Facebook in ethics face-off
Sue Buckley and John Kleinsman
The publication of a research paper that investigated the "emotional contagion" of 700,000 randomly selected Facebook users received extensive publicity recently because of the methods used by the researchers.
Two groups of Facebook users had their news feeds manipulated with a view to assessing its impact on their emotions. In one group, exposure to friends' positive emotional content in their News Feeds was reduced; in another group exposure to friends' negative emotional content was reduced. The effect on the participants was then measured by examining the emotionality of their status updates.
In explaining their project, the researchers stated that they used word-counting software, which meant that original posts were not viewed by them. As such, they considered that it was consistent with Facebook's Data Use Policy to which all users agree. They further claimed that the Data Use Policy precluded the need to seek additional consent from the study group. In addition, it was later claimed that as the experiment was conducted by Facebook for internal purposes, there was no obligation to "conform to the provisions of the Common Rule" which protect human research subjects.
However, there has been widespread questioning and criticism on the grounds that the researchers failed to obtain adequate informed consent from the unknowing participants. In response, one of the research authors appealed to the need for the research to take place: "We felt that it was important to investigate the common worry that seeing friends post positive content leads to people feeling negative or left out. At the same time, we were concerned that exposure to friends' negativity might lead people to avoid visiting Facebook." He also stated: "... our goal was never to upset anyone. I can understand why some people have concerns about it, and my coauthors and I are very sorry for the way the paper described the research and any anxiety it caused."1 However, he conveniently fails to address the issue of informed consent.
So, if the intention of research is never to upset anyone, if there is little reason to expect that it might be harmful and if there is a good reason for undertaking it, why is it important to gain informed consent? In answering this question it must be remembered that the Facebook researchers were not just observing behaviour but were specifically aiming to manipulate the emotions of the participants by an intentional intervention. As one commentator noted: "The study harmed participants, because it changed their mood".2
It is a well-established principle within research ethics that any research involving an intervention requires fully informed consent and should be overseen by an ethics committee independent from both the researchers and the organisation or company instigating the research. This means that participants should (1) know they are being experimented on; (2) be given clear information about the research; and (3) be informed of both the risks and benefits. The only exception to this would be in circumstances where, for various reasons, participants are unable to give consent, in which case consent must be sought from someone legally entitled to provide consent for them.
The history of 'informed consent' in research goes back to the Nuremberg Code of 1947, developed after the Nuremberg trials at the end of the Second World War. These trials exposed research by Nazi doctors on Jews which included the murder and torture of the participants, all done without consent. Since that Code was developed there have been numerous and serious instances of unethical research where consent was not obtained, including the 'Unfortunate Experiment' at National Women's Hospital in Auckland where the conventional treatment for carcinoma in situ (CIS) was withheld from some women without their knowledge. It is worth noting that the researcher, Dr Herbert Green, had no intention of harming anyone and felt it was important to test his theory that women were being over-treated.
Even if Dr Herbert Green's theory had been right, the fact remains that his research would still have been unethical because informed consent was not obtained. Participants in research always have a right to know the risks they are exposed to and, even more fundamentally, a right to know that they are involved in interventional research. There was also a lack of independent oversight of Green's research.
Research can never be judged to be ethical on the basis of its intended outcome alone. Neither does a good outcome justify an unethical research process. Good research is always ethical from its inception. No interventional research should ever be undertaken without informed consent. The Facebook research clearly went beyond benign, anonymous, observational monitoring, which meant it required informed consent. Neither was it subject to any sort of independent scrutiny. Even if it is true that the risks for the Facebook experiment were low, there is an important principle at stake here, which must be upheld.
In the same way that stealing is stealing no matter what amounts are involved, so we all have a right not to be experimented on without our knowledge whatever the nature of the research.
Sue Buckley is a researcher for The Nathaniel Centre and John Kleinsman is director of The Nathaniel Centre
1. Kramer, Adam D.I. Facebook post, June 30th 2014. https://www.facebook.com/akramer/posts/10152987150867796
2. James Grimmelmann, professor of law at the University of Maryland, quoted in the Guardian, 30 June, 2014. http://www.theguardian.com/technology/2014/jun/30/facebook-emotion-study-breached-ethical-guidelines-researchers-say
The Trans-Pacific Partnership and issues of social justice
That a marvelous order predominates in the world of living beings and in the forces of nature, is the plain lesson which the progress of modern research and the discoveries of technology teach us. And it is part of the greatness of man that he can appreciate that order and devise the means for harnessing those forces for his own benefit... Yet there is a disunity among individuals and among nations which is in striking contrast to this perfect order in the universe.1
– Pope John XXIII
In theory, patent law 'harnesses the forces' of knowledge and innovation by creating an incentive to invent and by providing for both the protection and dissemination of information, for the benefit of society. Indeed, translating an invention into a patentable product can be a long, complicated and expensive process. Imitating or replicating the product of invention, on the other hand, is relatively cheap and easy, and undermines this innovation process. Therefore, by imposing temporary restrictions on access to and use of information and ideas, patenting gives people an incentive to innovate and to publish their invention. The assumption is that because this stimulates research and development and enriches the public domain with knowledge and technology, it is to the benefit of all.
In reality, however, a property-based understanding of justice and an emphasis on patentability rather than practicality creates 'disunity among individuals and among nations'. Goods and services, including medicine and health care, become transactional resources, and socio-economic development becomes a disturbing reproduction of inequality, as resources are available only to those (individuals and/or nations) who can afford them. Our existing international agreements perpetuate these problems. The proposed Trans-Pacific Partnership Agreement (TPPA), as leaked, will exacerbate them even further.2
So what exactly is the problem with a property-based conception of justice? According to John Locke, "The great and chief end...of men's uniting into commonwealths, and putting themselves under government, is the preservation of their property."3 Preceding Locke, Galileo foresaw the importance of this preservation of property specifically in the context of innovation: "It does not suit me that the invention, which is my property and as created by me with great effort and cost, should become the common property of just anyone..."4. Therefore, the concept of exclusive property is central to our sense of society and individual freedom, indeed even justice.
