Euthanasia and the value and meaning of life

Philip Matthews: Euthanasia debate reveals deep divisions about the value and meaning of life

In December, the End of Life Choice Bill passed its first reading in Parliament with 76 out of 120 MPs voting to send it up to the Justice Select Committee on the slow process to becoming law.

Despite the deep nature of questions it raises about the meaning and quality of life, the Parliamentary debate was unusually polite and respectful. There was, as former MP and pro-euthanasia campaigner Maryan​ Street notes, a pleasant absence of grandstanding, time wasting or personal abuse.

The details may change but the bill presently would allow for a New Zealand citizen or resident over 18, who is suffering from a terminal illness that is expected to end their life within 6 months or has a grievous and untreatable medical condition, to opt for an assisted death. There are safeguards of informed consent and assessment by two doctors.

The pro-euthanasia camps argue that civilised countries like ours at this point in history should allow for death without suffering, a painless option. You hear a lot about the dignity of the dying.

“In a modern and compassionate society, the law should allow for a decent death,” said Chris Bishop, one of the 21 National MPs to vote for the bill.

The strongest opposition in Parliament came from Simon O’Connor​ who said that “fundamentally, I do not believe doctors should be killing their patients”. O’Connor was one of the 35 National MPs who voted against.

Nine Labour MPs voted against, including Pasifika MPs Jenny Salesa​ and Poto Williams, Māori MP Rino Tirikatene and Pākehā MPs Phil Twyford and Damien O’Connor.

All NZ First MPs voted for it at this stage, but want to see a referendum on euthanasia. All of the Green MPs backed it.

David Seymour’s bill was drawn from the members’ Bill ballot.

“It is not pleasant to talk about painful death,” said Act MP David Seymour, whose bill continued the unfinished business of Street’s earlier attempt to make assisted dying legal.

In this corner there is compassion and dignity, while opposition to euthanasia is often imagined as medieval and unenlightened, a product of redundant religious faith. But actually, Street says, arguments are more complex and nuanced.

It is a complex issue. I am generally in favour of legalising assisted dying/euthanasia and certainly want to be able to make choices for myself about the way I die if I get the chance, but have some concerns about how legislation will both give personal choice but also protect against abuse or misuse.

There is no monolithic block for or against. Her years as the unofficial godmother of the euthanasia movement in New Zealand – she is now president of the End of Life Choice Society – have shown her that there are some Catholics for, as well as many against. There are Māori for and against, Pasifika for and against, Asians for and against.

The polling Street cites was conducted by Horizon in May 2017 and found that 75 per cent of New Zealanders support or strongly support the right to die, with support at its highest among Pākehā and other Europeans and lowest among Asians and Indians.

It is, Street knows, a deeply individual matter. Faith or politics may play a part, or politics or, more likely, life experience.

I have experienced the end of life and deaths of both my parents over years (father, emphysema) and months (mother, cancer). I believe my father was effectively assisted to die but I was shut out of the process (by the hospital he was in, possibly to protect themselves), this was a very difficult time. My mother died in a hospice, under the best possible care but still fraught – they reacted to her pain with just enough pain killers, until the next time she suffered.

This is where Raymond Mok comes in. What does it mean to say that those with serious medical conditions can legally opt out of life with the help of the able-bodied? Does it imply that their lives are less precious, less valuable?

It smacks of discrimination to him. We want to be progressive in our thinking but legalising assisted suicide for only the ill or disabled is not moving forward.

“I think it’s not the Government’s role to say who is eligible to live or die,” Mok says. “If it is the choice of the individual, then it shouldn’t be limited to people with severe illness or disability.”

This does present a genuine dilemma that gets to the heart of our ethics. In our rush to offer a compassionate death to those who are suffering, we might also be suggesting that they are somehow worth less than others. As Mok says, the important thing is that a consenting adult is making an informed and conscious decision to die, regardless of illness or disability.

Street steps carefully into this ethical minefield and says that “when it comes to people with disabilities, this needs to be treated with the utmost respect, because their lives are typically a struggle, society views them differently already, and they feel that because they are already vulnerable, they will be more vulnerable”.

She believes that two things underpin both the assisted dying bill and disability charters, and they are maximum autonomy and dignity. Just as disability rights activists want to enshrine those qualities, so too does the pro-euthanasia camp.

