Deadly secrets could be exposed

23:23, Jun 20 2014
Chief coroner Judge Neil MacLean stand
Chief coroner Judge Neil MacLean

Changing the way doctors certify deaths could expose significant numbers of hidden voluntary euthanasia cases among the elderly, the chief coroner says.

As elderly patients are nursed to death, physicians or relatives could mercifully, but illegally, hasten their death and escape without conviction, Judge Neil MacLean said.

In most circumstances, under current legislation, only one doctor has to sign off a death certificate and they can do so without even viewing the deceased.

However, it would be impossible for the doctor to know if an elderly patient in palliative care, who has co-morbidities, had committed suicide by morphine overdose or had been assisted to die by a physician or relative, MacLean said. "Short of doing an autopsy on everybody, we would never know."

In these cases, often the patients would be having their medical treatment, such as food, fluids and antibiotics, withdrawn and they would be kept comfortable with constant pain relief.

"The difference between giving someone enough pain-killing drugs to ease their pain and then going to the next stage of upping the dose to deliberately bring their death forward a week or a month is a very fine line," MacLean said.


Last week, he ran a series of workshops in Rotorua where the subject was discussed with GPs, who he described as "the gatekeepers of the coronial system".

The majority of deaths are certified by GPs to be natural causes and only 20 per cent are referred to coroners.

MacLean encouraged doctors to increase their communication with coroners "so we can try and get a better feel for the 80 per cent of deaths we know nothing about".

"The unease is that in a typical palliative care situation, occasionally there may be a suicide or assisted suicide and we would just never know about it," he said.

"We would be interested in finding out a bit more about these deaths and perhaps try and pick up on some of those borderline ones."

The "borderline" deaths may include morphine overdoses administered by physicians, or even relatives smothering loved ones with a pillow.

"I'm talking about situations where someone would be charged if the police knew about it but where the police would likely never find out.

"We would be burying our head in the sand if we said this isn't happening. But what we can do about overcoming it is moot," he said.

However, this issue could be drawn into public debate as early as next year as Labour MP Maryan Street's controversial End of Life Choice Bill returns to the ballot box. Street withdrew the bill late last year to prevent euthanasia from becoming a political football in the lead-up to the election.

But she has vowed it will be back before Parliament immediately after the election "one way or another; win or lose". "This is an issue whose time has come in New Zealand," she said.

Euthanasia polarises opinion and nowhere more so than within the medical profession, who are guided by the Hippocratic oath to "first do no harm".

New Zealand Medical Association (NZMA) chairman Dr Mark Peterson is an anti-euthanasia advocate who believes it should never be legalised.

If it was legalised for the terminally ill, Peterson feared it could be extended to the chronically ill and then potentially to those suffering mental health conditions "and you have to wonder where it would stop".

Peterson believed euthanasia went against the historic Hippocratic oath.

"Ask yourself, if you were in that situation, would you actually do it? Would you get the syringe and inject it? I certainly wouldn't," he said.

However, Christchurch Hospital specialist Professor Mike Ardagh, who has a PhD in bioethics, had no doubt "active voluntary euthanasia was at times the right thing to do".

"There is no question in my mind that bringing about someone's death is at times doing more good than harm to them," he said.

"If I was convinced that death was in the patient's best interest and they wanted it, then I would happily push that syringe. The difficulty is having that certainty."

Legalising euthanasia could also result in elderly people seeking to die prematurely because they felt they were a burden to their families, or relatives requesting euthanasia for personal gain rather than the wellbeing of the patient.

"There is no question if we go down that route there will be consequences," Ardagh said.

The Press