The Nathaniel Centre

Making death easier makes life harder

What an absolute waste of the grandchildren’s college money!'

Richard Stith

Easing access to suicide continues to be debated, usually in discussions of the legalization of assisted suicide (now often called euphemistically “aid in dying”). But there is an argument that may not be heard in such debates: by making death easier, we make life harder.

Once suicide becomes readily available and accepted, dependent persons who refuse to choose death will be blamed for voluntarily burdening their caregivers, and for burdening society as well, thus filling the end of their lives with new sorts of suffering.

Yet this is not the harm ordinarily articulated by opponents of assisted suicide. They most commonly argue, rightly, that making a deadly drug available to dependent persons risks life itself by exposing vulnerable persons to pressure or coercion aiming at death.

But they often fail to mention the other great harm that results from any “right to die”: facilitating suicide endangers not just ailing or moribund bodies but the quality of ongoing human relationships.

Should some lives be deemed expendable?

When choosing to die is not seen as an option, we are able to imagine those who battle against serious illness or disabling conditions to be heroes struggling against an implacable fate. Their lives and their deaths are full of a meaning ready to be discovered by them and those around them.

If an ailing grandmother fights to live on, despite her pain and her disabilities, she can be the object of sympathy in her misfortunes. Insurance or governmental aid can seem to be well-deserved. Indeed, she may so inspire her family, friends, and neighbors that they feel privileged to share in some of her frustrations as they care for her. They can feel solidarity with her, and with each other, as they fight back at her side.

When death finally comes, the grandmother’s last experiences and the lasting memories of her caregivers can be of a network of persons bound together in her honor.

By contrast, the right of a severely infirm person to assisted suicide (or to voluntary euthanasia) means that the person’s life has been deemed especially expendable, that his or her continued existence is legally less important than that of healthy human beings (whose lives are still protected against suicide).

Disability groups have long pointed out that one reason assisted suicide is popular is that people who are severely disabled are just not very important to many of us. We may not really care whether they get pressured into killing themselves. If they choose instead to live, they do so knowing that they do not count for much any more.

More importantly, once an ailing grandmother has been given a way out through the option of assisted suicide, her freely chosen suffering will no longer seem to call for as much family compassion or community support. As Dr. Ezekiel Emanuel, a cancer specialist and ethicist (later appointed by former President Barack Obama as a healthcare advisor) once explained,

Broad legalization of physician-assisted suicide and euthanasia would have the paradoxical effect of making patients seem to be responsible for their own suffering. Rather than being seen primarily as the victims of pain and suffering caused by disease, patients would be seen as having the power to end their suffering by agreeing to an injection or taking some pills; refusing would mean that living through the pain was the patient’s decision, the patient’s responsibility. Placing the blame on the patient would reduce the motivation of caregivers to provide the extra care that might be required, and would ease [their] guilt if the care fell short.

Many relatively feeble persons already think they are a burden on others. But now they will think that they themselves, rather than illness or age, are to blame for the trouble they feel they impose.

Living a selfish life . . . by not dying

In choosing to continue to live in great dependence, moreover, a grandmother may be resented as deeply selfish, preferring to benefit herself at a heavy cost to those around her. And as the benefit she receives grows smaller in their eyes—as she nears death or becomes more laden with pains or disabilities—her seeming selfishness increases.

She chooses to increase the burden on her family, and on society, for the sake of an ever-smaller benefit to herself.

If she soldiers on to the point where caregivers and others judge her life to be a cost to her as well as to them, she becomes in their eyes irrational as well as selfish.

As the United States Conference of Catholic Bishops has warned, such a person “may . . . be seen as . . . a needless burden on others, and even be encouraged to view [herself] that way.” Her right to choose death thus brings with it a cruel paradox, if she insists on living: as her misery and consequent need for assistance increase, the sympathy and willingness of her family (and of health insurance payers) to sacrifice decrease.

This diminution of respect and concern for the sick will not be limited only to mean or stingy families and communities. If further care really contributed little to a grandmother’s physical well-being, and a painless death were easily attainable, how could anyone forget that fact?

Politeness and love would inhibit candor, but the person with disabilities would still know what her family can’t help thinking: “What an absolute waste of the grandchildren’s college money!”

Some years ago, the Times of London printed a letter in which ninety-year-old Margaret White wrote: “I am happy here in the nursing home with no wish to die. But were voluntary euthanasia to be made legal I would feel it my absolute duty to ask for it as I now have 19 descendants who need my legacy. I am sure I am not alone in this resolution.”

If Ms. White chose instead to live, she would clearly feel guilty of failing in her perceived “absolute duty.” By turning suicide into a right, we present those in greatest need of assistance with a choice between easy death and hard guilt.

A loving grandmother may constantly wonder whether she is being too selfish even in continuing to eat, when the money for her food could have been used for some better purpose. Agonized by guilt, she may find herself drowning in a sea of resentment, fearing that she will be remembered as a selfish human being who died a dishonorable death.

Dependence does not negate human dignity

A leading American legal theorist, the late Ronald Dworkin, has emphasized the disdain that may accompany this resentment, writing: “We are distressed by, even disapprove of, someone . . . who neglects or sacrifices the independence we think dignity requires.” For Dworkin, a person who chooses to live in great dependence denies that he is someone “whose life is important for its own sake.”

Dworkin can be heard here to echo that great nineteenth-century atheist who sought to purge our society of the remnants of Christian compassion. Friedrich Nietzsche urged prophetically: “To go on vegetating in cowardly dependence on physicians and machinations, after the meaning of life, the right to life, has been lost, that ought to prompt a profound contempt in society.”

Nietzsche complained that Christians (at least in his day) stand against such disdain for the dependent:

If the degenerate and the sick . . . are to be accorded the same value as the healthy . . . then unnaturalness becomes law — This universal love of men is in practice the preference for the suffering, underprivileged, degenerate: it has in fact lowered and weakened the strength, the responsibility, the lofty duty to sacrifice men . . .

