End of Life Choice Bill
For some issues with the amended Bill, see this link.
The Bill is currently at the Committee of the Whole House stage, during which amendments to the Bill are debated.
From about 4 pm on Wednesday 23 October 2019 Parliament will debate Clauses 1 and 2 of the Bill, which are about the Bill’s title and commencement. The debate will include a vote on whether there will be a referendum on this Bill at the next general election.
The debate on the Third Reading (final vote) on this Bill is expected to start at about 4 pm on Wednesday 13 November.
What is proposed
This Bill is NOT about turning off life support, ‘do-not-resuscitate’ requests (no CPR) or stopping medical treatment. In these situations, a person would die of natural causes – from their underlying medical condition.
The Bill proposes immunity from prosecution for medical practitioners and nurse practitioners who perform ‘assisted dying’, which is a euphemism for euthanasia and assisted suicide using lethal drugs.
It is assisted suicide when the person who dies takes the final action that ends their life, e.g. swallowing a deadly dose. It is euthanasia when someone elsetakes the final action that ends the person’s life, e.g. give a lethal injection.
Four methods are proposed for the administration of a lethal dose: ingestion or intravenous delivery triggered by the person (assisted suicide); and ingestion through a tube or injection (euthanasia). – Clause 15(3)(a)
Who would qualify
On 31 July it was decided to limit eligibility to people with a terminal illness that is likely to end their lives within 6 months.
Based on Oregon’s law, “a terminal illness that is likely to end his or her life within 6 months means that a person is likely to die within six months if the condition is allowed to take its course without medical treatment. In Oregon eligible conditions have included diabetes, heart disease, hepatitis, sclerosis, arteritis and arthritis.
It would be up to the individual to define ‘grievous’, ‘advanced’, ‘unbearable suffering’, ‘capability’ and ‘intolerable’.
These criteria still include disabled people, since terminal illness usually involve disability. It’s also possible for a person to have a disability, mental illness and/or age-related condition in addition to a terminal condition.
Clause 4: Meaning of person who is eligible for assisted dying (as decided on 31 July)
In this Act, person who is eligible for assisted dying means a person or eligible person means a person who—
(a) is aged 18 years or over; and
(i) a person who has New Zealand citizenship as provided in the Citizenship Act 1977; or
(ii) a permanent resident as defined in section 4 of the Immigration Act 2009; and
(c) suffers from a terminal illness that is likely to end their life within 6 months; and
(d) is in an advanced state of irreversible decline in physical capability; and
(e) experiences unbearable suffering that cannot be relieved in a manner that the person considers tolerable; and
(f) is competent to make an informed decision about assisted dying.
(2) A person is not a person who is eligible for assisted dying by reason only that the person—
(a) is suffering from any form of mental disorder or mental illness; or
(b) has a disability of any kind; or
(c) is of advanced age.
Clause 4A: Meaning of competent to make an informed decision about assisted dying
In this Act, a person is competent to make an informed decision about assisted dying if the person is able to—
(a) understand information about the nature of assisted dying that is relevant to the decision; and
(b) retain that information to the extent necessary to make the decisions; and
(c) use or weigh that information, as part of the process of making the decision; and
(d) communicate the decision in some way.
The proposed process in a nutshell
After a person has made a formal request, two doctors would assess whether the person is eligible. The second doctor must be a member of SCENZ, a purposely-created group of health practitioners who are willing to facilitate assisted suicide and euthanasia. If one or both doctors would doubt whether the person is competent, a psychiatrist would assess whether the person is competent.
A person can be declared competent despite having depression or another mental illness.
Each medical practitioner would send their completed forms to a registrar.
A doctor or nurse practitioner would administer the lethal dose and need to complete an assisted death report. Only this report gets reviewed by the Review Committee. Unlike the committees in the Netherlands, they won’t have access to forms completed before the death or the person’s medical records.
The Bill is available at tiny.cc/EOLCbill.
Some issues with the End of Life Choice Bill
- There is no clear definition of ‘terminal illness’. It could be interpreted to include any condition that is life-shortening or life-threatening. There is no bright line between terminal conditions and chronic conditions. Some chronic conditions can become life-threatening in a matter of minutes, for example diabetes, asthma, severe allergies and high blood pressure. There is also no bright line between terminal illness and disabilities, because many disabilities are life-limiting and involve complications that can become life-threatening. Even clinical depression could be regarded as a terminal condition by some, because it could lead to death (suicide), or to losing the will to live and fight a disease.
- Diagnosis and prognosis can be wrong. It’s impossible for doctors to accurately predict how long a person is expected to live, especially as long as six months out. There have been cases of people who were expected to die within hours or days, but they recovered and lived for months or years. Diagnosis can also be wrong, despite a doctor’s best intentions. Diagnosis and prognosis are not based on certainty, but on probability (the likelihood based on other cases). There is no guarantee that an individual’s disease will progress the same way as others’ have.
- Subjective terminology. Words such as ‘unbearable’, ‘suffering’ and ‘intolerable’ are entirely subjective (up to the individual to determine). If a patient would use any of these words to describe their condition, the doctor would not be able to argue.
- Involves disabled people. ‘An advanced state of irreversible decline in physical capability’ is just a wordy way of saying ‘disability’ or ‘ageing’. The Bill doesn’t explain what is meant by ‘capability’. Could a person qualify who has become less able to run, walk or read? Could a person’s ‘decline in capability’ become ‘irreversible’ by them refusing medical treatment?
- Includes people who are depressed. The End of Life Choice Bill doesn’t mention depression. Even if it did specifically exclude depression, some depressed people could still access death instead of treatment under such legislation. Depression can be hidden, even from doctors. Depression can be misdiagnosed or dismissed as ‘understandable depression’. Even subclinical depression can still have an effect on a person’s decision making capabilities.