Palliative care, not euthanasia

New Zealand needs more investment in palliative care, said Dr Bryan Betty, medical director at the Royal College of GPs.

He is concerned that ACT Party leader David Seymour wants to broaden the standards for end-of-life options laws. Seymour argues that change is needed because many people who want assisted suicide are “missed”.

According to Seymour, this is largely because these people do not have a terminal illness that could kill them within six months.

The 6-month end-of-life prognostic requirement precludes individuals with chronic illnesses or disabilities from qualifying.

Betty argues that broadening eligibility criteria will not improve equitable choice for those facing end-of-life decisions.

He warns that it should not progress in light of New Zealand’s current palliative care environment.

Nor should it happen without careful analysis.

Despite being so important to New Zealand’s healthcare system, palliative care is under-served, says Betty.

“We have no strategic plan for what will happen in palliative care. We have fragmented services, we are underfunded…the list goes on. We are not in a position to do so.”

The contrast and imbalance between palliative care and assisted suicide and euthanasia is substantial and cause for concern, he says.

“While some parts of the system are fully funded and overseen by the Ministry of Health (assisted suicide and euthanasia) in an apparently coherent manner, others have not even implemented a strategic plan. It is unfairly funded, and there is no consistent overview of how the service is developed.

“Why don’t we just focus on palliative care? Then anyone making the biggest decisions in their life can make fair and informed choices.”

It’s a failure of the government, politicians and the Ministry of Health, he says.

According to Betty, New Zealand’s 5,500 GPs, specialty GPs, trainees and doctors in local hospitals provide palliative care to patients, often for free.

That’s because there is no funding available for end-of-life care, a major flaw in the system, he says.

“Palliative care relies heavily on local funding, which is traditionally done by DHBs, which are completely lacking in funding, resources and national approaches.”

This, combined with increased workload and more complex clinical patient needs, is putting pressure on palliative care practice.

“The question is why aren’t we getting exactly the same focus on palliative care,” Betty says.

According to Assisted Dying Service Data and Report from November 7, 2021 to September 30, 2022, only about 80% of people who choose assisted suicide or euthanasia have access to palliative care.

Betty warns against this analysis.

“It doesn’t show any recognition of what’s going on or the quality of care they’re receiving,” he says.

The validity of the data should be questioned when the law is reviewed, he added.

“Everyone is affected by death and death. , should be given space and focus.”

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