The species requires that the ill-constituted, weak, degenerate perish: but it was precisely to them that Christianity turned as a conserving force.

Nietzsche said he was searching for “a thoroughgoing practical nihilism.” But, unsurprisingly, he found nihilism to be a hard sell. He mused, “Problem: with what means could one attain to a severe form of really contagious nihilism: such as teaches and practices voluntary death with scientific conscientiousness (—and not a feeble, vegetable existence in expectation of a false afterlife—)?”

Will Nietzsche’s “problem” finally be solved in our day? Will our very old, our very sick, our very incapacitated be convinced by a newly celebrated right to assisted suicide that they are contemptible burdens if they do not “autonomously” choose death?

Each withdrawal of protection against suicide endangers not only the lives but also the human dignity and support relationships of persons with burdensome infirmities. By contrast, when our law and culture treat suicide as a tragic rather than a benign choice and refuse to facilitate it, those most in need are more likely to receive sympathetic help rather than guilt-inducing blame and resentment.

Opponents of the legalization of assisted suicide thus have not only strong pro-life arguments but also telling quality-of-life arguments that they need to bring up whenever any right to suicide is being debated.

Richard Stith is a senior research professor at Valparaiso University Law School. This article originally appeared in Public Discourse, the online journal of the Witherspoon Institute of Princeton, New Jersey. It is reprinted with the permission of the author and Public Discourse. It is available online: https://www.thepublicdiscourse.com/2018/09/39887/

 

Advance Care Planning: Q&A for Faith Communities

by Noel Tiano

What is Advance Care Planning?

Advance Care Planning (ACP) is a “process of exploring what matters to you when thinking about end-of-life care, and sharing that information with your loved ones and health care team so treatment and care plans can support your wishes.” It can include “what is meaningful to you, such as people and pets, your values and the ways you would like those caring for you to look after your spiritual and emotional needs. It will also tell your loved ones and medical staff about the treatment and care you want if you are no longer able to tell them yourself.”

An Advance Directive (AD) which is a “consent or refusal to a specific treatment(s) which may or may not be offered in the future when the patient loses capacity to make healthcare decisions,” may form part of an Advance Care Plan.

What is the legal standing of Advance Care Plans and Advance Directives?

The New Zealand Bill of Rights Act guarantees the right of individuals to refuse medical treatment. According to New Zealand’s Code of Health and Disability Services Consumers’ Rights, Advance Directives can be written or oral instructions, specifying a decision to receive or refuse future health care procedures, including life sustaining treatments such as respirators and resuscitation. A valid Advance Directive is legally binding, but only becomes effective in circumstances where a person is unable to make decisions for themselves.

Both ACPs and ADs need the following criteria to be valid:

  • Voluntary
  • Informed consent
  • Decision-making capacity
  • Applicable to present circumstances

We live in a world where, in spite of our best intentions, complications may arise due to differences in expectations, communication breakdown and unforeseen events. Advance Care Planning conversations can bring patients, families and providers on the same page as regards care at the end of life.

If your Advance Directive indicates a particular preference, will that be followed?

The fact that a person requests a medication or intervention does not necessarily mean that their request will be granted: the procedure may not be medically indicated; there might be a lack of resources available such as an organ for transplantation; the request may be unethical. In real life, people’s choices need to be balanced by considerations of distributive justice and cultural/ community interests.

Can an Advance Care Plan be changed?

A person can change, void, or update their ACP at any time. A periodic review of ACPs as well as wills and EPAs is suggested, especially when experiencing major changes such as the death of a spouse or partner, separation/divorce, migration, etc. What does Catholic teaching say about end of life care?

Catholic teaching recognises that there are limits to the duty to maintain life and restore health:

“When inevitable death is imminent ... it is permitted in conscience to take the decision to refuse forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care due to the sick person in similar cases is not interrupted.” (US Conference of Catholic Bishops, 2006). The rationale for this teaching is spelt out in the Catechism of the Catholic Church: “Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of ‘over-zealous’ treatment. Here one does not will to cause death; one’s inability to impede it is merely accepted.” (# 2278) The modern hospice movement, founded by Dame Cicely Saunders, takes a holistic approach to caring for those with lifelimiting conditions that incorporates a person’s physical, mental, social and spiritual needs.

What does a Māori approach to Advance Care Planning look like?

The Northland DHB developed a Māori ACP model called He Waka Kakarauri as a way to engage Māori in Advance Care Planning. This can be found at their website at www.northlanddhb.org.nz

I’m ready to work on my Advance Care Plan. How do I start?

Please visit: www.myACP.org.nz

Concluding thoughts

Advance Care Plans provide the opportunity for patients and their whānau to engage in caring conversations about their values, beliefs and practices when facing a life-limiting health condition. While some deaths can be sudden, others are drawn out. Hence, it is imperative to give people ample time to talk about their care plans - their hopes, fears, spiritual needs and other preferences. ACPs can cover retirement, residential care options, palliation, comfort measures, complementary therapies such as music and arts, organ donation, funerals, wills, and enduring powers of attorney.

The complexities of end of life care will continue to increase as cultures and societies change. While ACPs are not a cure-all for all the challenges thrown up by the complexities we encounter at the end of life, nevertheless, such conversations are important steps in promoting patients’ rights and responsibilities. ACPs are meant to enhance future health planning by improving care for the dying through shared decision making.

I strongly recommend writing and dating your ACPs and sharing them with your doctor, family and loved ones.

The goal of care is to cure sometimes, to treat often, to comfort always. (Hippocrates)

 

Noel Tiano (ThD, MSCW) is a community social worker at Mary Potter Hospice in Wellington.

Aged Care, Elder Abuse and Euthanasia: “A fairer, kinder New Zealand”?