But yes, it is a highly tricky area that must be approached with as much sensitivity and empathy as we can muster. As for the palliative care backers, Street says that she too is a great supporter of it but “I only wish that in New Zealand it were universally accessible and it were universally of a high standard. Neither of those things is true.”

Hospices are as good as we could have under current law, but only a small number of people die in hospices.

The slippery slope argument is harder to combat, though. What happens if we keep normalising the right to die or keep expanding the parameters? How far does liberalism take us? Australian ethicist Xavier Symons made this point recently when euthanasia was debated and made legal in the state of Victoria. In the Netherlands, Symons noted, euthanasia deaths have trebled since 2002, and are now more than 4 per cent of all deaths, with increasing requests from people who are not terminally ill but simply “tired of life”.

Is it a slippery slope, or generally an increasing number of people choosing what they want?

There is something very sad about this trend: boredom, illness and loneliness in the most prosperous societies in history, where some would rather be dead and no longer a burden.

Whatever the reasoning and reason, it should be an individual’s choice, providing there are adequate safeguards.

Would we accept this in New Zealand? Street agrees it is not palatable and she has been adamant about safeguards that would restrict assisted dying to those old enough to vote and the need for citizenship or residency to stop New Zealand from becoming a site of death tourism, as has been seen in Switzerland.

The Swiss situation has only arisen because of a lack of legal choices in people’s own country.

Most of us already can make choices about committing suicide, but options are far from ideal.

One of the biggest fears is becoming incapable of taking our own lives but wanting to opt out of life.

One contradiction is the use of modern medicine to prolong life far beyond natural processes, but legally forbidding using medicine to easy one to their death a bit sooner than may otherwise occur.

It will be an interesting debate, with passion on both sides of the argument. I hope this debate can be conducted with dignity.

Matthews wraps one person’s illness, experience and views around his article, seeming to use that as a proxy for his own views, but there are many circumstances in which people live and die.

WHERE TO GET HELP:

* Lifeline (open 24/7) – 0800 543 354

* Depression Helpline (open 24/7) – 0800 111 757

* Gambling Helpline – 0800 654 655

* Healthline (open 24/7) – 0800 611 116

* Samaritans (open 24/7) – 0800 726 666

* Suicide Crisis Helpline (open 24/7) – 0508 828 865 (0508 TAUTOKO).

Victoria Upper House backs assisted dying bill

ABC News:  Voluntary assisted dying bill passes Victoria’s Upper House, state set to make history

Historic voluntary euthanasia laws have passed Victoria’s Upper House after a 28-hour marathon sitting, leaving the state on the brink of becoming the first in the country to legalise assisted dying for the terminally ill.

In a dramatic end to days of debate, the Andrews Government’s voluntary assisted dying bill passed — with amendments — 22-18 votes in the 40-member Upper House.

It was a conscience vote for all MPs. Eleven government MPs backed the bill, as did four Liberals, five Greens, the Reason Party’s Fiona Patten and Vote 1 Local Jobs Party MP James Purcell.

Because amendments to the bill were agreed it must now return to the Lower House for ratification before becoming law.

The bill passed in the Lower House last month, with MPs voting 47 to 37 in favour of introducing voluntary euthanasia.

The legislation required amendments to pass the Upper House, including halving the timeframe for eligible patients to access the scheme from 12 months to live to six months to live.

There will be exemptions for sufferers of conditions such as motor neurone disease and multiple sclerosis, who will be able to access the scheme in their final 12 months.

Once passed it will give patients suffering intolerable pain the right to choose a doctor-assisted death from 2019.

Premier Daniel Andrews said the law would give terminally ill people dignity at the end of their lives.

Parliamentary report on medically assisted dying

In June 2015 a petition was presented to Parliament from then MP Hon Maryan Street and 8,974 others requesting:

That the House of Representatives investigate fully public attitudes towards the
introduction of legislation which would permit medically-assisted dying in the event of a terminal illness or an irreversible condition which makes life unbearable.

Parliament’s Health Committee has just released their report on this. It looks in detail into many aspects of assisted dying and euthanasia.

This is a separate process to the Private Members’ Bill of David Seymour that was drawn from the ballot earlier this year, which hasn’t had it’s First Reading in Parliament yet (unlikely before the election).


Report on the petition of Hon Maryan Street presented

During its consideration of the petition, more than 21,000 individuals and organisations submitted their views to the committee. Over 108 hours, 944 people took the opportunity to share their opinions.

