The End of Life Choice Bill
The End of Life Choice Bill proposes to legalise ‘assisted dying’, a euphemism for voluntary euthanasia and assisted suicide.
It’s about only end-of-life choice: the administration of lethal drugs. Scroll down for key issues with this Bill.
Which choices would the End of Life Choice Bill legalise?
- This Bill is NOT about making it legal to turn off life support, to make a ‘do-not-resuscitate’ request (no CPR) or to stop medical treatment. These choices are already legal and not euthanasia. In these situations, a person would die of natural causes – from their underlying medical condition. Read more here about the ethical differences.
- The Bill is NOT about pain relief. It’s already legal to give a person enough medication to address their pain and make them comfortable, even if this may hasten their death.
- The End of Life Choice Bill is about only one means of death: a lethal dose of “medication”. The Bill proposes immunity from prosecution for medical practitioners and nurse practitioners who perform ‘assisted dying’, which is a euphemism for euthanasia and assisted suicide using lethal drugs.
- It is assisted suicide when a person receives help to access a deadly dose to swallow or self-administer. It is assisted suicide when the person who dies takes the final action that ends their life.
- It is euthanasia when someone else takes the final action that ends the person’s life, for example by administering a lethal injection.
- The Bill proposes four methods for the administration of a lethal dose: ingestion or intravenous delivery triggered by the person (assisted suicide); and ingestion through a tube or injection (euthanasia).
Lack of Safeguards
- No witnesses are required at any point in the process. If a person changed their mind but the doctor or nurse practitioner administered the lethal dose anyway, nobody else may know.
- The Bill lacks enforceable safeguards against coercion. Only the first doctor needs to “do their best to ensure that the person expresses their wish free from pressure” and stop the process if pressure is suspected. Coercion may have occurred before the person expresses their wish and without the doctor’s knowledge. This doctor doesn’t need to talk to the person face-to-face and doesn’t need to have met the person before. The doctor is permitted to speak only to family members who have been approved by the person. An abuser may be a friend or caregiver and may prohibit the person from giving the doctor permission to speak to them.
- A health practitioner may initiate a discussion about euthanasia with a patient, as long as the conversation is mainly on another topic (is not “in substance” about “assisted dying”). Even if a health professional does initiate a discussion ‘in substance’ with a patient, they cannot be treated as having committed a criminal offence (punishable by either imprisonment or a fine) but would face only the possibility of disciplinary action from a professional body.
- No written evidence is required to show that a person confirmed their death wish before receiving the lethal dose and that they were considered mentally competent at the time.
- A person doesn’t need to certify that they have asked someone else to sign the request on their behalf. The form needs to be signed in the person’s “presence”, but themeaning of “presence” is not defined. The person signing the form might readily claim that they don’t “know” for certain that they stand to gain from the death even if they may be likely to inherit. The form could be signed by someone who is coercing the person to request death. There is no protection against a person being pressured to sign the form on someone else’s behalf.
- The two medical practitioners assessing a person’s eligibility for euthanasia don’t need to have any training or experience in the field of medicine related to the person’s condition.
- Even a provisionally-registered doctor, fresh out of medical school, could be an attending medical practitioner (the first doctor in the process).
Lack of Oversight
- No witnesses are required at any point in the process. The Registrar and Review Committee cannot verify that any information on a form reflects what really happened.
- The poacher may also be the gamekeeper: The two health practitioners on the Review Committee could be reviewing a case which they were both involved in.
- Nobody would be responsible for following up missing assisted death reports.
- Nobody would be responsible for reviewing all the forms pertaining to a particular case. Nobody needs to check whether the report completed after the death contradicts information on the forms completed before the death. Contrary to the Review Committees in the Netherlands, the Review Committee set up by the End of Life Choice Bill would receive only the ‘assisted death report’ and no information about the person’s medical records or eligibility.
- No evidence is required that a nurse practitioner who administered a lethal dose was authorised to do so.