Dr John Kleinsman

The theme of a fairer, kinder nation has been taken up by our Prime Minister, Jacinda Ardern, as part of her narrative for what good leadership looks like. In her first 100 days speech (January 31, 2018), she voiced her commitment to “leave a legacy of a stronger, fairer, kinder New Zealand.” The phrase was utilised again in her leader’s speech at the Labour Party conference in November 2018 and was also used by Finance Minister Grant Robertson when presenting the 2019 “Wellbeing Budget”.

In using this phrase, the Prime Minister has provided us with a critical ethical lens through which her government’s policy-making decisions can be viewed and assessed. It is a lens that I hope will continue to be utilised by future governments – it provides a necessary, richer and more humane alternative to using ‘economic growth’ as the primary indicator for judging the ‘prosperity’ of our country.

The theme is not a new one for a Labour Leader. In 2014 it was used by David Cunliffe in an address given at the Grey Power AGM. Describing older persons as some of the most vulnerable members in our society, Cunliffe spoke of the need to “create a fairer, kinder New Zealand … [in which] all Kiwis can look forward to growing old” – one that has their “very best interests … at heart.”

‘A country in which it is not just safe for our elders to grow old, but one in which they feel valued as taonga and will flourish’: no-one I know would disagree that this constitutes a key characteristic of a fairer, kinder New Zealand.

Taking up this theme, and reflecting on whether legalising euthanasia is the right thing to do at this time – a question that may well yet be put to all New Zealanders in a referendum – it follows that one of the tests politicians should apply is whether legalising euthanasia will create a fairer, kinder New Zealand for our elders?

It is argued by some that the End of Life Choice Bill currently before Parliament provides an important legal remedy for those who strongly desire, but are currently denied, access to euthanasia. Proponents of change maintain they are simply advocating for ‘choice’, and that those who don’t want to avail themselves of euthanasia will still retain their choice to die a natural death. The veracity of this particular argument is premised on the (questionable) assumption that giving choice to a few will not undermine the choice to continue living for those who would otherwise not ask for euthanasia.

The veracity of the case against euthanasia, meanwhile, involves a more complicated argument – that giving choice to the few will, in real life, expose far greater numbers of people to the risk of a premature death because of the context in which our elders live – a context characterised by ableism, ageism, growing levels of social isolation for those over 65, and year on year rises in cases of elder abuse.

The statistics relating to elder abuse provided by Age Concern are shocking. In 2018 there were “more than 2,200 referrals. Two thirds of these [1,466] were confirmed to involve abuse or neglect”.1 Drawing on overseas research, it is recognised that the real number of abuse cases represent only 16% of the number reported,2 which puts the total of people being actively abused in New Zealand in any one year at more than nine thousand. It is of extreme concern that past figures from Age Concern show that the 2018 figures represent a 50% increase on the levels of abuse reported just four years ago in 2014. This state of affairs represents a tragic and shameful indictment on our society.

Justice and compassion demand that we ask: ‘What is going on in our culture to explain this disturbing phenomenon?’ The answer lies, to a significant extent, in recognising the increasing prevalence of negative attitudes towards older people in our society; a function of the erosion of their place and value in our world, combined with familial and societal pressures that in recent decades have made make it less practicable and more challenging for families and society as a whole to care for and support older people.

Disturbingly, Age Concern report that more than 75% of alleged abusers are family members, with more than 70% involving psychological abuse and 50% of all cases involving financial abuse. Typically, cases involve more than one type of abuse at a time.

In 2009, an Auckland University study3 identified “beliefs about the inter-generational transfer of money and property as leading to financial abuse”, a situation without doubt exacerbated by growing financial pressures on families. While interest rates are currently the lowest they have been for decades, a lack of housing stock, along with extreme house prices in the main centres and rising costs for people being cared for in rest homes, will ensure that financial pressures will continue to characterise our cultural landscape and will continue to contribute to our shocking rates of elder abuse.

Now, while the Age Concern figures focus largely on the ‘overt’ coercion and abuse that our elders are regularly experiencing, Michael Wood (MP), speaking at the second reading of the End of Life Choice Bill, eloquently describes an equally abhorrent and equally dangerous, but less well recognised, ‘covert’ or implicit pressure that our elders experience:

I am ... deeply concerned, on the basis of conversations with people and my knowledge of people, including my own loved ones, approaching an end of life situation, that many of those people ... [will] feel the implicit pressure. They feel the burden on their families, they worry about the pain that the final months may put them through, and they may see it simply as a better choice for other people to access the end of life provisions that are included within this bill. I do not believe that is conscionable.

In a similar vein, Don Mathieson (QC) accurately articulates how legalising euthanasia will play out in the rest homes caring for our elders:

I’ve recently had quite a bit to do with one rest home village and I’ve had a chance to get the feel of the elderly residents and I know for a fact that if you had a voluntary euthanasia regime, the whole tone of that rest home village would be greatly altered as people came to fear the suggestion that they think might be made to them that they should seek euthanasia, that their time has come, that they’ve lived a long life, that they’re being a burden to others, a very expensive burden in some cases, and that they’d be better off dead.

Our rising rates of elder abuse, combined with, and linked to, financial pressures and ageist attitudes that promote a dangerous undercurrent of overt and covert pressure, will, without doubt, influence the uptake of euthanasia by our elders should it be legalised.

It makes sense that the very availability of euthanasia will make our elders more vulnerable to a premature death. It is understandable that people who are neglected, undervalued, socially isolated and made to feel invisible, people who are conscious of the demands they are making on the State and/ or family at a time when resources are stretched, will come to believe they are a nuisance, a burden. This perception has gradually crept into our social narrative and is already a serious issue. In the words of one geriatrician:

I heard time and time again, older people telling me that they didn’t want to be a burden. Most were not terminally ill: just sensitive to a society that tends to regard its older population as a burden and therefore likely to accede to even subtle suggestions that they have had a ‘good-innings’.

