Wednesday, December 14, 2016

MAID in Canada

Image result for "Medical AID in Dying". canada

A good friend of ours has shared some notes on Canada’s new provisions for Physician Assisted Dying. In that country it’s termed Medical Assistance in Dying, MAID. And, of course, it's now become legal. 

However, hopeful reformers there are afraid that the legislation is too limited. For instance, when people sign the request for MAID, there have to be two witnesses in attendance. But there are so many restrictions around who these witnesses can be, that it is simpler if they are complete strangers.

So our friend has volunteered to be a witness and has in fact done it three times.  The patients can’t have MAID for at least ten days after signing and of course can change their mind at any time, or they can wait for as long as they like. On a whimsical note, she told us, "One woman was very interested in my red boots and asked me where I got them.  And I thought to myself, `Surely she isn’t going to go out to buy boots at this point.`"

Friday, December 2, 2016

Methodist Supernumerary Fund

For nearly ten years, retired ministers in the Supernumerary Fund of the Methodist Church of New Zealand have had no increase in their pension. For some beneficiaries, especially widows, this has been a difficult time.
This seemingly unjust situation has arisen partly because the Government’s Kiwi Saver scheme was required to replace the Church Fund. So this was no longer topped up from ongoing subscriptions as might have been expected.

But there were also more significant changes. First, the Government insisted that the Church’s Supernumerary Fund be put into the hands of a specialist company. It failed to serve the Church well. Then the Government allowed the Church to take back control of its own fund. Through these messy arrangements, substantial capital was lost.

Now a special Committee has been charged by the Conference to find a means of building up the capital again. A logical place for them to look might be the “PAC Endowment” which is open to receive suggestions from anyone in the Church.

Before people start to quibble over the use of PAC funds, the Church could reflect on how this huge fund was created. It came from the long term lease of the Prince Albert College property in Auckland – including but much more than the lovely old terrace shops at the top of Queen St.

Prince Albert College was originally built, on this land which was granted to the Wesleyan Mission in the 1830s for educational work . The school was to provide education for the children of Wesleyan missionaries throughout the Pacific. Instead of having to leave the Mission field to provide schooling for their children in England the missionaries would be able to remain in their chosen work and have their children well educated in the Pacific.

And who paid for this imaginative and costly enterprise? The Missionaries themselves. The Ministers of the time contributed to raise the capital fund that began Prince Albert College. It was to be for their children. They put in the original ten pound shares. 

Given this background, it might be seen to be appropriate to transfer some money from the PAC Endowment to ensure that today’s retired clergy and widowed partners receive a pension of which the Church can be proud. Ministers sowed the seeds of that fund in 1836 out of their own pockets. Let the present retirees enjoy a little of the vast harvest of property inflation 180 years later.

The Ca Pros Report

Just a quick update:

After about nine months of PSA flat-lined between 25 and 30, this week's two-monthly test is 40, a 25% increase. This is along the lines of the very steep increases of 2015 and a bit worrying.

However, I'm taking the long view and figuring that an increase from 25 to 40 in about ten months is really quite small!

But, I guess my oncology specialist will be wanting to see me before long...

"I Believe"

Image result for "I believe"

Here's a postscript to my last post on the relevance of Christmas carols:

In the last few months, Chorus members wanted to learn "I Believe". Some of them, I suspect,  chose it because it was more like "ordinary singing" than Barbershop. However, our indefatigable Director prepared a great arrangement in barbershop style and I crafted scores for everyone.

The problem was, there's only one verse and just singing the whole thing twice through didn't seem to make an item, no matter how "lovely" people thought it sounded.

Personally, just about everything in this song represents a whole style of theology that I have long since relinquished, so when the possibility arose that one of us might write a second verse, I had a go. I wrote the following and nobody complained about it so we learned it:

I be-lieve that some-where in the heart of me a vis-ion burns;
I be-lieve that in the eyes of friends a-round I see hope yearns;
I be-lieve that some-where in a hurt-ing world some-one will go
To ease the pain.
I be-lieve, Oh, I be-lieve.
I be-lieve that in us all the fut-ure of the world is sure;
I be-lieve that we are those whose life and all its works en-dure;
Ev-ry time I hear a new born ba-by cry
Or touch a leaf or see the sky,
Then I know why I be-lieve.

