Webcast archive: 18/03/02

In this episode of Euthanasia & Disability, Amy Hasbrouck, Christian Debray and Taylor Hyatt discuss:

  • An expansive assisted suicide and euthanasia bill is proposed in New Zealand

Please note that this text is only a script and that our webcast contains additional commentary.

  • Today, we’re looking at the End of Life Choice Bill proposed in New Zealand, which would allow both euthanasia and assisted suicide. The NZ parliament is accepting comments from the public about the content of the bill, and we’ve been asked by a New Zealand-based group to make a submission.
  • Before getting to the bill itself, we restated our opposition to assisted suicide and euthanasia (AS/E), explaining our four main arguments:
    • It’s Unnecessary – Everyone has the option to commit suicide or to refuse medical care and have palliative sedation on demand.
    • It’s Discriminatory – While people without disabilities receive suicide prevention services if they express a wish to die, people with disabilities will be encouraged and assisted to kill themselves.
    • Choice is an illusion – The choice to die cannot be free as long as people with disabilities don’t have the choice in where and how to live.
    • Safeguards don’t work – Where these practices are legal, safeguards do not prevent people from disabilities from being wrongly killed.
  • The proposed bill essentially takes the worst parts of existing AS/E laws, including Canada’s, and combines them. First, the background of the bill is based on some popular misconceptions about what legislation can actually do.
    • The section that describes the need and context for the bill, claims to allow people “to end their lives in peace and dignity, surrounded by loved ones.” We pointed out that legalizing AS/E does not guarantee an idealized death, nor can such an outcome be legislated.  There are many stages to the AS/E “process” where things can go wrong.
    • And while the government believes that “palliative care cannot alleviate all suffering,” (which is false) we pointed out that the bill makes no attempt to ascertain or document the cause of a person’s suffering, to learn the reason for the request for AS/E, to provide suicide prevention intervention, or to change public policy so as to eliminate the causes of suffering.
    • Among the sponsors’ reasons for introducing the bill is to enable New Zealand can “catch up” with the courts and governments around the world that permit assisted suicide.  This is based on the false assumption that if a law is popular and adopted with good intentions, there won’t be any problems with it.
  • The eligibility criteria are similar to the Canadian law, except that:
    • there is no requirement that the person’s death be “reasonably foreseeable;”
    • eligibility is limited to citizens and permanent residents.
    • Eligibility does not depend on the person being free from abuse, coercion or “external pressure.”
  • To be eligible for AS/E under the New Zealand bill, the person must:
    • be aged 18 years or over;
    • be a citizen or permanent resident of New Zealand;
    • have a terminal illness “likely to end their life within 6 months” or “a grievous and irremediable medical condition” – (This does not take into account that diagnoses are not always accurate, and the bill doesn’t define what a “grievous and irremediable medical condition” is.)
    • be “in an advanced state of irreversible decline” – (this isn’t defined either.)
    • experience “unbearable suffering that cannot be relieved in a manner that he or she considers tolerable.” The doctor is not required to ensure that the person has access to or receives palliative care, mental health treatment, or social supports.
    • “ha[ve] the ability to understand” the nature and consequences of assisted suicide and euthanasia. We recently talked about “capacity” and the ability to make medical decisions; this section does not even rise to that level. Having “the ability to understand” assisted suicide does not take into account:
      • the criteria for capacity to make medical decisions;
      • risk factors for suicidality and resources for suicide prevention; or
      • the presence of coercion, abuse or other circumstances pressuring someone to die.
  • There is no requirement that the AS/E request form be witnessed by someone who can attest to the capacity of the person making the request, and the voluntariness of the request.
  • If the person requesting AS/E cannot write, they have the option of getting someone to sign the authorization form on their behalf.  The person who signs must be an adult without “a mental disability,” though that term is not defined. As well, the signer cannot “[know] that he or she stands to benefit from” the person’s death. The most obvious form of benefit is financial, like a will. However, family members may “benefit” from no longer having the physical and financial responsibility of caring for someone. There are no penalties as long as the person claims to act in good faith.
  • In addition to deciding if he believes the person is eligible, the first (or “attending”) doctor must tell the person about their disease, its likely progression, and the ‘irreversible nature” of AS/E. The doctor must discuss the other available “options for end of life care.” The doctor must “do his best” to ensure that the choice to die is not coerced. This includes “encourag[ing] the person to talk about his or her choice with family, friends, and counsellors” while ensuring that the person does not feel obliged to do so.  Hopefully the person doesn’t only choose to talk to people who approve of their plans to die, and nobody in the person’s support system views disability negatively. There’s no mention of how a doctor is supposed to detect coercion created by the person’s circumstances.
  • Once the first doctor has given the green light, a second physician, recruited by the government’s “support and consultation” group (SCENZ) must agree that the person is eligible. The second doctor must be “independent” from the first, though there’s no information about what that means; does it exclude connections among family members, friends, colleagues, or in financial relationships? Neither physician is required to have expertise in the person’s condition.
  • If either the first or second doctor is unsure about the person’s “competence” (as referenced, but not defined, in § 12) they must ask for a mental health “specialist” to be appointed by the SCENZ.  The specialist will form an opinion about the person’s competence and forward it to the physicians.
  • The attending doctor must be in the room or “in close proximity” to the person when they die. This is not defined in the law. Thus, there is no certainty that the doctor will be able to record information about the timing of the death or respond to any complications.
  • Here’s what needs to be included in the report about the person’s death:
    • Their name
    • Their address
    • How the lethal substance was given to them
    • Any problems with the ingestion of the medication
  • Where does the buck stop?
    • The “support and consultation” group (SCENZ) is responsible for compiling a list of doctors, pharmacists and mental health specialists willing to participate in the AS/E program, coming up with standards for administering AS/E, and advising doctors if needed.
    • A registrar will collect forms related to the deaths, co-sign prescriptions, and report to the Minister of Health
    • An “end of life review committee” will “report its satisfaction” with the case forms sent to it by the registrar.  They may also “recommend actions” that the registrar “may take to follow up cases with which the review committee was not satisfied.”
  • The law doesn’t assign responsibility for verifying that the person meets all eligibility criteria, that all safeguards have been complied with, that all requirements of the law have been followed, and determining if any deaths have occurred outside the scope of the law.
  • A lot of information is missing. A few other problems we pointed out were:
    • There’s no provision for collecting detailed demographic information:
    • The bill does not ensure effective communication (expressive, receptive and impartial) with the person making the request;
    • The bill does nothing to prevent doctor shopping;
    • There is no process for recording the nature of the person’s suffering and efforts to relieve it.
  • At the end of the bill, there’s a line that says anyone involved in the AS/E process who acted “in good faith” even while violating any part of the law, cannot be held criminally responsible. Since “good faith” is a subjective standard that is almost impossible to disprove, this clause essentially confers blanket immunity and undoes any other “protection” the law provides.
  • Finally, public records (like death certificates) will indicate that the person died of their underlying condition, rather than by AS/E. This creates confusion in public health statistics on suicide and tends to hide the factors that lead to AS/E, as well as abuses of the system.
  • The bill’s sponsors are overlooking many of the dangers of assisted suicide and euthanasia in their rush to catch up with “lenient” countries where it’s been legalized. They appear to be ignoring the lessons learned in Canada and elsewhere. We hope the legislators will hear us out, and not let good intentions lead to bad law.