The petition requests that the House of Representatives investigate fully public attitudes towards the introduction of legislation which would permit medically-assisted dying in the event of a terminal illness or an irreversible condition that makes life unbearable.

Recommendation:

The Health Committee has considered Petition 2014/18 of Hon Maryan Street and 8,974
others and recommends that the House take note of its report.

This report gives us the opportunity to summarise, for the benefit of the House and the
public, what we heard and considered during our review of more than 21,000 submissions from the petitio extremely contentious. We therefore encourage 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.

Background

The petitioner, Hon Maryan Street, was a member of Parliament between 2005 and 2014.
While a member, she sought to introduce the End of Life Options Bill as a member’s bill.
The purpose of this bill was to provide individuals with a choice about how they end their life and allow them to receive assistance from a medical practitioner to die under certain circumstances. The petition originated with the Voluntary Euthanasia Society of New Zealand (VES) before being adopted formally by Hon Maryan Street. Since leaving
Parliament, Ms Street has become the President of VES.

There have been two first reading debates in Parliament on similar bills. Both were
unsuccessful. In 1995, members voted 61 to 29 against Michael Laws’ Death with Dignity
Bill. In 2003, members voted 60 to 58 against Peter Brown’s Death with Dignity Bill.
The petitioner’s bill was formally removed from the members’ bill ballot in December
2014.

Full report here

Conclusion

We thank the petitioner for bringing this petition before the committee and encouraging us to ascertain the views of New Zealanders on ending one’s life in this country. We appreciate that people come from a range of backgrounds and that this is a subject on which people hold strong views. We believe that the written submission and oral hearing process has provided a platform for people to share these views and discuss the issues with us. This report gives us an opportunity to summarise what we heard for the benefit of the House and the public.

Eighty percent of submitters were opposed to a change in legislation that would allow assisted dying and euthanasia. Submitters primarily argued that the public would be endangered. They cited concern for vulnerable people, such as the elderly and the disabled, those with mental illnesses, and those susceptible to coercion. Others argued that life has an innate value and that introducing assisted dying and euthanasia would explicitly undermine that idea. To do so would suggest that some lives are worth more than others. There were also concerns that, once introduced, eligibility for assisted dying would rapidly expand well beyond what was first intended.

Supporters of assisted dying feared their loss of dignity, independence, and physical and mental capacity. Submitters also spoke about the fear of pain and of having to watch loved ones suffer from a painful death. Supporters stressed their personal autonomy and that they should have the choice as to when to end their life.

Many submitters discussed their experiences of palliative care. We commend the service
given by palliative care providers and hospices. However, we were concerned to hear that there is a lack of awareness about the role of palliative care, that access to it is unequal, and that there are concerns about the sustainability of the workforce. We urge the Government to consider ways in which it can better communicate the excellent services that palliative carers provide, address the unequal access, consider how palliative care is funded, and address the workforce shortages.

The relationship between assisted dying and suicide was a common concern for submitters. Some believe that assisted dying should not be considered until New Zealand’s high suicide rate is reduced. Others believe that the lack of assisted dying legislation means that people are more likely to suicide.

We recognise that a lot of work and investment has gone into suicide prevention programmes and support services. However, we were concerned to hear that people feel that there is a lack of grief counselling. We therefore encourage the Government to investigate improving access to these services.

We have not made any recommendations about introducing assisted dying legislation. We understand that decisions on issues like this are generally a conscience vote.

The petitioner asked us to investigate attitudes towards the introduction of legislation that would permit assisted dying in the event of a terminal illness or an irreversible condition which makes life unbearable. However, some submitters thought that the criteria would or should be broader than terminal illness or an irreversible condition. This has made it difficult for us to consider what the safeguards should be. We were particularly concerned about protecting vulnerable people, such as individuals with dementia or reduced capacity. Some of us remain unconvinced that the models seen overseas provide adequate protection for vulnerable people.

We would like to thank all of the submitters for sharing their stories with us and for the
respect submitters showed for opposing views when they appeared before the committee.

This issue is clearly very complicated, very divisive, and extremely contentious.

We therefore encourage everyone with an interest in the subject to read the report in full and to draw their own conclusions based on the evidence we have presented.

New Zealand First minority view

New Zealand First congratulates the petitioner for bringing this issue before the Select Committee. Medically-assisted dying is a serious matter and is so serious that it is not one that should be taken by temporarily empowered politicians. New Zealand First cannot support such a fundamental change without a clear sign that this is the will of most New Zealanders. That would be achieved by either a binding Citizens’ Initiated Referendum, or a Government Initiated Referendum held with a future General Election thus allowing for a period of informed debate.