But in the end of year Village concert by the Barbershop singers the other night, we were  apparently running out of time so my verse somehow got omitted! 

Oh, the trials of a Progressive in an alien world!

Saturday, November 19, 2016

Carol time again

Shirley Murray’s touching hymn based on Away in a Manger has moved me to propose including it in our Barbershop Christmas Carol presentation in a few days. The association of everyone’s memories of that particular melody with some concern for a refugee baby on a sinking raft in the Mediterranean is profound.

Oh, dear, what a fuss.  Our manager has apparently heard from “several” members who object. Some apparently need to practice the tune first. So he has decided we will not sing it. One member who obviously know it well emailed me personally to say that she will NOT sing any other words to that tune.

All a little frustrating when, for three years, I have tried to suggest that we might sing something a little more relevant to the season and, hopefully, a little more theologically sound than the repertoire of the average shopping centre. But to no avail.

Now a slightly provocative step on my part has outraged our musical fundamentalists. One defended her position by saying, “We’ve got to allow for differences of opinion”. Pardon me, what about some allowance for my difference of opinion? Wouldn’t the Chorus be just a little disadvantaged if I said —
**I will NOT sing anything that doesn’t meet my personal standards of respectability.
**I will NOT help to set out the rehearsal room and bring in the keyboard every week if we are going to sing about the passionate affairs of young lovers.
**I will NOT print music sheets that enable the Chorus to promote mythical, out-dated views of the birth of Jesus.
**I will NOT spend hours on the computer preparing a power point with words for the Christmas audience to sing if I happen to think that the words are mostly untruthful and generally misleading.

But I understand that Barbershop is a community. It recognises that differences of opinion exist among its members as much as the differences in their singing style and range. But it knows that the best result is achieved when our personal views about the music and words are subsumed into a whole that gives pleasure to the singers as well as the listeners.

Not a bad message for Christmas, actually. A pity that our Chorus can’t quite demonstrate that message instead of just singing another verse of “Hark, the herald angels sing”. 

Now, hang on a bit: those are revised words: what Charles Wesley actually wrote was “Hark, how all the welkin rings”. That’s what the musical fundamentalists should be singing in 2016...

Wednesday, October 26, 2016

Is there another way?

 It seems likely that Parliament is not in a hurry to initiate a comprehensive law for Assisted Suicide. But nor can they easily bring in legislation to prevent the many “managed” deaths that take place already. The status quo is likely to continue in some form or other.

So, instead of putting all our energy into legislating for a comprehensive regime about end of life in general, why don’t we direct attention at the legal issue which inhibits more doctors from exercising the kind of compassion that many do already?

I don’t know much about the legal complexities but it seems to me that adjusting the section of the Crimes Act that makes it illegal to assist a person to suicide would be simpler than trying to achieve agreement for a comprehensive protocol to cover every possible kind of assisted death.

Could we not let the medical profession continue to use its own judgments while knowing that the law no longer makes them vulnerable to a criminal charge. 

Saturday, October 15, 2016

Submissions - and the Debate

Big day yesterday. 

We left home close to 1pm and arrived at the Hearing Venue at 3pm, an hour early, to get the feel of the proceedings. However, very wet weather had obviously disrupted the hearings and I was called nearly an hour early.

The two women Committee Members in our room were gracious and really helpful to some of the less confident submitters. We stayed for an hour or two; and it was fascinating to hear the different points of very personal views. Consistent with the overall submissions, the opinions ran about 2:1 against any law change.

But in a break I had a short chat with a young lady on the other side. I suggested that agreement would never be reached on the issue itself and she realised that she’d never thought about that. She probably wasn't going to change everyone. So she then saw she had to consider whether we should change to law to allow for natural differences exactly because there is no agreement. That's what Choice is about.

The most moving moment was when our room finished and about four of us went into another room just to watch. (The Committee was taking hearings in three separate rooms—250 five-minute submitters between 9am and 6pm!). One lady broke down before she could begin her talk and another one from our room went and sat beside her and held her hand. What neither realised at that moment was that the supporter was on the other side of the issue...

