparked questions such as “why where teachers asked their opinion on the child’s quality of life?” New Zealand early childhood teachers make every effort to ensure the children in their care have equal opportunity to learn. Equity is also important and this ensures children with disabilities are supported in gaining the help they need to develop holistically alongside their peers in a centre environment.   

Well, after this long journey of discovering what euthanasia really is, I have concluded that euthanasia is like a giant puzzle. However, you will never really be able to put it together because the more you read, the more your beliefs on the issue change. I am still not sure what side of the fence I am sitting on. I am not even sure there are only two sides. What I am sure of is each case is different and emotion run high when you talk to some who is directly involved. Doctors, nurses, the public, the government, and society all bring to the table an idea of euthanasia. I do not think this issue will ever settle either. There will still be controversy over it if it becomes legal in New Zealand, just as there is now when it is illegal. Overall, this blog has opened my eyes to world of euthanasia and helped me to become a critical thinker, taking on board new information on thinking about it with a wide lens. I did not struggle to find different perspectives, but I guess perspectives are what make euthanasia a social issue in New Zealand.

I will leave you with this video. A real life plea on why voulunrty euthanasia such be legalised in New Zealand.

References  

Ministry of Health. (2013). Hospice New Zealand standards for palliative care: Quality review programme and guide 2012. Retrieved from http://www.hospice.org.nz/cms_show_download.php?id=509

NZDoctor.co.nz. (2012). Euthanasia on demand a mistake. Retrieved from http://www.nzdoctor.co.nz/in-print/2012/december-2012/19-december-2012/euthanasia-on-demand-a-mistake.aspx.

Tiny Footprints

When people think of euthanasia, an image of a sick elderly person is what usually comes to mind. However, previously I have discussed the Death with Dignity Bill drafted by Michael Laws, who also included a section detailing euthanasia for disabled children. This sparked a shocking realization that child euthanasia is very real. As an early childhood teacher, this does not sit all that comfortably with me. So, for this blog, I have decided to go down that dark and gloomy road so I can develop some kind of understanding and relate it to what I believe and follow as an early childhood teacher.

It seems to go against all that humans stand for. It pulls on the heart strings, thinking about killing an innocent child just because the adults who are there to protect them believe their quality of life is not worth living.



Robert Latimer with his
daughter Tracy, at home.



On October 24 1993, 12-year-old Tracy Latimer sat in the cab of a pickup truck, unable to move, as it filled with carbon monoxide fumes. Her father, Robert Latimer, put her there. Eleven days after her death, Robert confessed to killing Tracy out of compassion; a mercy killing. Tracy was born with cerebral palsy and her father felt her life was no longer worth living. Tracy was a very sick child. She was unable to feed or toilet herself. She had minimal mussel control and could not talk. Her family claimed she was in a lot of pain and so, out of love, her father did what he thought was best for his child (Corelli, 1994). This case of euthanasia shocked the country and Canada was thrown into the debate of child euthanasia. Further details emerged as the debate began to grow. Although Tracy did experience pain, evidence built up supporting Tracy’s happiness and love of life. “According to the Crown prosecutors' brief presented at the second trial, "She also responded to visits by her family, smiling and looking happy to see them. There is no dispute that through her life, Tracy at times suffered considerable pain. As well, the quality of her life was limited by her severe disability. But the pain she suffered was not unremitting, and her life had value and quality"” (Wikipedia, 2012). This caused a lot of controversy. Tracy had days where she was pain free and happy, but her father had decided her quality of life was not worth the pain. After many trials, Robert Latimer was charged with second-degree murder and sentenced ten years in jail without parole (Council of Canadians with Disabilities, 2013).

As terrible as this case may seem, child euthanasia is happening in hospitals to infants who are born with spina bifida, or other disabilities. Every year 200,000 children are born in The Netherlands and out of these babies 1000 die within their first year of life. What is most shocking is that about 600 of these 1000 babies die because a medical decision has been made regarding their quality of life (Verhagen & Sauer cited in Life, 2011). In a survey of Dutch paediatricians, approximately half of them were willing to give a child lethal drugs when they ‘requested’ them and when parents agreed. In this instance, a child is defined as any person under twelve years of age. The results of this survey worsen. More than a third of the paediatricians surveyed were willing to end the life of a child who is unconscious with the consent of their parents. Some even admitted they were still willing to give a child lethal drugs when the child ‘requested’ it even if their parents did not agree or give consent (Cote, Lerman & Todres, 2009).  The results to this survey are dreadful yet frighteningly standard in The Netherlands, where voluntary euthanasia is legal no matter who the patient is. Surprisingly, paediatricians find it ethical to euthanize a child who ‘requests’ it. It seems hard to believe a child under twelve years could comprehend the willingness to die. One could assume what the child really wants is the pain and suffering to go away. The mask of pain clouds almost everyone’s ability to make a rational decision. Giving a child the power to make this life or death decision with, or without their parents consent is dangerous and takes away the value of human life.  