However individual rights are never absolute, and to claim that a patent confers upon the owner an absolute and unfettered right to use its intellectual property (IP) as it wishes, "is no more correct than the proposition that use of one's personal property, such as a baseball bat, cannot give rise to tort liability"5. Herein lies the central problem. A property-based conception of justice legitimises inequalities, on the basis of a welfare maximisation calculus that does not account for different circumstances, nor issues of accessibility and redistribution. Rather, this calculus assesses feasibility in terms of a net increase to welfare and to the quality of health care; indiscriminate as to whom this increase benefits or disadvantages and, as a result, it is the underprivileged that continually miss out.
To qualify for protection as a patent, an invention must be new, non-obvious and useful. The modern emphasis on technological advancement has, however, encouraged legislators, IP offices and the courts to interpret this so as to maximise eligibility for patenting and, therefore, further foster innovation. Thus, these rights become both easier to obtain and more readily sought, and their quality and value diminishes. It leads to premature patenting of whole gene sequences and genetic substances, for example, in exchange for information that is limited and incomplete. Ultimately, this overcompensates patent-holders and undermines technological and social development, which is the supposed rationale for patenting.
The emphasis on patentability, and patent protection as the ends, also creates inefficient races between potential patent-holders, particularly in profitable areas, leading to unnecessary duplication of research, and wasted resources. More significantly, this reflects the fact that profitability is the stimulus for innovation, such that medicines for rare diseases, and for those among lower socio-economic groups are not developed. This creates classes in terms of the availability of medicine and health care, and increases inequalities. Patents become a tool for large corporations to advance their economic growth and establish market dominance, rather than an incentive for socially valuable research.
This represents an inequitable bargain between society and patent-holders, one that is inevitably in favour of powerful stakeholders and their private economic interests. The principles of social justice, on the other hand, dictate that we should treat property and IP not as the foundation of society and justice, but as a tool for achieving a sustainable society of justice and equality. In practical terms this means accounting for different needs and circumstances through flexibility, and restricting the power and control of patent-holders, whereby their rights are confined within fixed parameters and better balanced with their duties.
The existing Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), an international agreement on minimum IP standards, attempts to reach a compromise between developed and developing countries, providing for the flexibility and fixed parameters envisioned above, at least on paper. The problem is, it assumes free and informed consent on the part of all its members as if they all have equal negotiating power, and as if the interests of all members are communicated by effective and representative democracies. It also assumes that members will be able to use these measures for flexibility freely, and without fear of tariffs and trade sanctions. Moreover, it assumes that future trade agreements will not further undermine these measures.
In reality, however, these [measures] are given the absolute minimum consideration by the community of people who interprets them. Developed countries and multinational corporations are putting strong pressure on developing countries wanting to use TRIPS' flexibility and, above all, are negotiating bilateral and regional free-trade agreements to impose more severe and contingent IP standards than those outlined in TRIPS.6
The Doha Declaration, in response, offers a more equitable and truly flexible approach to TRIPS and international IP law, with a domestic needs perspective. But this is only another step in the right direction. And now, the proposed TPPA threatens to negate these steps towards a more fair and sustainable approach. It does not do so by imposing stricter standards on those developing countries considered above (they are not party to the TPPA), although it will have the effect of putting pressure on them, but rather by undercutting TRIPS and its value for these countries, and by increasing the power of those (countries and corporations) whose interests subordinate these countries.
The first (leaked) draft of the TPPA omitted any mention of the Doha Declaration, and the second (leaked) draft makes only brief and heavily qualified reference to it, which does not inspire confidence. This is particularly concerning in light of the proposed expansion of the scope of patenting. Such expansion, as proposed largely by the United States and Japan, could prevent parties from denying protection if "the product [does] not result in an enhanced efficacy of the known product when the applicant has set forth distinguishing features"7. This is cause for more concern in terms of the quality and value of patents. More fundamentally, however, a wider scope for patent protection does not by any means create any further opportunities for developing countries to enjoy the benefits of IP and innovation. Instead it again favours those who already have the wealth and resources to expand, reinforcing the existing inequalities.
The good news is that, according to the leaked documents, New Zealand opposes proposals (such as that above) for significant expansion of patent protection8. The bad news is that our representatives, and those of the other parties, continue to discuss the TPPA behind a shroud of secrecy that thwarts public discussion and participation. Further bad news is that these negotiations, like those concerning TRIPS, are characterised by a typical disparity in bargaining power that ultimately serves the interests of the more powerful (countries and corporations). To the extent that this subordinates the interests of developing countries and stifles their economic growth, our involvement only supports such injustice.
A number of commentators have highlighted the fact that the TPPA poses potentially serious consequences for New Zealand, in terms of pricing and availability of medicine and health care, and bargaining power for purchasing pharmaceuticals. While this is a real concern, we should indeed be equally (if not more) concerned about the significant threat to global health care and equality, or at least the steps already made towards equality. The clear emphasis on property, patentability and profit ignores those whose needs are not voiced by purchasing power and instead serves those whose interests are largely private and economic.
By individualizing creation, by disembedding it from the social milieu from which all knowledge is drawn, intellectual property rights deny the importance of the public realm, and by doing so reward only a small group of rights holders rather than the carriers of social knowledge, and, more importantly, ignoring the social welfare benefits of those excluded from use, not by ignorance or lack of interest, but by their poverty.9
While it might be argued that we need more empirical evidence to prove the positive correlation between patent protection and innovation, we need no further evidence, as Pope Francis reminds us, for the fact that "each meaningful economic decision made in one part of the world has repercussions everywhere else; consequently, no government can act without regard for shared responsibility"10. We must understand the ramifications of the TPPA not just for New Zealand but also and above all for developing countries that are not party to this agreement. We must encourage our government to act with transparency and integrity, and with regard for the significant global concerns for which we share responsibility.
Daniel Kleinsman LLB, completed his Law Degree at Victoria University of Wellington in 2014. He has experience in the area of intellectual property law.
John XXIII, Pacem in Terris, http://w2.vatican.va/content/john-xxiii/en/encyclicals/documents/hf_j-xxiii_enc_11041963_pacem.html. Accessed 20 March 2015.
WikiLeaks, https://wikileaks.org/tpp-ip2/, accessed 20 March 2015.
 John Locke, Second Treatise of Civil Government: The Ends of Political Society and Government (1690), Chapter IX.
 Cited by R Hewitt Pate, Competition and Intellectual Property in the US: Licensing Freedom and the Limits of Antitrust, p 60.
United States v. Microsoft Corp., 253 F.3d 34 (D.C. Cir. 2001).