Apparently that spirit did not always prevail. One or two people felt that their reception among the audience was a bit hostile. One person at least happened to be in a situation where her voice was the only one on her side and she felt distinctly discouraged. Some of this could have been prevented if everyone had been given more notice of the hearings (mine was only four days!) so that supporters could have attended.

But on the whole, this experience of democracy in action was satisfying. I pay tribute to the MPs who sat throughout this long day and still had to disperse around the country to their homes afterwards. Probably they learned nothing they didn’t know already, but they paid respectful and sympathetic attention to everyone who had asked to make a personal impression.

It was a little anticlimactic to join a few dozen people at the Community of St Luke in Remuera in the evening. They offered a debate between Hon David Seymour, the promoter of the bill that is sitting in Parliament’s Ballot Box and Matthew Jansen, the Secretary of the Care Alliance. Between them was not much agreement, as might have been expected, but also, a wide range of conflicting statistics from the same countries.

And there was an astonishing claim that “If you can give me the name of one doctor who has hastened the death of a patient (“murdered” was the word used) I will go to the nearest Police Station and have him (sic) charged”. I could have given him names of two or three compassionate and practical medicos and someone else said she could name four. But considering 11.2% of NZ doctors admitted in a survey last year that they had taken just such steps, the ridiculous offer was just grandstanding and illustrated only the lengths to which one can when one’s case seems threatened.

Again, the evening produced nothing new. We’ve heard both sides of it all before. Parliament just needs to make a decision. Our best hope is for David Seymour’s bill to pop up out of the Ballot Box. I suspect that the Committee will produce a huge report but no firm strategy for Parliament.

Friday, October 14, 2016

What I said to the Enquiry

My Five Minutes Spoken Submission
to the Health Committee   4 pm 14 Oct 2016

I am Dave Mullan, of Red Beach, retired Methodist Presbyter, 81.
I have advanced prostate cancer.

Just over a century ago, my great-grandfather, TW Attwood, was in a deputation to the new Parliament House. He would have argued a strong case—not like mine, which probably doesn’t break any new ground. But the family say he also had great passion. I hope something of that passion in a parliamentary office long ago will be apparent in this submission.—
Tetany Spasms
After an emergency surgery, I woke in the middle of the night with the most appalling pain seizing me. Every muscle between my knees and shoulders seemed to be trying to tug on the massive abdominal incision and tear it apart. It was like every muscle was cramping at once. I couldn’t move for the moments of the attack, couldn’t even breathe, or speak or cry out. I immediately realised this was not normal post-operative pain. Something in me was creating it. Only with a conscious effort of will was I able to unravel the muscles, like easing a possum skin off the nailed board on which it’s been stretched. It took time and the pain continued throughout.
Although I reported this problem to the surgical Rounds team at 8am — and in fact had an episode right in front of them while they stood round the bed — not one of them offered any comment. Subsequent conversations with the pain specialist failed to deal with ongoing attacks for nearly 48 hours.
One night a nurse really listened to me and I was prescribed a drug that stopped the attacks. But there was still no diagnosis. Months later, a very knowledgeable nurse friend suggested that I might have experienced tetany spasms. I surfed the net—as you do—and found a surgeon who had experienced the same very rare symptoms after his own operation and was appalled at the level of pain.
If that kind of pain, even in short spasms, is what I might expect when this rather ordinary disease overtakes me some time, I don’t want it. If something like that is what broadcaster Andrew Denton described of his father’s agonising death, I don’t want it. From my own experience with the excruciating agony of those terrifying spasms, I don’t have any confidence that pain of that level will necessarily be palliated or even recognised. Nor do I believe for a moment that pain is a necessary part of the very ordinary business of dying in the modern age.
Looking over my submission, I don’t wish to change much. But I hope you will review carefully the sections on—
·       the Slippery Slope and Change and their risks and effects;
·       the suggestion that much traditional religious thinking is not helpful in this debate in the context of a secular society;
·       my claim that medicine, Government, and some Christians are trying to have a bet each way;
·       my view that full agreement on the issue should not be expected
·       but providing for choice is a demonstrably fair and reasonable expectation for some terminal patients.