- There is no requirement to monitor how much of the drugs were administered or to monitor what happened to any leftover drugs. Nobody needs to certify that prescriptions have been destroyed if they were no longer required. No witnesses are required when a person confirms whether they still want the death to go ahead.
Issues with Eligibility
- An eligible person needs to have New Zealand citizenship or a permanent residence visa, but does not need to live in New Zealand. This Bill will allow some euthanasia tourism.
- An eligible person can be as young as 18. However, the prefrontal cortex of the brain, which is responsible for decision-making, continues to mature until the mid-twenties.
- ‘Terminal illness’ is not defined. It could be interpreted to include any condition that is life-limiting or life-threatening. There is no bright line between terminal conditions and chronic conditions. Some chronic conditions can become life-threatening in a matter of minutes, for example diabetes, asthma, severe allergies and high blood pressure. There is also no bright line between terminal illness and disabilities, because some disabilities are life-limiting and involve complications that can become life-threatening. Even clinical depression could be regarded as a terminal condition by some, because it could lead to death (suicide), or to losing the will to live and fight a disease.
- The “6 months” prognosis is arbitrary. Do people with 6 months to live suffer more than people with 7 months or a year to live?
- In Oregon, “a terminal illness that is likely to end the person’s life within 6 months” means that a person is likely to die within six months if the condition is allowed to take its course without medical treatment. For example. a person with Type 1 diabetes with decades to live, could become terminal with weeks to live by stopping insulin. In Oregon eligible conditions have included diabetes, heart disease, hepatitis, sclerosis, arteritis and arthritis.
- Diagnosis and prognosis can be wrong. It’s impossible for doctors to accurately predict how long a person will live, especially as long as six months out. There have been cases of people who were expected to die within hours or days, but they recovered and lived for months or years. Diagnosis can also be wrong, despite a doctor’s best intentions. Diagnosis and prognosis are not based on certainty, but on probability (the likelihood based on other cases). There is no guarantee that an individual’s disease will progress the same way as others’ have.
- The Bill discriminates on the ground of disability and targets disabled people. In order to be eligible a person needs to be “in an advanced state of irreversible decline in physical capability”. A decline in capability is another way of describing a worsening disability. The Bill doesn’t explain what is meant by ‘capability’. Might a person qualify who has become less able to run, walk or read? Might a person’s ‘decline in capability’ become ‘irreversible’ simply because they choose to decline available and appropriate medical treatment?
- The Bill does not limit euthanasia and assisted suicide to a last resort. There’s no requirement that a person tries available treatments or palliative care before requesting death.
- A person’s “unbearable suffering” may be unrelated to their medical condition. A person may wish to die because they are suffering from homelessness, poverty, a lack of assisted living support, or because they are a victim of abuse. In contrast, Victoria’s euthanasia law specifies that the person’s medical condition needs to be causing their suffering.
- The Bill provides no protection for terminally ill people who suffer from depression or another mental illness. Under this Bill a person could have a mental illness and still be “competent to make an informed decision”. The End of Life Choice Bill doesn’t mention depression. Even if it were to specifically exclude depression, some depressed people would still access death instead of treatment under such legislation. Depression can be hidden, even from doctors. Depression can be misdiagnosed or dismissed as ‘understandable depression’. Since clinical depression is diagnosed when a person has had relevant symptoms for at least two weeks, even subclinical depression may affect a person’s decisions.
Clause 4: Meaning of person who is eligible for assisted dying
In this Act, person who is eligible for assisted dying means a person or eligible person means a person who—
(a) is aged 18 years or over; and
(i) a person who has New Zealand citizenship as provided in the Citizenship Act 1977; or
(ii) a permanent resident as defined in section 4 of the Immigration Act 2009; and
(c) suffers from a terminal illness that is likely to end their life within 6 months; and
(d) is in an advanced state of irreversible decline in physical capability; and
(e) experiences unbearable suffering that cannot be relieved in a manner that the person considers tolerable; and
(f) is competent to make an informed decision about assisted dying.
(2) A person is not a person who is eligible for assisted dying by reason only that the person—
(a) is suffering from any form of mental disorder or mental illness; or
(b) has a disability of any kind; or
(c) is of advanced age.
