Home / Politics / Euthanasia referendum – the case for ‘Yes’

Euthanasia referendum – the case for ‘Yes’

As well as choosing a new government, October’s election gives us the opportunity to support or oppose the legalisation of euthanasia and recreational use of cannabis. Here, Ann David of the End of Life Choice Society argues for a Yes vote in the referendum on the End of Life Choice Act.

Voting in the End of Life Choice Act referendum will resonate with all of us who have been through the heart-wrenching tragedy of watching someone we love die slowly in great suffering. We may have prayed quietly or railed loudly at the injustice and cruelty, asking “Why can’t the doctor do something?” It was because the doctor was not allowed to.

We can change that at this referendum. If we vote Yes, after a year to refine practical details it will be legal for a doctor to end a patient’s suffering with life-ending medication – but only if the patient personally requests it and only if strict safeguard criteria are met.

This is a controversial issue and those who do not share our compassionate view are unfortunately spreading mistruths and misinformation about it.

It is important to know what the Act allows and prohibits. With a computer you can read neutral, factual, information from the Ministry of Justice at referendums.govt.nz Those not engaged with the technology could ask their friendly librarian to find the website for them at their local library.

Here is a summary of what the Act would require:

  • The patient must meet several criteria including being diagnosed with a terminal illness likely to end their life in six months or less and being in unbearable suffering that cannot be relieved and being in “an advanced state of irreversible decline in physical capability”. All three criteria must apply.
  • The patient (18 years old or over) must be mentally competent in the same way as is necessary for any other significant health decision, such as whether to accept or reject the risks of life-saving surgery.
  • Two separate doctors, unknown to each other, must agree that the patient meets all eligibility criteria.

Here is what is not allowed (despite common claims by opponents):

  • The patient’s doctor cannot suggest or recommend assisted dying.
  • The request can only be made by the patient – not by any member of the family, or anyone else.
  • Any patient’s request though an Enduring Power of Attorney, Advance Care Plan or Living Will is not valid.
  • A patient is not eligible simply by reason of advanced age, disability or desire to not be a burden to others.
  • If the patient loses mental competence during the application process, they become immediately ineligible.
  • They also lose eligibility if doctors suspect they come any undue influence or coercion at any time.

More than 200 million people overseas can access voluntary assisted dying and research shows us that they benefit from improved and better funded palliative care. But it also shows that despite this, between 2 and 5 percent of patients suffer “severely” as they die in palliative care. That equates to as many as 250 New Zealanders every year. Palliative care has its limitations, and why should they suffer?

Parliament scrutinised every bit of this law over 2½ years before it passed. If it gets a majority of Yes votes, no more New Zealanders will die but fewer will suffer.

  • What’s your view? Contribute to the debate through the ‘Comment’ box below.

About Ann David

Ann David
Ann David is a retired human resources professional who now lives on the Kapiti Coast. Fifteen years ago, her mother died badly in palliative care. Since then she has campaigned to have assisted dying legalised in New Zealand. Ann is a member of the End of Life Choice Society (www.eolc.org.nz).

8 comments

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    The EOLC Act is flawed and has serious shortcomings. Some of these are:
    1. No independent witnesses are required at any stage of the process, including at the death. [s 16] This is in stark contrast to laws passed in other countries/jurisdictions.
    2. The person doesn’t need to be mentally competent when the lethal dose is administered.
    3. No prescribed cooling off period, such as the minimum of 15 days in Oregon [s 3.06] i, 9 days in Victoria [s 38]ii or 10 days in Canada [s 241.2(3)(g)]. The only timeframe specified in the End of Life Choice Act is the 48 hours between the writing of the prescription and the chosen time of death [s 15(4)].
    4. Only the attending medical practitioner needs to check for coercion. The independent medical practitioner is required to assess eligibility only [s 11], which is defined in [s 3] as meeting the criteria in [s 4]. The attending medical practitioner doesn’t need to talk to the person face-to-face and doesn’t need to have met the person before. Investigating coercion could be hampered if blocked from speaking to some of the person’s family [s 8].
    5. Health practitioners may still initiate a discussion on euthanasia with their patients providing it is not a suggestion “in substance” or the main topic of their conversation. Even if a health practitioner contravenes this prohibition, their guilt may be difficult to prove and they would not commit an offence under this Act [s 7].
    6. Specialist medical knowledge is not required. Neither of the two doctors need training or experience in the area of the person’s illness or vocational registration iv [s 3]. This is not the case in Victoria [s 10] or Oregon [s 1.01(4)].
    7. Diagnosis and prognosis can be wrong. Both are based on probability, not certainty.v Contrary to David Seymour’s claimvi, only the independent medical practitioner needs to examine the person and their records [s 8(2)], [s 10], [s 11].
    8. Euthanasia is not limited to a last resort. There’s no requirement that a person tries available treatments or palliative care first [s 8].
    9. The Act includes terminally ill people who also suffer from depression or another mental illness, and are considered “competent to make an informed decision” under this Act [s 4, s 4A].
    10. A proxy can sign the form without proof of request. A person is required to be ‘present’ at the time their form is signed, but there’s no explicit requirement to be awake, conscious or free from coercion. Protection against the proxy benefiting from the person’s will is weak [s 9].
    11. No bright line between terminal illness and disabilities, because some disabilities are life-limiting and involve complications that can become life-threatening.
    12. No bright line between terminal illness and chronic conditions, which can become terminal if the person is refusing treatment. In Oregon “death within six months” is applied as “death within six months if not receiving medical treatment” and includes conditions such as diabetes, arthritis, arteritis and musculoskeletal systems disorders.