The idea that people have had a ‘good innings’ points to changes that legalising euthanasia will bring to the ‘landscape of care’, by which I mean it will affect how we look at and regard our elders, especially those at the end of life. Psychiatrist Mark Komrad tells the story of the elderly father of a colleague of his who lives in Belgium, has a chronic condition and has chosen not to have euthanasia: “I am told, when his father complains about his symptoms that some of his friends will say – you chose not to have euthanasia.” This represents a subtle but profound shift in the collective psyche, one characterised by a loss of kindness, empathy and compassion. It is without doubt one of the most dangerous unintended consequences of legalising euthanasia. It is also one of the least well-recognised and spoken about risks of euthanasia legislation.

In the ageist, resource-impoverished society in which we live, many older persons will come to experience the ‘choice’ of euthanasia as a burden – the burden of justifying every single day, to themselves if not also to others, why they would not avail themselves of it. In my view, that is neither fair nor kind.

Our elders deserve better. There has never been a more dangerous time in which to introduce euthanasia in New Zealand.

Our Prime Minister has offered us a wonderful vision of a fairer and kinder New Zealand. In the current context, defined as it is by ageism and elder abuse, the End of Life Choice Bill, on balance, clearly fails the ‘fairer, kinder test’. The question I am left with is why she and many others remain blind to this fact?

 

Endnotes

1 See Age Concern, https://www.ageconcern.org.nz/ACNZPublic/ Information/Policy_and_Research/Research_into_elder_abuse/ACNZ_ Public/Elder_Abuse_and_Neglect_Research.aspx, accessed 4 August 2019.
2 See Elder Abuse and Neglect, (2007) Ministry of Health, https://www. health.govt.nz/system/files/documents/publications/family-violenceguideliens-elder-abuse-neglect.pdf, p. 15.
3 See Peri, Fanslow et al (2009), Keeping Older People Safe by Preventing Elder Abuse and Neglect, Social Policy Journal of New Zealand, Issue 35 at https://www.ageconcern.org.nz/files/EANP/Keeping%20Older%20 People%20Safe%20by%20Preventing%20Elder%20Abuse%20and%20 Neglect,%20Kathryn%20Peri,%202009.pdf.

Editorial: Euthanasia Memo to MPs: ‘Hard Cases Make Bad Law’

On Wednesday 13 November, David Seymour’s End of Life Choice Bill passed its final reading. This piece of legislation, which still requires a referendum to become law, is one of the most significant pieces of social policy to have been debated in New Zealand for some time.

Despite this fact, the overall quality of the 3rd reading speeches was severely lacking. While some reference was made to the medical, legal and other experts who contributed evidence to the Justice Select Committee Investigation, robust consideration of that evidence was notably absent. In the words of one acerbic tweeter: “NZ MPs vote the #euthanasia bill (EOLC) through tonight despite any number of warnings that it is a shonky, shoddy and dangerous piece of work. Deeply disappointed in all the MPs who were mired in their individualistic narratives.”

The case favouring euthanasia, when it is made, generally focuses on specific, individual hard cases. These stories are heart wrenching, difficult to tell and deserve to be told. There is a place for these “individualistic narratives” in the broader conversation about euthanasia, especially when they highlight a lack of quality end-of-life care. But there is more at stake when it comes to shaping law. As an ethicist, I have been surprised that so many MPs seem to think the presentation of one or more ‘hard cases’ is sufficient justification for supporting Seymour’s Bill. Have they forgotten the age-old maxim: ‘Hard cases make bad laws’?

When it comes to setting new public policy, my clear expectation is that MPs will focus assiduously on whether a Bill is fit for purpose. That is their job, one which requires them to set aside personal ideological motivations and move beyond personal anecdotes. Politics 101.

As former Prime Minister Sir Bill English articulated in an opinion piece published in the Dom Post (13 November): “It all comes down to deciding whether the bill, with its changes, will ultimately deliver what it says. My position on euthanasia is well known. I have spoken many times about why I am opposed in principle. But to my former colleagues I say, even if you agree in principle, this is not the bill to deliver euthanasia and assisted suicide to New Zealanders.”

Chris Penk was one of the few MPs to articulate his awareness of the parliamentary task: “The first [question] is not whether some people should die in a way that the bill allows, but whether any people could die in a way that the bill does not allow. Put another way, the question is not whether it is possible to imagine whether a person who is competent, in good mental health, has a supportive family, and whose first language is English ... might be able to make a choice and not be bullied into an early grave but ... what is the number of vulnerable New Zealanders who may EDITORIAL be coerced to exercise the so-called choice, absent other choices? A further question might be not whether the Bill is better than it was before – less dangerous, in other words – but whether it is good enough now.”

Answering the question about whether a bill is “good enough now” is a complex exercise which, above all, requires a willingness to engage with the evidence. And, as any researcher knows, that also means avoiding vague assertions. Again, that is another clear expectation I have of MPs. And again, I feel let down by many MPs response to the End of Life Choice Bill, including David Seymour, who has persistently refused to engage with the evidence.

For example, responding to a recent and detailed 10 page letter from 21 mental health experts and researchers (university academics, psychiatrists, psychologists and mental health workers) which carefully lays out the statistical evidence pointing to a potential link between suicide rates and an increase in the numbers of people dying by euthanasia or assisted suicide – a serious issue in a country with epidemic suicide numbers – Seymour’s only comment was to attack the integrity of the writers: “To see people in the Herald this morning saying that there is ‘suggested evidence’, well, I’ve heard that academic standards are falling, but suggestive evidence is a new low.”

Then, dismissing the argument as “frankly disgraceful”, Seymour concludes “there is no connection between legalised assisted dying and suicide anywhere.” But why, I ask, would anyone believe any MP over the claims of 21 experts who conclude their letter by stating that “it cannot be categorically stated that legalising assisted dying in New Zealand will not further exacerbate our rates of (non-assisted) suicide over time” and who are also witnessing evidence of a connection in their clinical work? A serious question needs to be treated seriously!