Louise Bernier, Justice in Genetics: Intellectual Property and Human Rights from a Cosmopolitan Liberal Perspective (Edward Elgar, 2010), p 139.
Wikileaks, https://wikileaks.org/tpp-ip2/, Article QQ.E.1: Patents / Patentable Subject Matter
Ibid., (see also Paper submitted by NZ on IP Proposal: http://www.citizen.org/documents/NZleakedIPpaper-1.pdf).
Louise Bernier, Justice in Genetics: Intellectual Property and Human Rights from a Cosmopolitan Liberal Perspective (Edward Elgar, 2010), p 111.
Francis, Evangelii Gaudium: http://w2.vatican.va/content/francesco/en/apost_exhortations/documents/papa-francesco_esortazione-ap_20131124_evangelii-gaudium.html. Accessed 20 March 2015
Creating Welcoming Churches: a disability resource for faith communities
Rev. Vicki Terrell
Whether someone comes to church as a casual visitor or is part of the regular congregation, the environment needs to be welcoming. “Creating Welcoming Churches a disability resource for faith communities” (CWC) is a practical guide on how to make church environments more accessible to all people including people living with disability. It was launched in Auckland and Wellington late last year, 2014. The book was made possible through funding from the Joint Special Project Fund of the Association of Presbyterian Women and Methodist Women’s Fellowship in 2013.
CWC was produced by the Disability, Spirituality and Faith Network Aotearoa New Zealand which has strong links both in the church and the disability communities. Most people within the network have (lived) experience of disability. We are passionately committed to making the church a place where all people are affirmed as having gifts to share because we are all made in the image of God.
CWC came from the desire to have a practical book about access to help churches become more welcoming to disabled people. Originally it started with someone asking whether the“Holy, Wholly Accessible” document, produced for the Anglican Diocese of Wellington in 1998, could be reproduced for other churches.
While agreeing in principle that this was good idea, the project grew as we realised that there had been other books published since 1998and the thinking around disability had changed rapidly in the last 15 years. The challenge thenbecame what would make this book new as well as useful for faith communities.
The rise of the social model of disability (as opposed to the medical model) and the United Nations Convention on the Rights of People with Disabilities, have helped people to understand thatmany barriers faced by disabled people are in the environment and in theattitudes of others. These barriers hinder the full and effective participation of people with disability in society on an equal basis with others.
For many in the group, much of the traditional theology linking disability with healing was problematic. Some people in the group wanted the book to reflect current thinking in the disability sector that communities need to be inclusive environments where all people are welcomed and valued for who they are. In the introduction to CWC the writer interweaves current thinking on disability and inclusion with theological reflection.
The theology of accessibility underpins the entire book. The two basic tenets are
- All people are made in the image of God
- People who follow Christ are called to serve and be served as members of Christ’s body.
The challenge becomes how does the church welcome and enable each member to fulfil their ministry.
The “Information, attitude, action” section has lots of practical suggestions for making buildings, liturgy and community events accessible. While assisting disabled people, many of the suggestions help other people, particularly children and immigrants, to participate more fullyin ministry.
There is advice on interacting with people with disabilities, their equipment and service animals. Much of this information was gathered from people active in the church who have a lived experience of disability. Becoming totally accessible is hard and the book may have errors and shortcomings and we invite critical comments so we can incorporate new learnings in further editions.
Real (life) experiences are highlighted in the book through quotes from disabled people about their experiences in a particular church. There are also stories of churches being welcoming to disabled people. Some are about physical changes which have been made and others reflect on the presence of disabled people in their congregations.
The book has been well received by churches because it addresses theology and practical issues in a clear and concise way alongside personal stories. Many people have commented on the clear layout and how easy it is to follow. There are alreadysigns that some people are thinking differently because of the book. It gently challenges some of the patronising attitudes and encourages a respectful engagement with disabled people as people made in the image of God.
I have been pleasantly surprised by the enthusiasm of the disability sector for this book. It has sparked interesting conversations and people working on disability/accessibility areas outside the church have asked for copies. The time spent in careful consideration of the changes in disability thinking and the emphasis on inclusion has paid off because it has credibility in the disability community. There is a real gap in practical resources for community groups who want to become more accessible to all including disabled people. The usefulness of this book goes beyond the church and it maybe a gift to other community groups who are trying to become more accessible to all people particularly disabled people.
Rev Vicki Terrell is an Anglican priest in the Diocese of Auckland and the writer and researcher for Creating Welcoming Churches. Her commitment comes from the two main strands in her life: Christian faith and lifelong impairment.
Copies cost $15 including postage.
Euthanasia polls: What do they really tell us?
In recent years, various polls seeking the views of the New Zealand public on euthanasia and assisted suicide have consistently reported that 60-70% of people support their legalisation,1 leading Horizon researchers, for example, to conclude that “Supporters of end of life choice … form a strong majority”2 in New Zealand and the Voluntary Euthanasia Society (VES) to state with confidence that “most New Zealanders support aid-in-dying legislation.” 3
The terminology and questions used in such polls are, however, rarely analysed and the results of these polls are rarely dissected or challenged. All of which means that the conclusions we draw from them need to be treated with caution. As Marcoux et al noted in 2007: “… the use of the argument that public opinion is in favour of euthanasia to support changing laws must be critically examined. There are methodological problems in the wording of survey questions that can bias responses, and the validity of responses may be compromised by pervasive misunderstandings of what euthanasia means.” 4
This article will seek to shed some light on the strengths and limitations of a number of polls carried out in New Zealand and around the world with a view to offering a more nuanced analysis.
A number of overseas polls have shown that people’s willingness to support the legalisation of assisted suicide and/or euthanasia depends on the language employed in the questions – specifically whether ‘softer’ or euphemistic descriptions such as ‘medically-assisted dying’ are used rather than those containing alternative technically correct terms such as ‘suicide’.
