By Sue Bull
New Zealand health authorities have neatly turned the euthanasia debate on its head in a particularly brutal and racist case of health system rationing. They have been prepared to impose what the government's deputy leader, Tau Henare, described as a "death sentence" on one of his constituents.
On June 8, Rau Williams, 64 and a Maori, began receiving interim dialysis to assess his suitability for the renal failure program. On September 17, he was taken off dialysis, told that he didn't meet the national criteria for hospital dialysis and that his mild dementia and diabetes would have jeopardised the success of home dialysis.
On October 11, after a huge public debate, a High Court case, an intervention from a private trust, a public rally of 200 people and a court of appeal case which was dismissed, Williams died.
Williams' nephew, Jim Shortland, who fought the case on behalf of his uncle, said, "He was drowned by three top judges and two clinicians. He drowned internally, that's how he died."
In reference to his aunt's death, Williams' late wife Mere, who also died from renal failure but refused dialysis because she couldn't bear to live that way, he said, "You have the right to say 'No' but not the right to say 'Yes'. You can't say 'Save me'."
Both New Zealand First (part of the ruling coalition) and the Labour Party supported the decision not to give Williams treatment, claiming that the decision was made on medical grounds. Alliance leader Jim Anderton and Tau Henare believed that dialysis had been denied on cost-cutting rather than medical grounds.
The whole case touched off a huge public debate around public health rationing. From next July, every sick New Zealander referred for surgery in the public health system will be scored on clinical and social criteria to determine when — or even if — they'll be treated. Instead of everyone being offered treatment, public patients will be told whether or not they are ill enough to qualify for public treatment.
The issue will really come to a head in the next few years, when a predicted epidemic of diabetes will engulf the ageing population and send demand for expensive renal dialysis soaring.
The problem will be exacerbated in South Auckland with its higher Pacific Islander population — a group with a rate of renal failure two to four times the European rate. It is expected that the rate of diabetes in the next 10-15 years will increase 20% in Europeans, 50% in Maoris and a staggering 130% among Pacific Islanders.
Massive cuts in the health system have led to a situation in which the government has the power to condemn the poor and disadvantaged to an early grave.