Choices, consequences

“You see, the reality is that for every choice, there is a consequence.” As the End of Life Choice Bill grinds its way through Parliament, Alfred Ngaro pithily captured what’s at stake as he spoke against the bill last Wednesday. The big question is what those consequences could be. In the absence of a crystal ball or a time machine, one of the best things we can do is study the experience of countries that have legalised euthanasia, or assisted suicide. Last week a visiting Dutch expert helped us do just that, and he painted a grim picture of the possibilities.

Dr Theo Boer used to support euthanasia, and as a self-described political liberal he still sympathises with individual cases where a patient may want to choose it. But his practical experience, reviewing 4000 euthanasia cases on an oversight committee, caused him to question the idea that governments should enable the practice, and he warned us to “look at the Netherlands, and this may be where you are 20 years from now”. I can think of at least two good reasons why the Dutch experience may illustrate our future.

First, the End of Life Choice Bill and the Dutch law have something important in common: they both permit euthanasia as well as assisted suicide. In assisted suicide a patient takes lethal medication themselves, while in euthanasia a doctor administers the dose, for example by lethal injection. Where both practices are allowed, euthanasia occurs at much higher rates than assisted suicide. For example, in the Netherlands in 2017 there were 6303 cases of euthanasia and only 250 cases of assisted suicide.

The Canadian experience is similar. Between June 2016 and October 2018 there were 5079 cases of euthanasia and only six cases of assisted suicide. So if the bill becomes law in New Zealand, we could expect higher rates of death than if it had been limited to assisted suicide.

Second, the higher the rate of deaths, the more quickly the practice could become normalised. Of course, higher rates may not bother those supporting euthanasia, but they’re likely to be part of the reason that Dr Boer says that euthanasia in his country has gone from being “a last resort”, a remedy for a small number of hard cases, and instead has fostered a view that dying is a “project” to be managed. Normalisation can also lead to expansion, such as new categories of patients, like when Dutch doctors developed guidelines for euthanasing infants in 2005.

It seems likely that the bill will come before Parliament for a final vote in late October or November, and MPs will continue to debate possible amendments to the bill, including the prospect of a referendum. But no amendment can change the fundamental character of the bill or the likely consequences of the choice it would provide. In Dr Boer’s words, legalising euthanasia would send a message of “organised despair” about the end of life. We should all heed his warning.

"Euthanasia in his country has gone from being ‘a last resort’, a remedy for a small number of hard cases, and instead has fostered a view that dying is a ‘project’ to be managed."