Dr Cynric Temple-Camp is one of New Zealand’s leading pathologists. In his new book The Quick and the Dead, published last month, Temple-Camp exposes the world of a pathologist. Through a series of stories and cases he’s been involved with, from early in his career in Africa through his time in New Zealand, he leads the reader into a world of disease and death as he seeks answers for those who were unlucky, and those still alive to tell the tale. His first book, a #1 bestseller The Cause of Death was published in 2017.
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Nothing is more certain to cause heat but little light than a debate at a dinner table of doctors on euthanasia. There will be strong and diverse opinions and you will leave stimulated but probably no wiser, says pathologist and The Quick and the Dead author Dr Cynric Temple-Camp, commenting on the euthanasia referendum to be held with this year’s General Election.
As a pathologist dealing often with the already dead, and with no personal experience regarding assisted death, I am no better informed and my opinion is no more valuable than anyone else’s. But together we, the New Zealand public, or more precisely the 50% of us who turn out on voting day, soon have to decide in a referendum whether to support the introduction of the End of Life Choice Act 2019. I would not presume to lobby on this issue, but a fundamental question about the probable outcome bothers me: will there be enough doctors willing to actually administer the overdose?
You would have to be without compassion to fail to understand the motive for euthanasia under some circumstances. There are the stories from the trenches of WWI of hideously injured men, screaming in pain with no hope of help, shot by their own. No-one who has not been in comparable circumstances can fairly criticise such an action.
It is not a big step, then, to see mentally competent patients at the end of prolonged suffering that is without hope of medical alleviation having a prescription to hand so they can choose their own moment. The evidence from countries where such a remedy is provided is that it is surprisingly rarely used. Palliative care these days is a robust and well understood discipline, and there are now very few who are truly beyond help to live a comfortable dignified life until an inevitable death. There are support networks available and no-one need suffer needlessly before succumbing. Families who have used them have high praise for modern palliative services.
It is also true that although medicine is good at beating death back, in many patients it is too often only a holding action. You smack it down for a bit but it soon bursts out elsewhere, like an Aussie bushfire. Many clinicians who would never administer a lethal drug to their patients are comfortable with stopping antibiotics, fluids, and other life-prolonging support to allow nature to take its course. This is common practice, and although it has some similar aspects it is perceived as quite different from the assisted euthanasia policy on which we are now to decide.
The referendum choice says, in part, that assisted dying involves – “a person’s doctor or nurse practitioner giving them medication to relieve their suffering by bringing on death.” The death in this definition is essentially physically caused by the doctor or nurse. It is certainly a “physician assisted death” and a stringent procedure is clearly laid out.
The question is, who will actually carry out this action? A contact list of willing doctors is proposed: but how many will be prepared to appear on it? It is quite something to toss aside the 2,400 year old Hippocratic Oath, which underpins our ethical approach to medicine. We swear in the traditional version of the oath that “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.” Modern versions depart from this concept somewhat, but they do not carry the same historical mana. The newer version uses wording along the lines of “Do your utmost for the patient,” which could be interpreted as providing for a drug-assisted death. Changing the wording, though, doesn’t change the tradition and teaching or professional beliefs that still underpin the profession and are held by the majority. And it is proposed now in 2021 that on the strength of a probably minority poll we discard this ancient tradition.
Pathologists of course will not be involved by the very nature of our work; but I cannot easily envisage my surgical, medical, paediatric or other specialist colleagues doing so either. Will GPs be prepared to do it? Some perhaps, but I suspect many, maybe even most, would not willingly. The palliative care doctors are obviously in the best position to carry out this sombre duty, but I sense they are devoted to helping patients live a good and dignified end of life, rather than helping them to an earlier death.
Some years ago a doctor visiting New Zealand from Belgium talked about his experience of euthanasia. Belgium, the Netherlands and a few others have legislation allowing euthanasia, and it has become an increasingly common way to die there. He showed us a video of a young woman wasted by disseminated cancer being administered a lethal injection. It was a horrible thing to have to watch though it was peaceful enough and she was surrounded by her loving family. All of us who were there felt uneasy about it, perhaps because we are not used to seeing a person put to death. A straw poll conducted recently among my colleagues did not find anybody eager for this law change. Perhaps I am wrong, and we will become accustomed to it and eventually accept the policy and method of implementation. The Act seems to take as a given medical willingness to act upon its provisions. I wonder if this is soundly based. You will certainly find some doctors prepared to reach for the needle and to speed you over the River Styx, as the ancient Greeks might have put it. There are always some, also passionately convinced that they do good.
But the doctor you choose to trust with your life may not be prepared to end it. You would then have to contact the New Zealand Support and Consultation for End of Life Group to get another doctor to administer that final injection. The law would require the signoff of two independent and willing doctors to satisfy requirements.
Is there any certainty they will be there? I wonder.