How end of life decisions are made

People considering euthanasia do not just think of themselves, but are heavily influenced by the concerns of, and impact on, others, writes Professor Kevin Dew from Victoria University of Wellington's School of Social and Cultural Studies.

Concerns about coercion have featured prominently in the euthanasia debate. An assumption that underlies this is that people can decide about ending their lives free from the influences of those around them – be they health professionals, family or friends – and that someone facing a terminal illness is able to make a decision based solely on their own values and best interests.

This assumption can and should be challenged by many decades of research showing that when people make decisions about their health care, particularly when a life-threatening condition or treatment is involved, they do not just think of themselves, but are heavily influenced by the concerns of, and impact on, others.

This can be illustrated by scenarios based on recorded consultations and interviews with patients who have been through cancer treatment in Aotearoa New Zealand. The scenarios show some of the issues patients face.

Take the scenario of deciding whether to have chemotherapy and radiotherapy for a cancer that is terminal. The treatment may have severe side-effects, but hopefully many of the worst of these can be controlled. But the treatment will, if it works, only extend life by some months. The person making this decision has her husband in the consultation with her. Other people outside the room play a strong influence in her response to her situation, particularly her young children. She is prepared to risk suffering severe side-effects if it gives her some chance of extending her life so her children do not lose their mother until as late as possible. If euthanasia was an option, it would not be a consideration for this patient.

Having considered this scenario, it is then easy to envisage one that would play out very differently.

In this case, the patient has had cancer for some time; it could be the same person from our first scenario but a bit later down the treatment pathway. She has gone through many treatments already, but after keeping the worst of the cancer at bay it is now starting to have a real impact on her capacity to look after herself. Her husband has been taking time off work to try to support her and her children have had their home lives turned upside-down by the presence of a very sick mother, with health professionals and support people regularly visiting the home.

She may be willing to fight on but realises others are having to sacrifice a lot to take care of her. Now, with euthanasia a possibility, she considers that option. There is no coercion here, she wants to consider this for the sake of others. Her motives are altruistic.

These two contrasting scenarios give us a sense that the influence of others is always going to be a factor when someone is deciding about euthanasia.

In these scenarios, the focus has been on influences of family. This is to simplify the argument. If we consider the role of health professionals in explaining, advising about and recommending cancer treatments, we see it is very unlikely, even with the best will in the world, they can remain at arm's length from any decision about euthanasia.

In practice, in the actual interaction between the health profession and the patient, the health professionals' values and concerns will undoubtedly be a factor, no matter how hard they try to stay out of the decision. Once the possibility of euthanasia is made available, it will always be 'the elephant in the room' when terminal illness is present, even if no-one mentions the word.

The fact decisions about euthanasia will not be made free from the influences of others, as seems to be envisaged by the way New Zealand's End of Life Choice Bill is being discussed, is neither a pro- nor anti-euthanasia concern. But we need to understand how these decisions are likely to be made so we can be comfortable we are doing the best for people facing terminal illness.

Read the original article on Stuff.