If child euthanasia is happening in The Netherlands, is it happening anywhere else in the world? Sadly, it is, and in strong, influential countries, that many people would have never believed it did.  



Kerri Bruning holding her son
Dylan on the day they fed him
for the last time.



“Little Dylan Walborn, Broomfield, Colorado, was a victim of America’s “mercy-killing,” euthanasia movement.  Judged better off dead by Denver’s Children’s Hospital, Porter Hospice, a Denver social worker, Dylan's public school teachers, and the Denver Post, four-year-old Dylan was starved to death over a period of twenty-four days” (America Right to Life, 2013, para. 1). That statement alone is enough for anyone’s stomach to drop and heart to swell with sadness for this child. However, what is really shocking is the fact that Dylan’s early childhood teachers had a say in whether he should live or die; and they said he was ‘better off dead’.

Any early childhood teacher would cringe at the thought of sharing their opinion of the quality of life for a child in their centre. In New Zealand, early childhood is about empowering, learning and communicating with the child in order to develop a reciprocal relationship that helps them to grow a sense of belonging within their centre environment regardless of culture, beliefs, age, or ability. Our curriculum, our policies, our philosophy, our values, and our morals go against what Dylan’s teachers suggested. Children like Dylan, who have cerebral palsy or other diseases are supported and welcomed into centres. Negative judgements are never passed, but instead their individuality is embraced. Early childhood teachers do not look at what the child cannot do, but look at what the child can do, encouraging them to build on their skills and knowledge through their interests. It is managements job to “ensure that training is available to enable the adults who work with children...have the knowledge and skills necessary to support the children’s learning and development” (Ministry of Education, 1996, p. 27).  Therefore, children with disabilities are supported by teachers who understand their disability, and are able to support and encourage them within a centre environment. The Māori concept of aroha encompasses aspects that New Zealand early childhood teachers believe. “A person who has aroha for another expresses genuine concern towards them and acts with their welfare in mind, no matter what their state of health...it is the act of love that adds quality and meaning to life” (Barlow, 1991, p. 8). Children with disabilities are embraced and treated as equals despite their need of special care. Their disability does not define them. Although there were many other factors in Dylan’s case, most New Zealand early childhood teachers, would never suggest to a parent that they should euthanize their child; whether they were invited to give an opinion or not.

However, the New Zealand education system is not perfect. The Ministry of Education are currently reviewing the way education providers are financially supported when it comes to educating special needs children. However, “the review is not looking comprehensively at services and support in early childhood education settings” (Ministry of Education, 2013, para. 4).  This contradicts what early childhood educators strive to achieve. Somewhere along the line, the government has forgotten how important a child’s early years are for their holistic development, regardless of their abilities.

Children like Dylan, and Tracy, do have limited means to enable them to live life to the full. However, their disability is all they know. They were born with cerebral palsy. That was the life they were given, and that life was taken away without their real knowing or consent. They suffered further pain as a result of their parents actions.

After reading their cases and understanding them fully, some will see why Tracy and Dylan were euthanized and may empathize with the parents. Others may read the same, and feel resentment towards the parents and sympathise with the child. Either way, a voice-less child was killed and cases like these are what cause intense debate over child euthanasia.  

References

America Right to Life. (2013). Children’s hospital euthanizes 4 year old. Retrieved from http://americanrtl.org/hospital-euthanizes-4yr-old.

Barlow, C. (1991). Tikanga Whakaaro: Key concepts in Māori culture. Oxford, England: Oxford University Press.

Corelli, R. (1994). Mercy on trial. Maclean’s, 107(47), 48. Retrieved from MasterFILE Premier database.

