Thursday, January 4, 2018

Now the A.C.T.

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The legislative assembly of the Australian Capital Territory has just opened an inquiry into End of Life Choices in the A.C.T.

With the example of Victoria before them, they seem to have moved smartly to follow suit, with a comprehensive terms of reference and a full year before they have to report.

Included in their terms of reference is the provision where Federal Government some years ago withdrew the right of States and Territories to write their own law on this matter. This was prompted by a Northern Territory decision to legalise voluntary euthanasia for its people. This Federal law will have to be overturned before progress can be made in any State or Territory - another big challenge for the movement.

However, in Australia, as in New Zealand, it is becoming clear that new law is no longer a matter of if, but when. The mood of our communities and the opinions of broad samples of our societies seem to be making that clear.

It is right that every jurisdiction should investigate its own needs thoroughly. If NZ is dragging its heels in what some see to be a liberal rush to respond to perceived community needs, let it be because the matter will be thoroughly and impartially investigated, not because some powerful minority groups are exercising undue influence in slowing down the decision-making.

Wednesday, January 3, 2018

A Challenge to Hospice

 Three or so years ago our local hospice ran an appeal based on the claim that some of their patients were dying in pain because there was not enough money to buy effective medication. The appeal letter could not be found when I asked for a copy a few months later. And, of course, it was not entirely factual. A year or so later the then Prime Minister asserted that “We don’t need Voluntary Euthanasia; we have hospice”. 

That, too, was a bit naive. We know now—as I personally found out after surgery a few years ago— that not all pain can be controlled. Indeed the World Health Organisation suggests that up to 25% of pain may be untreatable. So the palliative care movement cannot be expected to deal with all pain. And the dilemma for the hospice movement is what can they do with patients who unhappily fall into that category?

My answer would be that hospice should think about embracing the medical aid in dying movement for such patients as wish to avail themselves of it. I know all the traditional Hospice arguments against such a course. It would involve a sea change of thinking. But studying the values and aims of the hospice movement I can now point to a lot of hospice principles that could be honoured by taking palliative care to its logical conclusion in every case, instead of only in five out of six patients.

Respect, dignity and compassion are values that apply as well to a good programme of medical aid in dying as they do to palliative care. And, perhaps, at the end, for some people for whom pain is uncontrolled and who choose for another option, they apply more to the former than the latter.

Where could we find a more appropriate organisation to offer the qualities of nursing and pastoral care, support and judgment that will be required when Parliament has passed an appropriate law?

Friday, December 15, 2017

77-46 OK

So David Seymour's End-of-Life Choice Bill has passed its first reading - with a substantial majority compared with previous attempts in the last couple of decades. The debate is now a matter of formal Parliamentary action.

But NZ First's demand for a referendum is a bit of a spoiler. It would delay the final law beyond the time I might have wanted to avail myself of it. It smacks of party manipulation of what is supposed to be a conscience vote, too. I suspect that Seymour accepted this for the sake of the kind of solid vote that has been achieved to at least get the Bill off to a Select Committee.

And I note one Member who, having finally declared his personal view against the proposal just a few short weeks ago is listed among the "Ayes". I am sure there will be others who, while not sympathetic to the Bill, would be willing to permit the matter to be debated thoroughly. Good on them, I say. And thanks.

And a thorough hearing we hope to have from the Select Committee on Justice. It would have been a travesty of justice if it had gone back to "Turkey" O'Connor's Select Health Committee which took so long to accomplish so little.

Monday, December 11, 2017

A forthright article by Graham Adams at NOTED has been brought to my attention.  Written about six months ago, it is a very valuable summary of where the End-of-Life Choice conversation has been subverted by those who are opposed.

A most telling point for me was this quotation from the Roman Catholic submission to the Health Committee:

“Religious arguments have their own validity and rationale within a particular faith-based framework. However, we recognise - 
(i) they will not be compelling for persons who do not share our faith perspective and 
(ii) they are not sufficient for shaping public policy in a secular society. 
For this reason our submission will focus on arguments of a social, cultural, ethical and philosophical nature that can be understood and appealed to by all persons irrespective of their religious background.”

On the one hand, this looks pretty realistic as well as unexpected. The views of any church are not given a lot of weight when the nation is considering change even in ethical and moral matters. But Adams points out that   "...anyone who has a deep religious conviction that rejects any human interference with what they consider to be a natural life span ordained by God is not putting all their cards on the table if they don’t explicitly argue that position. Because if they did, they would have to admit that there is absolutely no evidence that would change their minds, no matter how compelling."

I am really interested that the Catholics apparently down-played their religious convictions in the submissions process.  That view is pretty much imitated by other mainline churches who have been conspicuously quiet or cooperatively indecisive during the whole debate. 

Well, I need to state that I have what Adams calls "deep religious convictions" in this matter. I am very clear that my advocacy for some form of end-of-life choice for certain people arises out of those faith convictions. Let's get on with the conversation.

Tuesday, December 5, 2017


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A few weeks ago our conscientious nursing staff announced that our Village had a new Automated External Defibrillator. Furthermore, it would be brought to every emergency call involving a collapse. If any of us did not want to be resuscitated in certain circumstances, we would have to provide a written record of our wishes. And we should also wear a Do Not Resuscitate tag.

I'd already been down this track with a wristband which I purchased (but don't normally wear, actually) so it was a simple matter to pick up a suitably inscribed dog tag and borrow a chain from Bev's collection. And I am wearing that all the time.

With total paralysis as a probable outcome of my journey with prostate cancer, I would welcome the opportunity of a substantial heart stoppage to let me go. "I mean it. Nurse. If  I've been out of it for some minutes, just keep that thing off me!"  What a way to outflank the opposition who are denying End-of-Life Choice for me and a few dozen others each year...

