David Menkes

Current position: Associate Professor (University of Auckland) and honorary consultant psychiatrist, Waikato District Health Board, Private Bag 3200, Hamilton 3240, New Zealand
David Menkes is an academic psychiatrist with a background in psychology and pharmacology (MD 1982; PhD 1983, Yale).  Since completing specialist training in Dunedin (FRANZCP 1989) he has worked as an academic liaison psychiatrist in NZ and the UK.  He has research and clinical expertise in the pharmacology of drug treatments in psychiatry, with a particular focus on the adverse effects of psychotropic medications, their interaction with other prescribed drugs and with alcohol. He is a an honorary consultant to the Uppsala Monitoring Centre (WHO Collaborating Centre for International Drug Monitoring), and participates in the Mental Health Sub-committee of the Pharmacology and Therapeutics Advisory Committee (PTAC) that advises New Zealand’s drug purchasing agency (PHARMAC). He has worked with the International Society of Drug Bulletins (www.isdbweb.org) and contributed to the development of its conflict of interest policies.

End-of-Life Care Act: Challenges And Opportunities 

​In October 2020, New Zealanders strongly supported adoption of the End-of-Life Care Act (EoLCA). From 7 November 2021, people with unbearable suffering from a terminal illness will be able to legally seek medical assistance to end their lives. Despite being the result of a binding referendum there remain uncertainties regarding how the Act will be implemented and the professional obligations of healthcare professionals involved.
 
For example, it remains to be determined:

• which doctors can legally discuss euthanasia with patients, and indeed which doctors can prescribe and administer the lethal dose (EoLCA refers only to the requirement for practising certificates)
• specific criteria that will trigger enforcement of the Act
• guidelines regarding conscientious objection by healthcare professionals and prevention of coercion from family and carers
• how professional colleges will educate, guide, and support their members

 
Apart from these practical and logistical considerations, medical practitioners now face the psychological challenge of adjusting to the new law, its implications for our professional identity and, crucially, doctor-patient relationships. Those with a philosophical/conscientious objection to euthanasia, while able to opt out from direct involvement in the process, are nonetheless obliged to enable motivated patients and their families to obtain information and access to medically-assisted dying. This is likely to be a particular challenge for palliative care specialists, given their traditional opposition to euthanasia.
 
Amidst these challenges also exist other opportunities for enhanced end-of-life care. Chief among these is the recent clinical rediscovery of psychedelic and related medicines. Accumulating evidence indicates these may offer important alternatives to conventional therapies, and reference will be made to a New Zealand trial of methylenedioxymethamphetamine (MDMA) in treatment-resistant anxiety and depression in terminal illness.