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.

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