For example, a 2005 poll carried out by the Pew Research Center for the People and the Press reported: “The survey found that 44 percent of respondents favored making it legal for doctors to ‘assist terminally ill patients in committing suicide’ when the question was worded this way. But support for the practice rose slightly, to 51 percent, when people were asked if they favor making it legal for doctors to ‘give terminally ill patients the means to end their lives.’”5 A 2005 Australian study which investigated cancer patients’ views on euthanasia and physician-assisted suicide likewise concluded that “professed support can depend upon the individual’s own definition, the language used in questions and the specificity of questions.” 6
Similarly, a 2013 Gallup poll found “70% of Americans in favor of allowing doctors to hasten a terminally ill patient's death when the matter is described as allowing doctors to ‘end the patient's life by some painless means.’ At the same time, far fewer – 51% – support it when the process is described as doctors helping a patient ‘commit suicide’.”7
A lack of consistency in the terminology used, as well as a propensity by of many pollsters to use softer language, characterises many New Zealand polls.
The 2005 Australian study referred to above also demonstrates that many poll respondents who profess support for assisted suicide and/or euthanasia do not understand the distinctions between these and withholding or withdrawing treatment. “Researchers need to be circumspect about framing and interpreting questions about support of ‘euthanasia’, as the term can mean different things to different people, and response may depend upon the specifics of the question asked.”8 In this study, interestingly, “79% of patients said they supported the idea of euthanasia, and 70% agreed ‘a doctor should be able to assist a patient to die’, [yet] 80% did not agree that ‘doctors should be able to kill their patients’.” 9
When terms such as ‘medical aid in dying are used’ the confusion is even greater. A 2013 Canadian survey by Ipsos Marketing, for example, specifically set out to assess what was understood by the people who supported ‘medical aid in dying’. This survey showed one third of Quebecers interpreted the phrase as being a patient’s request for lethal injection by a medical professional, while nearly 30% understood that it meant relieving symptoms through palliative care. Finally, nearly 40% of those surveyed associated it with a discontinuation of intensive medical treatment, or with assisted suicide. The researchers then concluded: “It is therefore essential to clarify applicable terms and tangibly convey the true definition of euthanasia, and avoid using even vaguer expressions such as ‘medical aid in dying’.” 10
Real World Scenarios
A further challenge when interpreting public opinion polls arises from the fact that the nature of the question or questions asked means that the views of respondents are often based solely on hypothetical scenarios.
Emanuel et al11 illustrate this clearly in their 2000 investigation into the attitudes of terminally ill cancer patients. While 60.2% of the participants supported euthanasia in a “hypothetical” situation, only 10.6% indicated that they would seriously consider euthanasia or physician assisted suicide for themselves. This result accords with an earlier study in which it was noted that people’s responses change according to the amount of detail they are given about personal circumstances – the proportion of the general public who agreed with euthanasia for unremitting pain was 66% but this dropped to 49.2%, 36.2% and 29.3% respectively for the categories “functional debility”, “burden on family” and “view life as meaningless”.12
Similarly, in a 2014 Comres/CARE poll carried out in the UK, 73% of those polled indicated support in principle for a Bill designed to enable mentally ill competent adults in the UK who are terminally ill and with a clear and settled intention the right to be provided with assistance to commit suicide by self-administering drugs.13 However, when those who supported assisted suicide in principle were offered a series of practical considerations (such as people feeling pressured so as not to be a burden and the steady rise of numbers in jurisdictions where it is legal), a large proportion, 42% of them changed their minds on the basis of at least one of the arguments. When these figures were added back into the original sample, aggregating all who opposed as a result of the arguments presented while incorporating all who still supported assisted suicide in spite of the arguments, the final result was 43% in favour, 43% opposed and 14% don’t know.
Meanwhile in New Zealand, close scrutiny of the 2012 Horizon Poll already referred to (which shows that 62.9% would support “mentally competent adults in New Zealand to receive medical assistance in ending their life if they are suffering from a terminal illness or an irreversible physical or mental condition that in their view renders their life unbearable”) reveals that people’s support is heavily premised on the need for, and belief in the effectiveness of, strict controls. As the researchers note: “The need for strict controls, like those measured in the survey, is demonstrated by support for them exceeding support for end of life choice overall.”14 As far as this poll goes, therefore, the more adequate and honest conclusion to draw is that 62.9% of New Zealanders believe in receiving medical assistance to end their life on the assumption that harms to others can be prevented by strong and effective safeguards. In the face of international evidence that safeguards are problematic and ineffective15, it is less than honest to use this poll to claim, as the Voluntary Euthanasia Society of New Zealand do, that most New Zealanders would in reality support euthanasia or assisted suicide legislation.
The 2012 Horizon Poll demonstrates that the willingness of New Zealanders to support euthanasia or assisted suicide in New Zealand is premised on an assumption that strict and effective controls can be put in place. Overseas research challenges this assumption; moreover, when polls include additional information about the complexities and risks, the numbers of people prepared to support a law change drops significantly. Overseas research also shows that people often fail to understand the terminology being used as well as the ethical distinctions between euthanasia and/or assisted suicide and withdrawing or withholding treatment.
Because most of the New Zealand polls relied on and quoted by proponents of change have failed to provide the level of nuanced questioning and information that would be required to confidently say their results are reliable, it is incorrect to say that “most New Zealanders support aid-in-dying legislation”16 or to assume that this reflects people’s informed views on euthanasia.
As our Prime Minister Hon John Key, who has previously declared his personal sympathy for a law change, noted recently: “Striking the right legislative balance with both clear definitions and adequately strong protections is an extremely difficult task, and that no bill has yet passed on this issue is testament to that.” 17 A true indication of New Zealanders’ support for euthanasia or assisted suicide will only be possible if and when polls take proper account of people’s understandings of the definitions and complexities associated with the practice of euthanasia and/or assisted suicide.
Dr John Kleinsman is the director of The Nathaniel Centre
 See “Legalisation of Euthanasia in New Zealand: Surveys in New Zealand” at http://policyprojects.ac.nz/jasonrenwick/surveys-in-new-zealand/
 See, for example, Horizon Research, "New Zealanders' views on End of Life Choices," (Auckland, New Zealand2012). at http://www.horizonpoll.co.nz/attachments/docs/horizon-research-end-of-life-choices-survey--1.pdf, accessed 1 May 2015.
 Marcoux, Isabelle, Brian L Mishara and Claire Durand (2007) “Confusion between euthanasia and other-end-of-life decisions: Influences on public opinion poll results” Canadian Journal of Public Health 98: 238.
 See: “The Right-to-Die Debate and the Tenth Anniversary of Oregon’s Death with Dignity Act” at http://www.pewforum.org/2007/10/09/the-right-to-die-debate-and-the-tenth-anniversary-of-oregons-death-with-dignity-act/, accessed 17 August 2015.