In every waiting room in the Health system I’ve seen posters encouraging me to become involved in my health decisions—until my last days when my wishes will suddenly expire like a twelve months’ old Prezzy Card. Please now take that further step and allow me a little simple responsibility in my dying. Please extend my personal choice to that life-defining moment.

“Looking Great”
All through my journey with prostate cancer people—becoming aware of my rising PSA said, “But, Dave, you’re looking great.”  They didn’t realise that it was hormone medication that was filling out my face so of course I looked good. Recalling the gaunt, emaciated faces of many terminal cancer patients, what I ask of you now is that after my death, anyone seeing me might say, “Gee, Dave, you’re looking great” — because you gave me the choice of dying with dignity.
And, oh yes, my great-grandfather’s petition to Parliament? The following year, exactly a century ago, Parliament granted their request which led to sweeping changes in the fruitgrowing industry. Tongue in cheek, I suggest that is a great precedent for your Committee today. You, also, could create significant change for our country by encouraging Parliament to permit me and other terminal patients to have some say in our end of life.

Dave Mullan

28/101 Red Beach Rd, Red Beach,  0932      +64 9 426 7562

Tuesday, October 11, 2016

Anyone remember Ecclesion?

Another fascinating talk we heard last week was from Dr Greta Vosper, minister of West Hills Uniting church in Toronto. Her extreme progessive position has led her denomination to resolve that she must leave her congregation.

But what interested me was one aspect of Greta's description of her congregation's Sunday mornings. They consider issues that are real for the congregation. They  draw freely on other inspiration than merely the Bible. And when business decisions come along they make them on the spot. There is no church meeting nor council so no group of individuals in assigned responsibility to make decsions on behalf of the whole community.

It interested me immediaely. Here was a working model of the Ecclesion Church that I proposed 25 years ago for small congregations.  I reckoned the contemporary church should devote its only gathering time in the week to elements of worship, education, fellowship and doing necessary business.  I'd still be very comfortable in that kind of gathering.

Monday, October 10, 2016

Medical Professionals will Cope with Assisted Dying

Many New Zealand medical professionals are surprisingly supportive of Assisted Dying in appropriate circumstances. Last week Bev and I attended a presentation by Dr Philippa Malpas on the responses of 1000 Doctors and Registered Nurses to a fairly searching questionnaire.

Some of highlights of the results were:

Around a third of doctors and half the nurses “strongly” or “mostly” agreed that AD should be legalised in NZ—assuming proper protocols were in place

A small proportion of the doctors and nurses had already been directly involved in providing or administering a lethal dose of medication to help someone have a hastened death. 

Most wanted a range of measures to ensure their safe participation in legal AD.

There are enough medical professionals prepared to become involved should the law be changed and AD be permitted on a voluntary basis.

It was interesting that TVNZ gave air time to the Care Alliance to attack the research but refused to permit the researchers to correct the misrepresentation. Nevertheless Dr Malpas observed that the law will be changed, sooner or later. 

Friday, September 30, 2016

PSA Update

There's still no invitation from the Enquiry into Dying in NZ so I probably am not going to have the opportunity to speak to my submission.  I'm happy enough to live with that as I am sure I couldn't say anything that hasn't been said already. That Committee is destined to be bored out of its mind if it hears a lot of submissions out of the 21,000 received. And the big question will be, will they or the Government to whom they will eventually report, be able to bite the bullet and acknowledge the vast amount of public opinion in favour of moving towards some kind of assisted death in particular circumstances.

Meanwhile, my PSA is still remaining stable between 24 and 29 over more than seven months this year. That's a huge change since the dramatic increases of 2015.  Long may it last.

Thursday, August 25, 2016

If "the people have spoken" what have they said?

Image result for opinion poll icon
The Parliamentary Health Committee, along with all its other business, is commencing to hear some of the 1800 who have asked to air their views on voluntary euthanasia. Members of the Committee will tour the country to make it possible for selected submitters to have their say.

It’s interesting that nearly 80% of the 21450 submitters are against voluntary euthanasia. However, public polls have risen consistently to almost the same figure in favour of it. 

The cynic in me suspects that a large proportion of the submitters simply sent in their names and addresses and a single statement such as “I am opposed to voluntary euthanasia”. This, as I have stated previously, is clearly what the somewhat biassed Chairperson urged his Catholic community to do last year.  See “Turkey” Collins, 30th March 2016 and my less filppant Ask Someone Else, Simon, 31 Jan 2016.