As we move towards a referendum on euthanasia, my sincere hope is that the public will show a greater willingness than Seymour to consider whether his Bill will, in real life, protect our most vulnerable elderly and disabled citizens. To everyone I say: ‘Look directly at what the experts have said yourselves, rather than be lulled by vacuous assertions from politicians which deny, defer and/or deflect attention from the evidence’.

Dr John Kleinsman is director of The Nathaniel Centre

Euthanasia in New Zealand

Over the last few years, there have been several events that have generated an active public discussion on euthanasia and assisted suicide in New Zealand. In 2012, then Labour List MP Maryan Street prepared a Private Members Bill, the "End of Life Choice Bill". It was subsequently withdrawn from the ballot box prior to the 2014 election campaign as the Labour Leadership did not want it debated during an election year.

Then, in 2015, Wellington lawyer Lecretia Seales, who was suffering from terminal brain cancer, sought a ruling from the High Court that "assisted dying" was not unlawful under the Crimes Act, and that a ban on "assisted dying" contravened her human rights under the New Zealand Bill of Rights Act 1990. The Court ruled that any assistance, whether in the form of assisted suicide or euthanasia by her doctor, would be unlawful and that the relevant provisions of the Crimes Act 1961 were consistent with the rights and freedoms contained in the Bill of Rights Act. It further suggested that changes to the law sought by Ms Seales could only be made by Parliament. Justice Collins referred specifically to the complexity and broad nature of the issues that are implicated in changing the law, stating that: "The complex legal, philosophical, moral and clinical issues raised by Ms Seales' proceedings can only be addressed by Parliament passing legislation to amend the effect of the Crimes Act.".

Following this ruling, a petition organised by the Voluntary Euthanasia Society (VES) was presented to Parliament in June 2015 by former MP and VES President Maryan Street and Matt Vickers, the husband of Lecretia Seales. It asked that the House of Representatives investigate public attitudes towards the introduction of legislation permitting "medically-assisted dying". The Select Committee investigated 1) factors that contribute to the desire to end one's life, 2) the effectiveness of services and support available to those who desire to end their own lives, 3) the attitudes of New Zealanders towards the ending of one's life and the current legal situation, and 4) international experiences.

ACT Party Leader and MP David Seymour submitted his own "End of Life Choice Bill" in October 2015. The key difference from Street's Bill was that it did not include End of Life care directives. While this Select Committee inquiry was still in process, Seymour's Bill was drawn from the private members ballot box on 8 June 2017. The Bill seeks to legalise euthanasia and assisted suicide in New Zealand for people 18 years and over with either a terminal illness or "grievous and irremediable medical condition" (effectively people with disabilities, chronic, and mental health conditions).

Meanwhile, the Health Select Committee released their report on the VES petition in August 2017. The submission process received over 21,000 unique submissions from around the country between 27 August 2015 and 1 February 2016, and heard 944 oral submissions (read the submissions here). 80% of the submissions were opposed to the legalisation of euthanasia and assisted suicide in New Zealand. The Report echoed Justice Collins' observation that the issue "is clearly very complicated, very divisive, and extremely contentious", but made no clear recommendations about legislation on euthanasia or assisted suicide in New Zealand, stating that it was a usually a matter of a conscience vote. Instead, the Report encouraged "everyone with an interest in the subject to read the report in full, and to draw their own conclusions based on the evidence presented in it".

Seymour's Bill had its first reading just before Christmas on the 13 Decmeber 2017. You can read the transcript or watch the videos from the first debate here. It is currently before the Justice Select Committee, who received over 35,000 submissions from New Zealanders. The Committee are now hearing from everyone who indicated that they wanted to be heard in person by the Committee. Information about hearing times and locations can be found here. Videos from some of the hearing sessions so far can be found here. Submissions for the Bill can be found here (not all submissions have been posted yet).

 

It is  important to understand that personal choices that people make are always contextually bound. The current New Zealand context, characterised as it is by 'functionalism', increasing ageism that is manifesting itself in growing elder abuse and an increase in the social isolation of the elderly, and a deficit understanding and fear of disability means, in our view, that there has never been a more dangerous time to make suicide and/or euthanasia more easily available.

The answer to the existential suffering that many people experience, and which drives requests for euthanasia and assisted suicide in overseas jurisdictions, is not to make it easier for people to end their lives but to continue to improve access to palliative care for all New Zealanders. It is our informed view that when all of the risks are objectively assessed and weighed up, any perceived benefits for a small minority of persons would be far outweighed by far larger numbers being exposed to the very real dangers of a premature death.

 

The current legal status quo remains the most responsible option for New Zealand at this time.

 

 

Download: Quick Facts: Euthanasia and Assisted Suicide.

 

 

 

Further articles

Articles in this section are ordered according to topic.

Disability

Dying/End of Life Experience

Euthanasia 

International

Medical/Palliative

Official Reports & Statements

Public Opinion/Discourse, Law

Suffering/Care/Compassion

Suicide/Assisted Suicide

Assisted Suicide in Oregon – Updated Facts re Safeguards

The State of Oregon (population 3.93 million) law allowing doctors to prescribe lethal overdoses for some patients’ suicides took legal effect late in 1997. Supporters often point to its safeguards operating well and having prevented abuse. In fact the data suggest that the “safeguards” are largely meaningless. The numbers of deaths under the Oregon Death with Dignity Act has greatly increased over the years.