 Parkinson L et al. Cancer patients’ attitudes towards euthanasia and physician-assisted suicide: the influence of question wording and patients’ own definitions on responses. J. Bioethical Inquiry 2005, 2: p. 88.
 Gallup, "U.S. Support for Euthanasia Hinges on How It's Described," (Washington2013). at http://www.gallup.com/poll/162815/support-euthanasia-hinges-described.aspx
 Ibid., p. 82.
 Ibid., p. 88.
 Ipsos Marketing, "Survey among the Canadian population about end of life issues," (Canada: Ipsos Marketing, 2013), p. 5.
 Emanuel EL, Fairclough DL & Emanuel L. “Attitudes and desires related to euthanasia and physician assisted suicide among terminally ill patients and their caregivers.” JAMA 2000 284:2460–2468.
 Emanuel EJ, Fairclough DL, Daniels ER, Clarridge BR. "Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public." The Lancet 347(1996).
 ComRes, "Care - Assisted Suicide Poll," (United Kingdom2014). at http://www.comres.co.uk/wp-content/themes/comres/poll/Care_Assisted_Suicide_Poll_July_2014_(with_summary_table).pdf
 Ibid., p. 4, emphasis added.
 See, for example, Golden M, and Zoanni T. "Killing us softly: the dangers of legalizing assisted suicide," Disability and Health Journal 3, no. 1 (2010); Dr David Jeffrey quoted in Health and Sport Committee, "Stage 1 Report on Assisted Suicide (Scotland) Bill," The Scottish Parliament, http://www.scottish.parliament.uk/S4_HealthandSportCommittee/Reports/her15-06w.pdf at para. 175;Barron H. Lerner and Arthur L. Caplan, “Euthanasia in Belgium and the Netherlands. On a Slippery Slope?” JAMA Intern Med. Published online August 10, 2015.
 Email sent to writer on behalf of the Prime Minister,
Editorial: Euthanasia, democracy and public policy – lessons from the abolition of capital punishment
When capital punishment was finally abolished in 1961 (see article in this issue), the abolitionist cause represented a minority view in New Zealand; fewer than one-third of people supported it. As Leon Gotz proclaimed: “In demanding the punishment for these vile crimes should be the forfeiture of the offender’s lives, I am expressing the opinion of the majority of New Zealand.”1
Robert Muldoon was one of ten National MPs to cross the floor and support abolition. At the time he acknowledged: “Abolishing capital punishment was contrary to popular opinion and the majority of people in New Zealand are not ready to accept it. However, Parliament should give a lead to public opinion.”2
Controversial issues such as capital punishment, and in our time euthanasia and assisted suicide (EAS), give us pause to reflect on the nature of democracy and, specifically, the role of MPs in shaping public policy. Gotz and Muldoon represent two very different approaches to understanding the nature of parliamentary leadership: (i) following closely the opinion of the public and voting according to popular opinion (taking the lead from one’s constituents) and (ii) voting according to one’s carefully formed and well researched views, taking account of but not being swayed by the opinion of the majority while being willing to vote against public opinion if one’s conscience dictates.
Put simply, the latter approach is premised on a belief that the formation of public policy should not be reduced to measuring public opinion. To paraphrase Muldoon: there are times when MPs should give a lead to public opinion. In a democracy such as ours, where 64 out of the 120 seats are electorate seats, this second approach to leadership is potentially costly at election time and will, therefore, demand of our MPs a high level of personal integrity and courage.
Reflection on the issues and challenges that MPs faced when dealing with the issue of capital punishment generates valuable insights for the current debate about EAS.
- Proponents of EAS repeatedly appeal to public opinion as a reason for changing the law. Their assumption is that majority public opinion is enough to determine public policy. In 1956, the Prime Minister Rt Hon Sydney Holland proposed that the issue of capital punishment be submitted to a referendum as a solution to the continued politicisation of the issue: “let us trust the people … Let us take it out of the hurly-burly of politics”. In response, Labour argued strenuously that capital punishment should be left to parliamentary responsibility; the issue was too complex and required dispassionate consideration. Many argued a referendum was inappropriate because emotions could be stirred up by a particularly brutal or nasty crime just before a referendum creating a serious bias. In a similar way, presentation of the high-profile, difficult cases can generate emotions that obscure people’s ability to take full account of the broader questions relating to the legalising of EAS.
- As was the case with capital punishment, media presentation of the issues surrounding EAS shows a distinct bias towards legalisation. Just as particular crimes became a focus for those arguing against abolition, so the media stories surrounding EAS have mostly focused on the single, emotive cases. For a more balanced and robust discussion to happen, there needs to be a deeper and more balanced exploration of the likely effects on society as a whole. The Justice Department report on capital punishment finally argued a ‘moral’ case against the death penalty; that on balance respect for human life was best protected when the law forbade it. The same argument can be made about EAS.
- The reinstatement of the death penalty in 1950 meant that the effects on those involved in the hangings began to be noticed; for many the impact was significant, taking an emotional and physical toll. These side effects were not necessarily immediate. Likewise, when considering the case for EAS, we must take into account the impact on those who would have to facilitate it, including the negative effects it would have on the medical profession and the doctor-patient relationship.
- Many MPs were persuaded by the fact that if the justice system was subsequently discovered to have wrongly convicted someone, there could be no going back. In New Zealand we now know that at least one innocent person would have been hanged if capital punishment had not been abolished - Arthur Allan Thomas who was convicted of murder in 1971 but received a Royal Pardon in 1979. With EAS there is a high possibility that a diagnosis and/or prognosis will be wrong. The argument that one innocent life lost is sufficient to justify the abolition of capital punishment is even more relevant to the euthanasia debate because of the risk of large numbers of lives being prematurely ended.
We hope that the Health Select Committee investigation into EAS enables the sort of robust debate and parliamentary leadership that was exemplified by the MPs who dealt with capital punishment.
Dr John Kleinsman is the director of The Nathaniel Centre and Sue Buckley is a researcher at The Nathaniel Centre.
The abolition of Capital Punishment in New Zealand
Staff of The Nathaniel Centre
Capital Punishment and euthanasia have the manifest similarity that both concern the deliberate and state-sanctioned ending of life, which is why both also, quite rightly, are controversial issues. While the euthanasia debate is still current and appears in the media on a regular basis, Capital Punishment was finally abolished in New Zealand in 1961. The question this article raises is what we might learn from the way in which Capital Punishment was abolished that might enlighten the current euthanasia debate.
