Help needed now assisted dying a reality

Now the End of Life Choice Act has come into force, future medical professionals need to learn more about how it works in practice, argue two lecturers in bioethics at the University of Otago.

The End of Life Choice Act 2019 made assisted dying legally available in November 2021. According to the Ministry of Health, the legislation gave people who are terminally ill and experiencing "unbearable suffering" the chance to seek medical assistance in ending their lives.

Philosopher and senior lecturer at the University of Otago’s Bioethics Centre Simon Walker and University of Otago bioethics senior lecturer and clinician at the Otago Community Hospice Dr Janine Winters have co-taught a third-year medical school lecture on assisted dying for six years.

The legislation might seem obvious in theory, but in practice assisted dying could be filled with tensions and contradictions, Dr Walker said.

"Things have changed.

"In the past, it was a hypothetical ‘What would you do?’ Now it’s a reality. It’s ‘What will you do when?’," Dr Walker said.

Dr Walker said those who taught medical ethics and end-of-life care needed to prepare students for the practical realities, including what they should consider when a patient requested assisted dying and what their professional responsibilities were. He said the ethics were complicated.

Dr Winters said the existing teaching was a chance to test ethical reasoning.

"We have questions on the board. Students sit in pairs and take different sides of assisted dying: one for, one against," Dr Winters said.

Both Dr Winters and Dr Walker agreed more practical discussion around assisted dying was necessary. No-one had yet decided yet how best to train medical students in this area, they said.

"End-of-life decisions are very sensitive.

"Helping the terminally ill and their families is a learned skill," Dr Winters said.

Dr Winters would like to see a workshop in which students could practice fielding questions and requests. Dr Winters said knowing how to talk to people was vital.

"What is frustration and what is a real request?

"If some says, ‘Just shoot me,’ that is probably stress and sickness talking," she said.

Dr Winters said specific language and practices could be learned so young doctors would not be overwhelmed when asked to assist in dying.

She suggested as a start the Ministry of Health’s online handbook "Responding When a Person Raises Assisted Dying."

eric.trump@odt.co.nz