Euthanasia: Dead by Saturday?
The End of Life Choice Bill — what are the arguments for and against
Euthanasia could soon be legal in New Zealand, but what exactly would that mean?
Could a patient tell their GP they want to die on a Wednesday and be dead by the weekend?
Is it inevitable that the proposed euthanasia law will be expanded from the terminally ill to those with depression? Or to children? And how secure are the safeguards?
These are some of the debates taking place in public meetings, on social media and over family dinner tables.
As part of the Herald’s ongoing coverage of the euthanasia and cannabis referendums, we take a look at some of the most headlinegrabbing arguments around voluntary euthanasia and whether they stack up.
The ‘slippery slope’
It is one the most common arguments against voluntary euthanasia — making it available for a small group of people, such as terminally ill adult patients in decline, will inevitably lead to broadening it to more people, like those with mental illness or young people.
Opponents usually point to the examples of the Netherlands and Belgium, where people can get access to euthanasia on the grounds of psychiatric illness, and where there is no minimum age for eligibility.
But there is no evidence that broadening the law is inevitable wherever euthanasia is legalised.
A Joint Select Committee in Western Australia reviewed international research on the issue in 2018 and concluded: “[Opponents to assisted dying] assert that a particular course of action will inevitably lead to another action, with unintended consequences.
“In other words, it implies something out of control or unmanageable. The Committee finds no evidence to suggest this has occurred in the jurisdictions that have legislated for voluntary assisted dying.
“Each jurisdiction has its own unique legal framework resulting from considered legislative processes and court rulings in those countries. The Oregon legislation, for example, has never been amended in its 20 years of operation.”
In some cases, it is wrongly believed that a law has been extended to mental health patients. The euthanasia schemes in the Netherlands and Belgium have always been available to people in this category.
In other cases, laws have been liberalised after being introduced. Belgium removed the minimum age limit in 2014. Since then, people as young as nine have ended their lives.
The Western Australian Joint Committee said that while the removal of the age limit expanded the scope of the legislation, it was not evidence of a slippery slope. It was deliberate and considered reform.
Six-month safeguard
Supporters of the End of Life Act say that safeguards included in the bill will limit the scheme only to those who are in unbearable pain, able to make an informed decision, and near the end of their life.
One of those safeguards is that a person has six months to live.
However, medical experts say predicting when a person will die is an inexact science. Dr Michal Boyd, Associate Professor at the University of Auckland’s School of Nursing, said clinicians were wrong in predicting death within six months 25 per cent of the time.
Boyd also said that cancer prognosis was becoming less certain as more effective therapies were developed. Cancers could develop into a chronic illness and no longer be lifelimiting, he said.
‘Dead by the weekend’
National MP Chris Penk, one of the most vocal opponents of the End of Life Choice Act, has said a person who chooses to die will be able to do so within a few days.
“It would be possible for a person to receive a diagnosis of terminal illness on a Wednesday, gain the necessary approvals under the bill that same day, and be dead before the weekend,” he said during debate on the law change.
Penk is referring to a “cooling off ”, “stand down” or “reflection” period. In Victoria, Australia, a patient must wait nine days between making a decision and taking or being given a lethal dose. In Canada, it is 10 days. The measure is designed to prevent people making rash decisions about ending their lives and having no time to reflect on it. There is no such provision in the New Zealand law.
The Ministry of Justice confirms that in a hospital setting, the minimum time between someone requesting assisted dying, going through the various checks, and dying under the New Zealand law would be an estimated four days. If they were at home, it would be an estimated 15 days.
However, the ministry said this assumed that all parties were available, there were no objections, and no concerns about competency. As a result, the estimated timeframes were likely to be much longer. The ministry said that in practice, the process could take months.
Abuse of the vulnerable
One of the main themes in the opposition to the End of Life Choice Act was that vulnerable people could be pressured to end their own lives. Hypothetical scenarios included a family pressuring an elderly relative to die to claim their inheritance, or parents of a disabled person pushing them to die to relieve their “burden”.
The Western Australian committee, having considered international evidence, concluded that vulnerable groups — disabled, minorities, people from poor households, children, dementia patients — were not more likely than others to access assisted dying or euthanasia.
Analysis of deaths in the United States, Canada and Europe found those most likely to access assisted dying were old, white, well-educated and relatively wealthy.
Under the New Zealand law, if at any point a doctor suspects a person is being pressured, they have to stop the process.
There is evidence that some feel a “duty to die” in countries where euthanasia is legalised. This is harder to safeguard against.
In Oregon, more than half the people who died through voluntary euthanasia in 2018 cited “burden on family, friends/caregivers” as one of their reasons for choosing to die. However, it was likely to be one of many factors in choosing to die. More than 90 per cent of people who died had also cited a loss of autonomy or being unable to engage in certain activities, which made their life less enjoyable.
Increased suicide rates
This is a particularly sensitive issue in New Zealand, where youth suicide rates are among the worst in the developed world. Some opponents of voluntary euthanasia make no distinction between suicide and assisted dying, and are concerned that legalising euthanasia will legitimise death as a response to suffering, leading to a rise in suicides.
A US study in 2015 found that suicide rates had risen in states which had legalised assisted dying — but this is disputed in academic literature. A review in 2017 found that the increase was not statistically significant.
In European countries which legalised euthanasia, suicide rates have remained steady or fallen.
As with all of these arguments, the international experience of euthanasia can only tell us so much. Experts stress that New Zealand has unique social, cultural, political and other factors which will influence how this country could respond to a legalised framework.