Much of the following history is drawn from a comprehensive study by Pauline Engel published in 1977, which tells the story of the abolition of Capital Punishment in New Zealand.
Abolition of Capital Punishment
There had been little questioning of Capital Punishment in New Zealand before the 1920s, and it was not until the election of the first Labour government in 1935 that the issue became political. The Labour Party was officially opposed to the death penalty and while the Labour Government did not immediately introduce legislation to abolish the death penalty it commuted all death sentences while in office.[a]
However, criticisms soon arose concerning judges sentencing people to hang while knowing it would not be carried out, leading to the government being accused of 'circumventing' the law. Then in 1940, a particularly brutal crime led to four men being sentenced to flogging. While the humanitarian elements in the Party found it unthinkable that such a sentence should be carried out, the Attorney-General was reluctant to remit the sentences without bringing forward legislation which he felt would have to cover both corporal and Capital Punishment. That an appeal against the severity of the sentence failed at the time is described by Engel as an indication of the adversity of the climate for abolition at this stage. However, with the caucus overwhelmingly in favour of a law change, a Bill was eventually introduced for the erasure of both flogging and hanging from the penal code.
Engel notes 'the reaction of the newspapers was almost universally unfavourable' and that 'almost every provincial daily pontificated in its editorial columns on the government's action in removing Capital Punishment and corporal punishment from the Statute Book, and scarcely any were complimentary'. Nevertheless, the Bill was passed entirely along Party lines, with no Government members speaking in favour of Capital Punishment and no Opposition members speaking in favour of abolition. Engel describes the debate as 'neither lengthy nor distinguished for anything save the incredible bathos of speakers on both sides of the House'. While most arguments against abolition focused on the deterrent value of Capital Punishment, one of the arguments against was that it could mean 'the menfolk might have to take the law into their own hands'.
Reintroduction of Capital Punishment
When the National Government came to power in 1949, there was immediately pressure to repeal. Engel suggests that the restoration of the death penalty by this Government in 1950 was not simply a matter of a more conservative, authoritarian government favouring Capital Punishment, but a more complex interweaving of social and political factors. There had been relatively few murders during Labour's first six years in office, but the murder rate had increased in the post-war years, culminating in the 'notorious Mt Victoria murder which appalled the Wellington community in 1948'. Grand juries throughout the country had been calling for the reinstatement of the death penalty and popular sentiment was in favour of it; it was widely held that the increase in murders was a direct consequence of abolition.
Although the Minister of Justice had called for a 'comprehensive report which would include statistics, philosophical and religious arguments for both sides of the case', Clifton Webb, the Attorney-General, made it clear that Capital Punishment would be reinstated without waiting for the contents of the report. In the debate on the Bill to reinstate Capital Punishment, Webb focused on the deterrence argument while H.G.R. Mason, the former Minister of Justice, concentrated on the moral aspects, rejecting the argument that hanging was necessary for the protection of women and suggesting that the move back to a retributive justice was a 'spiritual and moral relapse'. The Bill passed with members voting on Party lines, except for J. R. Hanan, the lone National Government member to speak against the Bill.
Nevertheless, when within a few months the Executive was faced with its first death sentence, it appeared anxious to find a reason for a reprieve. Fortunately for the government, the reports on the case suggested the prisoner's mental development was at a level to suggest he was not fully responsible. However, public reaction and the media suggested that 'if ever there was a case for hanging this is it', and the government was roundly accused of having 'cold feet'. When the next death sentence was imposed, 'the Executive could not risk a second retreat', even though it was clear that this case actually presented a weaker argument for execution. Commenting on this second case, one newspaper argued that while the prisoner was 'obviously a man of subnormal mentality', this was no reason that 'such an individual should survive as a burden on society'.
Over the next five years there were another seven executions as well as a number of reprieves, and Engel suggests it was often difficult to understand why, when murder cases were compared, some were not reprieved. In one case of a young man described as a 'bodgie'[b], tried and later executed for murder, the decision of the Executive to execute was considered to be influenced by reports that the 'bodgie lifestyle was an idle, violent and promiscuous one' and that it was necessary to make an example of this young man. Organised opposition to the death penalty over this time led to the development of a National Committee in 1956, partly as a consequence of one particular case where the prisoner's 'childish qualities and his socially deprived background' highlighted the inconsistencies around the reprieval decision-making process . Around the same time, a "Truth" article appeared, describing an execution in detail, ostensibly for the purpose of promoting the deterrent aspects of hanging, but having an ulterior motive of conveying to the public 'the sordid reality of hanging and to indicate the effect it had on many of those responsible for carrying it out'. The final paragraph of the article stated:
'Criticism of the method is not an argument against Capital Punishment. Murderers may deserve to die. It may be that the prospect of death does deter would-be murderers. What happens to them does not matter; what can happen to the people who have to hang them does.'
Effects of hanging on those involved
It was commonly claimed that the older prison officers who had been involved in and experienced hangings saw their participation as part of their duty; a duty which, while unpleasant, did not affect them deeply. One of these described himself and his generation of officers as having 'lived through the depression, seen active service overseas for some years during the last war, and been in German prison of war camps', experiences that 'toughened the spirit as well as the flesh'. In particular, Engel notes that 'they did not become emotionally involved in the execution process because they did not feel responsible for the decision which had been made to hang that particular person, although their professional position obliged them to carry out that decision. They did not feel that they were "inhumane" or "hardened", any more than a nurse or doctor who had become inured to much unpleasantness which would make the average lay person squeamish.'
However, while these officers were reportedly able to carry out their duty without too many after-effects, even if it took the experiences of a depression, war service and prison of war camps to achieve this, Engels notes that for the 'lay' officials the story was quite different; for at least some people, including sheriffs, prison psychologists, chaplains, and the prison Superintendent, the hangings had serious psychosomatic effects.
