1. WORKING GROUP OF THE JUSTICE PEACE AND DEVELOPMENT GROUP PALMERSTON NORTH DIOCESE Write to Life: Be Heard

2. Overview Euthanasia; what are we talking about? Clarifying misconceptions around death and dying So Why Not…. Catholic moral teaching How to write a submission

3. Euthanasia  The intentional causing of death in order that suffering may be eliminated.  An act undertaken by someone with the specific intention of ending another person’s life. Physician Assisted Suicide (PAS)  A person self-administers a lethal substance that has been prescribed by a physician.

4. What does research tell us about patients who consider an early termination of life? (Schroepfer, Linder & Miller, 2011) Loss of autonomy/ feelings of uselessness Loss of ability to enjoy life activities that give pleasure Loss of meaning in life/ loss of hope Loneliness/ Few social supports Loss of control over bodily functions Feeling one is a burden Perception of care giving needs as high Higher level of anxiety/ depression Loss of control over manner of death The fear of uncontrollable symptoms or pain These are all issues that supportive palliative care can help with

5. What to expect when someone is dying The majority of us will die from a life limiting illness – approximately 10% die sudden death The Last Stages of Life: o Increasing tiredness o Visions and Hallucinations o Decrease in appetite/food intake o Decreasing fluid intake o Confusion, Restlessness, and Agitation o Changes in Breathing, Congestion in Lungs or Throat o Change in Skin Temperature and Colour o Change in Bowel and Bladder Functions o Change in consciousness

6. Common Misconceptions regarding end of life care 1. Pain and suffering - use of medication and sedatives 2. Hydration and nutrition – withdrawing and withholding food and fluids

7. Pain and suffering a) Misconception: Pain is inevitable and cannot be managed Concept of pain = suffering Physical, emotional, existential b) Misconception: Use of pain relief medication at end of life = hastens death

8. When the intention is the relief of pain, then the use of pain relief treatment that is appropriately titrated to relieve symptoms is not euthanasia EuthaEuthanasia Defined by Euthanasia Defined by Intention

9. Hydration and nutrition Natural for people to reduce intake prior to dying Challenging as eating and drinking is part of nurturing Misconception: “They are dying because they are not eating and drinking” In reality: “They are not eating and drinking because they are dying”

10. People have the right to refuse life-sustaining treatments including the provision of medically assisted nutrition and/or hydration Withdrawing artificial hydration and/or nutrition that is burdensome for a person is not euthanasia. Euthanasia Defined by Intention

11. Why Not? 1. Right to die = duty to die. The vulnerable and those without a voice are at risk of; coercion, elder abuse 2. We are all connected 3. Changes the norm of death and dying. What constitutes good end of life care? 4. Goes against everything health professionals are committed to

12. 1. Right to Die = Duty to Die BLOGGERS/Monica: “Burnt out adults, under pressure with work, debts, and raising their own kids telling dear old mom in a gentle way, "yes, I hate the idea BUT it would be better for you to go, mom." Mom is vulnerable, exhausted, helpless, physically and mentally fragile, influence-able, emotional, and now broken-hearted. She doesn't want to be a burden …

13. 1. Right to Die= Duty to Die Given that families are becoming increasingly fragmented, the elderly are becoming more socially isolated, and we are being constantly reminded about the scarcity of health care resources, the burden of proof will inevitably shift onto the older person to justify their continued existence… Elder abuse rates in NZ are climbing 3-10% of older people are abused

14. 1. Right to Die = Duty to Die BLOGGERS/Alma: “In my 30 years as a doctor, never mind my 60 years as a human being, I have learned that many families are selfish, cruel and manipulative. There is absolutely no doubt that older people will be dispensed with for a range of perceived benefits to those they leave behind. The fact is that an old, weakened and tired person can seldom resist this kind of pressure from children and others.” Source: http://www.bioedge.org/index.php/pointedremarks/view/10566#sthash.AMYNkJOg.dpuf

15. 2. We are connected to others Never completely autonomous Evidence in the Netherlands - the grandchildren of those who opted for euthanasia are over-represented in drug use and suicide when corrected for other variables (Ilora Finlay, 2014) Evidence suggests those who are bereaved following euthanasia experience isolation, lack of support and they had no bereavement follow up (Belgium research, 2015)

16. 3. Change in end of life care Rate of euthanasia doubled in Belgium between 2009 -2013. The rates of unreported euthanasia in Belgium were around 50% (Chambre et al, 2015) The Netherlands has had an increase of 60% in five years. (Onwuteaka- Philipsen et al, Lancet, 2012). A disproportionate increase in non-terminal diseases, mental disorder increased by 200% (Euthanasia Annual report, 2013) Switzerland 2014, assisted suicide associated with living alone and divorce more frequent in women. 16% of deaths by AS no medical condition was listed (Steck et al, 2015) Who pays for End of Life Care? Currently NZ Hospices are part funded = Local Hospice 62%

17. 4. Health Professionals view Australian and New Zealand Palliative Medicine NZ Medical Association Palliative Care Nurses NZ Hospice NZ

19. What can I do? Kindness and compassion go a long way Be connected in your community Visit folk in rest homes/ in your neighbourhood Join with St Vincent de Paul Join Faith and Light – a community which supports those with disabilities Join Hospice as a volunteer