Monday, December 4, 2017

Oh, the technology around the PSA

After a year or two of delays my General Practitioner practice has opened up Patient Portal for me, so I can go to the internet and view my test results. This big step in patient information should have saved a lot of time for both him and me in delivering my monthly test results.

However, for two months, nothing has appeared in my "lab test results". This is because of another great step in technology. The local laboratory office has computerised themselves with laptops and printers in every booth. Now I can't just pop my test request into a box at reception. I now have to show a special card, take another card from a box, scan that and then leave both until I am called. In the test room, the operator has to scan the cards again to bring up my details, tap in some bits of information and print labels for the phials.

It was a lot easier when I just handed in my test request. Either way, she still has to take samples of my blood. And within a short time the simple-minded report at the high tech Patient Portal would have displayed Nov 2017 PSA 39 VERY HIGH.

At least it would have, if the system had been told that copies of reports had to go to my GP. But apparently that insignificant piece of information had been overlooked. So I have had an hour on the phone to various people today trying to get that corrected.

And the system's analysis that my PSA of 39 is VERY HIGH takes no account of the fact that six months ago it was doubling in two months and would have been heading for 200 so by now. 39 is actually a reduction over the last couple of months. Thank you, Pharmac NZ, for contributing $4326.19 a month for Abiraterone which does seem to be keeping me going.

Thursday, November 30, 2017

Well done, Victoria!

After a rumoured 100 hours of debate, both Houses of the Parliament of Victoria, Australia, have now adopted an End-of-Life Choice Bill to come into effect by 2019.

That's a huge result for this part of the world. Now we need to see how the David Seymour bill will go in the next Parliamentary term in New Zealand.

However, it is depressing to see the amount of discussion that this issue evokes. Even more depressing is that there is nothing new to be said. At a public meeting with our local electorate MP recently, I heard him trot out one or two of the risks associated with this kind of legislation as though they had never been considered. The meeting was Grey Power oldies and they didn't take too kindly to his naive and ill-informed comments.

But there was progress. A few months ago, he had declared on national TV that he hadn't made up his mind. At this meeting, when asked, he said that he had reached a point of view. As a lifelong Catholic, he was now personally against any form of shortening life. But, he said, he would "poll" his electorate when the Parliamentary vote was coming up and he would vote , not according to his conscience, but in the direction indicated by his constituents.

Funnily enough, that's exactly what every one of half a dozen candidates for Parliament said when asked for their personal views a few months ago by the same Grey Power members. But not one candidate described how they would organise this "poll". None assured us such a poll would be properly managed by a reputable profession firm. None even thought to mention that their poll would not be limited to members of their own party, or their own church or other easily accessible group. Sounds like a cop-out to me...

I'm pleased that our MP has now reached a point of conviction he can own up to in public. I don't share his view but I respect it. I certainly won't seek an audience with him to try to change his views.  And, personally, I would be happy for him to vote according to his conscience and not according to some mish-mash of a poll that might or might not represent the wide range of public opinion in any electorate.

I just want to see some action in response to the declared wishes of the vast majority of the population over several professionally managed opinion polls over a decade or more. Let's get on with the vote.

Thursday, November 9, 2017

A Literary Adventure with Parkinson's Disease?

Some time ago I made a commitment that I would not start another major project that might put me under pressure to finish before my Use By date was up. However, my Oncologist's challenge to do something worthwhile if I could enjoy another year of good quality of life has, in part, dropped me into another fairly large project.

One of our Village residents has recently prepared a substantial paper on a self-help regime that she and her husband worked on after his diagnosis of Parkinson's Disease. They have experienced some remarkable developments and she has recorded their story in considerable detail. Her draft has received some significant commendations from professional people in the field. She has now come to me for some suggestions about how her story could be told.

We're first going to spend a little looking at what she's written and how it might be re-shaped to help other couples experiencing this condition. Certainly, my interest has been piqued. One can't help but be inspired by her passion. It looks as if we are going to be travelling an interesting road over the next few weeks.

Wednesday, November 1, 2017

On the bus this morning

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This morning I took a free bus ride to Orewa to return a library book (Anne Salmond’s “Tears of Rangi”, an amazing and powerful account of “experiments across worlds” in our tentative bicultural journey in this country). To take the car would cost about 90c in electricity and that seemed extravagant and unnecessary.

Waiting at the bus stop for the return trip, two of us were extravagantly blessed by a long-haired, bearded, barefoot, not very kempt fellow, who from three metres away wished us a very cordial and enthusiastic good day “following in the steps of Jesus”. When he came by again I asked him to what part of the various flocks of Jesus did he belong. “Oh, just the Jesus Way”, he said. Now, as a progressive Christian, I should have been satisfied enough to hear that.

But I still followed him onto the bus and sat beside him, leaving about 42 seats for the other three passengers. I invited him to talk a little more about his faith and way of life but there was nothing forthcoming. I ventured a few thoughts of my own but he remained non-committal. I introduced myself as a retired minister but on reflection I guess that was never likely to help.

I don’t know what I expected. But I guess I hoped he had something more to share than just the passing catchphrase, no matter how elegant...

Tuesday, October 31, 2017

The CaPros Report

Just back from Medical Oncology. My PSA is down slightly from 57 to 43 which still seems pretty high to me. We are continuing on Abiraterone and half a dozen other things. Now we're adding in some medication for severe back pain the last six days - this is occurring in the right place but it may or may not be cancer-related. If not it will clear up in a few days... Nothing seriously depressing in all that, for which we continue to be grateful.

Afterwards we had a pleasant drive out to the airport for some free car electricity, some shopping, a trip through the Waterview Tunnel and some country driving back to home.