The first two sheriffs had breakdowns, due at least partly to their participating in executions; the prison doctor threatened to resign rather than participate in further executions; the prison psychologist wrote that his own feeling was one of 'complete revulsion' and that as he left the execution yard, felt that the hanged man was 'the only actor in the drama who came out of it clean'. The prison chaplain was infected 'with a peculiar horror so that he felt an almost irresistible urge to get as far away from the prison as possible at the time of a hanging – something he was rarely able to achieve'. The Superintendent of Mount Eden Prison had officiated in eight executions and although he was described 'as rough as guts, as tough as they come', resorted to drinking to get through the hangings and eventually suffered a major psychological breakdown.
From the mid-fifties, there was an increase in activity from the abolitionist movement and a referendum was proposed. This was opposed by some abolitionists on the grounds that the issue was too 'volatile' and too complex for a straight yes or no answer. J.R. Hanan and E.P. Aderman, the known abolitionists in government, and J.R. Marshall, a strong supporter of Capital Punishment, all supported a referendum, both sides thinking the public supported them. The two Wellington daily newspapers opposed a referendum, the Evening Post stating the question was 'not a subject for a decision by mass vote' and it would be 'wrong, clumsy and unsuitable' because many would wish to qualify their answers. The Dominion suggested that to conduct a referendum on any issue subject to emotion was bad policy: 'Impassioned appeals by abolitionists could stir up a fever far beyond the merits of their arguments. Similarly, a particularly fiendish or callous crime just before the poll could cause a public revulsion much stronger than the merits of the case for retention'. These sentiments, along with letters to local papers and submissions to Government led to the Prime Minister calling off a referendum. It would, if re-elected, legislate to provide the death penalty for 'the worst cases of murder' only.
Engel argues that a referendum would have without doubt supported Capital Punishment. 'Public opinion polls, except in Scandinavian countries, were consistently in favour of the death penalty' and in 1969 a United Kingdom survey reported that 'a substantial majority of men and women favoured the return of the death penalty for certain types of murder'. She suggests that New Zealand voters in 1957 would not have 'proved themselves more enlightened than their European and North American counterparts'.
After Labour won the 1957 election, the Attorney-General announced that it would follow its former policy of commuting the death sentence to life imprisonment. The Crimes Bill, introduced by the National government at the end of its term in 1957 and that dealt with Capital Punishment was shelved. When Labour then lost the 1960 election, the National Government that came in had abolitionist J.R. Hanan as Minister of Justice and Dr J L Robson, who also opposed to the death penalty, as Secretary for Justice. Hanan requested that Robson proceed with a ministerial report setting out the case for the complete abolition of the death penalty.
The report attacked the deterrence theory; suggested the death penalty ignored the principle of all punishment which was the reform of the offender; discussed the risk of an error in justice which could cause the execution of an innocent man; and stressed the 'great strain the process of execution imposed on officials, and detailed breakdowns in health which had occurred as a result'. The moral arguments against the death penalty were rounded off by John Bright's dictum that 'the best means of cultivating respect for human life were to refrain from taking it in the name of the law'.
When it was initially introduced, the Crimes Bill included a compromise clause which stipulated different degrees of murder. The intention behind this was that the death penalty would apply only for deliberate and premeditated murder, for homicide in the course of another crime or in flight from the law, where there was a previous conviction for murder, or a second murder. Hanan, however, argued that there was no 'compromise clause' that could be drafted that did not have serious flaws and indicated that another Member (Aderman) would be moving an amendment for total abolition of the death penalty which he would support. This amendment was subsequently passed with the support of the Opposition and ten Government members crossing the floor.
Engel notes that the reason for the Government Members crossing the floor was often attributed to the fact that they wanted to see the end of 'hanging by politics'. However, she suggests that this was not the real reason; Hanan and Aderman were long-term abolitionists whose motives needed no explanation. She suggests the others voted for a variety of reasons, including that the death penalty was not a deterrent to murder; that it was seen as 'the natural instinct of outrage, anger and the desire for revenge' (Muldoon); that it did not make sense when murder in 'the heat of the moment' received the death penalty or life imprisonment but when 'through inattention, carelessness or drink' someone kills in a motorcar, the event is not treated very seriously (Macintyre); the possibility of execution of an innocent person (Pickering); and that murder was usually the result of a 'twisted mind' that did not qualify for the death penalty (Talboys).
Steiner claims that in its 1961 report, the Justice Department recommended abolition primarily on the basis that the state could not legitimately take life as it could not be shown that its actions had a deterrent effect on the murder statistics. The report emphasised the comments of the (1958) Massachusetts Commission on Capital Punishment:
"The only moral ground on which the State could conceivably possess the right to destroy human life would be if this were indispensable for the protection or preservation of other lives. This places the burden of proof on those who believe that Capital Punishment exercises a deterrent effect on the potential criminal. Unless they can establish that the death penalty does in fact protect other lives at the expense of one, there is no moral justification for the State to take life."
In the years following the 1961 abolition of the death penalty there was little public enthusiasm for its reinstatement. Steiner mentions two National Party conference motions, one in 1961 to reinstate the death penalty, and another in 1976 to reintroduce flogging, which were both easily defeated. However, Steiner also notes that a number of opinion polls over the period 2004-2007, which may not be particularly reliable, appear to indicate that a significant number of New Zealanders would support reinstatement of the death penalty for some crimes. He notes that 'The continued sensationalisation of crime by the media has a lot to do with these findings. People are bombarded by images of the raw emotion from the victims and their families and informed of every sickening detail of the crime. The harsh reality of Capital Punishment is a million miles away from public consciousness, and it is easy to see why retributivist support for its practice lingers.'
Staff of The Nathaniel Centre
[a] There were a number of reasons for legislation not being introduced: the Labour Government had a full legislative programme, there were relatively few murders between 1936 –40 and, as it transpired later, the Prime Minister, Peter Fraser, was actually opposed to abolition.
[b] 'Bodgie' - a youth, especially of the 1950s, analogous to the British Teddy boy; often viewed as delinquent, 'bodgies' adopted particular clothing styles and frequented 'milk bars'.
 Engel, Pauline F. "The Abolition of Capital Punishment in New Zealand 1935 – 1961". Department of Justice, Wellington, 1977, p. 19.
 Ibid., p.23
 Ibid., p.21
 Ibid., p.22
 Ibid., p.27
 Ibid., p.39
 Ibid., p.56
 Ibid., p.56
 Ibid., p.56
 Yska, Redmer "All Shook Up. The Flash Bodgie and the Rise of the New Zealand Teenager in the Fifties". Penguin Books, Auckland, 1993, p.192.