    In addition to the above there are other concerns with the EOLC Act which I have not listed.

  2. Avatar

    It is false that the arguments against the EoLCA are “misinformation”. Please accept that people on both sides of this debate are grappling sincerely with complex and profoundly challenging issues. I have the deepest sympathy for the tragedies and suffering which Ann David’s family have been through.

    But there are serious problems with the Act. For instance, it allows euthanasia on far wider grounds than unbearable physical pain. Provided the person has a six-months-to-live diagnosis and advanced decline in physical ability, they are only required to be in what they themselves regard as “unbearable suffering”. The Act gives no definition of “unbearable suffering”; it is whatever the person themselves says. It could for instance easily be distress at having become very dependent on others, with loss of toileting control and of almost everything that has formerly made life meaningful. Indeed public comments make it clear some people are looking forward to using the Act that way if they reach that state. But this is the very kind of state which people have grappled with and coped with, and found self-respect again in, when adequately loved and supported by family, friends and professionals. It is false that life no longer has meaning or value under these circumstances.

    Untreated depression can also make a person feel that way. Although mental illness is not a qualifying ground in itself, it can still be having a big effect in association with other illnesses. Yet, and here is a big concern, under the Act the person can decline psychiatric treatment (or any other treatment) simply as something they do not “consider tolerable”. This is all too likely to happen in some cases, simply because the person is feeling too overwhelmed and defeated by all their circumstances, and they have no experience of the effectiveness of therapy.

    Quite simply, there is too much risk that some people will die who could have been helped to a further period of meaningful life and precious time with their family. And please remember, it is well-established that up to a quarter of six-months-to-live diagnoses turn out to be wrong. That valuable extra period of life which people can win through to can be months or years long.

    Briefly also: Alan Jenner is entirely correct in saying it will be impossible for doctors to reliably detect a lot of the subtle pressure, influence or coercion which some families impose on their dependent elderly members to quickly die. It is an ugly side of some families’ lives which I am aware of from my social work career. Even detectives often couldn’t expose a lot of these matters which families want to keep hidden. Elderly people are likely to be euthanised simply to rid their families of no-longer-wanted burdens.

    If readers want a euthanasia law simply aimed at relieving sufferers from final, unbearable physical distress and pain, this Act is not fit for purpose.

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    Life is a humbling experience. We do not chose our birth, and to what life we are born. In the same way I believe we must accept our death. In my mind this Act will lead to abuse and to the loss of the sacredness of death which is part of the cycle of life.

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    As a geriatrician of 25 years’ experience of working with older people and their families, I can say with 100% certainty that coercion is not always easy to detect. It is often hidden, often not revealed even by the person themselves because they are afraid. We have an epidemic of elder abuse – Age Concern studies revealed that 10% of older people living in the community experience abuse, and 75% of this is from family members. Age Concern receives 2200 reports of elder abuse per year. And under the act the doctor is not allowed to talk to family members to try and evaluate if there is coercion, unless the patient gives permission – but they may well not give that permission if they are afraid or feeling a burden. I have seen time and again the effects of subtle (and sometimes not-so-subtle) pressure from families on older people – especially people not getting the care they need because of financial benefit to families. The act’s requirements don’t mitigate against these risks at all. A single doctor (note not the second doctor, just the first) must just ‘do their best’ to ensure the decision is free from pressure. This is far from enough in this situation when so much is at stake.

