Whose death is it anyway? Why I support the euthanasia debate
There are few topics as popular, and yet divisive, as euthanasia. Both sides raise compelling arguments, and those arguments are numerous.
Clearly the issue requires detailed consideration and that, if nothing else, makes it unfortunate that David Seymour’s End of Life Choice Bill has been drawn in an election year. Euthanasia campaigner Matt Vickers noted that it would have been better if the issue could have been debated before the election year.
The best-case scenario is that it becomes a major election issue; the worst, it is dismissed quickly and quietly to allow politicians to get on with the important business of campaigning. But we should not be content to let this opportunity slip away.
Suicide itself has not been a crime in New Zealand since 1893, and attempted suicide was struck off the statute books in 1961. There is no legal barrier to a person taking his or her own life. The current prohibition on assisted suicide is also at odds with our otherwise patient-centred health system.
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End of life care for the terminally ill or those with irremediable illnesses is dictated by law, regardless of what is in the best interests of the patient. This is the one area of medical care in which the patient’s views cannot be considered and taken into account in determining a course of action.
Rather than law, then, the barrier is one of ability. Many of those who would seek assisted suicide are not physically capable of taking their own life. Even where a person is capable of taking action themselves, I would argue it is barbaric to leave them with the choice between a potentially long and undignified exit from this world or violent options to take their own life.
As Lecretia Seales said in her affidavit to the Supreme Court, “[as] my death has become more inevitable, I constantly worry that it could be slow, unpleasant, painful and undignified. I worry that I will be forced to experience a death that is in no way consistent with the person that I am and the way that I have lived my life.”
And that is the crux of the issue for pro-euthanasia campaigners – dignity.
The most commonly cited argument for rejecting any form of assisted suicide is that it is not possible to balance the right to dignity with the vulnerability of those potentially eligible. There is a fear that the disabled, chronically ill or elderly might feel obligated to relieve their families (and society) of the burden they are perceived to have become.
Alternatively, if patients are unable to make the decision for themselves, their lives could be ended too early under the guise of "best interests". These arguments have been used in high profile courts cases in the UK to rule against assisted suicide.
But such fears have been shown to be unfounded. Six states in the United States and four European countries have some form of assisted suicide and the ceiling has not caved in. Research looking at the state of Oregon, the first place in the world to allow assisted suicide and where it has been lawful since 1997, found no evidence of vulnerable people being abused as a result of the law.
Concerns specific to David Seymour’s bill centre around whether it is too vague to provide sufficiently robust protection of those vulnerable people, but I disagree.
In addition to requiring up to three different doctors to assess the person and their request, the bill provides for the appointment of a registrar to monitor compliance with the provisions and co-sign the prescription for the life-ending medication.
Finally, the bill would require the patient themselves to confirm their wish to die immediately prior to the medication being administered. I find it difficult to conceive of a way to make the safeguards any more robust without making the hurdles too high for the bill to be a realistic option for our terminally or irremediably ill.
Further, the comprehensive requirements for reporting compliance with the safeguards and the resulting death mean records would be clear and transparent. The fact that these reports must be reviewed by a committee comprised of two doctors and a medial ethicist would allow for constant monitoring to ensure there is no abuse of the system.
One important way in which the bill could be improved is in its definitions. Although it is not defined, "terminal illness" is sufficiently defined by the likelihood of it causing death within six months. The concept of an "irremediable disease" is more nebulous. Labour MP Carmel Sepuloni went so far as to suggest acne could be considered an irremediable disease for the purposes of the bill.
While common sense would say no doctor is going to certify that acne is sufficient cause for assisted suicide, the general issue of requiring watertight definitions is not unreasonable. Extending the definition section to at least include "irremediable" can only strengthen the bill.
My main concerns relate to the expectations placed on doctors. The mandatory requirements are onerous and time-consuming.
In addition to the expected requirements to explain the patient’s condition and their options, doctors are required to encourage their patients to discuss the option with their loved ones and/or a counsellor. They must provide the opportunity for the patient to do so while simultaneously ensuring the patient understands that they do not need to discuss the situation with anyone if they do not want to.
The burden of ensuring the patient’s decision is free from influence also falls on the doctor. It is these aspects that I see as the undoing of the Bill.
In a health system that is already stretched to breaking point, most doctors would tell you that as much as they would like to take the time required to guide a patient through this process, their workloads probably would not allow for it.
That, combined with the responsibility for ensuring the decision has not been made under pressure from others (something that is potentially subjective and difficult to evaluate), may lead many doctors to opt out under the conscientious objection clauses.
If our doctors do not feel that they can give effect to the bill without jeopardising themselves or their career they are far less likely to be comfortable with the process.
The bottom line is that only Parliament can deal with the issue of assisted suicide, but we should be as involved as possible.
The New Zealand Supreme Court, in the Lecretia Seales case, found that any declaration on the topic would have the effect of changing the law, therefore "trespassing on the role of Parliament". This is the perfect example of how important it is for everyday New Zealanders to be involved in our democratic processes.
At the end of the day, it is those we have elected to Parliament who will make these important decisions on our behalf. I sincerely hope the End of Life Choice Bill progresses to select committee stage and strongly encourage everyone to contribute to the discussion and leave Parliament in no doubt as to where the public stands.
- Stuff Nation