Cote, C., Lerman, J., & Todres, I. (2009). A practice of anesthesia for infants and children (4th ed.). Philadelphia, PA: Sauders Elsevier.

Council of Canadians with Disabilities. (2013). The Latimer Case: The Reflections of People with Disabilities – Chronology. Retrieved from http://www.ccdonline.ca/en/humanrights/endoflife/latimer/reflections/chronology.

Life. (2011). Infant euthanasia. Retrieved from http://www.life.org.nz/euthanasia/euthanasiamedicalkeyissues/infant-euthanasia/.

Ministry of Education. (2013). Introduction. Retrieved from http://www.minedu.govt.nz/theMinistry/Consultation/ReviewOfSpecialEducation/DiscussionDocument2010/Introduction01/Introduction.aspx.

Ministry of Education. (1996). Te Whāriki: He Whāriki mātauranga mō ngā mōkopuna o Aotearoa/Early childhood curriculum. Wellington, New Zealand: Learning Media.

Wikipedia. (2012). Robert Latimer. Retrieved from http://en.wikipedia.org/wiki/Robert_Latimer.

Kiwi's and Euthanasia

In this blog, I have looked into the New Zealand government and explored the specific political influences, both positive and negative. How political leaders understand euthanasia is reflected by what they say and do to help everyday New Zealanders to understand it too.

Although euthanasia is a universal debate, the ideas, views, and perspectives on this issue are strong in the minds and hearts of the people living in New Zealand. The government has its moments in the spotlight but as a nation, discussions on the topic are humming. Bringing the subject up into conversation creates a mini debate about the pro’s and cons of euthanasia and new ideas are bought up that others have not thought about before. For example, many people see it as a very black and white issue. Either they believe in it, or they do not. However, euthanasia is anything but simple and when ignorant, naive, and uneducated comments are made public, the community of New Zealand stand up and have their say.

New Zealand Prime Minister
Mr. John Key

In August 2012, the Prime Minister of New Zealand, Mr. John Key, stated in an interview, “I think there's a lot of euthanasia that effectively happens in our hospitals” (Stuff.co.nz, 2012, para. 4). This comment stirred the country and outraged many people especially medical professionals. Concern arose as to whether the comment would scare the families of terminally ill patients, and members of the public spoke out to defend doctors saying Key was being unprofessional and ignorant. Sinead Donnelly, New Zealand chairwoman of the Australian and New Zealand Society of Palliative Medicine said “it appears the Prime Minister has confused the ceasing of curative treatments with ending a person's life. In situations like this people are in fact dying from an advanced disease, not from the withdrawal of the treatment” (Otago Daily Times, 2012, para. 10). As a response, Mr. John Key apologised for making such a careless comment and expressed how he would support legalising euthanasia if the ballot were to be drawn.

In July 2012, Labour MP Maryan Street submitted her ‘End of Life Choice Bill’ into the private members ballot. This Bill supports patients who are terminally ill to have the choice to die with dignity rather than live their last chapter of life in agony. The bill provided specific conditions that need to be met in order for someone to be medically assisted to die. In summary these are:

• “that the person making the request must be mentally competent, as attested by 2 medical practitioners – and that there is no coercion involved
• that the person suffers from a terminal illness which is likely to cause death within 12 months, or from an irreversible physical or mental condition that, in the person’s view, renders his or her life unbearable
• A 7 day reflection period
• Can do an end of life directive, while mentally competent, specifying wishes. Must be renewed every five years
• Medical practitioners can refuse to be involved
• Family members cannot annul the wishes of the applicant (unlike with organ donations)
• An annual review of how the law is being operated” (Euthanasia-Free NZ, 2012, para. 4).

Although this bill is yet to be drawn, out of 1000 New Zealander’s surveyed in 2008, 71% supported the legal right to choose a medically assisted suicide. 20% did not support it and the remainder surveyed said they did not know. Furthermore, the University of Waikato survey asked 125 Waikato doctors, and found 54 of the doctors said they would practice euthanasia if it were made legal” (Legalization of Euthanasia in New Zealand, n.d, para. 3).

