A tale of two cities

Reginald lives in Auckland and was diagnosed with lung cancer.  He is quickly linked with an oncologist and referred to palliative care doctors who offer counselling, arrange family meetings, assist him in sorting out his affairs, and arrange for him to have oxygen and a hospital bed in his home.  He is visited regularly at home by the palliative care team or his GP, who are able to offer him admission to a hospice if he or his family needs the respite.  During the whole time, medicines are administered to ease his discomfort.

Taylah lives in rural New Zealand.  An appointment with a GP usually takes four weeks to achieve.  She is diagnosed with cervical cancer, which required her to go to a big town for surgery and radiation, and travel back home for chemotherapy at her local hospital.  She gets to see her oncologist once a month, and is given pain medications to take home if she needs them between visits.  Palliative care is limited in her region, hospice is full and the hospital only has beds some of the time.

The stories of Reginald and Taylah were written by Dr Carmen Chan, a young doctor in New Zealand.  She wrote that, as a student, she supported euthanasia and assisted suicide as a humane option for people at the end of their life, and acknowledged how difficult it is to witness the death of someone who has been long suffering through their illness.

But, Chan wrote, her front-line experience as an emergency department doctor has made her question her enthusiasm for legalised deaths.

“First and foremost, euthanasia is an equity problem,” Chan wrote.  “It broadens the gap in health outcomes for those already having trouble getting fair access to care - for example, Māori and Pacific populations, rural communities, those impoverished and anyone already marginalised by the healthcare system. For me, it’s obvious who would be more likely to opt to end their lives early through euthanasia because they cannot access the medical care and support that they need.”

Chan objects to euthanasia being used as an answer to gaps in the health care system, writing that its economic advantages is nothing short of dystopian:

Inserting an intravenous line, and injecting drugs to kill someone is far cheaper and easier than getting a hospital-in-the-home bed, counselling support, and nursing care. A junior doctor could admit you when you arrive to hospital, you’d wait for a specialist to review and confirm your choice, and a nurse could inject you with a protocolised set of drugs in a quiet room on the ward. We wouldn’t argue otherwise; we’d respect your decision. An orderly would then take your body to the morgue and from there it would be transferred onto the funeral home, or for cremation. It's not rocket science. Nor is it good medicine.”

Chan calls on the government to strengthen palliative care, social services and other support systems, rather than pushing euthanasia.  This doctor confirms what we all know: vulnerable patients deserve much better than euthanasia, no matter how much money it saves the healthcare system.