 Engel, op.cit., p.58
 Ibid., p.59
 Ibid., p.60
 Ibid., p.60
 Ibid., p.60
 Ibid., p.61
 Ibid., p.61
 Steiner, op.cit., p.33
 Engel, op.cit., p. 72
 Ibid., p.73
 Ibid., p.74
 Ibid., p.74
 Ibid., p.80
 Ibid., p.81
 Ibid., p.99
 Steiner, op.cit., p.25
 Ibid., p.49
When scepticism goes viral
This article by Michael Rozier uses the example of the anti-vaccination movement in the United States to raise questions about the role that scientists themselves might have played in the rejection by some sections of society of well-established scientific facts. He suggests that a debate that includes values and morals alongside science might do better at changing minds than simply ‘throwing more science at the problem’.
Available online at: http://americamagazine.org/issue/vaccine-wars
The Right to Freedom of Conscience
A recent post from Terry Bellamak, new president of the Abortion Law Rights Association of New Zealand (ALRANZ), questions why health professionals such as doctors and nurses should be legally able to use the claim of freedom of conscience in refusing to provide contraceptive or abortion advice or services. (http://wp.me/x1XY6w-z1, 14 Sep 2015). Bellamak likens this to the case of Kim Davis, county clerk of Rowan County in Kentucky, who was recently gaoled for refusing to issue licences for same-sex marriages. She fails to see why these two apparently similar cases should have such different outcomes; imprisonment in one case and privileged protection in the other.
There seem to be a number of flaws in Bellamak’s argument. I will examine three of these. The first is that a legal challenge on these grounds has already been laid and dismissed. The second is that the role of health professionals differs significantly from that of a county clerk. Finally, many historical examples show us the great evils that can arise when the grounds of freedom of conscience are overridden.
In 2009 the Medical Council of New Zealand sent out a draft statement entitled ‘Beliefs and Medical Practice’, touching especially on the area of reproductive health service provision. A group of health professionals known as the New Zealand Health Professionals Alliance Incorporated (NZHPA) applied to the High Court for a juridical review of this statement on the grounds that it contravened S174 of the Health Professionals Competence Act 2003.
Justice MacKenzie found in favour of the NZHPA, ruling that where a practitioner held a conscience objection in these areas he or she was not required to formally refer their patient onto another practitioner who would either provide or facilitate the service – it was required only that they inform their client that such a service could be obtained from another health provider or a family planning clinic. The Medical Council of New Zealand decided not to appeal this ruling and withdrew its statement. When commenting on this decision, the NZPHA stated that its members should not be compelled to do things that they believed to be ethically wrong, clinically inappropriate or against a patient’s best interests.
This last statement leads to consideration of the status and role of health professionals. In her argument Bellamak refers to health professionals as ‘providers of a service’. This is redolent of a mind-set common in the United States where the doctor/patient relationship is viewed as being more like that of a salesperson/customer or petrol pump attendant/car-driver. The nexus is a financial and individual contract. Underlying this vision is a significant philosophical shift, marked by a move from a sense of the common good (the well-being of the entire society) to individual rights and involving the deconstruction of social bonds to the lowest common denominator of financial contract and obligation.
Bellamak glides over this critical distinction by reducing all conscience objections to ‘moral’ grounds, thereby insinuating a basis of religious belief, whereas the more neutral term ‘ethical’ can cover religious, personal or social considerations. An excellent example of this is seen in the debates over euthanasia in the British House of Lords and in Canada in the course of which a number of health professionals, avowedly agnostic or even atheistic, objected to euthanasia solely on the grounds of deleterious social and medical consequences. Closer to home, a further example is the 1977 longitudinal study of 1265 children born in Christchurch conducted by Professor David Fergusson who pointed to later psychological difficulties faced by women who had undergone abortions in their youth. It is data such as this which can and should inform health professionals who wish to embrace a wider vison of the role and responsibility of their profession rather than adopt the individualised and contractual stance referred to above.
The stance I am advocating for is not novel. We see it in the famous speech by Edmund Burke to the electors of Bristol in November 1774. Burke, after acknowledging that an MP must have the highest regard for the views of his constituents, looking out for their interest with the greatest of diligence, then notes: “But his unbiased opinion, his mature judgment, his enlightened conscience, he ought not to sacrifice to you, to any man, or to any set of men living. These he does not derive… from the law or constitution. They are a trust from Providence, for the abuse of which he is deeply answerable.” He then goes on to speak of the role of Parliament in terms which could be aptly applied to the medical profession; “… Parliament is a deliberative assembly of one nation, with one interest, that of the whole, where not local purposes, not local prejudices, ought to guide, but the general good, resulting from the general reason of the whole.” (The Founders’ Constitution, volume 1, chapter 13, document 7.)
The importance of this stance is well borne out in history. Sometimes laws are passed which seem to meet the needs of the time and the approval of the populace. Such were the racial purity laws enacted by the Nazi government in Germany in the 1930’s, one result of which was the Shoah, the slaughter of six million Jews in slave and concentration camps. What is most frightening about these laws is that they were endorsed as scientific and sound by the leading professors of biology in German universities; theories of eugenics were embraced at every level of society. In passing, it is interesting to note that Margaret Sanger, one of the heroes of the women’s reproductive rights movement, was a leading member of the American Eugenics Society, frequently berating the Catholic Church for opposing eugenic legislation and ideology. One presumes that ALRANZ has completely stepped away from such advocacy on the basis of an ethical judgment, reinforced by scientific findings.
In summarising this reflection I would argue that the model of professional care embraced by the president of ALRANZ is strongly influenced by individualistic and commercial elements that reduce health professionals to mere service providers and too easily overlook the common good of the wider society. Such an understanding also ignores the lesson of history that suppression of the rights of individual conscience can so easily walk hand in hand with oppressive policies born of the social and political bias of a particular age … Stand up Archibald Baxter, Franz Jagerstatter, Mahatma Ghandi, Martin Luther King, Nelson Mandela and innumerable others.
In the words of Dietrich Bonhoeffer: “Conscience comes from a depth which lies beyond a person’s own will and reason and it makes itself heard as the call of human existence to unity with itself.”
Rev Dr Neil Vaney is a Marist priest who taught in the field of moral theology at Good Shepherd College in Auckland and is presently vicar-provincial for the Order, living and working in Wellington.