These statistics show that alongside the Prime Minister, the majority of the New Zealand population supports the legalization of assisted suicide. However, in 1995, Michael Laws and Cam Champion drafted the Death with Dignity Bill. This was the first time that New Zealand considered making euthanasia legal. There were requirements that needed to be met in order for someone to be euthanized, however confusion developed over the wordiness of the Bill. Basically, the Bill stated that terminally ill patients would be able to be euthanized if they had given prior consent but the simplicity of the explanation of the requirements did not convince the members of parliament. Controversy also arose when Laws explained the Death with Dignity would also apply to disabled children. Unsurprisingly, the Bill was defeated 61 to 29 votes (Life.org.nz, 2011). This outcome was a learning curve for Maryan Street who understood the importance of clear-cut requirements and how vital it is to make sure the voters understand what she is trying to make legal.

So what else is happening in New Zealand now in relation to this never-ending debate of euthanasia? As people who have terminal illness are the most likely to consider euthanasia, the medical professionals who are in charge of caring for them are likely to be the ones caught up taking responsibility for this issue the most. The World Health Organization (2013) says palliative care 

“provides relief from pain and other distressing symptoms, affirms life and regards dying as a normal process, intends neither to hasten or postpone death, integrates the psychological and spiritual aspects of patient care, offers a support system to help patients live as actively as possible until death, offers a support system to help the family cope during the patients illness ad in their own bereavement, uses a team approach to address the needs of patients and their families, including bereavement counseling, will enhance quality of life, and may also positively influence the course of the illness” (para. 2).

 

This amazing organization provided to support patients and their families, has been in the media spotlight for ‘supporting euthanasia’. Palliative care often provides the patient with strong medications to manage pain, and the media twisted this, convincing the public palliative care was the government’s way of secretly committing euthanasia (Stuff.co.nz, 2011). In fact, this is far from the truth and because of this negative attention, the government shared their palliative care strategy to increase public knowledge, and give confidence back to those who were under their care.

Patricia Ferguson and her son Sean, who
helped his mother to die without regret

The New Zealand government’s palliative care strategy has been influenced by a much bigger organization. The European Association for Palliative Care (EAPC)  have created the White Paper. “The White Paper covers key elements of palliative care: definition and terminology of palliative care and hospice care, common values and philosophy of palliative care, levels of care, patient groups, needs assessment and requirements for different types of services and settings” (EAPC, 2010, para. 4). In short, it is similar to the Code of Ethics professionals follow in a range of occupations such as early childhood educators, and doctors. The expectations the White Paper outlines for doctors and nurses who provide palliative care have been ‘adopted’ by the New Zealand government. The Ministry of Health are receiving extra funding so they can provide training for professionals who care for those transitioning from life to death. Their goal is that the quality of care will be so high that the number of requests for euthanasia will decrease resulting in a reduction of requests for euthanasia to be legalized (Adler, 2003). The Patricia Ferguson case shared with the world how painful and long a death can be without 24/7 professional care. There is a real need for the education of New Zealanders on the type of care that is offered to those who are terminally ill. This may encourage those who are contemplating euthanasia to take into account the high quality of care they could receive to make their last chapter in life as comfortable and enjoyable as possible.    

  

References

Adler, J. (2003). From New Zealand: On defining perspectives. Palliative Medicine, 17(2) 170-171. doi:10.1191/0269216303pm677op.

EAPC. (2010). EAPC white paper on standards and norms for hospice and palliative care in Europe. Retrieved from http://www.eapcnet.eu/?TabId=735.

Euthanasia-Free NZ. (2012). Maryan Street MP submits euthanasia bill. Retrieved from http://euthanasiadebate.org.nz/maryan-street-mp-submits-euthanasia-bill/.

Legalization of Euthanasia in New Zealand. (n.d). Surveys in New Zealand. Retrieved from http://policyprojects.ac.nz/jasonrenwick/surveys-in-new-zealand/.

Life.org.nz. (2011). The first death with dignity bill. Retrieved from http://www.life.org.nz/euthanasia/abouteuthanasia/nzeuthanasiahistory2/.

Otago Daily Times. (2012). Anger over Key’s euthanasia comments. Retrieved from http://www.odt.co.nz/news/politics/222991/anger-over-keys-euthanasia-comments.

Stuff.co.nz. (2012). Euthanasia already happening in hospitals – PM. Retrieved from http://www.stuff.co.nz/national/politics/7530298/Euthanasia-already-happening-in-hospitals-PM.

Stuff.co.nz. (2011). Euthanasia is not palliative care. Retrieved from http://www.stuff.co.nz/dominion-post/comment/letters-to-the-editor/5932245/Letter-Euthanasia-is-not-palliative-care.

