When we vote in the October 17 New Zealand General election, we will also be asked to vote for or against the End of Life Choice Bill. Here are five reasons why New Zealanders should consider voting ‘No’.
When we vote in the October 17 New Zealand General Election, we will also be asked to vote for or against the “End of Life Choice Act”. It is not ‘euthanasia’ in general that we are being asked to vote on, but specific legislation that will make euthanasia legal with a particular set of rules. There are a number of good reasons why New Zealanders from all walks of life, are concerned enough about this act to speak out against it.
We acknowledge that the rejection of this act comes at a cost to those who would wish to hasten their deaths. We do not wish to downplay the hope that some people see in this act. But what we want people to acknowledge is that if this act is accepted, there is cost that will be paid by someone else. These are the vulnerable New Zealanders who would rather continue their lives even with its difficulties. This is not a cost they should have to pay. It is in light of this that we ask New Zealand to vote No, and send the issue of euthanasia back to Parliament in order to be better served by more carefully designed legislation.
The five reasons we put forward are as follows. 1. The lack of safeguards against coercion to euthanasia. 2. The lack of requirement of proper support for suffering patients. 3. The inevitability of later changes to what we are voting on. 4. The scope for mistakes and abuses. 5. The cultural shift around death and dying.
If we cannot protect the choice to live while we offer the choice to die, we should not be legislating the choice to die.
1. Insufficient Safeguards to ensure a Person is making their own Free Choice
There are insufficient safeguards in this current legislation that will ensure someone is actually choosing euthanasia of their own free choice. There is no assessment for coercion, no requirement in each case to speak to a psychologist or social worker, no need even for the doctor to discern why someone is choosing euthanasia.
Dr. Ian Gwynne-Robson states that “Detecting coercion is extremely difficult and is not something doctors have any training in . . .” There is no way to guarantee the absence of coercion in the context of assisted suicide.
There is also no requirement for family or caregivers to be informed of the person’s choice before they die. Having a broader network of family and caregivers knowing that these decisions are being made prevents the possibility of social pressure towards ending one’s own life. They may be able to shed light on the motive behind the choice to die, because their choice might have nothing to do with suffering and more to do with external pressure or even guilt.
Having no requirement for any whanau or friends to be informed completely disregards New Zealand’s Māori health model Te Whare Tapa Whā (Te Reo Maori for ‘The House with Four Walls’, more commonly known as the Hauora philosophy) with its recognition of the reality and value of the wider social contexts that patients belong to. Including a wider range of health professionals and family members may not sit comfortably with more individualistic people, but our Ministry of Health acknowledges the wisdom in the Maori health philosophy, and so should we.[1] Furthermore this wider conversation would help to protect the right to live for our most vulnerable citizens and residents.
Another absent safeguard is one which would ensure the procedure is carried out at the patient’s request. No independent witness needs to be present at any point of the process in seeking or administering euthanasia. Absolute trust is being put in two medical doctors who will independently discuss the request with the patient. This is problematic as there is no accountability for the actions of the doctors. This legalisation is allowing the termination of one’s life, and our parliament has not seen the need for even one witness to be present.
In Victoria, Canada and Oregon one to two independent witnesses must be present at the signing of the request for euthanasia. Without having an independent witness at any part of the procedure in our New Zealand legislation, the possibility of human error and abuse is left wide open. The only witness to the whole process is the doctor and the patient – who will be dead.
Several MPs put forward amendments to the act which would remedy these issues. These amendments were all rejected by parliament. Here is a list of some of those.
2. Disregarding an Holistic Healthcare Model that offers support for suffering Patients.
There is no need to provide support for the person in their suffering before their life is terminated. Their greatest suffering might be depression or acute loneliness or family neglect. Under the proposed legislation the offer of counselling or social services for this is not required. If their suffering is for physical pain they do not need to try any pain relief or even speak to a palliative care specialist before being euthanized.
When these services are provided their desire to continue to live may in fact change dramatically.
Once again this completely disregards the holistic wellbeing of the patient that Te Whare Tapa Whā seeks to uphold. There is no need for physical, mental/emotional, social or spiritual support for the person requesting to end their life. Why does this Act not require that the patient is supported by healthcare professionals before they are given the lethal dose? If this is really about the unbearable suffering of the terminally ill, support in their suffering should be given as a prerequisite to euthanasia.
There is also no ‘stand-down’ period in this legislation – meaning there can be as few as 48 hours between completing the official paperwork and receiving the lethal dose. Victoria, Oregon, and Canada have between nine and fifteen days as a cooling off period, to ensure that patients aren’t making sudden decisions during a time of unmanaged suffering or severe mental or social stress.
Amendments were proposed by MPs that a person must first try palliative care, before being eligible, and that they would only be eligible if they were experiencing unbearable suffering of pain that could not be relieved in a satisfactory manner. These were turned down by parliament. Furthermore, it would be important to support the holistic wellbeing of the patient that they were required to spend time speaking through their suffering and wishes with a counsellor before being euthanized. A stand down period like other countries would also be a safeguard to ensure the patient is absolutely sure about their decision before taking the lethal dose.
3. Amendments to the Current Law are Inevitable
The Act we are voting on in the 2020 referendum is unlikely to be left unchanged in years to come. Other countries where euthanasia has been legalized have made later alterations to their legislation.