As far as I know, the Clerk of the Committee has not yet released an analysis of the submissions received; indeed, the impression given is that they still haven’t finished counting them! It’s usual for submissions to be classified as to weight and relevance and I, for one, would like to see that information.

I haven’t heard if my request to speak will be accepted. It’s hard to see how I could add anything to a debate in which so much about the facts and fallacies on both sides has been widely shared. But if I’m asked, I’ll be there... 

For me, and a few dozen others each year, this is a very personal issue.

Lost Luggage?

I notice  my last post was on the whimsical side. I could easily write in a similar vein today but the subject is a lot more serious.

Parliament has started discussing a Private Member's Bill giving airports permission to manage their own lost luggage problems. This popped out of the Parliamentary ballot box recently. But David Seymour's Voluntary Euthanasia bill languishes there, perhaps for ever. Well, that's how the system works.

But it seems in bad taste for a grinning Prime Minister to be reported saying that his caucus supports the lost luggage bill. But I guess any old bill would do to fill up some debating time and to keep V E off the agenda.

Yes, it could be whimsical. But for many of us it's darn serious.

Thursday, August 4, 2016

Colecalciferol Confusion

Image result for colecalciferol capsules 20000
A visit to Med Onc always ends up with prescriptions for all kinds of stuff, of course, and this week was no different.

However, what was different this time was a little difficulty arising from a small mistake several months ago.  I’d ordered up the full set of half a dozen items quarterly from my local doctor. He mistook my vague requirement for three Colecalciferol capsules a quarter and ordered up only two—which would be the correct dose for an Eclasta infusion which he assumed I would be having.

When I picked up the prescription and found I was one short, I contacted the pharmacy. They were sorry, but no, they could only provide exactly what was on the prescription. Certainly they couldn’t slip me another capsule.

I smoothed over the problem by ordering subsequent quarterly prescriptions somewhat earlier than I needed them so I would get access to this one capsule in time to take it on the proper day of the coming quarter. The system doesn’t seem to notice that I am getting several hundred dollars’ worth of medications somewhat ahead of when they are going to be used—at the end of this month I will have in my possession two Zoladex implants at around $500 each...

This week, to tidy all this up, my consultant prescribed four Colecalciferol, to enable me to catch up. But this morning I find only three capsules are in the container. Lengthy phone discussions with two people at the pharmacy have made it clear that this time they would be breaking the law if they filled the prescription exactly as the consultant wrote it. They can only issue three because the instructions were to take one each month. And they can only issue three months at a time.

So I asked if I could buy one capsule to make up the deficiency. No, they can’t sell prescription drugs—that’s against the law as well—but they could sell me a pack of 60 regular Vitamin D that were not as strong—for around $15. A sledgehammer to crack a nut, I thought.

“Just get your doctor to write another prescription for three”, they said.  Well my friendly GP would want $15 to write that and $5 to fax it to the chemist who would also charge the standard prescription part-charge of $5 when I pick it up. Not much of a deal, I thought.

How much are the darn capsules, I asked. They thought they were being refunded $15 for three. Actually, having extracted 120 pages of personal information from some eight systems linked to my National Health Index number—through some technical Right to Personal Information or something—I find that Colecalciferol capsules are being costed out on my records at a mere $1.01 each.

But I can’t give anyone a dollar to get one just to straighten this mess out. So I will carry on ordering the whole suite of stuff ahead of time just for the sake of having one capsule on the 6th of each month. And some time I’ll ask my Consultant for a separate prescription for just one Colecalciferol to bring everything up to date. That much cost will be on the generous public health budget but I will still have to pay the pharmacy part-charge of $5 when I fill the prescription. And I wouldn’t be surprised if the pharmacy didn’t make it up to two or three capsules because they couldn’t figure out what I would do with just one.

Somewhere in all this I think there must be the makings of a pretty good comedy script. But I wouldn’t write it because however much I am amused by its eccentricities I am grateful for the large amount of public funding that is keeping me going from day to day. 