  • In Oregon, 1545 lethal prescriptions have been written and at least 991 patients have ingested the drugs up to the end of 2015.
  • In 2015 there were 132 deaths, a 26% increase over 2014 and almost eight times the deaths in the law’s first full year.
  • All reporting about doctor-assisted deaths is self-reporting by the doctors prescribing lethal drugs.
  • Doctors cannot report reliably on the situation when patients actually ingest the lethal overdose and die, as nothing in the law requires them to be present. No one else who may be present is required to report.
  • In Oregon, the prescribing physician was present at the time of death in only 11% of cases in 2013 and 2015 and 14% in 2014, compared to an average of 16.5% in previous years.
  • From 1998 to 2012, on average only 6.2% of patients who died under the Act in Oregon were referred for counselling to check for “impaired judgment.” In 2013-2015 this declined to less than 4%.
  • Once lethal drugs have been prescribed the Act has no requirements for assessing the patient’s consent, competency, or voluntariness. No witnesses are required at the time of death.
  • In 2015, a clear majority were women (58%, compared to an average of 47% in past years).
  • Those dying under the law increasingly have no or only governmental health insurance – 56% in 2013, 60% in 2014, and 63% in 2015 (compared to an average of 35% in past years).
  • Inadequate treatment for pain or concern about it, is not among the top reasons for taking lethal drugs; in 2015, over 90% cite “losing the ability to engage in activities making life enjoyable” and “losing autonomy,” and 48% cite being a “burden” on family, friends or caregivers (compared to an average of 40% in past years).

Sources:

Oregon Death with Dignity Act: Data summaries 2013, 2014 and 2015. https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ar-index.aspx

Secretariat of Pro-Life Activities, United States Conference of Catholic Bishops
http://www.usccb.org/issues-and-action/human-life-and-dignity/assisted-suicide/to-live-each-day/upload/Oregon-and-Washing-euthanasia-2013.pdf

 

A Timeline of the Euthanasia Debate in New Zealand

Assisted Dying, Assisted Suicide, and Euthanasia

The term ‘assisted dying’ a generic term that can refer to either assisted sucide or to euthanasia or to both. Assisted suicide occurs when lethal drugs are prescribed to a person at their request but taken by the patient themselves to end their life. Euthanasia occurs when a third party ends the life of a person by administering a lethal drug, either orally or by injection.

A Catholic Understanding – Church Teachings

“It is a common human tendency to ignore our own mortality and pretend that death is something that is “far away” that we don’t have to worry about right now. But the reality for Christians is that death is not the end, but rather the beginning of a new, resurrected life with God. The catechism teaches that our fate after death ultimately hinges on the state of our souls when we die (CCC 1021)[1].

This view of death affects how we as Catholics make decisions regarding care at the end-of-life. For some people, end-of-life care involves the blessings and struggles that accompany old age. For others, it involves medical decisions that must be made without warning as a result of a sudden illness or accident that can afflict people of any age. In these situations, patients and their loved ones must decide which course of action, if any, upholds the dignity of the person nearing the end of life. While the Church recognizes, and encourages compassionate care that alleviates the suffering of those who are near death, the Church also vigorously teaches that immoral means (such as euthanasia or direct killing) may never be used to reduce suffering even if they are used with apparently good intention[2]”.

Palliative care is a relatively new and specialised branch of medicine that provides relief for physical pain and also addresses psychological, spiritual and emotional suffering. Recent advances make it highly effective in dealing with extreme pain. Euthanasia is not required to ensure people experience a dignified, comfortable, compassionate death, provided that quality palliative care can be accessed by those needing it. Quality care needs to be available to all, not just the privileged.

The Assisted Death / Euthanasia Debate in New Zealand – A Timeline of Key Events

1961. The Crimes Act is passed, which stipulates that “No one has a right to consent to the infliction of death upon himself or herself; and, if any person is killed, the fact that he or she gave any such consent shall not affect the criminal responsibility of any person who is a party to the killing.” Further information is available here – http://www.legislation.govt.nz/act/public/1961/0043/latest/DLM327382.html.

1995. MP Michael Laws introduces his Member’s bill “Death with Dignity Bill”, which would allow a patient to request a medical practitioner to assist them in ending their life. The bill was voted down, 61 to 29. Further information is available here – https://www.parliament.nz/en/pb/library-research-papers/research-papers/assisted-dying-new-zealand/ .

2003. MP Peter Brown introduces his Member’s bill, also called “Death with Dignity Bill”. It is almost identical to the bill proposed by Michael Law and is also voted down, 60 to 58 with one abstention. Further information is available here – https://www.parliament.nz/en/pb/library-research-papers/research-papers/assisted-dying-new-zealand/ .

2012. Labour List MP Maryan Street prepares a Private Members Bill, the "End of Life Choice Bill". The Bill was subsequently withdrawn from the ballot box prior to the 2014 election campaign, as the Labour leadership did not want it debated during an election year.

March – May 2015. Lecretia Seales, a Wellington lawyer suffering from terminal brain cancer, seeks a ruling from the High Court that “assisted dying” is not unlawful under the Crimes Act, and that a ban on assisted dying contravenes her human rights under the New Zealand Bill of Rights Act 1990.

June 2015. The High Court returns its verdict on Lecretia Seales’ case, ruling that any assistance, whether in the form of assisted suicide or euthanasia by her doctor, would be unlawful and that the relevant provisions of the Crimes Act 1961 are consistent with the rights and freedoms contained in the Bill of Rights Act 1990. The High Court further suggests that the changes to the law sought by Ms Seales could only be made by Parliament. Justice Collins refers specifically to the complexity and broad nature of the issues that are implicated in changing the law, stating that "the legal, philosophical, moral and clinical issues raised by Ms Seales' proceedings can only be addressed by Parliament passing legislation to amend the effect of the Crimes Act." Further information is available here - https://forms.justice.govt.nz/.

