Do you Support the End of Life Choice Act 2019 Coming into Force? – A Resource for Voters

What is the End of Life Choice Act 2019 Referendum About?

If passed, the End of Life Choice Act 2019 (EOLC Act) will make assisted suicide or euthanasia available to competent people with a terminal illness who are 18 or over, and are thought to have six months or less to live, and are in an advanced state of irreversible decline, and experience “unbearable suffering that cannot be relieved in a way the person considers tolerable”.

The group most at risk if we legalise euthanasia and assisted suicide are those vulnerable to the suggestion they would be ‘better off dead’ – our elders, disabled people, and people with depression and mental illness who find themselves fitting the eligibility criteria.

The specific wording of the referendum question is important. We are not being asked to vote on the idea or desirability of euthanasia. Rather, we are being asked to vote on the robustness of a specific law, one that differs in the quality of its processes and safeguards from assisted death laws overseas.

A group of more than 200 lawyers, some of whom support euthanasia, are opposed to the proposed EOLC Act because it is a badly drafted, dangerous law that is broader in its scope and riskier than comparable laws overseas – see www.lvnz.org. The Act cannot now be changed. If a simple majority of voters support the Act, it will be enacted in its current form without the opportunity to implement changes to make it safer.

What is “Assisted Dying”?

The term ‘assisted dying’ is the preferred language used by the Act. It is a generic term that can refer to either assisted suicide or to euthanasia or to both. The proposed EOLC Act would allow both.

What is “Assisted Suicide”?

Assisted suicide occurs when lethal drugs are prescribed to a person at their request but taken by the patient themselves to end their life.

What is “Euthanasia”?

Euthanasia occurs when a third party ends the life of a person by administering a lethal drug, either orally or by injection. The EOLC Act delegates this task to doctors or nurse practitioners.

What is “Palliative Care”?

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.

Why are people voting ‘NO’ to the End of Life Choice Act?

The EOLC Act is broader than a law recently passed in Victoria, Australia, as well as laws in the USA.
The Act is not designed to be an option of ‘last resort’ – it will not just apply for the ‘exceptionally difficult cases’ because it does not require that a person first make use of available treatments, nor that they first receive palliative care.
Quality palliative care is effective, but there is no corresponding legal right in New Zealand to access palliative care. Overseas, in places such as Canada, people are choosing assisted death because of a lack of other choices. There is a risk this will also happen in New Zealand because quality palliative care is not universally available to all who need it.
Any prognosis is a guess. Doctors cannot predict with accuracy how long a person with a life-limiting illness might live. Many people with a prognosis of less than six months go on to live full lives for years.
Overseas research shows that the choice of euthanasia is not driven by pain but by a range of personal reasons, including the fear of being a burden. Under the EOLC Act, a person with a terminal illness could choose assisted dying out of a misguided sense of duty based on their impression that they are a burden to their families or society.
The current law already allows people to say ‘no’ to treatments and to receive whatever level of pain relief they need, even to the point of being sedated if need be. These days, no-one need die in pain.
There is no mandatory stand-down or cooling off period in the EOLC Act as there is in other countries - under the proposed NZ law, a person could be dead less than 4 days after diagnosis.
Approximately 10% of our elders are the victims of abuse, mostly from their own families. Elder abuse laws are not able to protect our elders. It is naive to expect that the EOLC Act can keep people safe.
Key medical groups, including the New Zealand Medical Association, Hospice New Zealand, Palliative Care Nurses and Palliative Medicine Doctors all oppose the EOLC Act as unsafe.
Medical groups have stated that it will be impossible for doctors to detect if people are being pressured or coerced. The EOLC Act only requires a doctor to “do their best to ensure that the person expresses their wish free from pressure.” The Act fails to regulate for a process to ensure this happens. It also fails to recognise that doctors are not trained for this and do not possess the powers and means of the courts to make such a determination.
Requests for an assisted death can often be motivated by depression, something that is extremely difficult to detect. The EOLC Act does not provide for people to be screened for depression.
The EOLC Act does not require a patient to talk about a decision to end their life with a family member or other significant person.
Unlike overseas laws, the EOLC Act does not require independent witnesses in the decision process.
Unlike overseas laws, the person requesting an assisted death does not need to be competent at the time they make the final decision to end their life or have it ended for them.
While the research is not conclusive, statistical evidence from overseas indicates that, over time, as the rates of assisted dying increase, there is a corresponding increase in suicide rates. An increase in the non-assisted suicide rates in New Zealand cannot be ruled out.
In the Netherlands and Belgium, it was not originally envisaged that disabled people or people who are mentally ill would be eligible. However, assisted death is now offered to people with mental illnesses and dementia and to disabled people. The same changes will likely happen here.

How is the End of Life Choice Act 2019 Different From What is Already Legal in New Zealand?

Research shows many people are confused about what is already legal in New Zealand and what the Act will allow. The following things are already legal in New Zealand and are not euthanasia:

Turning off life support.
Refusing treatment.
Acting on ‘Do not resuscitate’ orders, where patients can request in advance not to be resuscitated if this becomes necessary to keep them alive.
Administering high doses of medication with the intention of relieving pain – to the point of sedating a person if required – even if it might unintentionally shorten a person’s life.

Conclusion: The EOLC Act is badly drafted and seriously flawed. It will expose many New Zealanders to the risk of a premature death at a time when they are most vulnerable. Whatever one’s views about the idea of euthanasia, it is not compassion to vote for a dangerous law.

Some Resources on Reasons to Vote No for the End of Life Choice Bill Referendum

Risky Law: www.riskylaw.nz/ - “Whatever your views of death and dying, this Act is poor legislation because it does not protect people from being killed against their will.”

Vote Safe: www.votesafe.nz/ - “LETHAL DOSE: with NO parental knowledge required; with NO assessment for coercion required; with NO mental health support required; with NO attempted treatment required; and with NO physical pain required.”

A Fatal Law with Fatal Flaws: https://carealliance.org.nz/ - The End of Life Choice Act is: “Unsafe – lacks adequate safeguards against wrongful deaths; Unwise – will fundamentally change our societal attitudes towards compassion for the worse; and Unnecessary – we can address end-of-life suffering without using lethal doses of drugs.”

Hospice, Euthanasia – Our Opinion: https://www.hospice.org.nz/resources/end-of-lifechoice-act-our-concerns/euthanasia-our-opinion/

Authorised by John Kleinsman, the Nathaniel Centre for Bioethics, 15 Guildford Terrace, Wellington 5028