Tuesday, August 2, 2016

Another trip to Med Onc

Another quarterly appointment...  Another trip across the city, and the 7am traffic report on the Northern Motorway was not encouraging. Another routine drag over the Bridge... Another Consultation with the dedicated specialists at Medical Oncology... But it was not quite routine. We had another change of consultant. And there was a little surprise to come.

I had to report a great increase in quality of life since the new meds early this year and that the side effects of these are quite manageable. My PSA had remained almost static for nearly four months. I commented that I’d had some weeks of a little more back pain than usual. My back has been a problem for half my life so we hadn’t paid a lot of attention to it. But Simon ran his fingers down my spine and when he got to L5 I jumped. No doubt about where the pain was coming from now. And a review of last month’s bone scan shows that the L5 and S1 vertebrae, the fundamental joint of the lower spine, are both now involved with the cancer.

So, another step on an interesting and challenging journey. It looks like I’ll be using some more consistent doses of Panadol from now on. No medication changes are being considered at this stage. It’s just a case of quarterly tests and watching and waiting while we get on with life. Plenty of that to do around here!

Monday, July 11, 2016

More on the Ca Pros Report and Barbershop Chorus

The radiologist who checked my bone scans a few days ago seems to have decided that there were no significant changes in my condition since last time. So I guess that's what we will hear when we meet the oncologist again in early August. By that time there will have been another set of the usual blood tests, too. Another challenge. Another milestone.

Meanwhile, in the absence of our musical director, I managed our Barbershop Chorus' invitational presentation at the Country Music Rally in Wellsford yesterday. Fairly demanding, trying to contribute the only tenor voice in the chorus as well as conducting. But we were very generously received. Especially with our first presentation of Country Roads, tackled especially for this group. We were certainly a big contrast to the noise of a seven piece band on stage - they drowned out most of the other vocal contributions.

I could never have done that before the medication we tried to end some ten years of regular hot flushes... How life can be improved with a small, cheap daily pill!

We're off now for ten days to check out the families in the south. We have started loading the car and there seems to be something for everyone in three households. A regular Grandfather Christmas trip in midwinter...

Tuesday, June 28, 2016

The Ca Pros Report

My latest two-monthly PSA is up about 15% on the last one. But, considered over four months, the rate of increase is barely significant - a huge relief from the dramatic climbs of a year ago.

Other tests seem to be OK but a bone scan yesterday, sneaked onto my phone camera from the operator's monitor, seems to show quite a lot more sparkly stuff than a year ago. We won't know much about that until my next consultation, at present not even scheduled. But what we don't know doesn't need to hold us back at the moment.

And the trying side effects of hot flushes and emotional discomfort have been greatly reduced. More and more I am doing all kinds of things that have been difficult or impossible for many years.

What price democracy?

It's interesting that the Brexit vote was carried on such a modest majority. I guess I would have thought that such a significant issue would need to be decided on more than a bare majority.

Usually a constitution provides for significant institutional changes to take place only on the vote of a strong majority of, say, 66%. Or there may be some checks and balances so that a wide popular vote can be reviewed and countered to some extent by some kind of group who might bring more thought to the decision. The complex US system of voting for President was deliberately enshrined in their constitution so that the collective will of every last individual voter need not necessarily carry the day; the President is elected by the Electoral College of only 538 voters. Furthermore, most of them are not bound by the political loyalties of those who appointed them to the College. Their task is to find the best person for the position.

That procedure could conceivably save the country from a somewhat unpresidential president. And some similar procedure, such as Parliament over-riding the popular vote, might have enabled a less controversial decision in the Disunited Kingdom last week.

Sometimes, the people do not have adequate understanding of the issues. Sometimes, the people are careless of the privilege of being able to vote. Sometimes the vote of the people does not deliver a result that is best for the whole community.

We have an AGM coming up in our village. We could probably use some similar electoral system this week!

Friday, June 10, 2016

Thank you, Aussie!

Image result for end of life choiceThe report has made 49 recommendations, including legalising assisted dying in certain circumstances. (Twitter/Andrew Lund)
Assisted dying a step closer in State of Victoria
Yesterday the cross-party Inquiry into legalising assisted death in the State delivered a revolutionary report to Parliament. The Committee has made some 49 recommendations and at least two members acknowledged that evaluating nearly 900 submissions had changed their point of view on the issue.

