Oral Submission to the Justice Select Committee on the End of Life Choice Bill
The Nathaniel Centre – the NZ Catholic Bioethics Centre
11 June 2018
The Bill being considered seeks to legalise both euthanasia and assisted suicide – we use these terms because legally and ethically they are the most precise, but for the purposes of this submission we will use the term EAS to refer to both.
We are strongly opposed to the EOLC Bill – it has many problems which are covered in our written submission. These include:
- Imprecise terminology
- Misunderstanding of the well-accepted ethical distinction between giving pain relief which may inadvertently shorten a life vs the intentional ending of a life using lethal medication
- Broad and vague criteria around eligibility
- Unbearable suffering is determined against subjective measures
- An absence of effective safeguards, particularly measures to detect and prevent coercion
- A naïve promotion of individual choice that fails to recognise the critical difference between choice and autonomy and fails to consider the broader social consequences of EAS
- Potentially negative consequences for those with mental illness and persons with a disability
- The unnecessary inclusion & involvement of doctors
In addition, it is increasingly apparent that, in places where euthanasia is available, the practice is contributing to a disturbing new norm around dying. Thus, Professor Theo Boer, a former member of a Dutch Review Committee and long-time supporter of assisted death has now “become increasingly hesitant to advise countries to legalize physician assisted dying”. He writes about “a gradual shift” where EAS has gone from being an act of “last resort” to becoming a “default way to die.” This is evident in the year-upon-year significant increase in numbers which belies the claim that these laws can be restricted to the so-called ‘difficult cases’.
Even in Oregon, where numbers are relatively speaking much lower than in Belgium or the Netherlands, there is, annually, a steady and steep climb in the numbers.
We have reflected on the arguments commonly used to promote EAS. We think the strongest argument coalesces around the hard cases that are routinely held-up by proponents of EAS. We understand there are those, MP’s included, who feel the need to somehow provide a ‘small back door’ for the “small but significant group” of people (and that’s a phrase from the Explanatory Note of the Bill) who fall into that category.
Putting aside for a moment the question as to whether it is even possible to safely create a small back door, and we doubt it is possible, it is obvious that the EOLC Bill will not provide this. Why? Because the very broad eligibility criteria, combined with the subjective calculation of unbearable suffering and the use of vague terms such as “advanced decline” will, in practice, create a ‘four-lane motorway’ access to assisted death in New Zealand for a very broad range of people. We argue this will in practice include people with depression and mental illness and other people who are not imminently dying.
Interestingly, and concerningly, we note that various submitters who have already presented to you were reported as arguing that the Bill in its current form is far too narrow!
We reject, in the strongest possible terms, the idea that, quoting again from the Explanatory Note, “evidence and developments have established that there are serious problems with the current state of the law in New Zealand.” ‘What evidence?’ we ask? ‘What developments?’
That is not to say that there are not people who are still experiencing bad deaths, deaths with unnecessary pain or suffering. Yes, things need to get better. Palliative care is great for those who can access it, but is not equally or equitably accessible. There is a problem, but EAS is not the ethical or caring answer.
We want to leave you today with two words: ‘TAKE CARE’. These two, simple words have a rich and multi-faceted meaning in the context of this debate.
- TAKE CARE as in, ‘be wary’ – step very carefully. This Bill is not what it seems. If EAS is considered a reasonable response to self-defined suffering, including existential suffering, then it must expand to include the suffering of others such as children, those with mental illness and those unable to give consent. Peer-reviewed research shows that safeguards overseas are not effective and that the laws are routinely violated – cases not reported and people euthanised without giving consent. Why would it be different here?
- TAKE CARE as in, let’s show nothing other than EXQUISITE CARE to those in our society who are most vulnerable and most dependant. We know, to our shame, that more and more of our elders are experiencing social isolation. We know loneliness is a predictor of poorer health outcomes, including depression. We know that even mild depression, which can be hard to detect, can skew people’s perceptions of their worth and desire to live. We know elder abuse is on the rise, despite everyone’s best efforts to prevent it, and the problem with elder abuse is not a weak law. There has never been a more dangerous time to implement assisted death in New Zealand.
- TAKE CARE as in, let’s promote a cultural shift in our society so that those who need to be cared for are empowered to accept care from others - indeed to see such care as their right. In real life, people with life-limiting illnesses veer between hope and despair – the desire to prematurely end one’s life is a fluctuating one. They may be afraid of how their illness will develop and what suffering it may bring. Many are worried about the impact of their illness on those around them, inevitably expressed in terms of ‘not wanting to be a burden’. It is of great concern that the fear of being a burden is increasingly becoming a part of our social narrative. People need hope above all – this Bill does the opposite by confirming people’s worst fears, including the fear of being a burden.
- Finally, TAKE CARE as in, take care of our medical system by keeping EAS right out of healthcare. Assisted death is not part of medical care. It will introduce a whole new negative dynamic into the doctor-patient relationship. If you really want to introduce an assisted death regime in New Zealand, at least keep it out of medicine. Doctors are not necessary for such a regime and do not want to be part of this. EAS violates medical ethics. It is opposed by all the major medical associations in New Zealand such as NZMA, ANZSPM and Palliative Care Nurses as well as Hospice NZ. As the NZMA noted in their written submission to this Committee, we should not ask doctors to be ‘life takers’ as well as ‘life savers’.
To conclude: This Bill will contribute to making NZ a less inclusive society for those who are least functional and most dependant on others for care.
Is this really the sort of society we want? We can do better when it comes to providing and delivering good quality palliative care at the end of life. We need to do better, especially when it comes to valuing our elders. We need to challenge the narrative ‘better off dead than disabled’ rather than buy wholesale into that narrative which is what this Bill does.
Were parliament to make EAS legal in New Zealand right now, it would be neither safe nor, after a relatively short time, would it be rare.