Green Party: assisted dying policy

The Green Party has released their ‘Medically-Assisted Dying policy’, aka their proposals on euthanasia.

They gave a brief description via @NZGreens:

We are releasing our Medically-Assisted Dying policy. Stories like those of Lecretia Seales, who stepped into the public eye to ask the courts to give her the right to choose, have recently brought this issue to the fore.

Adults with a terminal illness should have the right to choose a medically assisted death in a supported and open way.

The Green Party does not support extending assisted dying to people who aren’t terminally ill because we can’t be confident that this won’t further marginalise the lives of people with disabilities.

Parliament is currently running a committee inquiry into euthanasia and recently heard public submission. However this far from guarantees Parliament will debate legislation on euthanasia.

ACT MP David Seymour has an assisted dying bill in the Members’ ballot but it wasn’t the 1 out of 79 bills drawn yesterday. It will always be a long shot.

The Green Party policy in full:


Medically-Assisted Dying policy

The Green Party supports the current legal right of an individual to refuse medical treatment (under the Bill of Rights Act 1990) and the right of doctors to refuse to perform futile medical procedures. Furthermore, we believe that an individual aged 18 years or older who has been diagnosed with a terminal illness should have the right to choose to end their life in a supported and open way.

1. The Green Party will support a law change that allows an individual access to medically-assisted dying, provided that, as a minimum, the following safeguards are included:

a) An assessment of the individual by their treating doctor, and a review of this assessment by an independent registered medical practitioner, to determine that the patient

i. Is terminally ill; and
ii. Is experiencing enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable; and
iii. Has made durable and persistent requests for assistance in dying.

b) A further assessment by a suitably qualified and registered health practitioner to confirm that the individual:

i) has decision-making capability; and
ii) is making an informed decision free from undue influence;

c) Treating doctors and medical practitioners who elect not to participate in this process must refer the individual to a practitioner who is willing to participate;

d) Ongoing support from appropriately qualified professionals is provided in all cases;

e) A reflective period is always provided before medically-assisted dying occurs; unless two registered medical practitioners agree the individual’s suffering is so great as to render such a period inhumane;

f) For individuals who are declined medically-assisted dying, an appeal process to enable a reassessment of their eligibility;

g) The medically-assisted dying administered under medical supervision or directly by a registered medical practitioner;

h) The mandatory reporting of all consequent deaths to the coroner, as an independent safeguard and to allow monitoring of the assisted dying process.

In addition to these safeguards, the Green Party will:

2. Require oversight of the medically-assisted dying legislation by an appropriate statutory body to ensure compliance with legal requirements.

3. Ensure that prior to the medically-assisted dying legislation coming into force, professional guidelines, training and support are made available to medical practitioners on an ongoing basis.

4. Require annual reviews of the performance of the medically-assisted dying legislation with the findings made available to the public.

5. Not support the extension of medically-assisted dying to individuals who are not terminally ill until New Zealand has in place policies and practices that ensure full social inclusion, including equitable access to health services, for disabled people (see our Disability Policy).

Assisted Dying Bill added to Members’ ballot

David Seymour has added his Assisted Dying Bill to the Members’ lottery. It will only go to Parliament if it gets drawn. There are usually three Bills drawn from 60-70 every month or few.

A poll run for this shows 66% somewhat or strongly support euthanasia and 20% somewhat or strongly oppose.

This is a difficult issue to deal with. Political parties and MPs have tried to avoid issues like this. Labour’s Maryanne Street had a similar Members’ Bill in the pool last term but Andrew Little chose to avoid it when he became leader so it wasn’t taken up this term. That’s why Seymour stepped in.

Today’s announcement:

Seymour lodges assisted dying Bill

David Seymour, MP for Epsom, has lodged a Bill on assisted dying in Parliament’s Members’ ballot today.

“The End of Life Choice Bill is a response to the anguish faced by a small but significant minority of people with terminal illness or who are grievously and irremediably ill, as they anticipate the prospect of intolerable suffering and the indignity of the final few days and weeks of their lives,” said Mr Seymour.

“The motivation for this Bill is compassion. It allows people who so choose and are eligible under this Bill to end their life in peace and dignity, surrounded by loved ones.