    You are incorrect to say that ‘a desire to not be a burden to others’ makes a person ineligible – there is nothing at all in the act about this. In Oregon in 2018 63% of people who requested assisted suicide stated that not wanting to be a burden was one of the reasons they made the request. A right to die can easily become a duty to die. Euthanasia numbers have risen year on year in countries that legalised it (Netherlands 2.4% of deaths 1995, 4.5% in 2015)

    Studies show that doctors do not follow the reporting requirements. In 2010 in the Netherlands only 77% of euthanasia/assisted suicide deaths were reported – so in 23% of cases the doctors broke the law. In Belgium in 2010 only 53% were reported, and in those that weren’t reported many didn’t follow the legal requirements (e.g. written consent in only 18% of unreported cases c.f. 88% of reported cases; a 2nd doctor’s consultation occurred in only 55% cf 87% if reported). Why would we think NZ doctors would behave any differently?

    Why would those doctors and nurses that work in the underfunded palliative care sector be almost unanimously opposed to the act, if it was not that they see the dangers? They certainly are not afraid of losing patient numbers as the demand is escalating way beyond resources (no other sector of the health system relies so heavily on public donations!)

    It is incorrect to say that the act says an eligibility criteria is “unbearable suffering that cannot be relieved” – it actually says that it must be unrelieved in a manner the person finds acceptable. This means the person does not have to have had tried any treatment at all.

    There is no requirement for a psychiatric assessment (unless one of the doctors is not sure if the person may be competent). This means that depression will be missed. Depression is very common in those with terminal illnesses, and there is incontrovertible evidence that doctors (oncologists and GPs) miss depression very commonly in the terminally ill, up to 2/3 of cases. You can certainly be depressed and still retain competency (I say this as an expert in capacity assessment).

    Remember that the vote is not about euthanasia or assisted suicide in principle, but about the specific act as it stands now.

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    Far from being an instrument of compassion, this Act will turn out to be an instrument of abandonment for many who attempt to make use of its services. Take for example the individual whose application for euthanasia is turned down by the system. (Our Dutch and Belgian counterparts assure us that some are). What does the Act require? Only that the doctor who is handling the case reports back to the patient that they have been adjudged to be not suitable for euthansia. After that, nothing. No support group, counselling, assessment or what have you. So then they have two options: 1. Suicide 2. Befriending by a group of volunteers who have set up clinics and are prepared to offer euthanasia outside the legal requirements of the law. This happens in the Netherlands, Belgium, Oregon and Washington States of the USA and if it hasn’t started yet in Canada it soon will. Interesting that the people who organize such services are the very ones who insisted on the impregnability of “safeguards” during the debates prior to setting up the service.

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    Thank you for this clear explanation. One of the facts in this Act I really like is that nobody else than the “patient”, themselves initiates the voluntary assisted dying procedure. Not the family, not the doctor. We all know that doctors are trained to pick up signs of coercion, but in the case of the Act: states that as soon as “coercion” becomes apparent, the voluntary assisted dying procedure will be stopped immediately. Game over! It truly empowers the “patient” themselves, and nobody else. What I also like a lot is that at least two doctors are scrutinizing the whole procedure, and that a independent agency as SCENZ looks at each request. By the time the actual procedure can take place it will be 14 days later, so plenty of time for the “patient” to truly make their decision. Although it is a bit of a job it is absolutely worthwhile to read the whole Act on line: referendums.govt.nz. Our Government shows us the facts regarding this Act, so if you have any doubt take a look at this, either at home on a computer, or in the library. I will certainly vote: YES for choice at the End of Life!

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    The Director of the UK’s largest Hospice has stated that six percent of their patients do not respond to palliative care and experience severe pain at the end of their lives. Australian Hospices report similar failures. Why suppose the situation is any better in NZ?

    Only a small number of our population endure these agonizing deaths, but should we therefore abandon them to this cruel fate? One day it could be you or someone close to you – join me in voting ‘Yes’ to the End of Life Choice Act at the Referendum.

  8. Avatar

    Ann’s remarks make a lot of sense. If we don’t vote ‘Yes’ now we will never have another opportunity, so, for the sake of those few Kiwi who might need this choice, we have to say YES in October’s referendum.

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