For example, in many countries the criteria for eligibility has changed to allow more people to access euthanasia. This is concerning because when it is offered to those who are not terminally ill, we really are just assisting others in suicide who are struggling with depression, other mental illness, chronic pain, or who are from the disabled community. We should instead be supporting them and helping them recover.
There are some people who actively campaign for euthanasia who do indeed want it to be broader in its scope than the upcoming referendum outlines, as the bill Seymour himself first submitted to parliament was left open to be accessed by people not suffering from a terminal illness.
Voluntary euthanasia may lead to involuntary euthanasia. In the Netherlands, not long after Euthanasia become legalised, the Groningen Protocol made allowance for the euthanizing of infants. Euthanasia for adults may be extended to minors. This is what has happened in Belgium, where euthanasia was legalized for adults in 2002 and extended to include all ages in 2014. Former MP and euthanasia campaigner, Maryan Street herself admitted: ‘Application for children with terminal illness was a bridge too far in my view at this time. That might be something that may happen in the future, but not now.’
Canada legalized euthanasia in 2016 and has legislation very close to our own. It is already seeking to broaden the criteria to permit the euthanizing of people who have illnesses that are debilitating or chronic but not terminal. To assume our legislation will stay unchanged in the future is naïve to say the least, and to expect a referendum before any amendments are made is beyond hopeful.
Looking at it this way, it may not be a ‘slippery slope’ that we are facing in this referendum, but the thin edge of a very deliberately placed wedge. The euthanasia offered in 2020 won’t likely be the euthanasia we get by 2030.
The only way to safeguard against future amendments, is to place a clause in the legislation which makes it impossible to widen the criteria of eligibility without a further referendum. Most obviously this doesn’t exist in the current legislation.
4. Mistakes and Abuses can Occur, as well as Dangerously Broad Interpretations of the Legislation.
Abuses of the law have happened in other countries even with safeguards in place. Broad interpretation of legislation justifies practices which would otherwise be incriminating. People have been euthanized against their free choice, documentation has not taken place in many instances so there is no record of whether a patient explicitly requested euthanasia or not. In 2007 in the region of Flanders, Belgium, 32% of all euthanasia deaths occurred without the patients’ explicit request. People with disabilities and depression who were not terminally ill have been euthanized without their family’s knowledge.
There is a very real concern that if euthanasia is allowed, abuse of it or mistakes will follow.
People who do not want to die may be killed against their will, not because we legalise involuntary euthanasia, but because the safeguards are not robust enough to protect against this occurrence.
People with disabilities already feel they are undervalued and marginalised in society, and many of them, along with their families have been shocked to find their medical records to have unrequested “do not resuscitate orders” (see here and here).
People who are advocates for euthanasia have admitted that mistakes and abuses will be made, but they believe that it is a price worth paying. As neurosurgeon and euthanasia advocate Henry Marsh states, “They argue that grannies will be made to commit suicide. Even if a few grannies get bullied into it, isn’t that the price worth paying for all the people who could die with dignity?” This is fine and well to say when the one who states this is the privileged person who won’t be paying the price with their own lives.
So really the question is: is it worth giving some the choice to die, at the cost of compromising for others the choice to live? We would hope New Zealand would have the decency to affirm the answer ‘No’.
5. The Cultural Shift in Society’s Values and Practice
There is evidence of a cultural shift in the countries where euthanasia has been legalised. As euthanasia has become a normalised way to end life, there is an impact on the way life, death and suffering are viewed in these nations.
One key piece of evidence showing this cultural shift is the increasing rates of people choosing euthanasia or assisted suicide in these countries. For example the euthanasia rates have tripled in the Netherlands which legalised euthanasia in 2002, and by 2016 euthanasia accounted for 4% of all deaths. Canada legalised euthanasia in 2016 and its rate of use has already doubled.
What is causing this continual increase in the request for euthanasia? Is it a growing intolerance for suffering, a culture which stops caring for the sick, or is it that the choice to die over time becomes the duty to die?
There seems to be a clear link between the legalisation of medically assisted death and terminally ill patients feeling they are a burden to family, friends and caregivers. Someone might be ‘choosing’ euthanasia because they feel they are a burden to others. In 2018 in Oregon, being a burden to family, friends and caregivers was given as one reason over 50% of patients chose to end their lives through euthanasia. This is up from 34.1% in 1998 when it was first legalised there.
The question that must be asked about that is this: when does the ‘choice to die’ lead to people feeling it is their ‘duty to die’? Philosopher John Hardwig advocated the idea of the ‘duty to die’. Do we accept that this may in fact become an ingrained part of our society if we pass legalization which will legalize assisted death? Our most vulnerable and dependent members will begin to take their own life because they have been allowed to feel that they are burden.
Conclusion
Is it possible to both legalize euthanasia and protect the most vulnerable in our society? Not with this particular act. It is not robust enough to give assurance to our most helpless citizens. New Zealand declines to use capital punishment in part on the grounds that mistakes may be made. Surely we can decline this act on similar grounds.
If we cannot protect the choice to live while we offer the choice to die, we should not be legislating the choice to die. The rights of vulnerable New Zealander’s must not be overlooked, and in light of this the End of Life Choice act should be rejected by the New Zealand voting public.
Helpful websites
www.hospice.org.nz/resources/euthanasia
www.rejectassistedsuicide.org.nz
The Spinoff – ‘Why are we considering assisted dying in a pandemic?’
[1] Perhaps a party other than ACT should have drafted this Bill. These are not considerations that ACT is known for giving high regard.
Chris Northcott 