“The Bill carefully defines those eligible for assisted dying. It details a comprehensive set of provisions to ensure this is a free choice made without coercion, and outlines a stringent series of steps to ensure the person is mentally capable of understanding the nature and consequences of assisted dying.

“It is evident from polls that a substantial majority of the public want Parliamentarians to consider assisted dying legislation.

“In fact, an independent poll of 2,800 people which I have commissioned on this issue shows 66% of the public favour allowing assisted dying – 38% strongly in favour – and 20% oppose. Support is remarkably steady across age groups, rural and urban areas, and genders.

“This should give a clear message to Parliamentarians that the public wants this issue addressed. If this Bill is drawn, I hope MPs will support it through its First Reading, so the many complex issues can be considered through the select committee process.”

David Seymour has also launched a website which will act as an information source and campaign hub: End of Life Choice

The Bill can be viewed here.

ACT have prepared well for this, including having a larger than normal poll done on it.

Some people believe that the law should be changed to allow doctors to assist in ending the life of a person with an incurable illness, if the patient requests it. What is your view on whether voluntary euthanasia should be legal
– strongly oppose, somewhat oppose, somewhat favour, strongly favour?

  • Strongly oppose 13%
  • Somewhat oppose 7%
  • Neutral 11%
  • Somewhat support 28%
  • Strongly support 38%
  • Unsure 2%
  • Refuse 3%

EUTHANASIA POLL

Conducted 14 to 30 June and 7 September to 6 October 2015

A question was asked in our regular weekly poll of at least 333 adult New Zealanders.

There were 2,800 responses. This gives a 1.9% maximum margin of error at the 95% confidence level.

All the polling data from Curia can be read here.

Two polls strongly support euthanasia

Both One News and Three News have done polls on euthanasia with strong support for changing the law and allowing euthanasia.

One News/Colmar Brunton:

Should a patient should be able to request a doctor’s assistance to end their life?

  • Yes 75%
  • No 21%
  • Undecided 5%

1000 voters questioned

3 News/Reid Research

Should law be changed to allow “assisted dying” or euthanasia?

  • Yes 71%
  • No 24%
  • Unsure 5%

Patrick Gower asked John Key if the Government would heed public opinion and do something about it. Key said they wouldn’t, but if a well drafted Member’s Bill was put before parliament he said he would support it.

The chances of a Member’s Bill being drawn is low – ad at this stage there isn’t a Bill in the ballot anyway.

One News had a report with their poll result: Lecretia Seales’ widower praises Kiwis for poll showing support for doctor assisted euthanasia

Lecretia Seales’ widower Matt Vickers is welcoming a ONE News Colmar Brunton Poll which shows the majority of New Zealanders want dying patients to be able to rely on their doctor for help to end their lives.

“We’re glad to see that New Zealanders agree that it is appropriate, respectful and compassionate, and we hope that Parliament does their job and achieves legislative change that the majority of New Zealanders clearly want.”

“Through her High Court case, Lecretia hoped to raise awareness of the appropriateness of physician assisted dying legislation in some form,” he says.

The debate about euthanasia was back in the headlines last week when the results of a study of General Practitioners was released, showing some had made decisions likely to hasten the death of their terminally ill patients.

The study was published in the New Zealand Medical Journal and asked 650 GPs about the last death they’d attended.

There seems to be everything that’s needed except any political will to address euthanasia.

And Stuff reports: Doctors and nurses more involved in patients’ ‘end-of-life’ decisions – study

A University of Auckland study anonymously surveyed 650 GPs.

Sixteen reported prescribing, supplying or administering a drug with the explicit intention of bringing death about more quickly.

But in 15 of those cases, it was nurses who administered the drugs.

Researchers acknowledged the actions of the GPs would generally be understood as euthanasia, but the survey did not use that term.

In the survey, led by Auckland University senior lecturer Dr Phillipa Malpas, GPs were asked about the last death at which they were the attending doctor.

Of the 650 to respond, 359 (65.6 per cent) reported that they had made decisions, such as withdrawing treatment or alleviating pain, taking into account the probability that they may hasten death.

Some made explicit decisions about hastening death.

Of the 359, 16.2 per cent withheld treatments with the “explicit purpose of not prolonging life or hastening the end of life”.

A total of 316 doctors gave pain medication taking into account that death might come sooner, but it was not the intention. Rather, the doctor may have taken the decision to make the dying patient more comfortable in their final hours.