One of the clinchers was that Coroners reported that increasing numbers of terminally ill Australians "are committing suicide in horrific and terrible ways" ... "in the shadow of the law" while they are still able to. The implication is that some of those who committed suicide in Australia would not have done this had they known another choice could be available to them.  Certainly, evidence from countries where assisted dying is legal suggested to the Victoria Inquiry (members travelled to several countries) that half of those who obtain a prescription do not use it but live more comfortably and confidently because they have the means if they need it.

That is what choice is all about. That is the option I think we should move towards in NZ. The reasons and the evidence are as relevant for this country as for Victoria.

But I note that the Aussie Inquiry took some ten months and had only 900 submissions. I wonder when our Health Select Committee will get through ten or more thousand submissions.

Wednesday, June 1, 2016

"Give me a child..."

What a fascinating watch was the documentary WHY AM I? last night... The "Dunedin Project" began when I first went to that city and I was aware of some of its methodology and hopes and expectations.

By identifying only five personality types among 1000 pre-schoolers and following these subjects for more than forty years all kinds of possible predictions have been able to be made. And what surprises there are: one sixth of the subjects have had serious brushes with the law. More importantly, most of these were from only two of the five "types" of pre-schoolers in 1972.

I recall a huge fuss in the Church when we introduced personality assessments into the ministry candidate assessment process in 1968. We had to assure the Examiners that the such assessments would not be permitted to contribute to the actual decision. But I can say now that from personal knowledge of many of the 200 people who were involved, these data, now regrettably destroyed, could have predicted a number of very significant failings of the individuals' later performance in ministry.

Alas, the denominations had neither the curiosity, nor the immense international resources of "The Dunedin Project". This is now the largest and most comprehensive research programme of its kind in the world. What a tool for good this could be!

But will governments commit to the cost of the kind of early childhood special education that will be required...?

Tuesday, May 31, 2016

Ooooh, the pain!

I’ve just had my quarterly Zoladex implant. Having taken quite a few of them “cold turkey” in recent years, I must be getting soft. I made up a patch with some Emla cream and stuck this onto my skin in the approved area and the implant went in with less pain than usual. But I could have used more cream.

While waiting for the nurse practitioner to punch the Zoladex in I studied the notices on the walls, especially the one that states a patients’ rights. It’s a lot different from what I might have seen twenty years ago. Over and over again it says I have a right to make decisions about my treatment. It’s pretty impressive and inspires quite a bit of confidence. My views are, apparently, quite important.

All very fine, until the time when I get into that last stage of care where nothing anyone can do for me will make any kind of difference or relieve the waves of pain that may be washing over me. Then they will have to say, “Oh, sorry, your Patients’ Rights have just run out. We can’t do anything to ease the intolerable pain we know you are suffering. You just have to put up with it. We just hope it won’t be too long...”

It ought to be a terminal patient’s right to ask for  - and be assessed for - physician-assisted death. It ought to be the first principle of hospice therapy that an easy and comfortable death, one way or another, is the right of every terminal patient. We must change the law. 