June 2015. Following this ruling, a petition is organised by the Voluntary Euthanasia Society (VES) and is presented to Parliament by former MP and VES President Maryan Street and Matt Vickers, the husband of Lecretia Seales. It asks that the House of Representatives investigate public attitudes towards the introduction of legislation permitting "medically-assisted dying in the event of a terminal illness or an irreversible condition which makes life unbearable." The petition contains 8,974 names. A Health Select Committee is formed in response to this petition. Further information is available here – https://www.parliament.nz/

August 2015. The Health Select Committee process begins. The Committee’s task is to receive submissions from the electorate to investigate: 1) factors that contribute to the desire to end one's life; 2) the effectiveness of services and support available to those who desire to end their own lives; 3) the attitudes of New Zealanders towards the ending of one's life and the current legal situation; 4) international experiences. Further information is available here – https://www.parliament.nz/en/pb/sc/make-a-submission/document/0SCHE_SCF_51DBHOH_PET63268_1/petition-of-hon-maryan-street-and-8-974-others.

September 2015. The New Zealand Catholic Bishops Conference issue a statement in response to the Health Select Committee process. The Bishops state that “The present attempt to make euthanasia and assisted-suicide legal in New Zealand is a matter of extremely serious concern.” They argue that “The legalisation of euthanasia would send a message that the lives of some people are not worth living” and that “the sick, elderly, disabled and dying would too easily see themselves as a financial and/or emotional burden on their families and communities”, especially in a societal context of elder abuse. A call to action to encourage Catholics to share their thoughts and views, and to participate in the democratic process, is issued. Further information is available here – http://www.nathaniel.org.nz/euthanasia/23-bioethical-issues/bioethics-at-the-end-of-life/euthanasia/modal-windows/262-summary

October 2015. ACT Party Leader and MP David Seymour submits his own End of Life Choice Bill. The key difference between Maryan Street's Bill and David Seymour’s Bill is that Maryan Street’s Bill did not include end of life care directives. Further information is available here – https://d3n8a8pro7vhmx.cloudfront.net/

January 2016. The Nathaniel Centre and the New Zealand Catholic Bishops Conference prepare a written submission on euthanasia to the Health Select Committee. In this submission, they argue that “Euthanasia and/or assisted suicide are unnecessary” because “good palliative care, when available, can and does address the physical and psychological suffering of patients and their families.” They note that “in cases of extreme pain or extreme existential distress, health professionals already have the option of using palliative sedation.” Their submission goes on to note that “At the heart of the debate about ‘medically-assisted dying’ are two questions: Firstly whether suicide or euthanasia, understood as the premature ending of life, should ever be recognised as a socially acceptable means of dealing with suffering and secondly, the pragmatic question of whether these practices can be safely regulated in the real world.” Further information is available here – http://www.nathaniel.org.nz/euthanasia/health-select-committee.

November 2016. The Nathaniel Centre and the New Zealand Catholic Bishops Conference are invited to give an oral submission to the Health Select Committee. In this submission, they argue that in our current societal context, marred as it is by inequitable access to palliative care, distressing and growing rates of elder abuse, rising rates of mental illness, and discriminatory attitudes towards living with any sort of disability or dependence, that “there has never been a more dangerous time in our country’s history to think about implementing an assisted suicide or euthanasia regime.” Further information is available here – http://www.nathaniel.org.nz/euthanasia/health-select-committee.

June 2017. While the Health Select Committee investigation is in process, ACT Party leader and MP David Seymour's End of Life Choice Bill is drawn from the private members’ ballot box. The Bill seeks to legalise euthanasia and assisted suicide in New Zealand for people 18 years and over with either a terminal illness or a "grievous and irremediable medical condition", a phrase which effectively encompasses people with disabilities, chronic conditions, and mental health conditions. Further information is available here – https://www.parliament.nz/resource/en-NZ/51PLLaw25081/0f09371cd3e54b891816bdef4e30d1f61e1c975a.

August 2017. The Health Select Committee release their report on their investigation into New Zealander’s attitudes towards end of life care and assisted dying. The submission process has received over 21,000 unique submissions from around the country between 27 August 2015 and 1 February 2016, and the Committee has heard 944 oral submissions. Eighty per cent of these submissions are opposed to the legalisation of euthanasia and assisted suicide in New Zealand. The Health Select Committee’s report echoes Justice Collins' observation at the close of Lucretia Seale’s hearing in 2015 that the issue "is clearly very complicated, very divisive, and extremely contentious." However, the report makes no clear recommendations about legislation on euthanasia or assisted suicide in New Zealand, stating that it is a matter of a conscience vote. Instead of offering a clear directive, the Committee encourages "everyone with an interest in the subject to read the report in full, and to draw their own conclusions based on the evidence presented in it." Further information is available here https://www.parliament.nz/resource/en-NZ/SCR_74759/4d68a2f2e98ef91d75c1a179fe6dd1ec1b66cd24 and https://www.parliament.nz/en/pb/sc/submissions-and-advice/.

December 2017. David Seymour's End of Life Choice Bill receives its first parliamentary reading just before Christmas. The draft Bill passes this and is referred to the Justice Select Committee for the next stage of the parliamentary process. Further information is available here – https://www.parliament.nz/en/pb/hansard-debates/rhr/combined/HansDeb_20171213_20171213_52.

January 2018. The New Zealand Catholic Bishops Conference issue another call to action to encourage Catholics to continue to share their thoughts and views with the Justice Select Committee on the End of Life Choice Bill, and to continue to participate in the democratic process. Further information is available here – https://www.catholic.org.nz/news/media-releases/your-voice-counts-calling-for-submissions-on-the-end-of-life-choice-bill/.