World Health Organisation. (2013). WHO definition of palliative care. Retrieved from http://www.who.int/cancer/palliative/definition/en/.

The Law of Nature VS The Law of the Nation

In this blog, I will be discussing a real life case study of a want for euthanasia, and how this can create thinking about the meaning of ‘quality of life’.

It is quite interesting this euthanasia debate. There is so much information out there trying to push the many perspectives. After reading, and listening to what the many perspective have to say, I have discovered a new theory. This is not just a debate between whether euthanasia is right or wrong. It is a debate between the law of nature versus the law of the nation (16x9onglobal, 2011).

A book called ‘In the Midst of Life’ by Jennifer Worth, recalls a woman’s experiences as a nursing hand throughout the late 1950’s until 2010. The ideas on death that emerge through the pages, bring to light some interesting facts relating to euthanasia. She tells a story of when she first began practicing as a nurse hand. She shares with the reader an experience she had with an elderly woman, called Mrs Ratski, who had under gone some medical procedures.  Mrs Ratski was only meant to be in hospital for a few days, however, due to her old age, she developed further complications and her stay was unexpectedly prolonged. Jennifer explains how the doctors did everything they possibly could in order to get her well again. Little did they know, that she had recently shared with her son that she felt it was her time to die, and made her peace. For weeks, they drugged her and kept her alive. At one stage, she expressed her pain and discomfort by trying to rip the many cords and needles attached to her body out and escape the hospital. As a result, the doctors ordered the nurses to tie Mrs Ratski’s wrists to the bar on her bed so she could not make the same attempt again. As time when on, her health rapidly deteriorated resulting in many operations, including the removal and closure of her rectum. Eventually she was able to leave the hospital and move in with her daughter-in-law. Neither of them where happy with this arrangement and her daughter-in-law refused to care for her needs including change her colostomy, and over time, she put screens up around her bed so the children could not see their ill grandmother. After months of living in isolation, Mrs Ratski fell out of bed, breaking her pelvis. She was taken into theatre for the pelvis to be pinned into place but the injury did not heal. Mrs Ratski eventually developed generalised septicaemia and died alone (Worth, 2010).

It is shocking that this woman had to go through the amount of pain and suffering that she did, even after expressing her readiness to die. This story is an example of the law of the nation. Mrs Ratski felt her time was up. She was ready to die. Her body had lived many happy years and she was ready to rest, in comfort of home, with her son by her side. However, globally the law states that ‘old age’ is not an acceptable cause of death. There must be a medical reason, and heart failure alone is not acceptable (Ministry of Health, 2001). This is why doctors work so hard to preserve life, and why euthanasia is such a big issue. Nature can no longer take its course. People can no longer die of old age. The law now denies everyone of this.

However, this is not such a bad thing either. Imagine if doctors had the right to determine whether a life was worth trying to save. The words ‘quality of life’ come to mind and what this really means cannot really ever be determined. For someone to decide it is time to pull the plug because a person is too unwell to ever live a normal life again, is a choice that no one ever wants to make. Deciding for someone else whether his or her quality of life is worth holding onto is what makes euthanasia so easily debatable.  

In New Zealand, the law is clear. Euthanasia is illegal. However, New Zealand doctors cannot save everyone. At some point, they have to accept their care and obligation to ‘fix’ patients will not play out as planned. Some patients are just too unwell, too weak, too old, to be able to fight for life. The responsibility that individuals feel is that doctors have to keep loved ones alive. This means doctors have the hard job of gently sharing the reality of the situation with patients and their families. At some stage, everyone dies. So how do doctors ‘let patients die’ without it being labelled as euthanasia? Is euthanasia happening in New Zealand hospital without the public actually realising it?  How do medical professionals overcome this issue when a patient is in pain and begging for death to come?

References

Ministry of Health. (2001). A guide to certifying causes of death: A guide for doctors and coroners on the provision of information on deaths to the New Zealand health information service. Wellington, New Zealand: Ministry of Health.  

Worth, J. (2010). In the midst of life. London, UK: Orion Publishing Group.

16x9onglobal. (2012, March 21). Taking Mercy: Euthanasia debate [Video file]. Retrieved from http://www.youtube.com/watch?v=NxYmgrnGx_M.