Clause 4A: Meaning of competent to make an informed decision about assisted dying
In this Act, a person is competent to make an informed decision about assisted dying if the person is able to—
(a) understand information about the nature of assisted dying that is relevant to the decision; and
(b) retain that information to the extent necessary to make the decisions; and
(c) use or weigh that information, as part of the process of making the decision; and
(d) communicate the decision in some way.
Lack of Freedom of Conscience Rights Protection
- Read Freedom of conscience rights in a nutshell here.
- A doctor with a conscientious objection would be obliged to tell the person that they can ask the SCENZ Group for the contact details of a willing practitioner. This is a form of referral, which the World Health Organisation regards as unethical.
- A doctor who believes a euthanasia request is motivated by a mental illness would still be forced to steer the person towards death. The doctor would have only two options: to continue with the euthanasia process themselves or to direct the person to the SCENZ Group who would continue the process.
- Doctors who work as contractors would not be protected from discrimination in the workplace if they opt out of the euthanasia process.
- There would be no protection for people who are not registered as health practitioners. A healthcare assistant, caregiver, receptionist or cleaner who is pressured to assist a person, for example, by signing the form on someone’s behalf, would not be allowed to object on conscience grounds.
- The Bill offers no protection for organisations such as rest homes and Hospices. They may be forced to offer euthanasia on their premises to avoid losing government funding.
History of the End of Life Choice Bill
- The End of Life Choice Bill was drawn from the Member’s Ballot on 8 June 2017.
- The Attorney-General published a report on whether the End of Life Choice Bill is in line with the New Zealand Bill of Rights Act and found that it discriminates on the basis of age.
- The first reading passed with 76 votes in favour and 44 votes against on 13 December 2017. MP Simon O’Connor requested that every MP who wishes to speak would be allowed to do so, but another MP objected.
- Parliament’s Justice Committee accepted submissions from the public until 6 March 2018.
- The Committee considered 39,159 submissions – the most Parliament has ever received on any bill or issue. The Committee heard oral evidence from 1,350 submitters (77 organisations and 1,273 individuals) at hearings in Whangarei, Auckland, Tauranga, Rotorua, Hamilton, New Plymouth, Whanganui, Napier, Palmerston North, Wellington, Nelson, Christchurch, Dunedin, and Invercargill. See page 9 of the report.
- A full analysis of the written submissions revealed that over 90 % of submissions were opposed to the End of Life Choice Bill. Over 93 % of submissions from health professionals were opposed. Over 90 % of total submissions made no reference to religious arguments.
- An analysis of all the published oral submissions found that 85 % were opposed to the Bill and contrary to claims, 79 % made no reference to religious arguments.
- The Committee’s report on the End of Life Choice Bill was published on 9 April 2019.
- The Committee of the House stage started on 31 July with a debate on Part 1 of the Bill.
- Part 3 was debated on 11 September.
- Disabled people petitioned Parliament in support of Supplementary Order Paper No 381. The petition requested that disabled people and others be given the choice to receive services only from health professionals who don’t engage in ‘assisted dying’. The amendment was rejected by Parliament.
- Part 4 of the Bill was debated on 25 September.
- Clauses 1 (title) and 2 (commencement) were debated on 23 October. Parliament decided (63 votes in favour and 57 opposed) that if the bill were passed by Parliament, there would be a binding referendum to decide whether the Bill would come into force a year later.
- In total, 114 Supplementary Order Papers were proposed. Only three passed (the one proposed by David Seymour and the two on the referendum proposed by Jenny Marcroft). Of the 111 amendments that were rejected, 110 were from opponents to the Bill.
- On 13 November 2019 Parliament voted 69 votes to 51 in favour of its third reading. The Act would come into force only if passed by a binding referendum.
The Proposed Legislation
The Submissions Process
- Report from Parliament’s Justice Committee, including their recommended amendments to the End of Life Choice Bill
Debates on the End of Life Choice Bill