February 2018. The New Zealand Catholic Bishops Conference and The Nathaniel Centre prepare a written submission to the Justice Select Committee. In their submission, the Bishops acknowledge that “The factors that contribute to the desire to end one’s life are complex, and include grief, different forms of depression, social isolation, neglect, fear, loss of hope, and a sense of being trapped.” However, they note that “we know from our experience of walking with the dying that a fearful, vulnerable, powerless person – religious or not – can be bought, with good holistic care, into a peaceful place where pain is controlled, their circumstances are dignified, and family and whānau relationships can be healed, if necessary, and enjoyed prior to death.” In response to the argument that “those opposed to the legalisation of euthanasia and assisted suicide do not have to use it”, they respond that this rationale “narrows the issue down to a matter of individual choice, and ignores the societal effects of the legalisation which will be experienced by everyone, particularly vulnerable groups.” With regards to the vulnerable, they argue that the End of Life Choice Bill “is an abnegation of the responsibility of the kaumātua (including politicians) of a nation to protect its citizens and their well-being” and that it “undermines one of the prime functions of law which is to uphold the moral and ethical standards of a community in the interests of the most vulnerable.” The Nathaniel Centre’s submission echoes these thoughts, arguing that the End of Life Choice Bill “i) does not and cannot provide adequate safeguards against coercion; (ii) that in giving the choice of euthanasia or assisted suicide to a few, the Bill will severely constrain the choice and/or ability for many others to continue to live; (iii) that the practices of euthanasia and assisted suicide contradict medical ethics and are the antithesis of ethical healthcare.” Further information is available here – https://www.catholic.org.nz/resources/submission-to-the-justice-select-committee-from-the-new-zealand-catholic-bishops-conference/ and http://www.nathaniel.org.nz/component/content/article/16-bioethical-issues/bioethics-at-the-end-of-life/451-submission-to-the-justice-select-committee-end-of-life-choice-bill

March 2018. The deadline for submissions to the Justice Select Committee closes. The Committee has received 39,159 written submissions and it has heard 1,350 oral submissions. Of these submissions, approximately 90% are opposed to the Bill and approximately 8.5% are in support of Bill. Further information is available here - https://www.parliament.nz/en/pb/bills-and-laws/bills-proposed-laws/document/BILL_74307/end-of-life-choice-bill.

June 2018. The New Zealand Catholic Bishops Conference and The Nathaniel Centre are invited to give an oral submission to the Justice Select Committee. In their submission, the Bishops argue that if passed, the Bill would “be a regressive move.” They note that “New Zealand prides itself on being a progressive nation” and that to be truly progressive, as a society we must “challenge ageist attitudes and eliminate the sense that being sick or old or dependent equates to being a burden” – a message that the End of Life Choice Bill implicitly conveys. In its submission, The Nathaniel Centre speaks to the Bill’s problems, specifically: “i) its imprecise terminology; its vague and subjective language around eligibility; iii) its failure to consider broader social implications and the ethical contradiction of involving doctors in ending the lives of their patients; iv) the impossibility of ensuring people were not coerced into ‘assisted dying’; v) the growing rates of elder abuse as well as growing social isolation amongst older people along with an increased sense amongst our elders that they are a burden.” Further information is available here – https://www.catholic.org.nz/news/media-releases/catholic/ and http://www.nathaniel.org.nz/component/content/article/16-bioethical-issues/bioethics-at-the-end-of-life/461-oral-submission-to-the-justice-select-committee-on-the-end-of-life-choice-bill.

Apr 2019. The Justice Select Committee issues its report based on the submissions it has received. In this report, the Committee state that they are “unable to agree that the Bill be passed” because the Committee “hold diverse views”. Because of this, the Committee state that they “decided to report the bill back with minor, technical, and consequential amendments only” and that they “leave it to the full membership of the House to resolve the broader policy matters.” The Committee members further state that the Bill “is expected to result in conscience votes by members in the House”, noting that “in previous situations where a bill was expected to result in conscience votes, committees have recommended amendments that left the policy content of the bill largely intact, while trying to ensure that the bill was a coherent and workable piece of legislation— particularly regarding consequential amendments and amendments to related legislation.” Further information is available here – https://www.parliament.nz/resource/en-NZ/SCR_86640/c5b7adfc7598b85747ff94855bc46bfb40470db0.

Jun 2019. The End of Life Choice Bill receives itssecond reading in parliament. The Bill passes this reading. Further information is available here – https://www.parliament.nz/en/pb/hansard-debates/rhr/combined/HansDeb_20190626_20190626_28.

13 Nov 2019. The End of Life Choice Bill receives itsthird reading in parliament. The Bill passes this reading, meaning that the Bill has been approved by parliament to pass into law. However, it is decided that the final decision as to whether the Bill becomes law rests with the New Zealand electorate and should be subject to a binding referendum. October 2020 is set as the date for this referendum. In the meantime, however, the Bill receives its royal assent. Further information is available here – https://www.parliament.nz/en/pb/hansard-debates/rhr/combined/HansDeb_20191113_20191113_16 and https://www.parliament.nz/en/pb/bills-and-laws/bills-proposed-laws/document/BILL_74307/tab/hansard.

October 2020. The NZ public will vote in binding referendum on the question “Do you Support the End of Life Choice Act 2019 coming into force?”.

 

Resources

http://www.nathaniel.org.nz/the-dangers-of-euthanasia-a-statement-from-the-new-zealand-catholic-bishops

http://www.nathaniel.org.nz/component/content/article/16-bioethical-issues/bioethics-at-the-end-of-life/467-making-death-easier-makes-life-harder

https://corpus.nz/euthanasia-and-the-common-good/

http://www.nathaniel.org.nz/component/content/article/16-bioethical-issues/bioethics-at-the-end-of-life/451-submission-to-the-justice-select-committee-end-of-life-choice-bill

http://www.nathaniel.org.nz/component/content/article/16-bioethical-issues/bioethics-at-the-end-of-life/431-euthanasia-assisted-suicide-and-the-medical-profession-keep-doctors-out-of-it

https://carealliance.org.nz/

https://carealliance.org.nz/icare/

https://www.riskylaw.nz/

 

[1]https://dphx.org/respect-life/know-the-issues/euthanasia-and-assisted-suicide/

[2]https://dphx.org/respect-life/know-the-issues/euthanasia-and-assisted-suicide/

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