Thursday, May 19, 2016

Old Age is No Fun

Image result for Adam and eve turned out of the garden
In the 1970s I thought a lot about work and leisure. I developed a theme from, I think, Earle Brill, in an interesting little book titled Sex is Dead, that work was not all it was cracked up to be.
The idea came from the ancient Hebrew myth that the punishment of Adam and Eve was not just that they were thrown out of the Garden of Eden. Adam was told that only in the sweat of his brow would he get bread. So "work", in this context, is not the virtue that our Puritan forebears would have called it but is actually a punishment. It was not intended to be fun or enjoyable, but simply done.
Out of this came the Mission to Leisure which led the Dunedin Mission to make considerable investment  in the holiday camp site at Kawarau Falls. We instituted some special programmes to help people make the most of such leisure as they had.
Lately I have been taking the Garden of Eden story a little further. Not only is Adam told that he is going to be punished by having to work; but Eve hears that only in pain will she bring forth life. Pain, severe pain, I suggest, is also presented in this ancient context, as a punishment. I didn't think much about that in the 1970s.
But, my word, in later days I have become very conscious of the amount of pain that is experienced in the world of the descendants of Adam and Eve... The sheer scale of deprivation, dislocation and every kind of pain and suffering experienced by millions of our brothers and sisters in other lands beggars description. Even with the most modern technology to bring the problem right into our living rooms, we cannot get our minds around the sheer dimensions of the problem.
And in the last couple of years in this residential community of older people, I've become quickly aware that old age is not always so much fun, either. We may have all we need of shelter and food and affection but the maladies of age that we joke about among ourselves are sometimes more than some can bear. Several people in one of our cities have died in Council or State flats over the last year or so, with no one to miss them until the stench disturbs their neighbours. It could conceivably happen here, too, in this community of 350, even with emergency call-bells in all directions.
Singing out to small groups of "over 60s", our Barbershop quartet has seen groups that were, actually, over 80 or more, many of them transported in vehicles or using walking aids of one kind and another. Some of them said the simple hot meal provided afterwards would be the best meal they would have all week. Old age, for many of them, was not much fun - even with our entertainment!
I have wondered if the God of the Garden of Eden story might not have gone a bit further and said to both Adam and Eve "And, by the way, when you get old, don't count on that being a Garden of Eden, either...  there'll be more pain that is all part of the punishment... You aren't expected to enjoy it, just endure it."
A few modern critics would suggest, as the Puritans once did about work, that pain and suffering are really good for you. But they are wrong. It is that bit of thinking that encourages me in my modest campaign for the right of Choice at the End of Life. I just don't believe that suffering and pain and misery have any virtue in themselves at all. At the end of a life of working and bearing trials of one kind and another, there is no justice, never mind compassion, in a demand that we must continue to suffer long after our bodies and minds have decided to give up. Some Right to Life is fundamental, but so is some Right to a Good Death.
Of course, we don't base all our thinking and acting in these days on an ancient myth and its very simplistic views of right and wrong and good and evil. But those ancient thinkers seem to have sensed something that rings bells for me. The sweat of labour and the pain of life's beginnings and its endings, are not part of some great scheme of things. They are just reminders that in some way, we may be less than we can be And we must do the best we can with them. And there may be no lack of virtue in merely putting up with the one and choosing the avoid the worst of the other.

Wednesday, May 11, 2016

Spasms of pain

In Aussie in the early 1990s Bev and I enjoyed occasional glimpses of Andrew Denton in a Saturday night TV comedy show. Now I am hoping to hear him at the annual meeting of the Voluntary Euthanasia Society in a few weeks' time. Andrew has spent most of a year inquiring into Physician Assisted Death around the world and his podcasts on the Wheeler Centre have encouraged many of us to press for law change here in NZ.
I have been intrigued with his account of his father's death: "at the end, it was a violent series of spasms. It was as if something had crawled inside him and was tearing him apart from the inside."
I was immediately reminded of the pains after my first major surgery. Obviously not normal post-op pains, mine went undiagnosed and untreated for 36 hours. It was excruciating for up to half a minute at a time. I described it as being stretched on a rack with every part of my body from shoulders to knees trying to tear me apart. I wrote a three page report for the Hospital, but heard nothing back. Later someone suggested I had experienced

 tetany spasms.
If that kind of pain is to be my lot in my last hours it will probably be too late for what I would have wanted to do earlier: to have the choice of a peaceful and gentle death before that happens.
We need to change our thinking and change the law.

Monday, May 2, 2016

PSA much the same...

When we saw my consultant a few weeks ago he wanted to step up our routine tests to two-monthly. He was concerned about the effect of the heavy medication on my liver. But I suggested we continue with three monthly checks and that was agreed. With three-monthly implants and consultations I felt it would keep life simple if the tests continued on that basis, too.

Well, over the last couple of weeks I have been wondering how it was all going. I wasn't overly worried, but having been doing PSA tests every month I was a little curious as to how things were going.  So last week I presented myself for the three-month tests at just two months. The girl doing the job queried the order and I said airily, "Oh, we've decided to do it every two months" and she went ahead. 
My GP's nurse kindly looked up the scores for me next day.  PSA still 24, still up, but almost exactly static for the third month in a row. And my liver, she said, was "great". All very encouraging....