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 one end-of-life choice: the administration of lethal drugs.

It doesn’t follow that a person who supports ‘assisted dying’ in principle needs to support this particular Bill. It lacks important safeguards and was passed due to “deals made in closed rooms”. Scroll down for some 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.
  • This Bill would not legalise suicide, because suicide is not illegal. It is not prohibited by the Crimes Act 1961. It is suicide when a person intentionally ends their own life without assistance.
  • Although this Bill does not mention the words “euthanasia” and “assisted suicide”, these practices are what the Bill aims to legalise. A death is assisted suicide when a person has received help to end their own life, for example, to access a deadly dose to swallow or self-administer. It is assisted suicide when the person who died took the final action that ended 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.

Lack of Safeguards

  • 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.
  • 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.

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.
  • 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.

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.
  • ‘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.
  • 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?

 

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

(b) is—

(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

  • 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.

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.
  • 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.
  • The Committee of the House stage started on 31 July with a debate on Part 1 of the Bill.
  • 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.